Treatment of Canker Sores (Aphthous Ulcers)
The most effective first-line treatment for canker sores includes topical corticosteroids such as betamethasone sodium phosphate 0.5 mg in 10 mL water as a rinse-and-spit preparation four times daily, along with pain management using benzydamine hydrochloride oral rinse or spray. 1, 2
First-Line Treatments
- Apply topical corticosteroids as primary therapy - betamethasone sodium phosphate 0.5 mg dissolved in 10 mL water as a 3-minute rinse-and-spit preparation four times daily 1, 2
- For localized ulcers, apply clobetasol propionate 0.05% mixed in equal amounts with Orabase directly to affected areas daily 1
- Use Gelclair mucoprotectant gel three times daily to form a protective coating over ulcerated surfaces, reducing pain and promoting healing 1
- Apply white soft paraffin ointment to the lips every 2 hours if they are affected by ulcers 1
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
- Benzocaine-containing products can provide temporary pain relief for canker sores 3, 4
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 or 0.2% chlorhexidine digluconate mouthwash 1
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
- Alternatively, use miconazole oral gel 5-10 mL held in the mouth after food four times daily for 1 week 1
Second-Line Treatments for Refractory Cases
- Consider tacrolimus 0.1% ointment applied twice daily for 4 weeks 1, 2
- For ulcers that don't respond to topical treatment, intralesional triamcinolone injections in conjunction with topical clobetasol may be effective 1, 2
- Systemic corticosteroids can be used for highly symptomatic or recurrent ulcers 1, 2
Systemic Therapy for Severe Cases
- For recurrent aphthous stomatitis, colchicine can be effective 2
- In resistant cases, consider azathioprine, interferon-alpha, or TNF-alpha antagonists 2
Important Considerations
- Most canker sores are benign and self-limiting, typically healing within 7-14 days 5
- Recurrent aphthous ulcers can sometimes be a manifestation of serious health conditions, including autoimmune disorders, HIV, infections, or hematologic conditions 5
- Low-level laser therapy has shown promising results in relieving pain and promoting complete remission of oral ulcers in some cases 6
- Aphthous ulcers should be differentiated from herpes simplex virus infections, as they require different treatment approaches 7