Copyright 2006 Martin S. Spiller, D.M.D.

Canker sore located on the soft palate

Aphthous ulcers are pinkish white erosions which are surrounded by a halo of red, inflamed mucosa.  The one above is located on the soft palate and is especially painful during swallowing.  Canker sores generally occur suddenly and will last between 10 an 14 days without treatment. 

This condition happens in two varieties, each of which has its own treatment protocol:

Minor aphthous is defined as the occasional, small ulcer that most persons experience no more than once or twice a year.  These lesions are generally small (2-4 mm), and the ulcers are treated as isolated entities (one at a time).

• Topical applications of steroids such as "Lidex gel"  or "Kenalog in Orabase" ® (Note: Lidex is approximately ten times stronger than Kenalog, but Kenalog has the advantage of the Orabase which acts as a Band-Aid and keeps it in place longer).  These drugs are applied after meals and before bedtime, and both are prescription drugs.  They generally reduce or eliminate pain immediately and bring about resolution of the canker in two to three days.  I prefer Kenalog in Orabase in my own practice since it stays in place on the lesion
• Aphthasol paste ® is a prescription drug that is applied directly to the ulcer four times a day (the same as Kenalog in Orabase).
• Cautery using either chemical or laser treatment. 
  • Chemical cautery agents  include silver nitrate (generally on a wooden stick) or commercial agents such as Debacterol®, both of which are applied by a dentist or physician and offer immediate pain relief. 
  • Over-the-counter agents such as Zilactin®, Ora5® and Gly-Oxide® are mild cautery agents that work more slowly.
  • Laser treatment is quick and painless and also offers immediate pain relief.  Laser treatments are done only on small lesions in the dentist's office.  This type of treatment is strictly palliative.  It destroys active lesions and does not prevent others from forming. 

Major aphthous  is defined as a chronic condition in which patients are plagued with multiple aphthous lesions occurring several times a month.  These ulcers are generally quite large, on the order of the size of a dime, and they often heal leaving scar tissue behind.   Major aphthous has no known cure, but chronic aphthous lesions may be treated using the following methods:

• Vitamin B12 has been found to be effective in reducing the frequency and severity of the lesions in patients suffering from major aphthous.  1 mg is dissolved under the tongue every evening.  Some formulations of vitamin B12 are manufactured specifically for this route of administration. 
• Steroid mouth rinse-- Betamethasone sodium phosphate (Betnesol mouthwash/Diprolene) one 0.5mg tablet dissolved in 5 to 10 ml of water.  Patients rinse using this solution four times a day (after meals and before bed) whenever lesions are present.  Another method is for the patient to mix about 1/4 inch of  Fluocinonide (Lidex) cream or gel in four ounces of water.  This mouth rinse is used the same way that betamethasone is used.  Remember--Never swallow a steroid mouth rinse!  Steroids are powerful drugs and mouth rinses made with them should be used sparingly since they can have systemic effects, even when used topically.

Other, more traditional methods of controlling the pain of aphthous:

• Change your toothpaste to one that does not contain sodium lauryl sulfate (SLS).  Some studies indicate that SLS may precipitate aphthous in individuals who are predisposed to get these ulcers.  Tom's of Maine offers a special brand without SLS.  (Note: Fluoride in toothpaste has NOT been found to predispose people to this problem.)
• Try a diet avoiding acidic beverages and spicy or sharp/crispy foods, such as chips.
• Antiseptic mouth rinses such as hydrogen peroxide or the prescription mouth rinse chlorhexidine may reduce the discomfort.
• Palliative mouth rinses made using liquid antacids such as Maalox, milk of magnesia, or other antacids reduce the discomfort from these lesions.  do not swallow these products.  Just rinse and spit.
• "Numbing" mouth rinses made using the above antacids mixed with Benadryl or Lidocaine.  Once again, do not swallow these mouth rinses.

Canker sores are not contagious.  For more on aphthous, click on one of the images above.

Copyright 2006 Martin S. Spiller, D.M.D. courtesy of Dr. Ed Cataldo