Mouth ulcer

From Ganfyd

Mouth ulcer on lower lip.

Aphthous ulcers in the mouth are common. They are also commonly recurrent.^[1]

An ulcer is a breach in the epithelium. This exposes the nerve endings in the lamina propria beneath to the saliva, which may periodically contain irritants, which produce considerable pain.

The causes are unclear although they are associated with some systemic conditions^[2], many treatments have been suggested and there is evidence for effectiveness of some of them.

Investigations

• FBC
• Haematinics (Ferritin; Folate and vitamin B12)
• Consider (screening for) Coeliac disease

Treatment

• NSAID gargle
• Saline rinses
• Directly applied local anaesthetic (symptomatic only)
• Benzydamine spray/rinse (Difflam®)
• Carbenoxolone gel (Bioral®)
• Sucralfate suspension
• Licorice
• Steroid as:
  • Triamcinolone (Adcortyl® in Orabase)
  • Clobetasol (Dermovate ®)
  • Hydrocortisone (Previously Corlan® but now available only as a generic - oroadhesive hydrocortisone)
  • Beclomethasone from a metered dose inhaler sprayed onto the ulcer.^[3]
• Tetracycline/Minocycline or DOxycycline, opened and used as a mouthwash.
• Thalidomide in intractable, slow-healing ulcers in HIV patients.^[4][5]

With RCT evidence available

• Chlorhexidine gluconate mouth rinses reduce the severity of each episode of ulceration, but do not reduce recurrences.

RCTs found that chlorhexidine reduced the mean severity of pain compared with an inert preparation.

• Topical corticosteroids

Small RCTs found that topical corticosteroids reduced the number of ulcer days compared with control preparations. They also don't prevent more ulcers. They may reduce the duration and pain of ulcers and hasten pain relief without causing notable local or systemic adverse effects.

• Hexitidine On limited RCTs it probably doesn't work.^[6]

References