Canker Sores

Aphthous Ulcer is an autoimmune disease with poorly understood triggering causes. The lesions occur exclusively on unattached (cheek, floor of mouth, etc) mucosa. (As opposed to secondary herpes simplex, which, intraorally, occurs only on attached mucosa.)

Treatment for canker sores is divided into 3 sections:

1. Prevention
2. Pain relief
3. Pharmacological treatment

1. Prevention

• Avoid triggering foods: Nuts, chocolate, acidic fruits
• Avoid trauma: Toothbrush trauma, cheek bite, etc
• Avoid stress: Now that is useless advice − who has the time to avoid stress?
• Avoid sodium lauryl sulfate: A soap found in most toothpaste and mouthwashes. Consider Biotene toothpaste or Rembrandt for canker sore sufferers.
• Consider an antimicrobial mouthrinse: Chlorhexidine or Listerine − for prevention only. Do not prescribe for treatment − it does not work to treat lesion and the alcohol stings.

2. Pain Relief

Products which coat the lesion or numb the ulcers or both:

Coat and numb lesion:

• Orabase B
• Zilactin B
• Kanka

Coat lesion only:

• Orabase Soothe-n-Seal
• Liquid Carafate
• Benadryl / Kaopectate

3. Pharmacological Treatment

• Corticosteroids to reverse the autoimmune process (all are by prescription):
• Kenalog in Orabase (often not potent enough)
• Lidex Ointment
• Temovate Ointment
• Dexamethasone Elixir
• On rare occasions, use systemic (oral ingestion): Prednisone, 40 mg/day for 7 days
• Cauterizing (Chemical) Treatment: Debacterol
• Ora 5 (www.ora5.com, 1-800-746-5486)