Aphthous Stomatitis Treatment & Management

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

Medical Care

Recurrent aphthous ulcers are treated using a variety of agents. These are directed at palliation of symptoms, shortening of healing time,[36, 37] and prophylaxis against future episodes. Many of the treatments are used without research demonstrating therapeutic results specific to aphthous stomatitis. Many episodes can be prevented by avoidance of common triggers such as walnuts and pineapple. Also note a listing of various clinical trials in Further Reading.

Therapy for recurrent aphthous ulcers must be directed by the extent of the condition, as determined by the patient and the clinician. Patients often report great pain when clinical examination reveals only a minor ulcer of 1-2 mm in diameter. In addition, the frequency and the extent of involvement should direct therapy.

Topical regimens may include the following:

  • Anti-inflammatory (eg, corticosteroids) and immunomodulatory agents (eg, retinoids, cyclosporin) are used initially. These may include topical gels, creams, pastes, ointments, sprays, and rinses.
  • Adjuvant rinses reduce bacterial loads, which is thought to reduce inflammation and shorten healing. These may include chlorhexidine gluconate, dilute hydrogen peroxide, and topical lidocaine or benzocaine.

Systemic agents may include the following:

  • Colchicine (0.6 mg 3 tid) can be used.
  • Prednisone (20-80 mg/d) is another possibility.
  • Azathioprine use (50 mg/d) has been reported.
  • Montelukast sodium (10 mg/d) has been reported as potentially effective with fewer adverse effects than steroids.[38]
  • Clofazimine has shown efficacy in some trials in reducing the frequency of lesions and symptoms in patients who continue to experience lesions.[39]
  • Thalidomide is the only treatment the US Food and Drug Administration (FDA) has approved for the treatment of major aphthae in individuals with HIV infection.

Miscellaneous treatments are as follows:

  • Bismuth subsalicylate (Kaopectate) may protect raw mucosa and accelerates reepithelialization.
  • Multivitamins with iron are recommended but do not have any clear benefit unless the patient has laboratory-confirmed hematinic deficiency.
  • Recommend the patient avoid using sodium laurel sulfate. This agent is a detergent found in most dentifrices, and it disrupts the surface of the epithelium. Although it has not been proven causative in recurrent aphthous ulcers, results are equivocal in whether elimination of the agent prevents episodes of ulceration.
  • Laser therapy has been reported to provide pain relief and lesion resolution for isolated lesions, but it does not affect episodic recurrence.[40]
  • Nicotine replacement therapy may help ameliorate lesions that have resulted from cessation of a tobacco habit.[41]
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Surgical Care

No surgical treatment has been used effectively because of the recurrent nature of recurrent aphthous ulcers.[42]

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Diet

  • An elimination diet may help control outbreaks by revealing suspected allergic stimuli that initiate oral lesions. If food exposure is thought to be the culprit, a food diary can be helpful.[43, 44, 45]
  • A gluten-free diet helps patients with GSE (celiac disease) control outbreaks of aphthae.
  • Patients with oral lesions should avoid hard or sharp foods that may gouge existing ulcers or create new ones (koebnerization).
  • Advise avoidance of salt and hot spices to prevent pain from unnecessary aphthae irritation. Some patients report aphthae after exposure to nuts, pineapple, cinnamon, or other agents. In such cases, remission may be achieved by avoiding the inciting agent.
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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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