What is the treatment for oral ulcers?

Treatment of Oral Ulcers

The first-line treatment for oral ulcers should be topical measures including local corticosteroids, anesthetics, and antiseptic rinses, with systemic therapies reserved for resistant or severe cases. 1

First-Line Topical Treatments

• Apply topical corticosteroids as primary therapy for accessible lesions:

  • For localized ulcers: clobetasol gel or ointment (0.05%) 1
  • For widespread ulcers: dexamethasone mouth rinse (0.1 mg/ml) or betamethasone sodium phosphate 0.5 mg in 10 ml water as a rinse-and-spit preparation four times daily 1, 2

• Use topical anesthetics for pain management:

  • Viscous lidocaine 2% before meals (for adults and children over 12 years, apply 3-4 times daily) 1, 3
  • Benzocaine preparations for temporary relief of pain associated with canker sores (not more than 3-4 times daily) 4
  • Benzydamine hydrochloride rinse or spray every 3 hours, particularly before eating 1, 2

• Implement oral hygiene measures:

  • Clean the mouth daily with warm saline mouthwashes 1, 2
  • Use antiseptic oral rinses twice daily (e.g., 0.2% chlorhexidine digluconate) 1, 2
  • Apply barrier agents like white soft paraffin ointment to lips every 2 hours or mucoprotectant mouthwashes (e.g., Gelclair) three times daily 1

Second-Line Treatments for Refractory Cases

• For ulcers that don't respond to topical therapy within 7 days, consider: 4

  • Intralesional steroid injections (triamcinolone weekly, total dose 28 mg) 1, 2
  • Systemic corticosteroids for highly symptomatic or recurrent ulcers (prednisone/prednisolone 30-60 mg or 1 mg/kg for 1 week with tapering over the second week) 1, 2

• For recurrent aphthous stomatitis:

  • Try colchicine as first-line systemic therapy, especially effective for erythema nodosum or genital ulcers 1, 5
  • Consider azathioprine, interferon-alpha, TNF-alpha inhibitors, or tacrolimus 0.1% ointment for resistant cases 1, 2

Special Considerations

• Different types of oral ulcers require specific approaches:

  • Acute ulcers (trauma, infections) typically resolve within 2 weeks with appropriate treatment 6, 7
  • Chronic or recurrent ulcers may indicate underlying systemic conditions requiring additional evaluation 5, 8

• For Behçet's disease with oral ulcers:

  • Start with topical steroids and colchicine 9, 1
  • Progress to immunosuppressives for refractory cases, but avoid ciclosporine A in patients with neurological involvement 9

• Discontinue treatment and consult a doctor if:

  • Sore mouth symptoms do not improve in 7 days 4
  • Irritation, pain, or redness persists or worsens 4
  • Swelling, rash, or fever develops 4

Common Pitfalls to Avoid

• Failing to identify the underlying cause of chronic or recurrent ulcers 6, 10
• Premature tapering of corticosteroids before disease control is established 1
• Not referring patients with ulcers lasting more than 2 weeks for specialist evaluation and possible biopsy 1, 10
• Using ciclosporine A in Behçet's disease patients with central nervous system involvement 9