What is the treatment for a lateral tongue ulcer?

Treatment of Lateral Tongue Ulcer

Begin with identification and elimination of any traumatic source (such as sharp teeth, dental appliances, or retained roots), followed by topical corticosteroids and pain management as first-line therapy. 1, 2

Initial Assessment and Etiologic Factor Removal

• Examine for and remove any mechanical irritants including sharp tooth edges, broken teeth, retained roots, ill-fitting dentures, or orthodontic appliances that contact the ulcer site 2
• Extract or smooth any teeth in direct contact with the lateral tongue ulcer, as traumatic ulcers typically heal within one week after removing the causative factor 2
• Obtain detailed history focusing on duration (ulcers >2 weeks require specialist referral), trauma history, recent viral illness, medication exposure, and systemic symptoms 1, 3

First-Line Topical Therapy

For localized lateral tongue ulcers:

• Apply triamcinolone acetonide 0.1% paste directly to the dried ulcer 2-4 times daily 1, 3, 2
• Alternatively, use clobetasol 0.05% ointment mixed in 50% Orabase applied twice daily to dried mucosa for more severe lesions 1

For pain control:

• Use benzydamine hydrochloride rinse or spray every 3 hours, particularly before meals 1, 3
• Apply topical lidocaine 2% (viscous) cautiously before eating, limiting frequency in young children due to systemic absorption risk 1, 3
• Administer oral acetaminophen at age-appropriate dosing for systemic pain relief 3

Supportive Care Measures

• Clean the mouth daily with warm saline mouthwashes to reduce bacterial colonization 1, 3
• Use antiseptic oral rinses (0.2% chlorhexidine digluconate) twice daily 1
• Apply mucoprotectant preparations (such as Gelclair or Gengigel) three times daily for barrier protection 1, 3

Second-Line Management for Non-Healing Ulcers

If the ulcer persists beyond 1-2 weeks despite removing traumatic factors:

• Refer to a specialist immediately for ulcers lasting more than 2 weeks or not responding to initial treatment 1, 3
• Perform biopsy to exclude malignancy (squamous cell carcinoma), eosinophilic ulcer (TUGSE), tuberculosis, or other chronic conditions 1, 2, 4
• Consider intralesional triamcinolone injections weekly (total dose 28 mg) for persistent ulcers 1
• For highly symptomatic cases, use systemic corticosteroids (prednisone/prednisolone 30-60 mg or 1 mg/kg for 1 week with tapering over the second week) 1

Critical Diagnostic Considerations

• Lateral tongue ulcers with induration, keratotic white halo, or failure to heal within 2 weeks may mimic oral squamous cell carcinoma or traumatic ulcer granuloma with stromal eosinophilia (TUGSE) 2, 4
• Blood tests including full blood count, coagulation studies, fasting glucose, HIV antibody, and syphilis serology should be performed before biopsy 1
• Eosinophilic ulcers are benign, self-limiting lesions that can recur and may not have a purely traumatic origin despite their appearance 4, 5

Common Pitfalls to Avoid

• Do not use topical corticosteroids for suspected viral or bacterial infections, as this can worsen the condition 3
• Do not delay biopsy for ulcers that fail to heal after removing traumatic factors, as malignancy must be excluded 1, 2
• Avoid premature tapering of corticosteroids before disease control is established 1
• In children, use topical lidocaine cautiously due to risk of systemic absorption and potential toxicity 3