Treating canker sores with prescription medications.

Canker sore
images.

Link to pictures of aphthous ulcers.

This page describes the use of prescription drugs in the management of canker sores (recurrent minor aphthous ulcers).

They include: Aphthasol (amlexanox), Kenalog (triamcinolone) in Orabase, as well as other corticosteriod medicines, Tetracycline, Minocycline, Chlorhexidine (Peridex, Paroex).

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).

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).

Slideshow of pictures of aphthous ulcers.

Pictures of canker sores (aphthous ulcers).

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.

When should a prescription approach be considered?

Canker episodes that only occur a few times a year, and only last for a few days and just cause minimal pain are probably best managed using OTC medications or even just home remedies.

But for people who experience painful breakouts frequently (on the order of once every month or so), with each lasting for five to 10 days, investigating the benefits that the use of a prescription medication can provide is clearly warranted.

Note -

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.

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) [page 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) Topical corticosteroids -

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 treatment is beneficial, and may prevent full ulcer formation. Patients who experience noticeable prodromal symptoms, such as tingling or swelling, should begin treatment as soon as these signs are noticed. (Chavan 2012)

The regular use of triamcinolone has not been shown to decrease the rate of recurrence of canker sore outbreaks. (McBride 2000)

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.

3) Corticosteroid rinses -

Dexamethasone elixir (0.5 mg per 5 ml) is sometimes used in the treatment of canker sores. A common regimen involves rinsing with and spitting out the solution three times per day. (McBride 2000, Chavan 2012)

Oral side effects.

Just as with topical applications, the use of a steroid rinse may promote an environment where an overgrowth of Candida may occur.

4) Systemic corticosteroids -

Systemic steroids are not usually used in the management of aphthous ulcers. If they are, they're just indicated for very short treatment periods (5 days). Generally speaking, a decision to utilize this management approach is best left to a physician. (Chavan 2012)


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) Minocycline -

Like tetracycline, the antibiotic minocycline is also sometimes used in the management of aphthous ulcers.

A common regimen is 100mg dissolved in 180 ml of water (3/4 cup), rinsing with and spitting out this suspension twice daily for 4 to 5 days. (McBride 2000)

Dental side effects.

Like tetracycline, minocycline is also known to cause tooth staining. However person's of all age groups may be affected by this drug.

3) Peridex / Paroex -

Peridex and Paroex are prescription anti-bacterial mouthwashes whose active ingredient is chlorhexidine gluconate. Rinsing with this compound has been shown to speed up canker sore healing but not to reduce ulcer pain.

Instructions usually involve rinsing with (and then spitting out) the product 3 times a day. This regimen is sometimes used in conjunction with topical steroid treatment (see triamcinolone above).

Side effects.

Peridex is formulated with an alcohol base, which may be irritating to sores. Paroex may be the preferred product for this application because it's non-alcoholic.

One problem associated with the use of chlorhexidine rinse is that it tends to stain teeth and white dental fillings.

(Chavan 2012)

 

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