What are the topical treatments for mouth ulcers?

Topical Treatments for Mouth Ulcers

The most effective first-line topical treatments for mouth ulcers include high-potency corticosteroids such as betamethasone sodium phosphate 0.5 mg dissolved in 10 mL water as a rinse-and-spit preparation four times daily, or clobetasol propionate 0.05% mixed with Orabase for localized ulcers. 1, 2

First-Line Topical Treatments

• Apply white soft paraffin ointment to affected lips every 2 hours to protect and promote healing 1
• Use Gelclair mucoprotectant gel three times daily to form a protective coating over ulcerated surfaces 1
• For widespread ulcers, use betamethasone sodium phosphate 0.5 mg dissolved in 10 mL water as a rinse-and-spit solution four times daily 2
• For localized ulcers, apply clobetasol 0.05% ointment mixed in equal amounts with Orabase directly to the affected areas 1, 2
• Fluticasone propionate nasules diluted in 10 mL of water twice daily can be used as an alternative corticosteroid option 2

Pain Management

• Use benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating 3, 1
• For more severe pain, apply topical anesthetic preparations such as viscous lidocaine 2% up to 3-4 times daily 3, 1
• For moderate pain, consider topical NSAIDs such as amlexanox 5% oral paste 3
• Barrier preparations like Gelclair or other mucoprotectant mouthwashes can provide additional pain relief 1, 2

Oral Hygiene Measures

• Clean the mouth daily with warm saline mouthwashes to reduce bacterial colonization and prevent secondary infection 3, 1
• Use antiseptic oral rinses twice daily, such as:
  • 1.5% hydrogen peroxide mouthwash (e.g., Peroxyl) 3
  • 0.2% chlorhexidine digluconate mouthwash (may be diluted by up to 50% if causing soreness) 3, 1
• A bland non-alcoholic, sodium bicarbonate-containing mouthwash can be used 4-6 times daily, increasing to hourly if necessary during active ulceration 3

Treatment for Secondary Infections

• If candidal infection is suspected, treat with:
  • Nystatin oral suspension 100,000 units four times daily for 1 week 3, 1
  • Alternatively, miconazole oral gel 5-10 mL held in the mouth after food four times daily for 1 week 1
• Take regular oral and lip swabs if bacterial or fungal infection is suspected 3

Second-Line Treatments for Refractory Cases

• Tacrolimus 0.1% ointment applied twice daily for 4 weeks 2
• For persistent ulcers, consider intralesional triamcinolone injections (weekly; total dose 28 mg) in conjunction with topical clobetasol gel or ointment (0.05%) 3, 2
• For highly symptomatic or recurrent ulcers, consider systemic corticosteroids (high-dose pulse 30-60 mg or 1 mg/kg oral prednisone/prednisolone for 1 week followed by dose tapering over the second week) 3, 4

Common Pitfalls and Considerations

• Ensure proper diagnosis of the type of mouth ulcer before initiating treatment, as different types may require specific approaches 1, 5
• For patients with recurrent aphthous ulcers, consider underlying systemic conditions that may require additional treatment 6
• Pain management is crucial as ulcers can significantly impact eating, drinking, and quality of life 3
• Topical treatments are generally preferred for localized ulcers, while more widespread or severe cases may require systemic therapy 2, 4
• Benzocaine-containing products can provide effective anesthetic relief but duration and intensity vary between products 7
• Regular oral care protocols should be maintained throughout treatment to prevent worsening of ulcers 3