Over-the-Counter Treatment for Oral Ulcers
For adult patients with oral ulcers, start with topical corticosteroid mouthwash (betamethasone sodium phosphate 0.5 mg dissolved in 10 mL water, used as a rinse-and-spit four times daily) combined with benzydamine hydrochloride oral rinse every 3 hours for pain control. 1, 2
First-Line OTC Treatments
Topical Corticosteroids
- Betamethasone sodium phosphate 0.5 mg dissolved in 10 mL water should be used as a 2-3 minute rinse-and-spit preparation four times daily 1, 2
- For localized ulcers on accessible areas (buccal mucosa, tongue), apply clobetasol propionate 0.05% ointment mixed in equal amounts with Orabase directly to dried mucosa twice weekly 1, 2
Pain Management
- Benzydamine hydrochloride oral rinse or spray should be used every 3 hours, particularly before eating, to reduce inflammation and pain 3, 1, 2
- For severe pain, viscous lidocaine 2% (15 mL per application) can be applied up to 3-4 times daily 2, 4
- Gelclair mucoprotectant gel applied three times daily forms a protective barrier over ulcerated surfaces, reducing pain and promoting healing 1, 2
Oral Hygiene Measures
- Clean the mouth daily with warm saline mouthwashes to reduce bacterial colonization 3, 1, 2
- Use 0.2% chlorhexidine digluconate mouthwash twice daily as an antiseptic rinse 1, 2, 4
- Apply white soft paraffin ointment to the lips every 2 hours if they are affected 3, 1, 4
Treatment for Secondary Infections
If candidal infection is suspected (white coating, burning sensation):
- Nystatin oral suspension 100,000 units four times daily for 1 week 1, 2, 4
- OR miconazole oral gel 5-10 mL held in mouth after food four times daily for 1 week 1, 2, 4
Dietary Modifications
- Avoid crunchy, spicy, acidic foods and hot beverages during the healing period 2, 4
- Wait 30 minutes after using topical treatments before eating or drinking for maximum effectiveness 4
When to Seek Further Medical Evaluation
Obtain professional evaluation if:
- Ulcers persist beyond 3 weeks despite appropriate treatment 2
- Multiple sites with different morphological characteristics are present 2
- Systemic symptoms develop (fever, weight loss, malaise) 2
- Ulcers are recurrent (≥4 episodes per year), which may indicate underlying conditions like nutritional deficiencies, celiac disease, inflammatory bowel disease, or Behçet's disease 5
Critical Pitfalls to Avoid
- Do not assume all oral ulcers are benign aphthous ulcers - chronic solitary ulcers require biopsy to rule out squamous cell carcinoma 5, 6
- Oral ulcers may be the first manifestation of systemic diseases including Crohn's disease, Behçet's disease, or hematologic malignancies 2
- Hyperglycemia is an important predisposing factor for invasive fungal infections presenting as oral ulcers 2
Evidence Quality Note
The recommendations for topical corticosteroids and benzydamine come from high-quality guidelines published in the British Journal of Dermatology 3 and synthesized in recent clinical practice summaries 1, 2. While older research articles describe various causes of oral ulcers 7, 5, 8, 9, 6, the specific treatment recommendations are derived from guideline-level evidence prioritizing symptomatic relief and healing promotion.