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Palliative cancer care - oral problems - Management
How should I treat aphthous ulcers?
- Correct any underlying iron, folate, or vitamin B12 deficiency if the prognosis allows.
- Topical corticosteroids:
- Hydrocortisone lozenges are best used in the prodromal period, before the ulcer develops.
- Beclometasone spray or betamethasone soluble tablets are more potent and are generally reserved for use when ulceration is extensive, or is at a difficult-to-reach site.
- Triamcinolone in an adhesive paste (Adcortyl in Orabase®) has been discontinued.
- For severe recurrent aphthous ulcers doxycycline mouthwash can be used (which can be made up by stirring the contents of a doxycycline 100 mg capsule into a small amount water and rinsing around in the mouth for 2 to 3 minutes, four times a day).
- Chlorhexidine mouthwash can be used to prevent secondary bacterial infection.
- For management of pain associated with aphthous ulcers, see Managing oral pain.
- For severe persistent ulceration, seek specialist advice.
In depth
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