From the Research
As a second-line treatment for severe aphthous ulcers in an adult patient, I would prescribe topical corticosteroids such as triamcinolone acetonide 0.1% dental paste applied to the ulcers 2-3 times daily after meals for 7-10 days, as supported by the most recent evidence 1. The treatment of aphthous ulcers is primarily aimed at reducing pain, promoting healing, and preventing recurrence.
- Topical corticosteroids, such as triamcinolone acetonide, are effective in reducing inflammation and suppressing the immune response that contributes to ulcer formation 2, 1.
- Alternatively, dexamethasone elixir 0.5mg/5ml can be used as a rinse for 2 minutes then spit out, 4 times daily, for patients who prefer a rinse or have difficulty applying a paste directly to the ulcers.
- For particularly severe cases, a short course of systemic corticosteroids such as prednisone 40-60mg daily for 5-7 days with a tapering dose may be necessary, as suggested by older studies 3, 4. However, the most recent evidence suggests that topical treatments are preferred due to their minimal side effects 1.
- I would also recommend continuing first-line treatments like topical anesthetics (benzocaine 20%) for pain relief and chlorhexidine 0.12% mouthwash twice daily to prevent secondary infection.
- The patient should be advised to avoid spicy, acidic, or rough-textured foods that may exacerbate pain. If these treatments fail to provide relief or if ulcers recur frequently, further investigation for underlying systemic conditions would be warranted, and referral to an oral medicine specialist might be necessary 2, 1.