Medication Summary
NSAIDs or topical anesthetics (eg, viscous lidocaine, benzocaine, dyclonine) may be used to provide temporary pain relief and comfort while the patient eats.
Some clinicians suggest that the use of corticosteroids may delay healing; however, a mixture Orabase with a topical corticosteroid ointment (eg, clobetasol, fluocinonide, triamcinolone) often is effective.
Although unnecessary, treatment with systemic prednisone or intralesional injections of triamcinolone has been successful in some patients.
Dexamethasone elixir and magic mouthwash may also provide relief.
Topical anesthetics
Class Summary
These agents may provide temporary symptomatic relief of pain. They also may improve the patient's comfort while eating.
Viscous lidocaine 2% (Xylocaine)
Anesthetic liquid prescribed to treat painful lesions of the oral mucosa or lips. Inhibits neuronal membrane depolarization, blocking nerve impulses.
For small lesions, apply to ulcer with a cotton-tipped applicator. Generally not recommended for use in children because therapeutic doses usually approach potentially toxic levels. If necessary, use lowest effective dose and supervise children.
Benzocaine (Americaine, Benzocol, Cylex)
Inhibits neuronal membrane depolarization, blocking nerve impulses. In pediatric patients, this is a safe alternative to lidocaine.
Dyclonine (Dyclone)
Ketone local anesthetic agent administered topically. Affects cell membrane permeability and blocks impulses at peripheral nerve endings in mucosa.
Analgesics
Class Summary
Analgesics are used for the relief of mild to moderate pain.
Ibuprofen (Motrin, Advil, Pediaprofen)
DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.
Acetaminophen (Tylenol, Tempra, FeverAll, Aspirin-Free Anacin)
DOC for pain relief in patients with documented hypersensitivity to aspirin or NSAIDs, those with upper GI tract disease, or those who are taking oral anticoagulants.
Dental aids and preparations
Class Summary
These are topical corticosteroids that share anti-inflammatory, antipruritic, and vasoconstrictive properties. However, they should be mixed with a carrier such as Orabase to ensure adherence of the drug to the mucosal surface. Otherwise, saliva quickly washes away the medication.
Clobetasol (Temovate in Orabase)
Class I superpotent topical steroid; suppresses mitosis and increases synthesis of proteins that decrease inflammation and cause vasoconstriction. Ointment is recommended for intraoral use. Most pharmacists mix 15 g of clobetasol with 15 g of Orabase; this should be indicated on the prescription.
Fluocinonide (Lidex in Orabase)
Class II high-potency topical corticosteroid that inhibits cell proliferation; immunosuppressive and anti-inflammatory. Ointment is recommended for intraoral use. Most pharmacists mix 15 g of fluocinonide with 15 g of Orabase; this should be indicated on the prescription.
Triamcinolone topical (Kenalog in Orabase)
Group III, intermediate potency. Used to treat inflammatory mucosal lesions that are responsive to steroids. Decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing capillary permeability. Ointment is recommended for intraoral use. Most pharmacists mix 15 g of triamcinolone with 15 g of Orabase; this should be indicated on the prescription.
Corticosteroids
Class Summary
These agents have anti-inflammatory properties and cause profound and varied metabolic effects. They modify the body's immune response to diverse stimuli.
Dexamethasone (Decadron, Dexone, Hexadrol, Methasone)
Elixir for various allergic and inflammatory diseases. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability. Supervise pediatric patients during administration.
Prednisone (Orasone, Deltasone, Meticorten)
May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. In most cases, systemic corticosteroids are unnecessary in the management of eosinophilic ulcers. Dividing dose may increase efficacy, but also increase risk of adrenal suppression/adverse effects.
Palliative agents
Class Summary
These agents provide temporary symptomatic relief and may improve the patient's comfort while eating.
Diphenhydramine, aluminum hydroxide, magnesium carbonate (Magic Mouthwash)
Provides symptomatic relief of stomatitis. Variations of this formulation may be available through a pharmacy or may be personally specified.
Standard recipe may include 30 mL diphenhydramine (Benadryl) elixir, 60 mL calcium carbonate and magnesium hydroxide (Mylanta), and 4 g sucralfate (Carafate). Preparations may also include tetracycline (avoid tetracycline if < 9 y), attapulgite (Kaopectate), lidocaine, cherry syrup (for children), or hydrocortisone.
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