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Aphthous Ulcers Medication

  • Author: Crispian Scully, MD, MRCS, PhD, MDS, CBE, FDSRCS(Eng), FDSRCPS, FFDRCSI, FDSRCSE, FRCPath, FMedSci, FHEA, FUCL, FSB, DSc, DChD, DMed(HC), Dr(HC); Chief Editor: Arlen D Meyers, MD, MBA  more...
 
Updated: May 10, 2016
 

Medication Summary

TCs remain the mainstay of treatment for recurrent aphthous stomatitis (RAS). TCs reduce the number of ulcer days compared with controls, but they have no consistent effect on the frequency of ulceration. TCs may reduce the ulcer duration and pain. Amlexanox oral adhesive pellicles or oral adhesive tablets appear to reduce ulcer pain and duration.

Chlorhexidine gluconate mouth rinses reduce the severity and pain of ulceration but do not affect the frequency.

The range of systemic medications available is of variable or unproven efficacy or may have serious adverse effects; such agents include systemic corticosteroids, colchicine, clofazimine, and thalidomide (and many others).[10]

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Corticosteroids

Class Summary

A spectrum of different TCs can be used. All can reduce symptoms, and neither hydrocortisone nor triamcinolone preparations cause adrenal suppression. Ulcers still recur.

Hydrocortisone topical (Cortaid, Dermacort, Westcort)

 

Decreases inflammation by suppressing migration of PMNs and reversing increased capillary permeability.

Triamcinolone topical (Aristocort, Flutex, Kenalog)

 

Decreases inflammation by suppressing migration of PMNs and reversing capillary permeability.

Betamethasone topical (Alphatrex, Diprolene, Maxivate)

 

For inflammatory dermatoses responsive to steroids. Decreases inflammation by suppressing migration of PMNs and reversing capillary permeability.

Fluocinolone (Synalar, Fluonid)

 

High-potency topical corticosteroid that inhibits cell proliferation and is immunosuppressive, antiproliferative, and anti-inflammatory.

Fluocinonide (Fluonex, Lidex)

 

High-potency topical corticosteroid that inhibits cell proliferation and is immunosuppressive and anti-inflammatory.

Clobetasol (Temovate)

 

Class I superpotent topical steroid; suppresses mitosis and increases synthesis of proteins that decrease inflammation and cause vasoconstriction.

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Oral Rinses

Class Summary

Mucoadhesive action reduces pain by adhering to the mucosal surface of the mouth.

Bioadherent oral (Gelclair)

 

This agent adheres to the mucosal surface of mouth and forms a protective coating that shields exposed and overstimulated nerve endings. Ingredients include water, maltodextrin, propylene glycol, polyvinylpyrrolidone (PVP), sodium hyaluronate, potassium sorbate, sodium benzoate, hydroxy ethylcellulose, polyethylene glycol (PEG)–40, hydrogenated castor oil, disodium edetate, benzalkonium chloride, flavoring, saccharin sodium, and glycyrrhetinic acid.

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Contributor Information and Disclosures
Author

Crispian Scully, MD, MRCS, PhD, MDS, CBE, FDSRCS(Eng), FDSRCPS, FFDRCSI, FDSRCSE, FRCPath, FMedSci, FHEA, FUCL, FSB, DSc, DChD, DMed(HC), Dr(HC) Emeritus Professor, University College London; Visiting Professor, Universities of Athens, BPP, Edinburgh, Granada, Helsinki and Plymouth

Crispian Scully, MD, MRCS, PhD, MDS, CBE, FDSRCS(Eng), FDSRCPS, FFDRCSI, FDSRCSE, FRCPath, FMedSci, FHEA, FUCL, FSB, DSc, DChD, DMed(HC), Dr(HC) is a member of the following medical societies: Academy of Medical Sciences, British Society for Oral Medicine, European Association for Oral Medicine, International Academy of Oral Oncology, International Association for Dental Research, International Association for Oral and Maxillofacial Pathology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Robert M Kellman, MD Professor and Chair, Department of Otolaryngology and Communication Sciences, State University of New York Upstate Medical University

Robert M Kellman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Head and Neck Society, American Rhinologic Society, Triological Society, American Neurotology Society, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, Medical Society of the State of New York

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

Additional Contributors

Hassan H Ramadan, MD, MSc Professor and Vice-Chair, Department of Otolaryngology-Head and Neck Surgery, Professor, Department of Pediatrics, West Virginia University School of Medicine

Hassan H Ramadan, MD, MSc is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Rhinologic Society

Disclosure: Nothing to disclose.

References
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  13. Borra RC, de Mesquita Barros F, de Andrade Lotufo M, Villanova FE, Andrade PM. Toll-like receptor activity in recurrent aphthous ulceration. J Oral Pathol Med. 2009 Mar. 38(3):289-98. [Medline].

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  16. Gallo Cde B, Mimura MA, Sugaya NN. Psychological stress and recurrent aphthous stomatitis. Clinics (Sao Paulo). 2009. 64(7):645-8. [Medline]. [Full Text].

  17. Gulcan E, Toker S, Hatipoğlu H, Gulcan A, Toker A. Cyanocobalamin may bebeneficial in the treatment of recurrent aphthous ulcers even when vitamin B12levels are normal. Am J Med Sci. 2008. 336:379-82.

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  27. Volkov I, Rudoy I, Freud T, Sardal G, Naimer S, Peleg R, et al. Effectiveness of vitamin B12 in treating recurrent aphthous stomatitis: arandomized, double-blind, placebo-controlled trial. J Am Board Fam Med. 2009. 22:9-16.

 
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Traumatic ulcer on ventrum/lateral margin of tongue; these must be differentiated from aphthae.
Recurrent aphthae in floor of mouth, showing ovoid ulcer with inflammatory halo.
Typical aphthous ulcer in a common site, showing inflammatory halo surrounding a yellowish round ulcer.
 
 
 
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