Aphthous ulcer medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: José Eduardo Riceto Loyola Junior, M.D.[2]
Overview
The majority of cases of aphthous ulcers are self-limited and require only supportive care. Aphthous ulcers normally heal without treatment within 1 to 2 weeks. Good oral hygiene should be maintained, and spicy, acidic, and salty foods and drinks are best avoided, as they may irritate existing ulcers and cause pain. Strong mouthwash such as Listerine has also been known to cause irritation because of its strong ingredients, and many oral care professionals discourage the use of it while having a mouth ulcer.
Medical Therapy
Pharmacotherapy
Pain Relief and Healing
- Pain can be mitigated by an OTC pain-relieving gel, such as Anbesol, Bonjela, Campho-Phenique, Orabase B, Zilactin, or Kanka, available in drugstores.
- Chlorhexidine may reduce the severity, incidence and duration of the ulcer besides pain.[1]
- Carbenoxolone gel or mouthwash - may be more effective in reducing the number of ulcers and pain than placebo.[1]
A recent study of the Oral-B product Amosan suggests that it may reduce anaerobic bacteria, such as those found in oral wounds. The study did not, however, demonstrate the efficacy of the product in treating mouth ulcers.[2]
Tincture of benzoin can be used as a protectant for recurring aphthous ulcers, by forming a layer over the sore and protecting it from further irritation.
Topical Corticosteroids
Topical corticosteroids may reduce the incidence of new ulcers and duration. May quickly reduce pain without causing adverse local events.[1]
Triamcinolone Acetonide dental paste can be very effective in reducing pain; the steroid reduces the immune system's response in the area of the ulcer. It is available by prescription only for bigger pack size - 10g or over the counter for smaller pack size - 5g in pharmacies in the UK.
Systemic Corticosteroids
In very severe cases, a doctor may prescribe a steroid treatment. One such steroid is methylprednisolone (usually in a dose-pack), taken orally for a period of 7 days. Alternatively, the doctor may inject a steroid directly into the site of the ulcer (this treatment is performed with kenalog. Between 0.2 and 0.4 ml of kenalog is injected into the site of the ulcer, which will usually be completely healed 72 to 96 hours after the injection).
Patients in whom ulcers do not respond to local treatment may benefit from a short course of pulsed prednisone.
Controversial Therapies
Controversial therapies include levamisole, colchicine, gamma-globulin, dapsone, estrogen replacement,MAOIs, and tetracycline.
Some evidence supports treatment with tetracycline. Tetracycline oral mouth rinse (ie, swish orally and swallow) decreases healing time and pain severity and duration. Whether this benefit is due to a direct antimicrobial effect, tetracycline's anti-inflammatory properties[3] or to an inhibitory effect on chemotaxis and chemotoxicity is not known.
The miracle cures that are advertised should be viewed with skepticism. However, aqueous sulphuric acid products as listed above can provide significant pain relief, if not treating the underlying causes.
Other Treatments
Some dentists recommend a sulfuric acid solution for treating mouth ulcers, such as debacterol.
Thalidomide has been effective in unresponsive aphthous stomatitis. Thalidomide has been used successfully generally to treat various inflammatory conditions characterized by tissue infiltration with polymorphonuclear leukocytes (PMNLs). Therapeutic benefit has been attributed to depression of PMNLchemotaxis and, possibly, PMNL phagocytosis. However, adverse effects can be both problematic and clinically significant.
Another chemical treatment option is the application of silver nitrate to cauterize the sore. In clinical trials it was found that this treatment reduced pain in patients by 70% with one application but had no effect on healing compared to placebo.[4]
Another choice doctors have is to prescribe Aphthasol, the only Food and Drug Administration (FDA) approved treatment specifically indicated for Aphthous ulcers.
Home Remedies
Some home remedies that have been suggested include:
- Licorice Root (Glycyrrhiza) in the form of over-the-counter medicated disk patches may help heal or reduce the growth of canker sores if applied early on.[3]
- Sticking a small aspirin on the sore and applying pressure
- Apply three pinches of table salt on the sore. (Note this can be painful)
Antacid techniques suggested include the following:
- Gargling warm water and salt sometimes provides temporary relief from pain, and the salt may promote healing.
- Swab the ulcers with Milk of Magnesia.[4]
- Make a paste of baking soda and water; apply directly to the ulcers.[5]
- Make a mix of half milk of magnesia and half Benadryl, and hold in the mouth for up to 3 minutes.[5]
Recalcitrant recurrent episodes
Several systemic treatments have been suggested with mixed results:
- Corticosteroids;
- Pentoxiphylin;
- Levamisole;
- Colchicine and dapsone;
- Thalidomide;
- Biologic drug;
- Clophazimine;
- Others (methotrexate, azathioprine, cyclosporine, cyclophosphamide).[1]
References
- ↑ 1.0 1.1 1.2 1.3 Riera Matute G, Riera Alonso E (2011). "[Recurrent aphthous stomatitis in Rheumatology]". Reumatol Clin. 7 (5): 323–8. doi:10.1016/j.reuma.2011.05.003. PMID 21925448.
- ↑ Wennström J, Lindhe J (1979). "Effect of hydrogen peroxide on developing plaque and gingivitis in man". J Clin Periodontol. 6 (2): 115–30. PMID 379049.
- ↑ Jain A, Sangal L, Basal E, Kaushal GP, and Agarwal SK. "Anti-inflammatory effects of Erythromycin and Tetracycline on Propionibacterium acnes induced production of chemotactic factors and reactive oxygen species by human neutrophils". Dermatology Online Journal. 8 (2).
- ↑ Alidaee M, Taheri A, Mansoori P and Ghodsi S (2005). "Silver nitrate cautery in aphthous stomatitis: a randomized controlled trial". Br J Derm. 153 (3): 521. doi:10.1111/j.1365-2133.2005.06490.x. Unknown parameter
|month=ignored (help) - ↑ Canker Sores: What Are They and What Can You Do About Them? (American Academy of Family Physicians)
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