What is the treatment for mouth ulcers?

Management of Mouth Ulcers

The first-line treatment for mouth ulcers should include topical steroids, protective agents, and pain management, followed by systemic therapies for refractory cases based on the underlying cause and severity of the ulcers. 1, 2

First-Line Treatments

Topical Steroids

• Apply topical steroids as first-line therapy for accessible oral ulcers 1, 2
• For localized ulcers, use clobetasol propionate 0.05% mixed in equal amounts with Orabase applied directly to affected areas daily 1, 3
• For widespread or difficult-to-reach ulcers, use betamethasone sodium phosphate 0.5 mg in 10 mL water as a 3-minute rinse-and-spit preparation four times daily 1, 3

Protective Agents

• Apply Gelclair mucoprotectant gel three times daily to form a protective coating over ulcerated surfaces 1, 2
• Use white soft paraffin ointment on affected lips every 2 hours throughout the acute phase 3, 1

Pain Management

• Use benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating 1, 3
• For more severe pain, apply topical anesthetic preparations such as viscous lidocaine 2% up to 3-4 times daily 4, 1
• Note: After applying lidocaine, wash hands with soap and water 4

Oral Hygiene Measures

• Clean the mouth daily with warm saline mouthwashes 3, 1
• Use antiseptic oral rinses twice daily, such as 1.5% hydrogen peroxide mouthwash or 0.2% chlorhexidine digluconate mouthwash 3, 1
• Avoid crunchy, spicy, acidic, or hot food/drinks that may exacerbate pain 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, use miconazole oral gel 5-10 mL held in the mouth after food four times daily for 1 week 3, 1
• Take oral and lip swabs regularly if bacterial or candidal secondary infection is suspected 3

Second-Line Treatments for Refractory Cases

• For ulcers that don't respond to topical therapy, consider intralesional steroid injections (triamcinolone) 1, 2
• Consider 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) 2, 5
• For recurrent aphthous stomatitis, consider colchicine as first-line systemic therapy 2, 6
• Other options include tacrolimus 0.1% ointment applied twice daily for 4 weeks 1

Special Considerations Based on Ulcer Type

Recurrent Aphthous Stomatitis (RAS)

• Primary goals of therapy are pain relief, reduction of ulcer duration, and restoration of normal oral function 7
• Secondary goals include reduction in frequency and severity of recurrences 7
• Topical medications can achieve primary goals but may not alter recurrence rates 7, 5

Persistent Ulcers

• Refer patients to a specialist for oral ulcers lasting more than 2 weeks or not responding to 1-2 weeks of treatment 8, 9
• Every oral solitary chronic ulcer should be biopsied to rule out squamous cell carcinoma 8, 6

Common Pitfalls and Considerations

• Ensure proper diagnosis of the type of mouth ulcer before initiating treatment 2, 9
• For patients with recurrent aphthous ulcers, consider underlying systemic conditions that may require additional treatment 8, 7
• Avoid premature discontinuation of treatment before ulcers have fully healed 2
• Don't rely solely on topical treatments without establishing a definitive diagnosis for persistent ulcers (>2 weeks) 8

Alternative Treatments

• Some evidence supports the use of Alchemilla vulgaris (Lady's Mantle) in glycerine, which has been shown to accelerate wound healing in minor aphthous ulcers 10