How to use Zytee-L Gel (Choline Salicylate, Lignocaine Hydrochloride, Benzalkonium Chloride Solution) for oral ulcers?

How to Use Zytee-L Gel for Oral Ulcers

Apply a small amount of Zytee-L gel directly to the dried ulcer surface 3-4 times daily, particularly before meals, after first cleaning the mouth with warm saline and gently drying the ulcer area with gauze. 1, 2

Pre-Application Preparation

• Clean the oral cavity first by gargling with warm saline mouthwash or 0.2% chlorhexidine digluconate solution (can be diluted by 50% to reduce stinging) for 1 minute to reduce bacterial colonization 1
• Gently dry the ulcer surface with sterile gauze or cotton before application, as the gel adheres better to dried mucosa 3, 4
• Ensure good oral hygiene is maintained throughout treatment 1

Application Technique

• Apply a thin layer of Zytee-L gel directly to the ulcer, extending slightly (2-3 mm) beyond the ulcer margins 2, 4
• Use 3-4 times daily, with timing specifically before meals to maximize pain relief during eating 1, 2
• The lidocaine component provides rapid local anesthesia within minutes, while choline salicylate reduces inflammation over hours 1, 2
• Avoid eating or drinking for at least 30 minutes after application to allow adequate contact time 2, 4

Duration and Monitoring

• Continue treatment for 7-10 days or until the ulcer heals 2, 4
• If ulcers persist beyond 2 weeks despite treatment, refer for specialist evaluation to exclude serious underlying conditions 4
• Most simple aphthous ulcers should show improvement within 3-5 days of consistent application 2, 3

Important Caveats and Pitfalls

Avoid prolonged or excessive use of choline salicylate preparations, particularly in children, as systemic absorption can occur and cause adverse effects including mucosal burns, hemolytic anemia (especially in G6PD deficiency), and paradoxical ulcer formation 5, 6

• Do not use in children under 16 years without medical supervision due to risk of Reye's syndrome-like complications from salicylate absorption 5
• The benzalkonium chloride component may cause local irritation in some patients; if burning sensation persists beyond initial application, discontinue use 1
• This is a symptomatic treatment only—it does not address underlying causes of recurrent ulceration 1

When Topical Treatment Alone Is Insufficient

If ulcers do not respond adequately to Zytee-L gel after 1-2 weeks, escalate to:

• Topical corticosteroids such as betamethasone sodium phosphate 0.5 mg in 10 mL water as a rinse-and-spit preparation four times daily 1, 2, 3
• For localized resistant ulcers, clobetasol propionate 0.05% mixed with Orabase applied directly to dried mucosa 1, 3, 4
• Consider adding a mucoprotectant mouthwash (e.g., Gelclair) three times daily to form a protective barrier over the ulcer 1, 2
• For severe pain uncontrolled by Zytee-L, use viscous lidocaine 2% (15 mL per application) as needed, up to 3-4 times daily 1, 4

Adjunctive Measures

• Maintain meticulous oral hygiene with twice-daily antiseptic rinses (1.5% hydrogen peroxide or 0.2% chlorhexidine) to prevent secondary infection 1, 4
• Apply white soft paraffin ointment to affected lips every 2 hours if lip involvement is present 1, 2
• If candidal superinfection is suspected (white patches, delayed healing), treat with nystatin oral suspension 100,000 units four times daily for 1 week 1, 3