++
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.
+++
Associations to consider
++
Blood dyscrasias, denture pressure, Crohn disease, pernicious anaemia, iron deficiency.
+++
Precipitating factors
++
++
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.
+++
Topical chloramphenicol
++
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.