These acutely painful ulcers on the mobile oral mucosa are a common problem in general practice and puzzling in their cause and response to treatment. Their cause is unknown, but several factors indicate a localised abnormal immune reaction.
Minor ulcers: < 5 mm in diameter—last 5 to 10 days.
Major ulcers: > 8 mm in diameter—last weeks and heal with scarring.
Blood dyscrasias, denture pressure, Crohn disease, pernicious anaemia, iron deficiency.
These treatments should be used early when the ulcer is most painful. Several optional healing methods are presented.
Apply topical lidocaine gel or paint, e.g. SM-33® adult paint formula or SM-33® gel (children) every 3 hours. If applied before meals, eating is facilitated.
Alternatively, use a mixture of:
Gargle well and swallow 4 times a day.
One of the following methods can be chosen.
Consider applying a wet, squeezed out, black teabag directly to the ulcer regularly, such as 3 to 4 times daily. The tannic acid promotes healing and alleviates pain. Another method is to prepare a strong cup of tea (concentrated), cool and dip in a cotton bud or ball and hold it against the ulcer for 3 minutes.
Topical corticosteroid paste
Triamcinolone 0.1% (Kenalog in orobase®) paste. Apply 8 hourly and at night.
Topical corticosteroid spray
Spray beclomethasone on to the ulcer 3 times daily.
Use 10% chloramphenicol in propylene glycol. Apply with a cotton bud for 1 minute (after drying the ulcer) 6 hourly for 3 to 4 days.
Tetracycline suspension rinse for multiple ulcers
Empty the contents of a 250 mg tetracycline capsule into 20–30 mL of warm water and shake it.
Swirl this solution in the mouth for 5 minutes every 3 hours.
An alternative method is to apply the solution soaked in cotton wool wads to the ulcers for 5 to 10 minutes.
Note: This has a terrible taste but reportedly shortens the life of the ulcers considerably. We recommend spitting out the rinse, although some authorities suggest swallowing the suspension.
Dissolve 1 g sucralfate in 20–30 mL of warm water. Use this as a mouth wash.