OTC treatments for canker sores.

While there's no real cure for canker sores (aphthous ulcers), there are a number of different treatment approaches that can be useful in providing palliative care (promote healing, relieve pain, prevent secondary infection).

This page explains the use of Over-the-counter (OTC) treatments. These are the kinds of products you buy off the shelf of your local store.

We have other pages that describe the use of home remedy solutions and prescription medications.


How over-the-counter products work.

OTC medications typically provide their benefit via one, or some combination, of the following approaches:

A) SLS-free products.    
B) Protective films.    
C) Numbing agents.    
D) Antibacterial compounds.    
E) Ulcer cleansing agents.


A) Sodium lauryl sulfate (SLS) free products.

The vast majority of mouthwash and toothpaste products contain the foaming agent sodium lauryl sulfate ("SLS").

Some studies have suggested that this compound is a risk factor for, or has an aggravating effect upon, canker sores. (More information.)

Locations in the mouth where aphthous ulcers typically form.

Locations where canker sores form.

SLS-free products.

A few manufacturers formulate versions of their products without SLS. It's easy enough to find them. They're usually readily marked "SLS-free." (Tom's of Maine®, Rembrandt®, Verve Ultra®)

By using one of these alternatives a person can reduce their level of exposure to SLS. And as a result, hopefully they'll find that they either have fewer outbreaks or experience less intense symptoms with those that form.

Of course, this treatment method can easily be used in conjunction with other treatment approaches or products.

Does it work?

It should be simple enough to give this approach a try. However, being able to actually determine how much of a benefit it provides may entail some work.

You'll need to keep records and compare your before and after results. Depending on your usual frequency of outbreaks, this may take some time.

SLS-free products usually do cost a bit more than regular ones. For example, a 5 oz. tube of toothpaste might cost around 2 dollars more. So, testing to see how this approach works for you has some cost although not much.


B) Films / Oral bandages.

Bioadhesive pastes have been developed that can create a semi-lasting film over wet oral tissues (possibly for as long as 6 hours). Two such brands are Orabase® and Zilactin®.

What the film does.

When used over canker sores, this type of covering can provide two benefits:

1) It acts as a barrier. - The film helps to protect the sore from exposure to irritating substances like foods and beverages. It also helps to create a protected environment that promotes healing.

2) It can be used to apply medications. - Some manufacturers add compounds to the paste that can provide some type of treatment benefit. For example, a numbing agent might be included so to help to minimize ulcer pain.

Variations.

More modern formulations of these kinds of products are based on the compound cyanoacrylate. (This is the main component of "super" glue.) It helps to form a longer-lasting film. Orabase Soothe-N-Seal® was the first product of this type to receive FDA approval.

Does it work?

When you have a sore that hurts, none of these products probably creates a covering that's as durable as you'd like. But yes, and especially in the case of products that contain numbing agents (see below), using one can provide some relief. The film tends to be more adherent if you dry the sore and surrounding tissue somewhat first (a cotton swab can be used).


C) Numbing agents.

Due to their size or location, some canker sores can be so sensitive to touch that a person must limit their oral movements (eating, chewing gum, sometimes even just smiling).

In these cases, using a treatment that contains a numbing agent may make it possible for these people to return to somewhat normal activities.

What's available?

You should be able to find products that contain compounds such as the benzocaine, benzoin tincture, lidocaine, camphor, and phenol. (Benzocaine is the compound that a dentist rubs on your gums before giving you a shot. Lidocaine is the anesthetic that's usually given to numb your tooth.)

What you find might be a liquid, gel, ointment, rinse or spray. Or, as mentioned above, some are mixed in with barrier film paste. Some brand names are: Orabase®, Orajel®, Kank-A®, SensoGard®, Tanac®, UlcerEase®, Zilactin® and Anbesol®.

Make sure you read the instructions that come with the one you choose and follow them. Many are intended for short-term use only. If over applied, some may cause a chemical burn.

Does it work?

Numbing agents don't speed up the healing process but yes, if you're having a lot of pain they can provide some much needed relief.


D) Antibacterial compounds.

Medications

Some OTC products contain antibacterial compounds such as iodine. They may either be a liquid or paste that you apply directly to the sore. The idea is that their use helps to prevent the formation of a secondary bacterial infection, which would delay the healing of the lesion.

(Ora5® contains iodine and copper sulfate. The latter is an astringent that helps to reduce ulcer pain. One study reported that use of Ora-5® did decrease ulcer size and pain (initially). But duration still exceeded 7 days and pain actually increased between days 5 and 8.) (Dale 1989) [topic references]

Rinses

Some research suggests that rinsing with prescription antibacterial solutions can both speed up healing and lessen pain. Listerine® (or a generic equivalent) can be used as an OTC substitute (two to three times a day). It does contain alcohol, however, which some people may find irritates their sores.


E) Cleansing agents.

Debris that accumulates on the ulcerated surface of a canker sore may interfere with its normal healing. Using an OTC cleansing agent can be a gentle way of removing it.

These types of products usually contain an active ingredient (carbamide peroxide, hydrogen peroxide or sodium perborate monohydrate) and glycerin (which makes their consistency syrupy).

When they're applied, they release oxygen. This, in turn, creates a foaming action that helps to cleanse the lesion and carry away debris. The release of oxygen also creates an environment that's inhospitable to some types of bacteria. The glycerin component forms a coating that helps to protect the sore. Some of the brand names associated with these kinds of products are Gly-oxide®, Amosan® and Cankaid®.


This may help.

Some OTC products create a stinging sensation when they are initially applied and then, usually within some moments, start to provide relief. You may be able to minimize their initial sting by numbing your sore with an ice cube first.

 

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