Canker Sores are a Pain!
As dental professionals, we regularly encounter a wide variety of oral health conditions, and among these, Aphthous Ulcers—commonly referred to as canker sores—are a frequent challenge for patients.
Despite being a commonplace oral problem, aphthous ulcers present a complexity due to their recurrent nature and multifaceted etiology, which includes factors like stress, trauma, allergies, and nutritional deficiencies. This article aims to delve into the current pharmacological and non-pharmacological treatment options available for managing this prevalent condition.
What Causes Canker Sores?
General causes of Canker Sores
Canker sores can occur for several reasons, including:
Stress or anxiety
Minor oral injuries (e.g., from braces, sharp teeth, or accidental cheek bites)
Allergic reactions to specific foods
Deficiencies in vital nutrients like iron or vitamin B12
Hormonal changes, such as those during pregnancy
Although they are not contagious, canker sores can recur frequently, especially in patients with underlying risk factors.
Canker Sores and Pregnancy
Pregnancy can increase the risk of canker sores due to hormonal changes, nutritional deficiencies, stress, and dietary adjustments. Patients should be advised to use safe remedies like saline rinses, baking soda pastes, or pregnancy-safe topical gels, maintain a balanced diet, stay hydrated, and practice gentle oral hygiene to minimize discomfort and recurrence.
Can Vaping Cause Canker Sores?
While vaping is often marketed as a safer alternative to smoking, it is not without its risks to oral health. The relationship between vaping and canker sores is not fully understood, but several factors associated with vaping and oral nicotine products may contribute to their development. As dental professionals, it’s important to understand the potential link between vaping and oral health issues like canker sores.
Vaping exposes the oral mucosa to chemicals such as nicotine, propylene glycol, and flavouring agents, which can irritate sensitive tissues. Additionally, vaping reduces saliva production, leading to dry mouth and increased vulnerability to irritation or injury. Heat exposure from vaping devices may further exacerbate this risk. Check out our article on how other nicotine products like Zyns can cause mouth sores and have an effect on patients' oral health.
Mouth Ulcers After Dental Work
Mouth ulcers, including canker sores, are a common complaint after dental procedures due to irritation and trauma to the oral tissues. Understanding the causes and advising patients on prevention and management can enhance post-treatment care.
Canker Sore on Wisdom Tooth: When wisdom teeth erupt or are removed, the surrounding tissues can become inflamed, leading to canker sores. The irritation caused by surgical instruments or the healing process itself may trigger these painful lesions.
Canker Sore After Tooth Extraction: Tooth extractions, particularly those involving surgical procedures, can create stress and trauma in the oral cavity. These factors, combined with changes in oral hygiene routines during recovery, can make patients more susceptible to canker sores.
Braces and Canker Sores: Orthodontic appliances like braces can cause mechanical irritation to the inner cheeks, lips, and tongue. This constant friction may lead to the development of canker sores, especially in patients new to wearing braces.
How to Treat Canker Sores: Pharmacological Management
First-line Treatment
First-line treatment for aphthous ulcers often involves the use of topical corticosteroids, primarily for their anti-inflammatory properties. Agents such as triamcinolone acetonide (Kenalog) and fluocinonide (Lidex) are frequently utilized. These reduce the inflammatory response, alleviate pain, and potentially shorten the healing time.
These agents are supplied as dental pastes and can now be prescribed by pharmacists in BC. This is part of the new Minor Ailments and Contraception Service (MACS) that was released in the Spring of 2023. A standard prescription for triamcinolone, which may be prescribed by pharmacists, would look like this:
triamcinolone 0.1% paste AAA orally QID x 3 days
If you are a dental professional in BC, feel free to take advantage of the pharmacist prescribing program or contact your local pharmacy for more information!
Second-line Treatment
Second-line treatments include systemic corticosteroids, typically used for severe or refractory cases. Prednisone can be particularly effective but should be employed judiciously due to the associated potential systemic side effects and adrenal suppression. A standard prescription may look like this:
Prednisone 25 mg PO daily x 5 days
Another beneficial approach involves using topical analgesics like benzocaine or lidocaine to manage the pain associated with aphthous ulcers. These are offered as a variety of Over-the-Counter (OTC) products that can be found at your local pharmacy. While these can offer immediate symptomatic relief, they don’t expedite the healing process.
Amongst oral analgesics, there are also a variety of anesthetic mouthwashes and steroid mouth rinses that can be helpful in the treatment of aphthous ulcers. While usually used for mucositis, the following is an extensive list of mouthwashes that can also be prescribed for oral pain:
Magic Mouthwash – 20 mL swish and spit q4h PRN
Akabutus Mouthwash – 20 mL swish and spit q6h PRN
Pink Lady – 20 mL swish and spit q6h PRN
HSC (Hospital for Sick Children) Mouthwash – 10 mL swish and spit q6h PRN
Viscous Lidocaine 2% – 15 mL swish and spit q6h PRN
Benzydamine – 15 mL swish and spit q6h PRN
Diphenhydramine 7.5 mL + Magnesium Hydroxide 7.5 mL swish and spit q4h PRN
In instances where aphthous ulcers are triggered by a bacterial infection, topical antiseptics like chlorhexedine 0.12% or doxycycline mouthwash can be used. For recurrent and severe cases, systemic agents such as colchicine may be considered, albeit the risk-benefit ratio must be carefully evaluated due to their significant side effect profiles.
Laser Treatment for Canker Sores
Canker sore laser treatment and cold sore laser treatment are innovative and effective options for managing these common oral lesions, offering rapid relief and promoting faster healing. These non-invasive approaches use low-level laser therapy (LLLT) or diode lasers to target the ulcerated or affected area without causing discomfort or damage to surrounding tissues. Laser therapy is ideal for patients with large, painful, or recurrent canker sores or cold sores that interfere with daily activities like eating and speaking. It can be offered as an in-office treatment for immediate relief and long-term benefits.
As dental professionals, incorporating laser treatment into your practice not only enhances patient care but also positions your clinic as a provider of advanced, minimally invasive oral health solutions. Many modern dental practices, such as Sovrle Dental, have started incorporating laser treatment into their services.
This advanced approach not only enhances patient care but also positions these clinics as leaders in providing minimally invasive, state-of-the-art oral health solutions. Dental professionals are encouraged to explore the integration of laser technology to improve outcomes for patients with canker sores.
Benefits of Laser Treatment for Canker Sores:
Immediate Pain Relief: Patients often report significant pain reduction immediately after the procedure.
Accelerated Healing: Lasers stimulate cell regeneration, leading to faster resolution of the sore.
Prevention of Recurrence: Regular use of laser therapy may decrease the frequency and severity of future canker sores.
Safe and Comfortable: The procedure is quick, painless, and well-tolerated by most patients.
Canker Sore Gel and Protective Pastes
Canker sore gels and protective pastes can provide a physical barrier to shield ulcers from further irritation, promote healing, and reduce pain. These are especially beneficial for ulcers caused by trauma or irritation from orthodontic appliances.
Mouth Ulcer Gel: These gels, such as Orajel for canker sores, are specifically designed to soothe pain and protect the ulcerated area. Many formulations also include antiseptic properties to reduce the risk of infection.
Canker Sore Patch or Canker Sore Cover: Adhesive patches or covers act as a shield over the sore, providing protection from food, braces, or other irritants while allowing the area to heal more comfortably.
Toothpaste for Mouth Sores: Specialized toothpaste free from sodium lauryl sulfate (SLS) can help prevent and reduce irritation in individuals prone to canker sores. These toothpastes are gentler on the oral tissues and support a less abrasive cleaning routine.
Homemade Paste Recipes for Canker Sores
For patients looking for natural remedies to manage canker sores, homemade pastes can offer soothing relief. While these remedies are not a replacement for professional treatments, they may help reduce discomfort and promote healing.
Borax for Canker Sores: A paste made with borax and water is often used as a homeopathic remedy for canker sores. As there is no evidence for the use of homeopathic remedies, we cannot specifically recommend its use.
Canker Sores and Essential Oils: Certain essential oils, such as tea tree oil or lavender oil, have natural anti-inflammatory and antibacterial properties that can soothe canker sores. If used, it must be used sparingly to avoid overuse and prevent irritation.
Baking Soda for Canker Sores: Baking soda can help manage canker sores. It helps neutralize acids and reduce inflammation.
How to Treat Canker Sores: Patient Education and Lifestyle Modifications
Foods to Avoid with Canker Sores
Certain foods can irritate canker sores and delay healing. Patients should avoid:
Spicy Foods: Chili peppers, hot sauces, and heavily spiced dishes can worsen pain and irritation.
Acidic Foods: Citrus fruits (like oranges and lemons), tomatoes, and vinegar-based dressings can increase discomfort.
Crunchy or Hard Foods: Chips, nuts, and toast can scrape or aggravate sores.
Salty Foods: Pretzels and salted snacks can sting and intensify soreness.
Chocolate: Known to trigger or worsen canker sores for some individuals.
Encouraging patients to opt for soothing, bland foods can support healing and reduce discomfort.
Oral Hygiene
Oral hygiene also plays a pivotal role in managing canker sores. Patients should be advised to maintain good oral hygiene habits, including regular tooth brushing and flossing, using a soft toothbrush, and avoiding abrasive toothpaste.
Nutritional Considerations
Supplemental therapy can be considered for patients with nutritional deficiencies. For example, vitamin B12, folate, and iron supplementation can benefit patients with recurrent ulcers and these specific deficiencies. A standard prescription for these supplements would be the following:
Vitamin B12 (cyanocobalamin) 1000 mcg PO daily
Folic Acid (folate) 1-3 mcg PO daily
Ferrous Fumarate 300mg PO Q2D (Heme iron may also be used to avoid GI distress)
You can also combine iron supplements with Vitamin C to increase absorption!
Lysine: 500-1000 mg PO daily, which may help prevent or reduce the severity of canker sores in some patients.
Laboratory studies to identify deficiency are not always ordered by physicians, but if you are suspicious of vitamin or mineral deficiency, I encourage you to practice to the full scope of your profession! Ordering lab values is entirely within the scope of dental professionals if there is a potential indication (such as recurrent aphthous ulcers).
If you are not comfortable ordering lab values for your patients, you can always refer them to a physician, or provide symptomatic treatment recommendations with frequent recall/ follow-up.
Resources for your Dental Clinic
At DentalRx, we are passionate about providing value to all dental clinics. The guidelines stated here, and many more, are available for FREE on the DentalRx web and mobile app. Also available on the mobile app are prescription templates and handouts to help improve your patients’ recovery.
Conclusion
The management of aphthous ulcers involves a holistic approach, combining both pharmacological and non-pharmacological strategies. While drug therapy is often vital, non-pharmacological interventions can play a substantial role in preventing recurrences and improving patients’ quality of life.
As dental professionals, our goal is to relieve discomfort, expedite healing, and prevent recurrences. Understanding the wide array of treatment options available and tailoring therapy to each patient’s needs will be instrumental in achieving this goal.
Keep updated with the most recent clinical guidelines and research as our understanding and treatment options for aphthous ulcers continue to evolve. By staying on the frontline of knowledge, we can provide the most effective care for our patients.
Canker Sores are a Pain!
As dental professionals, we regularly encounter a wide variety of oral health conditions, and among these, Aphthous Ulcers—commonly referred to as canker sores—are a frequent challenge for patients.
Despite being a commonplace oral problem, aphthous ulcers present a complexity due to their recurrent nature and multifaceted etiology, which includes factors like stress, trauma, allergies, and nutritional deficiencies. This article aims to delve into the current pharmacological and non-pharmacological treatment options available for managing this prevalent condition.
What Causes Canker Sores?
General causes of Canker Sores
Canker sores can occur for several reasons, including:
Stress or anxiety
Minor oral injuries (e.g., from braces, sharp teeth, or accidental cheek bites)
Allergic reactions to specific foods
Deficiencies in vital nutrients like iron or vitamin B12
Hormonal changes, such as those during pregnancy
Although they are not contagious, canker sores can recur frequently, especially in patients with underlying risk factors.
Canker Sores and Pregnancy
Pregnancy can increase the risk of canker sores due to hormonal changes, nutritional deficiencies, stress, and dietary adjustments. Patients should be advised to use safe remedies like saline rinses, baking soda pastes, or pregnancy-safe topical gels, maintain a balanced diet, stay hydrated, and practice gentle oral hygiene to minimize discomfort and recurrence.
Can Vaping Cause Canker Sores?
While vaping is often marketed as a safer alternative to smoking, it is not without its risks to oral health. The relationship between vaping and canker sores is not fully understood, but several factors associated with vaping and oral nicotine products may contribute to their development. As dental professionals, it’s important to understand the potential link between vaping and oral health issues like canker sores.
Vaping exposes the oral mucosa to chemicals such as nicotine, propylene glycol, and flavouring agents, which can irritate sensitive tissues. Additionally, vaping reduces saliva production, leading to dry mouth and increased vulnerability to irritation or injury. Heat exposure from vaping devices may further exacerbate this risk. Check out our article on how other nicotine products like Zyns can cause mouth sores and have an effect on patients' oral health.
Mouth Ulcers After Dental Work
Mouth ulcers, including canker sores, are a common complaint after dental procedures due to irritation and trauma to the oral tissues. Understanding the causes and advising patients on prevention and management can enhance post-treatment care.
Canker Sore on Wisdom Tooth: When wisdom teeth erupt or are removed, the surrounding tissues can become inflamed, leading to canker sores. The irritation caused by surgical instruments or the healing process itself may trigger these painful lesions.
Canker Sore After Tooth Extraction: Tooth extractions, particularly those involving surgical procedures, can create stress and trauma in the oral cavity. These factors, combined with changes in oral hygiene routines during recovery, can make patients more susceptible to canker sores.
Braces and Canker Sores: Orthodontic appliances like braces can cause mechanical irritation to the inner cheeks, lips, and tongue. This constant friction may lead to the development of canker sores, especially in patients new to wearing braces.
How to Treat Canker Sores: Pharmacological Management
First-line Treatment
First-line treatment for aphthous ulcers often involves the use of topical corticosteroids, primarily for their anti-inflammatory properties. Agents such as triamcinolone acetonide (Kenalog) and fluocinonide (Lidex) are frequently utilized. These reduce the inflammatory response, alleviate pain, and potentially shorten the healing time.
These agents are supplied as dental pastes and can now be prescribed by pharmacists in BC. This is part of the new Minor Ailments and Contraception Service (MACS) that was released in the Spring of 2023. A standard prescription for triamcinolone, which may be prescribed by pharmacists, would look like this:
triamcinolone 0.1% paste AAA orally QID x 3 days
If you are a dental professional in BC, feel free to take advantage of the pharmacist prescribing program or contact your local pharmacy for more information!
Second-line Treatment
Second-line treatments include systemic corticosteroids, typically used for severe or refractory cases. Prednisone can be particularly effective but should be employed judiciously due to the associated potential systemic side effects and adrenal suppression. A standard prescription may look like this:
Prednisone 25 mg PO daily x 5 days
Another beneficial approach involves using topical analgesics like benzocaine or lidocaine to manage the pain associated with aphthous ulcers. These are offered as a variety of Over-the-Counter (OTC) products that can be found at your local pharmacy. While these can offer immediate symptomatic relief, they don’t expedite the healing process.
Amongst oral analgesics, there are also a variety of anesthetic mouthwashes and steroid mouth rinses that can be helpful in the treatment of aphthous ulcers. While usually used for mucositis, the following is an extensive list of mouthwashes that can also be prescribed for oral pain:
Magic Mouthwash – 20 mL swish and spit q4h PRN
Akabutus Mouthwash – 20 mL swish and spit q6h PRN
Pink Lady – 20 mL swish and spit q6h PRN
HSC (Hospital for Sick Children) Mouthwash – 10 mL swish and spit q6h PRN
Viscous Lidocaine 2% – 15 mL swish and spit q6h PRN
Benzydamine – 15 mL swish and spit q6h PRN
Diphenhydramine 7.5 mL + Magnesium Hydroxide 7.5 mL swish and spit q4h PRN
In instances where aphthous ulcers are triggered by a bacterial infection, topical antiseptics like chlorhexedine 0.12% or doxycycline mouthwash can be used. For recurrent and severe cases, systemic agents such as colchicine may be considered, albeit the risk-benefit ratio must be carefully evaluated due to their significant side effect profiles.
Laser Treatment for Canker Sores
Canker sore laser treatment and cold sore laser treatment are innovative and effective options for managing these common oral lesions, offering rapid relief and promoting faster healing. These non-invasive approaches use low-level laser therapy (LLLT) or diode lasers to target the ulcerated or affected area without causing discomfort or damage to surrounding tissues. Laser therapy is ideal for patients with large, painful, or recurrent canker sores or cold sores that interfere with daily activities like eating and speaking. It can be offered as an in-office treatment for immediate relief and long-term benefits.
As dental professionals, incorporating laser treatment into your practice not only enhances patient care but also positions your clinic as a provider of advanced, minimally invasive oral health solutions. Many modern dental practices, such as Sovrle Dental, have started incorporating laser treatment into their services.
This advanced approach not only enhances patient care but also positions these clinics as leaders in providing minimally invasive, state-of-the-art oral health solutions. Dental professionals are encouraged to explore the integration of laser technology to improve outcomes for patients with canker sores.
Benefits of Laser Treatment for Canker Sores:
Immediate Pain Relief: Patients often report significant pain reduction immediately after the procedure.
Accelerated Healing: Lasers stimulate cell regeneration, leading to faster resolution of the sore.
Prevention of Recurrence: Regular use of laser therapy may decrease the frequency and severity of future canker sores.
Safe and Comfortable: The procedure is quick, painless, and well-tolerated by most patients.
Canker Sore Gel and Protective Pastes
Canker sore gels and protective pastes can provide a physical barrier to shield ulcers from further irritation, promote healing, and reduce pain. These are especially beneficial for ulcers caused by trauma or irritation from orthodontic appliances.
Mouth Ulcer Gel: These gels, such as Orajel for canker sores, are specifically designed to soothe pain and protect the ulcerated area. Many formulations also include antiseptic properties to reduce the risk of infection.
Canker Sore Patch or Canker Sore Cover: Adhesive patches or covers act as a shield over the sore, providing protection from food, braces, or other irritants while allowing the area to heal more comfortably.
Toothpaste for Mouth Sores: Specialized toothpaste free from sodium lauryl sulfate (SLS) can help prevent and reduce irritation in individuals prone to canker sores. These toothpastes are gentler on the oral tissues and support a less abrasive cleaning routine.
Homemade Paste Recipes for Canker Sores
For patients looking for natural remedies to manage canker sores, homemade pastes can offer soothing relief. While these remedies are not a replacement for professional treatments, they may help reduce discomfort and promote healing.
Borax for Canker Sores: A paste made with borax and water is often used as a homeopathic remedy for canker sores. As there is no evidence for the use of homeopathic remedies, we cannot specifically recommend its use.
Canker Sores and Essential Oils: Certain essential oils, such as tea tree oil or lavender oil, have natural anti-inflammatory and antibacterial properties that can soothe canker sores. If used, it must be used sparingly to avoid overuse and prevent irritation.
Baking Soda for Canker Sores: Baking soda can help manage canker sores. It helps neutralize acids and reduce inflammation.
How to Treat Canker Sores: Patient Education and Lifestyle Modifications
Foods to Avoid with Canker Sores
Certain foods can irritate canker sores and delay healing. Patients should avoid:
Spicy Foods: Chili peppers, hot sauces, and heavily spiced dishes can worsen pain and irritation.
Acidic Foods: Citrus fruits (like oranges and lemons), tomatoes, and vinegar-based dressings can increase discomfort.
Crunchy or Hard Foods: Chips, nuts, and toast can scrape or aggravate sores.
Salty Foods: Pretzels and salted snacks can sting and intensify soreness.
Chocolate: Known to trigger or worsen canker sores for some individuals.
Encouraging patients to opt for soothing, bland foods can support healing and reduce discomfort.
Oral Hygiene
Oral hygiene also plays a pivotal role in managing canker sores. Patients should be advised to maintain good oral hygiene habits, including regular tooth brushing and flossing, using a soft toothbrush, and avoiding abrasive toothpaste.
Nutritional Considerations
Supplemental therapy can be considered for patients with nutritional deficiencies. For example, vitamin B12, folate, and iron supplementation can benefit patients with recurrent ulcers and these specific deficiencies. A standard prescription for these supplements would be the following:
Vitamin B12 (cyanocobalamin) 1000 mcg PO daily
Folic Acid (folate) 1-3 mcg PO daily
Ferrous Fumarate 300mg PO Q2D (Heme iron may also be used to avoid GI distress)
You can also combine iron supplements with Vitamin C to increase absorption!
Lysine: 500-1000 mg PO daily, which may help prevent or reduce the severity of canker sores in some patients.
Laboratory studies to identify deficiency are not always ordered by physicians, but if you are suspicious of vitamin or mineral deficiency, I encourage you to practice to the full scope of your profession! Ordering lab values is entirely within the scope of dental professionals if there is a potential indication (such as recurrent aphthous ulcers).
If you are not comfortable ordering lab values for your patients, you can always refer them to a physician, or provide symptomatic treatment recommendations with frequent recall/ follow-up.
Resources for your Dental Clinic
At DentalRx, we are passionate about providing value to all dental clinics. The guidelines stated here, and many more, are available for FREE on the DentalRx web and mobile app. Also available on the mobile app are prescription templates and handouts to help improve your patients’ recovery.
Conclusion
The management of aphthous ulcers involves a holistic approach, combining both pharmacological and non-pharmacological strategies. While drug therapy is often vital, non-pharmacological interventions can play a substantial role in preventing recurrences and improving patients’ quality of life.
As dental professionals, our goal is to relieve discomfort, expedite healing, and prevent recurrences. Understanding the wide array of treatment options available and tailoring therapy to each patient’s needs will be instrumental in achieving this goal.
Keep updated with the most recent clinical guidelines and research as our understanding and treatment options for aphthous ulcers continue to evolve. By staying on the frontline of knowledge, we can provide the most effective care for our patients.
Canker Sores are a Pain!
As dental professionals, we regularly encounter a wide variety of oral health conditions, and among these, Aphthous Ulcers—commonly referred to as canker sores—are a frequent challenge for patients.
Despite being a commonplace oral problem, aphthous ulcers present a complexity due to their recurrent nature and multifaceted etiology, which includes factors like stress, trauma, allergies, and nutritional deficiencies. This article aims to delve into the current pharmacological and non-pharmacological treatment options available for managing this prevalent condition.
What Causes Canker Sores?
General causes of Canker Sores
Canker sores can occur for several reasons, including:
Stress or anxiety
Minor oral injuries (e.g., from braces, sharp teeth, or accidental cheek bites)
Allergic reactions to specific foods
Deficiencies in vital nutrients like iron or vitamin B12
Hormonal changes, such as those during pregnancy
Although they are not contagious, canker sores can recur frequently, especially in patients with underlying risk factors.
Canker Sores and Pregnancy
Pregnancy can increase the risk of canker sores due to hormonal changes, nutritional deficiencies, stress, and dietary adjustments. Patients should be advised to use safe remedies like saline rinses, baking soda pastes, or pregnancy-safe topical gels, maintain a balanced diet, stay hydrated, and practice gentle oral hygiene to minimize discomfort and recurrence.
Can Vaping Cause Canker Sores?
While vaping is often marketed as a safer alternative to smoking, it is not without its risks to oral health. The relationship between vaping and canker sores is not fully understood, but several factors associated with vaping and oral nicotine products may contribute to their development. As dental professionals, it’s important to understand the potential link between vaping and oral health issues like canker sores.
Vaping exposes the oral mucosa to chemicals such as nicotine, propylene glycol, and flavouring agents, which can irritate sensitive tissues. Additionally, vaping reduces saliva production, leading to dry mouth and increased vulnerability to irritation or injury. Heat exposure from vaping devices may further exacerbate this risk. Check out our article on how other nicotine products like Zyns can cause mouth sores and have an effect on patients' oral health.
Mouth Ulcers After Dental Work
Mouth ulcers, including canker sores, are a common complaint after dental procedures due to irritation and trauma to the oral tissues. Understanding the causes and advising patients on prevention and management can enhance post-treatment care.
Canker Sore on Wisdom Tooth: When wisdom teeth erupt or are removed, the surrounding tissues can become inflamed, leading to canker sores. The irritation caused by surgical instruments or the healing process itself may trigger these painful lesions.
Canker Sore After Tooth Extraction: Tooth extractions, particularly those involving surgical procedures, can create stress and trauma in the oral cavity. These factors, combined with changes in oral hygiene routines during recovery, can make patients more susceptible to canker sores.
Braces and Canker Sores: Orthodontic appliances like braces can cause mechanical irritation to the inner cheeks, lips, and tongue. This constant friction may lead to the development of canker sores, especially in patients new to wearing braces.
How to Treat Canker Sores: Pharmacological Management
First-line Treatment
First-line treatment for aphthous ulcers often involves the use of topical corticosteroids, primarily for their anti-inflammatory properties. Agents such as triamcinolone acetonide (Kenalog) and fluocinonide (Lidex) are frequently utilized. These reduce the inflammatory response, alleviate pain, and potentially shorten the healing time.
These agents are supplied as dental pastes and can now be prescribed by pharmacists in BC. This is part of the new Minor Ailments and Contraception Service (MACS) that was released in the Spring of 2023. A standard prescription for triamcinolone, which may be prescribed by pharmacists, would look like this:
triamcinolone 0.1% paste AAA orally QID x 3 days
If you are a dental professional in BC, feel free to take advantage of the pharmacist prescribing program or contact your local pharmacy for more information!
Second-line Treatment
Second-line treatments include systemic corticosteroids, typically used for severe or refractory cases. Prednisone can be particularly effective but should be employed judiciously due to the associated potential systemic side effects and adrenal suppression. A standard prescription may look like this:
Prednisone 25 mg PO daily x 5 days
Another beneficial approach involves using topical analgesics like benzocaine or lidocaine to manage the pain associated with aphthous ulcers. These are offered as a variety of Over-the-Counter (OTC) products that can be found at your local pharmacy. While these can offer immediate symptomatic relief, they don’t expedite the healing process.
Amongst oral analgesics, there are also a variety of anesthetic mouthwashes and steroid mouth rinses that can be helpful in the treatment of aphthous ulcers. While usually used for mucositis, the following is an extensive list of mouthwashes that can also be prescribed for oral pain:
Magic Mouthwash – 20 mL swish and spit q4h PRN
Akabutus Mouthwash – 20 mL swish and spit q6h PRN
Pink Lady – 20 mL swish and spit q6h PRN
HSC (Hospital for Sick Children) Mouthwash – 10 mL swish and spit q6h PRN
Viscous Lidocaine 2% – 15 mL swish and spit q6h PRN
Benzydamine – 15 mL swish and spit q6h PRN
Diphenhydramine 7.5 mL + Magnesium Hydroxide 7.5 mL swish and spit q4h PRN
In instances where aphthous ulcers are triggered by a bacterial infection, topical antiseptics like chlorhexedine 0.12% or doxycycline mouthwash can be used. For recurrent and severe cases, systemic agents such as colchicine may be considered, albeit the risk-benefit ratio must be carefully evaluated due to their significant side effect profiles.
Laser Treatment for Canker Sores
Canker sore laser treatment and cold sore laser treatment are innovative and effective options for managing these common oral lesions, offering rapid relief and promoting faster healing. These non-invasive approaches use low-level laser therapy (LLLT) or diode lasers to target the ulcerated or affected area without causing discomfort or damage to surrounding tissues. Laser therapy is ideal for patients with large, painful, or recurrent canker sores or cold sores that interfere with daily activities like eating and speaking. It can be offered as an in-office treatment for immediate relief and long-term benefits.
As dental professionals, incorporating laser treatment into your practice not only enhances patient care but also positions your clinic as a provider of advanced, minimally invasive oral health solutions. Many modern dental practices, such as Sovrle Dental, have started incorporating laser treatment into their services.
This advanced approach not only enhances patient care but also positions these clinics as leaders in providing minimally invasive, state-of-the-art oral health solutions. Dental professionals are encouraged to explore the integration of laser technology to improve outcomes for patients with canker sores.
Benefits of Laser Treatment for Canker Sores:
Immediate Pain Relief: Patients often report significant pain reduction immediately after the procedure.
Accelerated Healing: Lasers stimulate cell regeneration, leading to faster resolution of the sore.
Prevention of Recurrence: Regular use of laser therapy may decrease the frequency and severity of future canker sores.
Safe and Comfortable: The procedure is quick, painless, and well-tolerated by most patients.
Canker Sore Gel and Protective Pastes
Canker sore gels and protective pastes can provide a physical barrier to shield ulcers from further irritation, promote healing, and reduce pain. These are especially beneficial for ulcers caused by trauma or irritation from orthodontic appliances.
Mouth Ulcer Gel: These gels, such as Orajel for canker sores, are specifically designed to soothe pain and protect the ulcerated area. Many formulations also include antiseptic properties to reduce the risk of infection.
Canker Sore Patch or Canker Sore Cover: Adhesive patches or covers act as a shield over the sore, providing protection from food, braces, or other irritants while allowing the area to heal more comfortably.
Toothpaste for Mouth Sores: Specialized toothpaste free from sodium lauryl sulfate (SLS) can help prevent and reduce irritation in individuals prone to canker sores. These toothpastes are gentler on the oral tissues and support a less abrasive cleaning routine.
Homemade Paste Recipes for Canker Sores
For patients looking for natural remedies to manage canker sores, homemade pastes can offer soothing relief. While these remedies are not a replacement for professional treatments, they may help reduce discomfort and promote healing.
Borax for Canker Sores: A paste made with borax and water is often used as a homeopathic remedy for canker sores. As there is no evidence for the use of homeopathic remedies, we cannot specifically recommend its use.
Canker Sores and Essential Oils: Certain essential oils, such as tea tree oil or lavender oil, have natural anti-inflammatory and antibacterial properties that can soothe canker sores. If used, it must be used sparingly to avoid overuse and prevent irritation.
Baking Soda for Canker Sores: Baking soda can help manage canker sores. It helps neutralize acids and reduce inflammation.
How to Treat Canker Sores: Patient Education and Lifestyle Modifications
Foods to Avoid with Canker Sores
Certain foods can irritate canker sores and delay healing. Patients should avoid:
Spicy Foods: Chili peppers, hot sauces, and heavily spiced dishes can worsen pain and irritation.
Acidic Foods: Citrus fruits (like oranges and lemons), tomatoes, and vinegar-based dressings can increase discomfort.
Crunchy or Hard Foods: Chips, nuts, and toast can scrape or aggravate sores.
Salty Foods: Pretzels and salted snacks can sting and intensify soreness.
Chocolate: Known to trigger or worsen canker sores for some individuals.
Encouraging patients to opt for soothing, bland foods can support healing and reduce discomfort.
Oral Hygiene
Oral hygiene also plays a pivotal role in managing canker sores. Patients should be advised to maintain good oral hygiene habits, including regular tooth brushing and flossing, using a soft toothbrush, and avoiding abrasive toothpaste.
Nutritional Considerations
Supplemental therapy can be considered for patients with nutritional deficiencies. For example, vitamin B12, folate, and iron supplementation can benefit patients with recurrent ulcers and these specific deficiencies. A standard prescription for these supplements would be the following:
Vitamin B12 (cyanocobalamin) 1000 mcg PO daily
Folic Acid (folate) 1-3 mcg PO daily
Ferrous Fumarate 300mg PO Q2D (Heme iron may also be used to avoid GI distress)
You can also combine iron supplements with Vitamin C to increase absorption!
Lysine: 500-1000 mg PO daily, which may help prevent or reduce the severity of canker sores in some patients.
Laboratory studies to identify deficiency are not always ordered by physicians, but if you are suspicious of vitamin or mineral deficiency, I encourage you to practice to the full scope of your profession! Ordering lab values is entirely within the scope of dental professionals if there is a potential indication (such as recurrent aphthous ulcers).
If you are not comfortable ordering lab values for your patients, you can always refer them to a physician, or provide symptomatic treatment recommendations with frequent recall/ follow-up.
Resources for your Dental Clinic
At DentalRx, we are passionate about providing value to all dental clinics. The guidelines stated here, and many more, are available for FREE on the DentalRx web and mobile app. Also available on the mobile app are prescription templates and handouts to help improve your patients’ recovery.
Conclusion
The management of aphthous ulcers involves a holistic approach, combining both pharmacological and non-pharmacological strategies. While drug therapy is often vital, non-pharmacological interventions can play a substantial role in preventing recurrences and improving patients’ quality of life.
As dental professionals, our goal is to relieve discomfort, expedite healing, and prevent recurrences. Understanding the wide array of treatment options available and tailoring therapy to each patient’s needs will be instrumental in achieving this goal.
Keep updated with the most recent clinical guidelines and research as our understanding and treatment options for aphthous ulcers continue to evolve. By staying on the frontline of knowledge, we can provide the most effective care for our patients.
