What are the recommended treatments for frequent mouth ulcers in senior citizens?

Treatment of Frequent Mouth Ulcers in Senior Citizens

Topical corticosteroids are the first-line treatment for frequent mouth ulcers in senior citizens, with options including betamethasone sodium phosphate 0.5 mg dissolved in 10 mL water as a rinse-and-spit solution four times daily. 1, 2

First-Line Topical Treatments

• Apply topical corticosteroids as primary therapy for oral aphthous ulcers in elderly patients 1, 3:
  • Betamethasone sodium phosphate 0.5 mg dissolved in 10 mL water as a rinse-and-spit solution four times daily 1, 2
  • Fluticasone propionate nasules diluted in 10 mL of water twice daily 1, 3
  • For localized ulcers, clobetasol 0.05% ointment mixed in 50% Orabase applied twice weekly to dried mucosa 1, 2

Pain Management

• Benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating 2, 3
• Topical anesthetic preparations such as viscous lidocaine 2% applied 3-4 times daily (not more than 3-4 times daily for adults and children over 12 years) 2, 4
• Barrier preparations such as Gengigel mouth rinse/gel or Gelclair for pain control and protection of ulcerated surfaces 1, 2
• Benzocaine topical can be applied up to 4 times daily for adults and children over 2 years of age (children under 12 should be supervised) 5

Oral Hygiene Measures

• Clean the mouth daily with warm saline mouthwashes to reduce bacterial colonization 2, 3
• Use antiseptic oral rinses twice daily, such as 0.2% chlorhexidine digluconate mouthwash 2, 3
• White soft paraffin ointment should be applied to the lips every 2 hours if they are affected by ulcers 2

Treatment for Secondary Infections

• If candidal infection is suspected (common in elderly patients), treat with 6, 2:
  • Nystatin oral suspension 100,000 units four times daily for 1 week 2
  • Miconazole oral gel 5-10 mL held in the mouth after food four times daily for 1 week 2

Nutritional Support for Elderly Patients

• Consider vitamin B12 supplementation, which has shown effectiveness as an analgesic treatment for aphthous ulcers 7, 8
• Assess for and correct nutritional deficiencies that are common in elderly patients and associated with recurrent aphthous stomatitis, including vitamin B12, folic acid, and ferritin 8
• High protein oral nutritional supplements may be beneficial for elderly patients with mouth ulcers, especially those at risk of malnutrition 6

Second-Line Treatments for Refractory Cases

• Tacrolimus 0.1% ointment applied twice daily for 4 weeks for recalcitrant ulcers 6, 1, 3
• Intralesional triamcinolone injections in conjunction with topical clobetasol for ulcers that don't respond to topical treatment 1, 3

Systemic Therapy for Severe Cases

• Consider systemic corticosteroids (prednisone/prednisolone 30-60 mg or 1 mg/kg for 1 week with tapering over the second week) for highly symptomatic or recurrent ulcers 1, 3

Common Pitfalls and Considerations

• Stop treatment and consult a doctor or dentist if sore mouth symptoms do not improve in 7 days, or if irritation, pain, redness persists or worsens 5
• Ensure proper diagnosis of the type of mouth ulcer before initiating treatment, as oral ulcers can be related to a wide range of conditions 2, 9
• Consider underlying systemic conditions that may require additional treatment in elderly patients with recurrent aphthous ulcers 9, 8
• Dry mouth is common in elderly patients (especially those taking multiple medications) and can exacerbate mouth ulcers; consider mechanical salivary stimulants and oral moisturizers 8
• Institutionalized older people are particularly prone to oral health problems due to frailty, disabilities, multi-morbidity, and multiple medication use 10