Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Although there is no cure for canker sores, treatment can decrease symptoms, reduce the likelihood that they will return, and prolong periods of remission. Your doctor has a number of treatments available:
Silver nitrate can be applied directly to the lesion. A medical provider who is experienced in application should do this; however, the nitrate sticks can be purchased over the Internet. There is a randomized trial demonstrating the efficacy of this treatment. There is almost immediate relief of pain and the lesion heals over the next three to five days. Many patients do not like the burnt taste that they get in their mouth immediately after the procedure but love the total relief of pain within a few hours.
Debacterol is a combination of sulfonated phenolic compounds and sulfuric acid that works in a very similar manner to the silver nitrate. It chemically abrades/burns the ulcer. This causes almost immediate relief of the pain and causes the lesion to heal over the next three to five days. It is only available by prescription, but it can be applied by either a dentist or physician. It only has to be applied once.
Prescription medications: If over-the-counter medications do not help, your doctor may prescribe one of a number of medications:
Triamcinolone Acetonide Dental Paste USP (Kenalog in Orabase): This can be applied up to three times a day, preferably after meals or at bedtime.
Amlexanox (Aphthasol): This can be applied up to four times a day, after each meal and at bedtime. There is little evidence that the medication actually decreases pain or speeds healing.
Tetracycline suspensions (Achromycin, Nor-tet, Panmycin, Sumycin, Tetracap) used as a mouthwash can relieve pain and accelerate healing; however, their use does not prevent recurrence. Also, use for more than five days may cause problems with reactions and yeast infections in the mouth.
Viscous lidocaine: This is a 2% gel that is applied to the affected area up to four times a day. In order to avoid toxicity, patients should avoid swallowing the medication and should not use the medication more than four times a day.
Sucralfate slurry (Carafate, a prescription medication used to treat peptic ulcers): This treatment is not recommended by many experts and there are limited studies supporting its use. You mix one tablet in 5-10 milliliters (1-2 teaspoons) of water. The slurry is swished around the mouth and spit out four times a day.
The doctor may prescribe folic acid, iron, or vitamin B12 supplements if you are deficient in these. In such cases, you may require several months of therapy to improve. No benefit has been shown, however, from taking these vitamins if you are not deficient.
Corticosteroids: In extremely severe cases, doctors may consider giving oral doses of corticosteroids, if they believe the benefits of treatment exceed the risks of oral steroids. Risks of steroid therapy include weight gain, weakening of the immune system, brittle bones, increase in gastric acidity leading to ulcers, and others.
Thalidomide (Thalomid): In extremely severe cases, doctors may consider using thalidomide. Unfortunately, its severe adverse effects limit its use, and it is only FDA approved for treatment of major aphthous ulcers in HIV-positive patients.
Other potential medications. A long list of medications has been tried and may be used to treat aphthous ulcers in carefully selected patients. Each of these has significant potential adverse effects, and many are quite expensive. These include colchicine, pentoxifylline (Trental), Interferon, Cimetidine (Tagamet), clofazimine (Lamprene), anti-TNF-α agents, infliximab (Remicade), etanercept (Enbrel), levamisole (Ergamisol), and dapsone.