From the Research
For a severe case of aphthous ulcer in an adult patient, I would prescribe topical corticosteroids such as triamcinolone acetonide 0.1% dental paste as the first-line treatment, followed by more potent topical corticosteroids like clobetasol propionate 0.05% ointment as the second-line treatment, and systemic therapy with prednisone as the third-line treatment. The treatment regimen would involve applying the topical corticosteroids directly to the ulcer 3-4 times daily after meals and before bedtime for 7-10 days, as this helps reduce inflammation and pain by suppressing the local immune response 1. Additionally, I would suggest chlorhexidine 0.12% mouthwash to be used twice daily to prevent secondary infection and promote healing, as well as over-the-counter analgesics like acetaminophen 500mg every 6 hours as needed for pain management. Some studies have also shown that low-level laser therapy can be effective in reducing pain and ulcer size, and improving healing, although the evidence is not yet conclusive 2. However, based on the most recent and highest quality study, topical corticosteroids remain the first-line treatment for severe aphthous ulcers 1. The patient should also maintain good oral hygiene, avoid spicy or acidic foods, and use a soft-bristled toothbrush to prevent further irritation of the ulcers. Key points to consider in the treatment regimen include:
- Topical corticosteroids as the first-line treatment
- More potent topical corticosteroids as the second-line treatment
- Systemic therapy with prednisone as the third-line treatment
- Good oral hygiene and avoidance of irritants to prevent further irritation of the ulcers
- Pain management with over-the-counter analgesics as needed. It is also important to note that the treatment should be tailored to the individual patient's needs and response to treatment, and that the patient should be closely monitored for any signs of improvement or worsening of symptoms 3, 4, 5.