What are the treatment options for canker sores?

Treatment Options for Canker Sores

For canker sores, topical corticosteroids should be used as first-line therapy, 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, 3

First-Line Treatments

• Apply white soft paraffin ointment to the lips every 2 hours if they are affected by ulcers 1
• Use a mucoprotectant gel such as Gelclair three times daily to form a protective coating over ulcerated surfaces, reducing pain and promoting healing 1
• For localized ulcers, apply clobetasol propionate 0.05% mixed in equal amounts with Orabase directly to affected areas daily 1, 2
• Benzocaine-containing products can provide temporary pain relief for canker sores 4, 5

Pain Management

• Use benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating 1, 2
• For more severe pain, apply topical anesthetic preparations such as viscous lidocaine 2% up to 3-4 times daily 1
• Barrier preparations can help control pain by protecting the ulcerated surface 2, 3

Oral Hygiene Measures

• Clean the mouth daily with warm saline mouthwashes to reduce bacterial colonization 1, 2
• Use antiseptic oral rinses twice daily, such as:
  • 1.5% hydrogen peroxide mouthwash 1
  • 0.2% chlorhexidine digluconate mouthwash (can be diluted by up to 50% to reduce soreness) 1, 2

Treatment for Secondary Infections

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

Second-Line Treatments for Refractory Cases

• Tacrolimus 0.1% ointment applied twice daily for 4 weeks 2, 3
• Intralesional triamcinolone injections in conjunction with topical clobetasol for ulcers that don't respond to topical treatment 2, 3
• 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 2, 3

Additional Options for Resistant Cases

• Colchicine can be effective for recurrent aphthous stomatitis 2
• Azathioprine, interferon-alpha, or TNF-alpha antagonists can be considered for highly resistant cases 2
• Caustic agents such as silver nitrate can stop the growth and pain of lesions in some cases 6
• Adhesive tablets containing natural active agents have shown effectiveness in reducing pain and decreasing healing time 7

Common Pitfalls and Considerations

• Ensure proper diagnosis of the type of mouth ulcer before initiating treatment 2
• For patients with recurrent aphthous ulcers, consider underlying systemic conditions that may require additional treatment 8
• Premature tapering of corticosteroids before disease control is established should be avoided 2
• Recurrent aphthous stomatitis affects 20-60% of all persons and typically begins in the second decade of life, peaking in the third decade 6, 8