Aphthous Stomatitis Medication

  • Author: Jeffrey M Casiglia, DMD, DMSc; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Apr 29, 2010
 

Medication Summary

Therapy for this condition is aimed at palliating symptoms, shortening healing time, and reducing the number of episodes (prophylaxis)

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Corticosteroids

Class Summary

Topical steroids are the first-line therapy. They are used to suppress immunologic- and inflammatory-mediated attacks resulting in ulceration. They are used to treat idiopathic and acquired autoimmune disorders. The great variety of vehicles includes topical gels, creams, pastes, ointments, sprays, and rinses.

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Prednisone (Deltasone)

 

Systemic corticosteroid for cases of severe aphthae; inactive and must be metabolized to the active metabolite prednisolone. Close follow-up care and monitoring required to monitor for candidiasis and other secondary infections and adverse reactions. Available in 5 mg/5 mL elix.

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Dexamethasone (Decadron, Dexasone)

 

DOC for recurrent aphthous ulcer and various inflammatory diseases. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability. May use elix 0.5 mg/5 mL (high potency, substituted, fluorinated).

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Triamcinolone topical (Aristocort)

 

For inflammatory dermatosis responsive to steroids; decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability. Advisable when local disease accessible to patient. Use 0.1% gel.

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Fluocinonide (Fluonex, Lidex)

 

High-potency topical corticosteroid that inhibits cell proliferation; immunosuppressive and anti-inflammatory. Advisable when local disease accessible to patient. Use 0.05% gel.

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Clobetasol propionate (Temovate)

 

Class I superpotent topical steroid that suppresses mitosis and increases synthesis of proteins that decrease inflammation and cause vasoconstriction. Use 0.05% gel.

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Anesthetics

Class Summary

These agents locally relieve pain of recurrent aphthous ulcers.

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Lidocaine anesthetic (Xylocaine)

 

Amide-type local anesthetic. Decreases permeability to sodium ions in neuronal membranes; inhibits depolarization, blocking transmission of nerve impulses.

Use 2% viscous solution.

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Benzocaine (Americaine, Anbesol)

 

Para-aminobenzoic acid (PABA) derivative, ester-type local anesthetic, minimally absorbed. Inhibits neuronal membrane depolarization, blocking nerve impulses.

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Coating agents

Class Summary

These agents protect and bolster natural mucosal barrier.

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Attapulgite (Kaopectate)

 

Absorbent and protectant.

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Immunosuppressants

Class Summary

These agents blunt immunologically mediated destruction leading to mucosal ulceration. Systemic immunosuppressants are indicated for severe and recalcitrant cases of aphthous stomatitis.

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Azathioprine (Imuran)

 

Largely converted to active metabolites 6-mercaptopurine and 6-thioinosinic acid; antagonizes purine metabolism and inhibits synthesis of DNA, RNA, and proteins. May decrease proliferation of immune cells, lowering autoimmune activity.

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Thalidomide (Thalomid)

 

Only FDA-approved therapy for recurrent aphthous ulcer. Immunomodulatory agent that may suppress excessive production of TNF-alpha and may down-regulate selected cell-surface adhesion molecules involved in leukocyte migration.

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Topical immunomodulators

Class Summary

These agents are inhibitors of the formation and/or release of inflammatory mediators.

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Amlexanox (Aphthasol)

 

Mechanism of action unknown. Appears to accelerate healing of aphthous ulcers. Potent inhibitor of formation and release of inflammatory mediators (histamine and leukotrienes) from mast cells, neutrophils, and mononuclear cells in in vitro studies.

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Antibacterial agents

Class Summary

These agents treat inflammation of the oral mucosa caused by bacterial or fungal actions.

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Chlorhexidine gluconate (PerioGard, Peridex)

 

Adjunct treatment for gingival disease; binds to negatively charged bacterial cell walls and extramicrobial complex, causing bacteriostatic and bactericidal effects. Effective, safe, and reliable topical wash or PO mouthwash antiseptic.

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Tetracycline

 

Treats gram-positive and gram-negative organisms and mycoplasmal, chlamydial, and rickettsial infections. Inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunits. Use oral susp. May have anti-inflammatory in addition to antibacterial mechanism of action.

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Topical occlusives

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2-Octyl cyanoacrylate

 

OTC formulations of cyanoacrylate (essentially Super Glue) form a waterproof occlusive barrier over ulcers

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Hemorheologic agents

Class Summary

May be beneficial in patients who do not respond to other therapies; not first-line treatment.[46]

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Pentoxifylline (Pentoxil, Trental)

 

Inhibits production of TNF-alpha and reduces migration of neutrophils. Specific action in aphthous stomatitis unclear but has been shown to reduce severity and frequency of episodes.

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Contributor Information and Disclosures
Author

Jeffrey M Casiglia, DMD, DMSc  Lecturer, Harvard School of Dental Medicine; Private Practice, Salem, Massachusetts

Jeffrey M Casiglia, DMD, DMSc is a member of the following medical societies: American Academy of Oral Medicine and American Dental Association

Disclosure: Nothing to disclose.

Coauthor(s)

Ginat W Mirowski, MD, DMD  Adjunct Associate Professor, Departments of Oral Pathology, Medicine, and Radiology, Indiana University School Medicine

Ginat W Mirowski, MD, DMD is a member of the following medical societies: American Academy of Dermatology and American Medical Women's Association

Disclosure: Nothing to disclose.

Christy L Nebesio, MD  Dermatologist

Christy L Nebesio, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Specialty Editor Board

David P Fivenson, MD  Associate Director, St Joseph Mercy Hospital Dermatology Program, Ann Arbor, Michigan

David P Fivenson, MD is a member of the following medical societies: American Academy of Dermatology, Medical Dermatology Society, Michigan Dermatological Society, Michigan State Medical Society, Photomedicine Society, Society for Investigative Dermatology, and Wound Healing Society

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Warren R Heymann, MD  Head, Division of Dermatology, Professor, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey

Warren R Heymann, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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