Aphthous ulcer medical therapy: Difference between revisions
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{{Aphthous ulcer}} | {{Aphthous ulcer}} | ||
{{CMG}} | {{CMG}} | ||
== | ==Pain relief and healing== | ||
'''Any mouth sore that does not heal after two weeks should be looked at by a dentist or an oral surgeon as it could be a sign of a more serious condition such as [[oral cancer]].''' | |||
Aphthous ulcers normally heal without treatment within 1 to 2 weeks. Good oral [[hygiene]] should be maintained, and spicy, acidic, and salty foods and drinks are best avoided, as they may irritate existing ulcers. Strong mouthwash such as [[Listerine]] has also been known to cause irritation because of its strong ingredients, and many oral care professionals discourage the use of it while having a mouth ulcer. | |||
Pain can be mitigated by an [[Over-the-counter_drug|OTC]] pain-relieving gel, such as [[Anbesol]], [[Bonjela]], Campho-Phenique, Orabase B, Zilactin, or Kanka, available in drugstores. | |||
[[Triamcinolone]] Acetonide dental paste can be very effective; the [[steroid]] reduces the immune system's response in the area of the ulcer. It is available by prescription only for bigger pack size - 10g or over the counter for smaller pack size - 5g in pharmacies in the UK. | |||
A recent study of the Oral-B product Amosan suggests that it may reduce [[anaerobic bacteria]], such as those found in oral wounds. The study did not, however, demonstrate the efficacy of the product in treating mouth ulcers.<!-- | |||
--><ref>{{cite journal | author = Wennström J, Lindhe J | title = Effect of hydrogen peroxide on developing plaque and gingivitis in man. | journal = J Clin Periodontol | volume = 6 | issue = 2 | pages = 115–30 | year = 1979 | id = PMID 379049}}</ref> | |||
[[Tincture of benzoin]] can be used as a protectant for recurring aphthous ulcers, by forming a layer over the sore and protecting it from further irritation. | |||
===Home remedies=== | |||
<!-- | |||
PLEASE ONLY INCLUDE REMEDIES SUGGESTED BY RELIABLE SOURCES - E.G. UNIVERSITIES, MEDICAL ORGANISATIONS, HOSPITALS, ETC - OTHERWISE THIS COULD EASILY GET OUT OF HAND | |||
[[Aspirin]] is an excellent home remedy. Applied directly to the ulcer, it both alleviates pain and reduces inflamation from the T-cells. Care should be taken to avoid leaving an aspirin poltice on the ulcer for more than a few minutes, as burning of surrounding tissues may ensue. Those who find the taste of aspirin objectionable may prefer to use children's aspirin. | |||
-->Some home remedies that have been suggested include: | |||
* Licorice Root (Glycyrrhiza) in the form of over-the-counter medicated disk patches may help heal or reduce the growth of canker sores if applied early on.[http://www.webmd.com/oral-health/news/20070322/patch-may-help-heal-canker-sores] | |||
* Sticking a small aspirin on the sore and applying pressure | |||
* Apply three pinches of table [[salt]] on the sore. (Note this can be painful) | |||
[[Antacid]] techniques suggested include the following: | |||
* Gargling warm water and salt sometimes provides temporary relief from pain, and the salt may promote healing. | |||
* Swab the ulcers with [[Milk of Magnesia]].<!-- | |||
-->[http://www.mayoclinic.com/health/canker-sore/DS00354/DSECTION=7] | |||
* Make a paste of baking soda and water; apply directly to the ulcers.<!-- | |||
-->[http://www.pitt.edu/~cjm6/s98canker.html] | |||
* Make a mix of half [[milk of magnesia]] and half [[Benadryl]], and hold in the mouth for up to 3 minutes.<ref>[http://familydoctor.org/613.xml Canker Sores: What Are They and What Can You Do About Them? (American Academy of Family Physicians)]</ref> | |||
== Treatment for severe cases == | |||
In very severe cases, a doctor may prescribe a [[steroid]] treatment. One such steroid is [[methylprednisolone]] (usually in a dose-pack), taken orally for a period of 7 days. Alternatively, the doctor may inject a steroid directly into the site of the ulcer (this treatment is performed with kenalog. Between 0.2 and 0.4 ml of kenalog is injected into the site of the ulcer, which will usually be completely healed 72 to 96 hours after the injection). | |||
Patients in whom ulcers do not respond to local treatment may benefit from a short course of pulsed [[prednisone]]. | |||
Some [[Dentistry|dentists]] recommend a [[sulfuric acid]] solution for treating mouth ulcers, such as debacterol. | |||
[[Thalidomide]] has been effective in unresponsive aphthous stomatitis. Thalidomide has been used successfully generally to treat various inflammatory conditions characterized by tissue infiltration with [[polymorphonuclear leukocytes]] (PMNLs). Therapeutic benefit has been attributed to depression of PMNL [[chemotaxis]] and, possibly, PMNL [[phagocytosis]]. However, adverse effects can be both problematic and clinically significant. | |||
Another chemical treatment option is the application of [[silver nitrate]] to cauterize the sore. In clinical trials it was found that this treatment reduced pain in patients by 70% with one application but had no effect on healing compared to placebo.<!-- | |||
--><ref>{{cite journal | author=Alidaee M, Taheri A, Mansoori P and Ghodsi S | title=Silver nitrate cautery in aphthous stomatitis: a randomized controlled trial | journal=Br J Derm | year=2005 | month=September | volume=153 | issue=3 | pages=521 |id={{DOI|10.1111/j.1365-2133.2005.06490.x}}}}</ref> | |||
Another choice doctors have is to prescribe Aphthasol, the only [[Food and Drug Administration]] (FDA) approved treatment specifically indicated for Aphthous ulcers. | |||
Controversial therapies include [[levamisole]], [[colchicine]], gamma-[[globulin]], [[dapsone]], [[estrogen]] replacement,[[MAOIs]], and [[tetracycline]]. [http://www.emedicine.com/ped/topic2672.htm] | |||
Some evidence supports treatment with tetracycline. Tetracycline oral mouth rinse (ie, swish orally and swallow) decreases healing time and pain severity and duration. Whether this benefit is due to a direct antimicrobial effect, tetracycline's anti-inflammatory properties<!-- | |||
--><ref>{{ cite journal | author=Jain A, Sangal L, Basal E, Kaushal GP, and Agarwal SK | title=Anti-inflammatory effects of Erythromycin and Tetracycline on Propionibacterium acnes induced production of chemotactic factors and reactive oxygen species by human neutrophils | journal=Dermatology Online Journal | volume=8 | issue=2 |url=http://dermatology.cdlib.org/DOJvol8num2/original/antibiotics2/jain.html }}</ref> or to an inhibitory effect on chemotaxis and chemotoxicity is not known. | |||
The miracle cures that are advertised should be viewed with skepticism. However, [[aqueous]] sulphuric acid products as listed above can provide significant pain relief, if not treating the underlying causes. | |||
==References== | ==References== | ||
Revision as of 19:34, 25 January 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Pain relief and healing
Any mouth sore that does not heal after two weeks should be looked at by a dentist or an oral surgeon as it could be a sign of a more serious condition such as oral cancer.
Aphthous ulcers normally heal without treatment within 1 to 2 weeks. Good oral hygiene should be maintained, and spicy, acidic, and salty foods and drinks are best avoided, as they may irritate existing ulcers. Strong mouthwash such as Listerine has also been known to cause irritation because of its strong ingredients, and many oral care professionals discourage the use of it while having a mouth ulcer.
Pain can be mitigated by an OTC pain-relieving gel, such as Anbesol, Bonjela, Campho-Phenique, Orabase B, Zilactin, or Kanka, available in drugstores.
Triamcinolone Acetonide dental paste can be very effective; the steroid reduces the immune system's response in the area of the ulcer. It is available by prescription only for bigger pack size - 10g or over the counter for smaller pack size - 5g in pharmacies in the UK.
A recent study of the Oral-B product Amosan suggests that it may reduce anaerobic bacteria, such as those found in oral wounds. The study did not, however, demonstrate the efficacy of the product in treating mouth ulcers.[1]
Tincture of benzoin can be used as a protectant for recurring aphthous ulcers, by forming a layer over the sore and protecting it from further irritation.
Home remedies
Some home remedies that have been suggested include:
- Licorice Root (Glycyrrhiza) in the form of over-the-counter medicated disk patches may help heal or reduce the growth of canker sores if applied early on.[2]
- Sticking a small aspirin on the sore and applying pressure
- Apply three pinches of table salt on the sore. (Note this can be painful)
Antacid techniques suggested include the following:
- Gargling warm water and salt sometimes provides temporary relief from pain, and the salt may promote healing.
- Swab the ulcers with Milk of Magnesia.[3]
- Make a paste of baking soda and water; apply directly to the ulcers.[4]
- Make a mix of half milk of magnesia and half Benadryl, and hold in the mouth for up to 3 minutes.[2]
Treatment for severe cases
In very severe cases, a doctor may prescribe a steroid treatment. One such steroid is methylprednisolone (usually in a dose-pack), taken orally for a period of 7 days. Alternatively, the doctor may inject a steroid directly into the site of the ulcer (this treatment is performed with kenalog. Between 0.2 and 0.4 ml of kenalog is injected into the site of the ulcer, which will usually be completely healed 72 to 96 hours after the injection).
Patients in whom ulcers do not respond to local treatment may benefit from a short course of pulsed prednisone.
Some dentists recommend a sulfuric acid solution for treating mouth ulcers, such as debacterol.
Thalidomide has been effective in unresponsive aphthous stomatitis. Thalidomide has been used successfully generally to treat various inflammatory conditions characterized by tissue infiltration with polymorphonuclear leukocytes (PMNLs). Therapeutic benefit has been attributed to depression of PMNL chemotaxis and, possibly, PMNL phagocytosis. However, adverse effects can be both problematic and clinically significant.
Another chemical treatment option is the application of silver nitrate to cauterize the sore. In clinical trials it was found that this treatment reduced pain in patients by 70% with one application but had no effect on healing compared to placebo.[3]
Another choice doctors have is to prescribe Aphthasol, the only Food and Drug Administration (FDA) approved treatment specifically indicated for Aphthous ulcers.
Controversial therapies include levamisole, colchicine, gamma-globulin, dapsone, estrogen replacement,MAOIs, and tetracycline. [5]
Some evidence supports treatment with tetracycline. Tetracycline oral mouth rinse (ie, swish orally and swallow) decreases healing time and pain severity and duration. Whether this benefit is due to a direct antimicrobial effect, tetracycline's anti-inflammatory properties[4] or to an inhibitory effect on chemotaxis and chemotoxicity is not known.
The miracle cures that are advertised should be viewed with skepticism. However, aqueous sulphuric acid products as listed above can provide significant pain relief, if not treating the underlying causes.
References
- ↑ Wennström J, Lindhe J (1979). "Effect of hydrogen peroxide on developing plaque and gingivitis in man". J Clin Periodontol. 6 (2): 115–30. PMID 379049.
- ↑ Canker Sores: What Are They and What Can You Do About Them? (American Academy of Family Physicians)
- ↑ Alidaee M, Taheri A, Mansoori P and Ghodsi S (2005). "Silver nitrate cautery in aphthous stomatitis: a randomized controlled trial". Br J Derm. 153 (3): 521. doi:10.1111/j.1365-2133.2005.06490.x. Unknown parameter
|month=ignored (help) - ↑ Jain A, Sangal L, Basal E, Kaushal GP, and Agarwal SK. "Anti-inflammatory effects of Erythromycin and Tetracycline on Propionibacterium acnes induced production of chemotactic factors and reactive oxygen species by human neutrophils". Dermatology Online Journal. 8 (2).
zh-min-nan:Chhiūⁿ-iam-ke-lâ
de:Aphthe
eo:Afto
gl:Afta
id:Sariawan
it:Afta
he:אפתה
la:Ulcus Aphthous
nl:Afte
sq:Afta
fi:Afta
sv:Afte
th:แผลร้อนใน
uk:Афти