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New Treatments for Aphthous Ulcers

Aphthous ulcers (canker sores) are a common condition of the oral mucosa. About 20% of the population is affected at one time or another. The lesions can be very painful. There is a genetic predisposition and an increased prevalence among patients with such autoimmune diseases as Crohn's disease, chronic ulcerative colitis, Behcet's syndrome, and Reiter's syndrome. Contributing factors include deficiencies of iron, folate, and vitamin B₁₂ ; psychological stress; generalized physical debility; and trauma. In some women, flares occur premenstrually. Regardless of etiology, once mucosal breakdown has occurred, the lesions are invaded by mouth flora.

Clinical Presentation

Aphthous stomatitis develops in four clinical stages:

1. Premonitory--tingling, burning, or hyperesthetic sensation, lasting up to 24 hours;
2. Preulcerative--lasting from 18 hours to 3 days, characterized by moderately painful erythematous macules or papules with erythematous halos;
3. Ulcerative--lasting 1 to 16 days, characterized by painful discrete ulcers 2 to 10 mm in diameter,

Treatment

When the chief reason for seeking medical care is concern, reassurance that the lesions will heal spontaneously and that they do not represent more serious pathology will often suffice. For patients with large lesions and those bothered badly by the discomfort, additional measures are reasonable. In the presence of extremely painful lesions, use of a topical anesthetic agent

Tetracycline liquid (250 mg four times a day) used as a mouthwash that is held in the mouth for several minutes before expectorating is easy to use. Topical corticosteroids impregnated into a paste vehicle (e.g., Orabase) help apply the steroid to the mucous membrane and may provide some added relief. Carbamide peroxide gel is an oxidizing agent.

In the presence of extremely painful lesions, use of topical anesthetic agents (e.g., viscous lidocaine) before meals may allow the patient to eat. Avoidance of abrasive foods also helps. Levamisole, which stimulates immune response, has been used experimentally and reported efficacious in about two thirds of cases, but the unknown long-term safety of this agent limits its use for this self-limited condition. Topical use of sucralfate liquid may provide.

Women with a definite premenstrual flare may be helped by estrogen-dominated oral contraceptives. Identification and correction of an existing deficiency of folate, vitamin B12, or iron may cure aphthous stomatitis. For lesions precipitated by emotional stress, attention to the underlying problem may help.