Aphthous Ulcer - Treatment

Treatment

A number of treatments for apthous ulcers exist, including analgesics, anesthetics agents, antiseptics, anti-inflammatory agents, steroids, sucralfate, tetracycline suspension, Debacterol, and silver nitrate. Amlexanox paste has been found to speed healing and alleviate pain.

Suggestions to reduce the pain caused by an ulcer include avoiding spicy food, rinsing with salt water or over-the-counter mouthwashes, proper oral hygiene, and non-prescription local anesthetics. Active ingredients in the latter generally include benzocaine, benzydamine or choline salicylate, and phenol.

Anesthetic mouthwashes containing benzydamine hydrochloride have not been shown to reduce the number of new ulcers or significantly reduce pain, and evidence supporting the use of other topical anesthetics is very limited, though some individuals may find them effective. In general, their role is limited; their duration of effectiveness is, in general, short and does not provide pain control throughout the day. Such medications may cause complications in children.

Evidence is limited for the use of antimicrobial mouthwashes but suggests that they may reduce the painfulness and duration of ulcers and increase the number of days between ulcerations, without reducing the number of new ulcers.

Corticosteroid preparations containing hydrocortisone hemisuccinate or triamcinolone acetonide to control symptoms are effective in treating aphthous ulcers (Triamcinolone Acetonide was used in the product 'Adcortyl in Orabase' which was well known amongst ulcer sufferers but discontinued in the UK during 2009).

The application of silver nitrate will cauterize the sore; a single treatment decreases pain but does not affect healing time though in children it can cause tooth discoloration if the teeth are still developing. The use of tetracycline is controversial, as is treatment with levamisole, colchicine, gamma-globulin, dapsone, estrogen replacement and monoamine oxidase inhibitors.

While commonly used, magic mouthwash, a combination of a number of ingredients including viscous lidocaine, benzocaine, milk of magnesia, kaolin-pectate, chlorhexidine, or diphenhydramine, has little evidence to support its use.