Canker Sore Treatment

Self-Care at Home

• Try rinsing your mouth with a solution of ½ teaspoon salt dissolved in 8 ounces of water.
  
  
• Another mixture that may be helpful consists of 1-2 tablespoons of Maalox mixed with ½ tablespoon of liquid diphenhydramine (Benadryl). Swish a teaspoonful in your mouth and spit it out. This can be done four times a day.
  
  
• A number of medications are available over the counter, for example, calamine (Calamox) lotion.
  
  
• Liquids or ointments with a numbing ingredient such as benzocaine (Anbesol, Oragel, Orabase, Zilactin-B, Tanac) help relieve the discomfort of canker sores.

Medical Treatment

Although there is no cure for canker sores, treatment can decrease symptoms, reduce the likelihood that they will return, and prolong periods of remission.

• Applying certain steroid salves directly to the sore is effective if you use the salve early in an attack. If over-the-counter medications do not help, a common prescription consists of triamcinolone acetonide, a corticosteroid, in a sticking dental paste (Kenalog in Orabase). Typically, you apply the paste to the lesions three times daily. More recently, doctors have prescribed amlexanox (Aphthasol). Although no one knows why amlexanox works, it may be related to its anti-inflammatory and anti-allergic effects.
  
  
• Tetracycline suspensions (Achromycin, Nor-tet, Panmycin, Sumycin, Tetracap) used as a mouthwash can relieve pain and accelerate healing.
  
  
• The doctor can prescribe viscous lidocaine (an anesthetic) to numb the ulcers before meals and at bedtime, making it easier for you to eat.
  
  
• A slurry made with Carafate, a prescription medication used to treat peptic ulcers, has been reported to successfully coat canker sores, promoting comfort and healing. However, the FDA has not approved the use of Carafate officially for canker sores.
  
  
• The doctor may prescribe folic acid, iron, or vitamin B12 supplements if you are deficient in these. In such cases, you may require several months of therapy to improve. No benefit has been shown, however, from taking these vitamins if you are not deficient.
  
  
• For unknown reasons, some women may develop new attacks or worsening of canker sores during their premenstrual phase. An estrogen-dominant oral contraceptive may help if given for four to six months.
  
  
• In extremely severe cases, doctors may consider giving oral doses of corticosteroids, if they believe the benefits of treatment exceed the risks of oral steroids. Risks of steroid therapy include weight gain, weakening of the immune system, brittle bones, increase in gastric acidity leading to ulcers, and others.
  
  
• Cimetidine (Tagamet) may be useful in treating canker sores. This is the same medication that decreases acid production by the stomach and is used for peptic ulcers and heartburn. The FDA has not approved cimetidine officially for the treatment of canker sores.
  
  
• Surprisingly, some recent studies have found thalidomide effective for managing severe cases of canker sores. Thalidomide is available only experimentally, having been taken off the market years ago because it caused severe birth defects. The drug also can be toxic to the nerves. Hence, use of thalidomide is restricted to research studies.
  
  
• Additional drugs reported to be beneficial include colchicine, pentoxifylline (Trental), and dapsone (Avlosulfon). Colchicine may aid prevention as well as treatment. Interferon and levamisole also may be useful in severe cases. At this time, the FDA has approved none of these drugs for the treatment of canker sores.
  
  
• More recently, a prescription drug, Debacterol, was released that is applied to the ulcer and helps to seal it and allow it to heal.