Mouth ulcer treatments?
February 5, 2008 1:52 AM Subscribe
Treatment for mouth ulcers. I've been using Bonjela since 1837, and it's only just now struck me that medical science must have come up with something better in recent years. So what do you find works well?
TCP FTW!
posted by zemblamatic at 2:58 AM on February 5, 2008
posted by zemblamatic at 2:58 AM on February 5, 2008
Best answer: The small aphthous mouth ulcers everybody gets at some point in their lives are mainly caused by localised viral infections and tend, by and large, to occur in times of increased stress.
Of course people can develop large confluent whitish ulcerations which are probably thrush caused by fungal infection and need to be treated with antifungals such as nystatin or miconazole.
Local treatment aims to protect the ulcerated area, to relieve pain, to reduce inflammation, or to control secondary (bacterial) infection. People with an unexplained mouth ulcer of more than 3 weeks' duration require urgent medical attention to exclude oral cancer or immunosuppression.
A saline mouthwash may relieve the pain of ulceration caused by trauma (e.g. from tongue bite or poorly fitting dental appliances). The mouthwash is made up from warm water and household salt, and used at frequent intervals until the discomfort and swelling subsides.
Secondary bacterial infection may become a feature of any mucosal ulceration; it can increase discomfort and delay healing. Use of an antiseptic chlorhexidine or povidone–iodine mouthwash is often beneficial and may accelerate healing of recurrent aphthae. Warning: This tends to "sting" on application (a bit like an aftershave)!
Carmellose gelatin paste provides mechanical protection for the ulcer site and may relieve some discomfort arising from ulceration. The paste adheres to dry mucosa, but is difficult to apply effectively to some parts of the mouth.
Topical corticosteroid therapy (e.g. cortisone pellets, triamcinolone dental paste, beclometasone inhaler spray or betamethasone tablets dissolved in water as a mouthwash) may be used for some forms of oral ulceration. In the case of aphthous ulcers it is most effective if applied as early as possible (i.e. in the ‘prodromal' phase). Note that the appearance of thrush/candidiasis is a recognised complication of prolonged local or systemic corticosteroid treatment.
The usefulness of local analgesics is limited by their short duration of action. Lidocaine 5% ointment or lozenges, or 10% spray can be applied thinly to the ulcer using a cotton bud. When local anaesthetics are used in the mouth care must be taken not to produce anaesthesia of the pharynx before meals as this might lead to choking. Local anaesthetic overdosing can occur and have adverse cardiovascular or neurological effects - dizziness or "buzzing in the ear" are useful warning signs.
Nonsteroidal anti-inflammatory agents are useful: Benzydamine mouthwash or spray will help reduce the discomfort; if the full-strength mouthwash causes stinging, it should be diluted with an equal volume of water. Flurbiprofen lozenges are an alternative. Bonjela dental gel contains choline salicylate, an aspirin derivative. Be mindful that excessive application or confinement of the agent under a denture irritates the mucosa and can itself cause ulceration, and that excessive use can lead to salicylate poisoning.
Doxycycline antibiotic rinsed in the mouth may be of value for recurrent aphthous ulceration.
The above is a combination of my own experience (I am a doctor but neither a general practitioner nor an ENT specialist, and get aphthous ulcers when I'm stressed) and of material from the British National Formulary (BNF). I generally use either benzydamine mouthwash or cortisone pellets, or both. If things haven't improved within one week using two over-the-counter agents you should definitely see a doctor!
Hope this helps.
posted by kairab at 3:12 AM on February 5, 2008 [7 favorites]
Of course people can develop large confluent whitish ulcerations which are probably thrush caused by fungal infection and need to be treated with antifungals such as nystatin or miconazole.
Local treatment aims to protect the ulcerated area, to relieve pain, to reduce inflammation, or to control secondary (bacterial) infection. People with an unexplained mouth ulcer of more than 3 weeks' duration require urgent medical attention to exclude oral cancer or immunosuppression.
A saline mouthwash may relieve the pain of ulceration caused by trauma (e.g. from tongue bite or poorly fitting dental appliances). The mouthwash is made up from warm water and household salt, and used at frequent intervals until the discomfort and swelling subsides.
Secondary bacterial infection may become a feature of any mucosal ulceration; it can increase discomfort and delay healing. Use of an antiseptic chlorhexidine or povidone–iodine mouthwash is often beneficial and may accelerate healing of recurrent aphthae. Warning: This tends to "sting" on application (a bit like an aftershave)!
Carmellose gelatin paste provides mechanical protection for the ulcer site and may relieve some discomfort arising from ulceration. The paste adheres to dry mucosa, but is difficult to apply effectively to some parts of the mouth.
Topical corticosteroid therapy (e.g. cortisone pellets, triamcinolone dental paste, beclometasone inhaler spray or betamethasone tablets dissolved in water as a mouthwash) may be used for some forms of oral ulceration. In the case of aphthous ulcers it is most effective if applied as early as possible (i.e. in the ‘prodromal' phase). Note that the appearance of thrush/candidiasis is a recognised complication of prolonged local or systemic corticosteroid treatment.
The usefulness of local analgesics is limited by their short duration of action. Lidocaine 5% ointment or lozenges, or 10% spray can be applied thinly to the ulcer using a cotton bud. When local anaesthetics are used in the mouth care must be taken not to produce anaesthesia of the pharynx before meals as this might lead to choking. Local anaesthetic overdosing can occur and have adverse cardiovascular or neurological effects - dizziness or "buzzing in the ear" are useful warning signs.
Nonsteroidal anti-inflammatory agents are useful: Benzydamine mouthwash or spray will help reduce the discomfort; if the full-strength mouthwash causes stinging, it should be diluted with an equal volume of water. Flurbiprofen lozenges are an alternative. Bonjela dental gel contains choline salicylate, an aspirin derivative. Be mindful that excessive application or confinement of the agent under a denture irritates the mucosa and can itself cause ulceration, and that excessive use can lead to salicylate poisoning.
Doxycycline antibiotic rinsed in the mouth may be of value for recurrent aphthous ulceration.
The above is a combination of my own experience (I am a doctor but neither a general practitioner nor an ENT specialist, and get aphthous ulcers when I'm stressed) and of material from the British National Formulary (BNF). I generally use either benzydamine mouthwash or cortisone pellets, or both. If things haven't improved within one week using two over-the-counter agents you should definitely see a doctor!
Hope this helps.
posted by kairab at 3:12 AM on February 5, 2008 [7 favorites]
So, apart from the 'transmission control protocol', what's a 'TCP'?
posted by pompomtom at 3:13 AM on February 5, 2008
posted by pompomtom at 3:13 AM on February 5, 2008
TCP is a proprietary disinfectant for skin application (ie. superficial infections/wounds). Before applying it in the mouth where you are bound to swallow it, make sure to read the instructions: They may advise against "internal use".
posted by kairab at 3:16 AM on February 5, 2008
posted by kairab at 3:16 AM on February 5, 2008
Canker Cover does a great job. It really does clear up a mouth ulcer in 1 application.
posted by 26.2 at 4:05 AM on February 5, 2008
posted by 26.2 at 4:05 AM on February 5, 2008
Also, you may want to change toothpaste. I'm somehow allergic to Colgate and once I made the switch to Crest, my frequent mouth ulcers/canker sores dropped from "I can never have tomato juice again" to "Hey, pizza!" Also consider a humidifier as dry mouth late a night seems to cause more outbreaks. Nightly rinsing with an antiseptic mouthwash (I use Crest Prohealth as the high alcohol content of Listorine also dries stuff out a lot) helps.
Treatment-wise (and I know I should do this, but do anyway and have for years and am still alive) I use Bactine on a q-tip to numb the sore. I spit afterwards to make sure I don't swallow anything more than trace amounts. My folks used to swear by vitamin e capsules (you take a pin and poke a hole in a vitamin e gelcap, squirt contents on ulcer), but that never seemed to help as much as smacks of voodoory to me.
posted by robocop is bleeding at 4:22 AM on February 5, 2008
Treatment-wise (and I know I should do this, but do anyway and have for years and am still alive) I use Bactine on a q-tip to numb the sore. I spit afterwards to make sure I don't swallow anything more than trace amounts. My folks used to swear by vitamin e capsules (you take a pin and poke a hole in a vitamin e gelcap, squirt contents on ulcer), but that never seemed to help as much as smacks of voodoory to me.
posted by robocop is bleeding at 4:22 AM on February 5, 2008
Seconding KrisJohn; look in your pharmacy for some stuff called SM-33. It's a topical anaesthetic (containing lignocaine); you dab it on a mouth ulcer, and it stings for five seconds, then does a terrific job of anaesthetising and curing ulcers.
posted by The Shiny Thing at 4:54 AM on February 5, 2008
posted by The Shiny Thing at 4:54 AM on February 5, 2008
I always found rubbing salt on them to be effective. Rudimentary and painful as hell, but effective.
posted by jontyjago at 5:30 AM on February 5, 2008
posted by jontyjago at 5:30 AM on February 5, 2008
I grew up using Gly-Oxide, but I haven't had to in quite awhile so my memory may be clouded by nostalgia.
posted by rhizome at 5:41 AM on February 5, 2008
posted by rhizome at 5:41 AM on February 5, 2008
I find that (prescription) Tagamet decreases the time-to-heal by a few days.
posted by dmd at 6:28 AM on February 5, 2008
posted by dmd at 6:28 AM on February 5, 2008
Best answer: I once was a chronic mouth ulcer sufferer - They make you miserable and it seemed as soon as one vanished another would appear. I did quite a bit research (before I ever found metafilter - probably 5 years ago) and found a solution that takes care of the treatment, because it eliminates the problem - I have probably only had 5 ulcers in the last 5 years!
I found that the Sodium Lauryl Sulfate added to every widely available toothpaste brand is what irritates my gums. Adding this SLS to your mouth twice a day in your toothpaste irritates any small lesion you might have and prevents them from healing, resulting in an ulcer that takes forever to go away due to the repeated attacks from the SLS.
My solution has been to use toothpaste that does not contain SLS - I use Squigle which you can buy directly from the inventor but I can't find his contact info at this moment - will post it as a follow up. Finding out about SLS and finding this SLS-free toothpaste have been MAJOR quality of life improvements for me. I can't recommend it highly enough! I buy the toothpaste by the case.
You won't have to worry about how to treat them when you no longer get one, and even when one does appear, the fact that you are not irritating it every morning and night with your harsh SLS containing toothpaste will enable your body to heal the ulcer much more quickly, with less SLS-induced pain.
posted by idzyn at 7:09 AM on February 5, 2008
I found that the Sodium Lauryl Sulfate added to every widely available toothpaste brand is what irritates my gums. Adding this SLS to your mouth twice a day in your toothpaste irritates any small lesion you might have and prevents them from healing, resulting in an ulcer that takes forever to go away due to the repeated attacks from the SLS.
My solution has been to use toothpaste that does not contain SLS - I use Squigle which you can buy directly from the inventor but I can't find his contact info at this moment - will post it as a follow up. Finding out about SLS and finding this SLS-free toothpaste have been MAJOR quality of life improvements for me. I can't recommend it highly enough! I buy the toothpaste by the case.
You won't have to worry about how to treat them when you no longer get one, and even when one does appear, the fact that you are not irritating it every morning and night with your harsh SLS containing toothpaste will enable your body to heal the ulcer much more quickly, with less SLS-induced pain.
posted by idzyn at 7:09 AM on February 5, 2008
I'm a current "Recurrent Aphthous Stomatitis" (canker sore) sufferer, and I've tried everything from saline washes to non-SLS toothpaste. The only thing I've found to work is topical corticosteroids (self-link). The verdict is actually still out on what causes canker sores--virus vs bacteria--and why some people get them more than others. Here's a review article from the dental literature on the subject.
posted by gramcracker at 7:53 AM on February 5, 2008
posted by gramcracker at 7:53 AM on February 5, 2008
I get a canker sore every once in a while, and I find that eating blackberries (mushing them around near the sore) really helps. I read it in some study somewhere and have found that it works for me. Maybe you could eat a couple a day as a preventative measure if you get them a lot.
posted by Eringatang at 8:04 AM on February 5, 2008
posted by Eringatang at 8:04 AM on February 5, 2008
Best answer: baking soda or baking soda toothpaste work great on canker sores. Just put a little dab on the sore and leave it there for 5-10 minutes then rinse, the sores will heal in less than a day.
posted by estronaut at 8:48 AM on February 5, 2008
posted by estronaut at 8:48 AM on February 5, 2008
To back up idzyn's comment, I also found that removing toothpaste with sodium laurylate from my cabinet made an enormous difference - you can buy Rembrant Classic toothpaste, or Biotene toothpaste, both commonly available in US drugstores, neither containing SLS.
posted by canine epigram at 8:53 AM on February 5, 2008
posted by canine epigram at 8:53 AM on February 5, 2008
My personal favorite is Amosan by Oral-B. It's supposed to be similar to rinsing with old fashioned hydrogen peroxide, but it seems to be more effective in my experience. I use it once or twice and it's like waving a magic wand.
posted by mausburger at 9:22 AM on February 5, 2008
posted by mausburger at 9:22 AM on February 5, 2008
I only get canker sores once in a blue moon- usually when my diet is bad, but I've had good luck with Cankermelts. They're a nuisance to find, though.
posted by small_ruminant at 9:22 AM on February 5, 2008
posted by small_ruminant at 9:22 AM on February 5, 2008
I recommend taking a L-Lysine, an amino acid when you have mouth ulcers. I take between 2 and 4 every day when I have them or feel like one is coming on. It helps it not feel so painful and it also helps if you put it directly on the sore. Hurts a bit and doesn't taste great, but there's not nearly as much pain.
They've started making L-Lysine chapstick for lips too - but I haven't had much experience with that. The pill form is usually really effective for me.
Good luck!
posted by mulkey at 10:54 AM on February 5, 2008
They've started making L-Lysine chapstick for lips too - but I haven't had much experience with that. The pill form is usually really effective for me.
Good luck!
posted by mulkey at 10:54 AM on February 5, 2008
Response by poster: Thanks for the great answers. The non-sls toothpaste sounds interesting. I think I'll give it a try, and if that fails, I've got a ton of alternatives for treatment. I'll try to remember to post an update in a wee while. I notice that the question got a few favourites - it might be good if anyone who has conspicuous success or failure with a new treatment suggested here also adds an update.
posted by Jakey at 11:00 AM on February 5, 2008
posted by Jakey at 11:00 AM on February 5, 2008
I get canker sores and always have. I tried the no-SLS and it didn't really work. The only preventive I've found that works for me is to avoid vinegar (eg in salad dressings, ketchup, etc). When I have vinaigrette, reliably I will get a canker the next day. When I avoid it, I only get them once every 6 months or so. The difference is really night and day. I still get them when stressed etc, but it's nothing like it was before.
So I think there really is something to the food-based-triggers theory. Try to keep track of what you're eating and drinking and see if there are patterns. Esp keep track of very acidic foods, tannins (tea, red wine), and other things that are likely to irritate the mouth lining.
posted by LobsterMitten at 1:17 PM on February 5, 2008
So I think there really is something to the food-based-triggers theory. Try to keep track of what you're eating and drinking and see if there are patterns. Esp keep track of very acidic foods, tannins (tea, red wine), and other things that are likely to irritate the mouth lining.
posted by LobsterMitten at 1:17 PM on February 5, 2008
Contact info for previously mentioned Squigle SLS-free toothpaste: 610-645-5556 - I think the actual developer of the toothpaste answers the phone.
posted by idzyn at 2:44 PM on February 5, 2008
posted by idzyn at 2:44 PM on February 5, 2008
Response by poster: Update: success!
Treatments tried (no real winner):
canker cover, corlan (cortisone pellets). Neither was particularly successful, and both were pretty irritating.
TCP. Didn't seem to be any more effective than bonjela.
Prevention: Switched to SLS-free toothpaste. Haven't had a mouth ulcer in 3 months despite having cut my mouth a couple of times which would almost certainly become ulcerated normally. This is the longest ulcer free period in years. I have found one each of the Rembrandt and Sensodyne toothpaste varieties which are SLS-free and should be available in any big UK supermarket. No doubt it won't work for everyone, but I'd certainly SLS-free a go if you have similar problems.
Thanks again everyone.
posted by Jakey at 2:54 AM on May 13, 2008 [1 favorite]
Treatments tried (no real winner):
canker cover, corlan (cortisone pellets). Neither was particularly successful, and both were pretty irritating.
TCP. Didn't seem to be any more effective than bonjela.
Prevention: Switched to SLS-free toothpaste. Haven't had a mouth ulcer in 3 months despite having cut my mouth a couple of times which would almost certainly become ulcerated normally. This is the longest ulcer free period in years. I have found one each of the Rembrandt and Sensodyne toothpaste varieties which are SLS-free and should be available in any big UK supermarket. No doubt it won't work for everyone, but I'd certainly SLS-free a go if you have similar problems.
Thanks again everyone.
posted by Jakey at 2:54 AM on May 13, 2008 [1 favorite]
This thread is closed to new comments.
I use Rinstead pastels during the day which also helps reduce the swelling and pain.
posted by mr_silver at 1:59 AM on February 5, 2008