From the Guidelines
Treatment for an aphthous ulcer should prioritize pain management and promoting healing, with the most recent and highest quality study suggesting the use of topical corticosteroids, such as dexamethasone mouth rinse or clobetasol gel, as the first line of treatment 1. When it comes to managing aphthous ulcers, the goal is to reduce pain, inflammation, and promote healing.
- Topical measures, including sodium bicarbonate containing mouthwash, can be used to prevent and treat stomatitis, as suggested by expert opinion in the management of oral and gastrointestinal mucosal injury 1.
- For more persistent or painful ulcers, prescription options like triamcinolone dental paste or chlorhexidine gluconate mouthwash can be considered, in addition to non-steroidal anti-inflammatory drugs like ibuprofen for pain management.
- Good oral hygiene is essential, but it's crucial to use a soft-bristled toothbrush to avoid further irritation, and to avoid spicy, acidic, or rough-textured foods that may irritate the ulcer.
- If ulcers are larger than 1cm, last longer than three weeks, or recur frequently, medical evaluation is recommended, as this could indicate an underlying condition requiring different treatment, such as systemic corticosteroids or other immunosuppressive agents 1. The most recent study from 2022 highlights the complexity and diversity of oral ulcerations, emphasizing the need for a comprehensive diagnostic work-up, including detailed clinical medical history inquiry, histopathological examination, and screening for ulceration-related systemic diseases 1. However, when it comes to treatment, the 2015 study provides more specific guidance on the use of topical corticosteroids and other measures to manage aphthous ulcers, which is more relevant to the current question 1.
From the Research
Treatment Options for Aphthous Ulcers
- Topical treatments are the first line therapy for aphthous ulcers, including topical anesthetics, topical steroids, and sucralfate 2
- Colchicine associated with topical treatments constitutes a suitable treatment for most recurrent aphthous stomatitis (RAS) 2
- Thalidomide is the most effective treatment for RAS, but its use is limited by frequent adverse effects 2
- Hard, acidic, and salty foods and toothpastes containing sodium lauryl sulfate should be avoided, along with alcohol and carbonated drinks 3
- Antiseptic agents and local anesthetics should be tried first, and if these are ineffective, topical corticosteroids should be used 3
Specific Treatments
- Debacterol, a chemical cautery agent, has been shown to be effective in treating recurrent aphthous stomatitis, with a significant decrease in pain and ulcer size 4
- Topical curcumin has been found to be clinically beneficial in reducing pain, size, and healing period of minor aphthous ulcers, and can be safely recommended on a long-term basis 5
- Topical diclofenac in hyaluronan has been shown to provide sustained relief of oral aphthous ulcer pain, with a 35% to 52% pain reduction 2 to 6 hours after application 6
Considerations
- The treatment of aphthous ulcers is palliative and symptomatic, and is tailored to the severity of the problem in the individual case 2, 3
- Every oral solitary chronic ulcer should be biopsied to rule out squamous cell carcinoma 2
- The efficacy of systemic treatment for aphthous ulcers is debated, and should only be used for refractory or particularly severe cases 3