What is the best treatment for canker sores?

Best Treatment for Canker Sores

The best treatment for canker sores is topical corticosteroids, particularly betamethasone sodium phosphate 0.5 mg dissolved in 10 mL water as a rinse-and-spit solution four times daily. 1, 2

First-Line Treatments

• Apply topical corticosteroids as primary therapy for canker sores (aphthous ulcers) 2
• For localized ulcers, clobetasol propionate 0.05% mixed in equal amounts with Orabase can be applied directly to the affected areas daily 1
• Gelclair mucoprotectant gel applied three times daily forms a protective coating over ulcerated surfaces, reducing pain and promoting healing 1
• White soft paraffin ointment should be applied to the lips every 2 hours if they are affected by ulcers 1

Pain Management

• Benzydamine hydrochloride oral rinse or spray should be used every 3 hours, particularly before eating 1, 2
• Topical anesthetic preparations containing benzocaine or lidocaine can provide temporary pain relief 3, 4
• Benzocaine-containing products should be applied to the affected area not more than 3-4 times daily 4
• Among benzocaine products, some formulations may provide longer duration and greater intensity of anesthetic effect 5

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 0.2% chlorhexidine digluconate mouthwash 1, 2
• Avoid potential irritants such as spicy foods, citrus fruits, and hot beverages 6

Treatment for Secondary Infections

• If candidal infection is suspected, treat with Nystatin oral suspension 100,000 units four times daily for 1 week 1, 2
• Miconazole oral gel 5-10 mL held in the mouth after food four times daily for 1 week can be used as an alternative treatment for candidal infections 1, 2

Second-Line Treatments for Refractory Cases

• Tacrolimus 0.1% ointment applied twice daily for 4 weeks for recalcitrant ulcers 1, 2
• Intralesional triamcinolone injections in conjunction with topical clobetasol for ulcers that don't respond to topical treatment 1, 2
• Systemic corticosteroids for highly symptomatic or recurrent ulcers 1, 2
• Low Level Laser Therapy (LLLT) has shown excellent results in relieving pain and promoting complete remission of oral ulcers 7

Important Considerations and Pitfalls

• Most canker sores are benign and self-limiting, typically resolving within 7-14 days 8
• Stop using topical treatments and consult a healthcare provider if sore mouth symptoms do not improve in 7 days, or if irritation, pain, redness, swelling, rash, or fever develops 3
• Recurrent aphthous ulcers can sometimes be a manifestation of serious health conditions such as autoimmune disorders, HIV infection, or hematologic conditions 8
• For patients with recurrent aphthous stomatitis, consider underlying systemic conditions that may require additional treatment 9

"Magic Mouthwash" Option

• For more severe cases, a "magic mouthwash" formulation can be considered, typically containing:
  • Viscous lidocaine 2% for pain relief 6
  • Nystatin oral suspension to prevent candidal infections 6
  • Standard administration: 15 mL per application, held in mouth for 1-2 minutes before spitting out 6
  • Avoid eating or drinking for 30 minutes after use for maximum effectiveness 6