A/AMLEXANOX appears to be most effective overall. Amlexanox 5% paste reduces ulcer size, pain duration, and healing time (strength of recommendation [SOR]: A, multiple randomized controlled trials [RCTs]).
Topical steroids may alleviate pain and decrease ulcer burden, defined as total number of ulcers over a measured time, usually 4 to 6 weeks (SOR: B, multiple small heterogenous RCTs). Chemical cautery agents also lessen pain (SOR: A, single RCTs on differing agents), and chlorhexidine mouthwashes may reduce overall ulcer burden (SOR: B, heterogeneous RCTs). The herbal preparation Eupatorium laevigatum alleviates pain and improves healing (SOR: B, single RCT).
Oral vitamin B12 supplements and avoiding toothpastes containing sodium lauryl sulfate may prevent recurrent ulcers (SOR: B, small RCTs). The TABLE compares ulcer treatments.
A systematic review of 4 double-blind RCTs found that the anti-inflammatory amlexanox 5% paste significantly reduced ulcer size compared with placebo (-1 vs 0 mm on Day 3 and -3 vs -1 mm on Day 5; P<.01). It also decreased healing time by Day 3 and duration of pain. When applied during the prodromal stage, amlexanox dramatically reduced the number of patients who progressed to full ulcers. (1)
Clobetasol also reduces pain, ulcer size
A double-blind RCT comparing amlexanox 5% with another anti-inflammatory, clobetasol propionate 0.05% paste, showed equal declines in visual analog pain scores (an average drop from 6 to 2 points out of 10 for each treatment by Day 3 compared with baseline; P<.001). Both treatments produced equivalent reductions in ulcer size from baseline by Day 5 (P<.001). (2)...
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