From the Guidelines
Aphthous ulcers can be effectively treated with topical corticosteroids, such as clobetasol propionate 0.05%, which can be applied directly to the ulcers daily during the acute phase, as recommended by the most recent and highest quality study 1.
Treatment Options
When it comes to treating aphthous ulcers, several approaches can be considered depending on the severity of the condition. For mild cases, over-the-counter topical treatments like benzocaine gel (Orajel) or antimicrobial mouthwashes containing chlorhexidine can provide relief.
- Apply benzocaine gel directly to ulcers up to 4 times daily.
- Use antimicrobial mouthwashes, such as 0.2% chlorhexidine digluconate mouthwash, twice daily to reduce bacterial colonization of the mucosa, as suggested by 1.
Moderate to Severe Cases
For moderate to severe cases, prescription options include:
- Triamcinolone dental paste (Kenalog in Orabase) applied 2-3 times daily after meals.
- Dexamethasone elixir (0.5mg/5mL) used as a rinse for 2 minutes then spit out, 2-4 times daily, as recommended by 1.
- Topical corticosteroids, such as clobetasol propionate 0.05%, which can be applied directly to the ulcers daily during the acute phase, as recommended by 1.
Pain Management
Pain can be managed with over-the-counter analgesics like acetaminophen or ibuprofen.
- For moderate pain, a topical NSAID (e.g. amlexanox 5% oral paste) may be considered, as suggested by 1.
- For severe pain, more aggressive pain management may be considered, including systemic corticosteroids or intralesional steroid injections, as recommended by 1.
Additional Considerations
While treating aphthous ulcers, it is essential to:
- Avoid spicy, acidic, or rough-textured foods that can irritate ulcers.
- Maintain good oral hygiene using a soft-bristled toothbrush and gentle brushing technique.
- Consider using a topical anesthetic preparation, such as viscous lidocaine 2%, to reduce pain and discomfort, as suggested by 1.
From the Research
Oral Aphthous Treatment
- The treatment of oral aphthous ulcers is palliative and symptomatic, with topical treatments being the first line therapy 2.
- Topical anesthetics, topical steroids, and sucralfate are commonly used to treat oral aphthous ulcers 2, 3.
- Recurrent aphthous stomatitis (RAS) can be treated with colchicine associated with topical treatments, and thalidomide is the most effective treatment but its use is limited by frequent adverse effects 2.
- The primary goals of therapy for recurrent aphthous ulcers are relief of pain, reduction of ulcer duration, and restoration of normal oral function 4.
- Systemic medications, such as levamisole and oral corticosteroids, can be used if topical therapy is ineffective 4, 3.
- Avoiding hard, acidic, and salty foods, toothpastes containing sodium lauryl sulfate, alcohol, and carbonated drinks can help prevent oral aphthous ulcers 3.
- Topical corticosteroids are the first line of treatment for oral aphthous ulcers, with systemic medications being necessary if the disease progresses 5.
- A multidisciplinary treatment approach can be effective in managing major aphthous ulcers, which are refractory and may persist for several weeks to months 6.
Treatment Options
- Topical treatments:
- Topical anesthetics
- Topical steroids
- Sucralfate
- Systemic treatments:
- Colchicine
- Thalidomide
- Levamisole
- Oral corticosteroids
- Lifestyle changes:
- Avoiding hard, acidic, and salty foods
- Avoiding toothpastes containing sodium lauryl sulfate
- Avoiding alcohol and carbonated drinks
Treatment Goals
- Relief of pain
- Reduction of ulcer duration
- Restoration of normal oral function
- Reduction in the frequency and severity of recurrences
- Maintenance of remission