What are the directions for using triamcinolone (corticosteroid) dental paste to treat canker sores?

Triamcinolone Dental Paste Application for Canker Sores

Apply triamcinolone acetonide 0.1% dental paste directly to the dried ulcer surface 2-4 times daily, pressing a small amount onto the lesion without rubbing, and avoid eating or drinking for 30 minutes after application.

Application Technique

• Dry the ulcer surface with a cotton swab or gauze before application to ensure proper adhesion of the paste 1, 2
• Apply a thin layer of triamcinolone acetonide 0.1% paste directly to the lesion using a clean finger or cotton-tipped applicator 3, 4
• Press gently onto the ulcer without rubbing to allow the paste to adhere to the mucosa 1
• Avoid eating, drinking, or rinsing for at least 30 minutes after application to maximize mucosal contact time 5

Dosing Frequency

• Use 2-4 times daily depending on severity of symptoms, with applications ideally after meals and at bedtime 2, 3
• For localized, easily accessible ulcers, the paste can be mixed with 50% Orabase and applied twice weekly as an alternative regimen 1, 2

Expected Timeline

• Pain reduction typically begins within 24-48 hours of initiating treatment 3
• Ulcer size reduction becomes noticeable by day 3-5 of consistent application 3
• Complete healing usually occurs within 7-10 days with proper adherence 3, 4
• Continue treatment until the ulcer has completely healed, then discontinue 5

Critical Precautions

• Monitor for oral candidiasis (thrush), which is the most common complication of topical corticosteroid use in the mouth 5
• If white patches or increased burning develop, treat presumptively with nystatin oral suspension or miconazole oral gel 2, 5
• Do not use if there is evidence of oral herpes simplex infection or other active viral/bacterial infections 1

When Topical Treatment Fails

• If no improvement after 7-10 days of proper application, consider intralesional triamcinolone injection (28 mg total dose weekly) in conjunction with continued topical therapy 1, 2
• For highly symptomatic or recurrent ulcers, systemic corticosteroids (30-60 mg oral prednisone for 1 week with tapering) may be necessary 1, 2

Adjunctive Pain Management

• Use barrier preparations such as Gelclair or Gengigel mouth rinse/gel three times daily for additional pain control 1, 2, 5
• Benzocaine-containing products can provide temporary anesthetic relief before meals 6
• Avoid spicy, acidic, crunchy, or hot foods that may irritate the ulcer 5