Aphthous ulcers (canker sores)

Question 1

Associations to consider:

Answer 1

blood dyscrasia

denture pressure

Crohn disease

coeliac disease pernicious anaemia

Behcet disease

iron deficiency

excessive stress

Question 2

Types and Rx

Answer 2

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.

Question 3

Treatment

Answer 3

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

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

Question 4

Healing

Answer 4

1). One of the following methods can be chosen:

Triamcinolone 0.1% (Kenalog in orobase) 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

2). Major ulceration—consider:

• oral prednisolone 25 mg daily 5–7 days or
• injection of steroids into base of ulcer