Treating canker sores with prescription medications.

Page Graphics.
Link to pictures of aphthous ulcers.

This page describes some of the prescription drugs that have shown to be useful in the management of canker sores (recurrent minor aphthous ulcers).

They include: Aphthasol (amlexanox), Kenalog (triamcinolone) in Orabase, Tetracycline, Peridex (chlorhexidine).

Some of these medications have been specially formulated for this purpose. Others are drugs developed for and primarily used to treat other conditions but have also been found to be beneficial for this purpose too (termed an "off-label" application).

Keep in mind, the use of prescription products is only one treatment method. Our pages also discuss the use of over-the-counter medications and home remedies.


How do they work?

Listed below are some of the more common prescription items that are used to manage aphthous ulcers. Collectively they tend to fall into one of two main categories:

A) Anti-inflammatory medicines.

Anti-inflammatory compounds can help to minimize the extent to which a sore's ulceration will form. The idea is that the smaller the actual size of the ulceration the quicker it will heal.

In this category, this page discusses the use of tetracycline and Peridex (chlorhexidine).

B) "Anti-bacterial" collagenase-inhibiting medicines.

At first glance, the members of this group of compounds all seem to be similar by way of the fact that they're used to combat bacteria. And while that's true, what's instead important in this application is that they inhibit the action of collagenase.

Collagenase breaks down collagen (an important tissue protein) and therefore aids in ulcer formation. If its activity can be reduced, a smaller lesion will form. And smaller sores heal more quickly.

In this category, this page discusses the use of Aphthasol (amlexanox) and Kenalog (triamcinolone) in Orabase.


Remember, any prescription medication should only be used under the supervision of a health care professional. What may seem like a harmless application to you could, in some instances, create medical consequences.


Pictures of aphthous ulcers.

Pictures of canker sores (aphthous ulcers).

A) Anti-inflammatory medications.

1) Aphthasol -

Aphthasol (amlexanox) is a prescription drug specifically developed for treating canker sores.

How does it work?

Its precise mode of action is not known but it's thought that it has both anti-allergic and anti-inflammatory properties.

Research

Studies have shown that using it tends to both speed up healing and reduce the number of days that a sore is painful.

In one study, subjects were evaluated on the third day after the first appearance of their canker sore. 44% of those that had been using Aphthasol since day 1 reported complete resolution of pain, whereas only 20% of non-users did. Also, 21% of users reported complete ulcer healing by day 3 whereas only 8% in the non-user group did. (Binnie 1997) [topic references]

How is it used?

Aphthasol is a paste. When it's applied it forms a film over the lesion so to both hold the product's active ingredient (amlexanox) in place and also to cover over and protect the sore's ulcerated surface.

Its instructions state is should be applied four times daily (after each meal and before bedtime) until healing has occurred.

Using it on a regular basis (when you don't have a sore) has not been shown to reduce the frequency of outbreaks.

2) Kenalog in Orabase -

The active ingredient.

Kenalog (triamcinolone acetonide) is a synthetic corticosteroid. Corticosteroids are compounds that have an anti-inflammatory effect and therefore can help to limit the full extent to which a sore's ulceration will form.

[Fluocinonide (Lidex), betamethasone (Diprolene), and clobetasol (Temovate) are other corticosteriods that can be used in similar a fashion.]

The base component.

The Orabase aspect of this compound is simply a paste that has been specially formulated to adhere to wet oral tissues. In effect, it creates a protective film over the sore that holds the Kenalog in place, and also covers over and protects its ulcerated surface.

How is it used?

Triamcinolone 0.1% (in Orabase) can be applied 2 to 4 times per day from the time the first signs of lesion formation are noticed until healing has occurred. (McBride 2000)

Early initiation of this treatment is thought to provide better results. The regular use of this compound has not been shown to decrease the rate of recurrence of outbreaks.

Oral side effects.

A side effect associated with the use of topical corticosteriods in general is that they tend to create an environment where an overgrowth of Candida (an oral yeast-like fungus) can occur.


B) Collagenase inhibitors.

1) Tetracycline -

Clinical studies have shown that rinsing with a tetracycline solution several times a day can reduce canker sore pain and speed up their healing. Tetracycline is a commonly prescribed antibiotic.

Instructions for adults typically include creating an oral suspension by dissolving a 250-mg capsule in 180 mL (3/4 cup) of water. This solution is then swished and spit out 4 times per day for several days. (McBride 2000)

The regular use of tetracycline rinse has not been shown to reduce a person's frequency of outbreaks.

Dental side effects.

If tetracycline is ingested (swallowed) during tooth formation, permanent tooth staining can result. For this reason, it's not usually used with children and pregnant women.

2) Peridex -

Peridex (chlorhexidine gluconate) is an anti-bacterial mouthwash. Its use has been shown to speed up canker sore healing but it's not been shown to reduce ulcer pain.

Instructions usually involve rinsing with it (and then spitting it out) 3 times a day.

Dental side effects.

One problem associated with its use is that it tends to stain teeth and white dental fillings.

 

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