Treatment
Topical Therapy — First Line
Reduce pain, accelerate healing
- • Topical corticosteroids: triamcinolone acetonide 0.1% in orabase — apply 3-4x daily to dry ulcer surface; fluocinonide 0.05% gel; fluticasone propionate inhaler applied topically
- • Topical analgesics: lidocaine 2% viscous gel before meals; benzydamine mouthwash 0.15% for pain relief
- • Antimicrobial mouthwashes: tetracycline 250 mg in 10 mL water, held 2 minutes then spit, 4x daily — reduces secondary infection and may reduce healing time
- • Chlorhexidine mouthwash 0.12-0.2% — reduces secondary bacterial colonization
- • Colchicine 0.5 mg BD or dapsone 50-100 mg daily for herpetiform RAS (specialist prescribing)
Systemic Therapy — Severe/Frequent Cases
Immunomodulation for major and severe minor RAS
- • Prednisolone 25-40 mg daily for 5-7 days — for major aphthae causing inability to eat
- • Thalidomide 100-200 mg daily — highly effective for major RAS and Behçet's, but teratogenic; strict pregnancy prevention required
- • Colchicine 0.5-1.5 mg daily — reduces frequency of recurrence
- • Pentoxifylline 400 mg TID — inhibits TNF-α; useful adjunct
- • Vitamin B12 1000 μg/month IM — even in patients without documented deficiency, may reduce recurrence frequency
Trigger Identification and Prevention
Reduce recurrence frequency
- • Switch to SLS-free toothpaste (Biotene, Sensodyne Pronamel SLS-free)
- • Correct nutritional deficiencies (B12, iron, folate, zinc) if identified
- • Stress reduction techniques for stress-triggered cases
- • Avoid identified food triggers
- • Protective dental wax over sharp appliances or teeth causing trauma
- • Celiac disease management (gluten-free diet) for confirmed celiac-associated RAS