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Aphthous ulcer - Management
Antimicrobial mouthwash
- Chlorhexidine is the antimicrobial mouthwash of choice. It has the most evidence to support its use, and is recommended in the literature by experts [Scully et al, 2003].
- Chlorhexidine can stain teeth brown when used regularly. The stain is not usually permanent, and can be reduced by avoiding drinks that contain tannin (e.g. tea, coffee, or red wine), and by brushing teeth before, rather than after, use. However, the mouth should be rinsed well after tooth brushing as some ingredients in toothpaste can inactivate chlorhexidine [ABPI Medicines Compendium, 2005].
- Tetracycline mouthwash has been used for severe recurrent aphthous ulceration. Although it may reduce the duration and severity of ulcers, it can cause oral candidiasis and a burning-like sensation of the pharynx [Porter et al, 2000]. Tetracycline capsules are no longer available in the UK so doxycycline is usually substituted instead; the contents of a doxycycline 100 mg capsule are dispersed in water and rinsed around the mouth four times a day.
- Doxycycline mouthwash should not be used in pregnant or breastfeeding women, or in children.
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