Aphthous Ulcers (Canker Sores)

Associations to consider:

• blood dyscrasia, denture pressure, Crohn disease, coeliac disease pernicious anaemia, Behçet disease, iron deficiency, excessive stress

Minor ulcers: <5 mm in diameter—last 5–10 d

Major ulcers: >8 mm in diameter—last weeks and heal with scarring. Refer a non-healing ulcer for biopsy within 3 wks of presentation.

Treatment methods (use early when ulcer worse) Consider applying a wet, squeezed-out, black teabag directly to the ulcer regularly (the tannic acid promotes healing).

Symptomatic relief

• Apply topical lignocaine gel or paint (e.g. SM-33 adult paint formula or SM-33 gel [children] every 3 h). If applied before meals, eating is facilitated or

• Eutectic EMLA cream 5 g applied on a cotton bud for 5 mins

Healing One of the following methods can be chosen:

• Triamcinolone 0.1% (Kenalog in orabase) paste apply 8 hrly and nocte (preferred method) or

• Hydrocortisone lozenges dissolved on ulcer qid or

• Beclomethasone dipropionate spray onto ulcer tds or

• Dissolve 1 g sucralfate in 20–30 mL of warm water. Use this as a mouth wash

Major ulceration—consider:

• oral prednisolone 25 mg/d 5–7 days or

• injection of steroids into base of ulcer