Canker sore treatments: Prescription medications used in the management of aphthous ulcers.

Treating aphthous ulcers with prescription medications.

Most prescription medications that are used to treat canker sores (recurrent minor aphthous ulcers) seem to fall into one of two main categories:

Anti-inflammatory medicines.: Anti-inflammatory medicines can help to minimize the extent to which a canker sore's ulceration will progress. The smaller an ulceration is the quicker it can heal.
"Anti-bacterial" collagenase inhibiting medicines.: This group of prescription items, at least at first glance, all seem to all be similar by way of the fact that they are each anti-bacterial in nature. While it is true that these products can provide that function it has also been discovered that these medicines possess the ability to inhibit the action of collagenase. Collagenase is a compound that can break down collagen (an important tissue protein) and its presence is instrumental in the formation of canker sore ulcerations.

Our review of dental literature shows that there are a number of prescription medications that have been studied or suggested for use in the treatment of canker sores. The items we discuss on this page are simply some of the more commonplace products dentists typically utilize.

All prescription medications should only be used under the supervision of a health care professional.

Anti-inflammatory prescription medications.

Aphthasol: Aphthasol (amlexanox) is a prescription compound whose sole intended use is for the treatment of canker sores (recurrent minor aphthous ulcers) and it quite possibly offers the most effective solution for those who suffer from them. The precise mechanism of action of Aphthasol is unknown although it has been found to be both anti-allergic as well as anti-inflammatory. Research studies have demonstrated that the use of Aphthasol can both accelerate the resolution of pain from canker sores and accelerate their healing. The use of Aphthasol (continuously or intermittently) has not been shown to reduce the rate of recurrence of canker sores.
One study evaluated participants on day three of their canker sores' presence. At this point 44% of the participants using Aphthasol vs. 20% of those not using this product reported complete resolution of pain from their canker sores. 21% of the participants using Aphthasol vs. 8% not using this product reported complete ulcer healing.
Aphthasol is a paste. When it is applied it forms a film over the sore so to both hold the product's active ingredient in place and also to cover over and protect the canker sore's ulcerated surface. The manufacturer's instructions include applying Aphthasol directly to a person's canker sores four times daily (after each meal and before bedtime) until healing has occurred.
Kenalog in Orabase: Kenalog (triamcinolone acetonide) is a synthetic corticosteroid. Corticosteroids have anti-inflammatory properties and therefore can help to limit the full extent to which a canker sore's ulceration will progress. The Orabase component of this product is a paste specially designed to adhere to the surface of oral lesions. As used in this formulation, the Orabase creates a protective film over the canker sore that holds the Kenalog in place, and also covers over and protects the canker sore's surface. The use of Kenalog has not been shown to decrease the rate of recurrence of canker sores.
Fluocinonide (Lidex), betamethasone (Diprolene), and clobetasol (Temovate) are other corticosteriods that are used in similar fashion in the treatment of canker sores. A problem associated with the use of topical corticosteriods in general is that they can facilitate the overgrowth of Candida (an oral yeast-like fungus).

Collagenase inhibiting prescription medications.

Tetracycline: Clinical studies at the National Institute of Dental Research have found that rinsing with the antibiotic tetracycline several times a day can reduce the pain associated with canker sores and also speed up their healing. Patients are typically instructed to swish with tetracycline for up to five minutes (and then spit it out) several times a day. The use of tetracycline rinse has not been shown to reduce the rate of recurrence of canker sores.
Peridex: Peridex (chlorhexidine gluconate) is a prescription anti-bacterial mouthwash whose use has been shown to speed up the healing of canker sores. A regimen of rinsing (and spitting out) three times a day has been studied and found to provide a benefit. The use of chlorhexidine has not been shown to lessen the pain that accompanies canker sores. One problem associated with the use of this product is that it will stain teeth and white dental fillings.

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References:

Binnie, W., Curro, F., Khandwala, A., and Van Inwegan, R. Amlexanox Oral Paste: A Novel Treatment that Acccelerates the Healing of Aphthous Ulcers. Compendium. Vol. 18, No. 11. 1997.

Bonner, P. Diagnosing Oral Lesions. Dentistry Today. June,2000; 19(6).

Casiglia, J. Recurrent aphthous stomatitis: Etiology, diagnosis, and treatment. General Dentistry. Vol. 50, No. 2. 2002.

Chahine, L., Sempson, N., and Wagoner, C. The Effect of Sodium Lauryl Sulfate on Recurrent Aphthous Ulcers. Compendium. Vol. 18, No. 12. 1997.

Florman, M.(editor). Dental Therapeutic Digest 6th Edition. Odontos Publishing, Inc. (c)1999

Hay, K., and Reade, P. The use of an elimination diet in the treatment of recurrent aphthous ulceration of the oral cavity. Oral Surg Oral Med Oral Path 1984; 57.

Herlofson, B. and Barkvoll, P. The Effect of Two Toothpaste detergents on the Frequency of Recurrent Aphthous Ulcers. Acta Odontology Scand. Vol. 54, No. 3. 1996.

Khandwala, A., Van Inwegen, R., Alfano, M. 5% Amlexanox Oral Paste, a New Treatment for Recurrent Minor Aphthous Ulcers. Oral Surg Oral Med Oral Path Oral Radiol Endod. Vol. 83, No. 2. 1997.

McBride, David. Management of Aphthous Ulcers. American Family Physician 2000; 62(160).

National Institute of Dental Research. Fever Blisters and Canker Sores. National Institutes of Health publication no. 92-247. Revised July 1992.

O'Neill, Hugh and Ed Clafin. The Doctors Book of Home Remedies. Rodale, 1999.

Pray, S. Advising Patients About Oral Ulcers. U.S. Pharmacist 2000; 25(1)

Ship, J. and et.al. Recurrent Aphthous Stomatitis. Quintessence International. Vol. 31, No. 2. 2000.

Stay, Fora Parsa. The Complete Book of Dental Remedies. Avery Publishing Group. (c)1996

Woo, S. and Sonis, S. Recurrent Aphthous Ulcers: A Review of Diagnosis and Treatment. Journal of the American Dental Association. Vol. 127. August, 1996.

Wray, D., Vlagopoulos, T., and Siraganian, R. Food allergens and basophil histamine release in recurrent aphthous stomatitis. Oral Surg Oral Pathol Oral Med 1982; 54.

Prescription medications useful in treating canker sores (recurrent minor aphthous ulcers).

Treating aphthous ulcers with prescription medications.

Anti-inflammatory prescription medications.

Collagenase inhibiting prescription medications.