As healing is spontaneous, treatment is directed towards decreasing the pain associated with mouth ulcers and using agents which protect the area from trauma and encourage healing. As the cause has an immune component, the use of mild topical steroids can be used to decrease the inflammation and facilitate healing.
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Kenalog in Orabase is a commonly used topical corticosteriod. Dexamethasone mouthwash can used as a rinse for multiple ulcerated areas. Both Kenalog and dexamethasone require a doctor's prescription. Mouth rinses containing the antibiotic tetracycline have been shown to speed the healing by reducing the incidence of bacterial infection and unpleasant discomfort associated with canker sores. Research has shown that rinsing several times a day with tetracycline mouth rinse can reduce the pain within 24 hrs and speed healing down to 5-7 days. It is critical to avoid tetracycline if you are pregnant and do not give it to children. It is well documented that tetracycline can permanently stain the teeth during a child's development.
Oral steroids or other immuno-suppressive drugs may be required in recurrent severe cases of canker sores. These drugs have undesirable side effects and should only be administered under close supervision of a physician or dentist.
Over the counter topical medications, some of which contain benzocaine and other soothing agents help reduce the discomfort of canker sores. Another remedy is to apply a diluted hydrogen peroxide solution (1 part hydrogen peroxide and one part distilled water) with a cotton swab on the canker sore. Follow this up with a small dab of milk of magnesia on the canker sore 2-3 times a day. Milk of magnesia is not only a soothing agent, but appears to help healing.
As canker sores are an open wound they are prone to bacterial infection and irritation which would delay healing. It is therefore important to have good oral hygiene and avoid hot or spicy foods to minimize further irritation. Mild mouth washes such as salt water or non-alcoholic mouth washes may aid in hygiene and increase comfort. To reduce the frequency of outbreaks it is recommended to use a soft toothbrush, avoid spicy and hard foods like tortilla chips, reduce your daily stress and maintain a balanced diet and healthy lifestyle.
You must consult your physician if you are not sure if you have true canker sores, if your mouth sores are accompanied by fever, weakness and swollen lymph nodes or if your ulcer does not heal. Tests may include blood and allergy tests. The only definitive diagnosis is to have a biopsy of the ulcerated area.
For a full list of medications for canker sores please click here.