Medication for mouth ulcers

Most mouth ulcers clear up on their own within 1 to 2 weeks. But, if your ulcer is painful or not healing as quickly as you think it should, there are variety of medicines you can use.

Mouth ulcer medicines help protect the ulcerated area, relieve pain, reduce swelling or prevent further infection. The choice of medicine will depend on the severity of the discomfort you are experiencing and the cause of the ulcer – talk to your pharmacist about the right one for you. If you have had a mouth ulcer for a few weeks that won’t go away, see your doctor. They may prescribe a stronger medication to treat severe, recurrent or infected mouth ulcers. 

Read more about mouth ulcers.

Mouthwashes

Saline mouthwashes can help relieve pain and can be prepared by mixing half a teaspoon of salt in a glass of warm water. Rinse your mouth as needed and spit out.

Antiseptic mouthwashes such as chlorhexidine mouthwash are used to prevent secondary infection, by reducing the build-up of bacteria. Rinse your mouth with the mouthwash, and spit out (do not swallow) twice a day. It should not be used within 30 minutes of using toothpaste.

Protective paste (such as Orabase® paste)

Orabase® paste acts as a protective covering when applied to the mouth ulcer. A small amount of paste is dabbed on the affected area as often as needed, particularly after eating. Do not rub in. The paste sticks to the mouth ulcer and helps to prevent irritation from foods, and drinks and eases discomfort.

Steroid-containing pastes (such as Kenalog in Orabase® and Oracort®)

Steroid-containing pastes can be bought from your pharmacy without a prescription, after consultation with your pharmacist. They may be used for some forms of mouth ulcers but are not suitable if you have got a viral, bacterial or fungal infection in your mouth or throat (for example oral thrush). Steroids can make these infections worse. Check with your pharmacist if steroid-containing pastes are suitable for you. 

Steroid-containing pastes help to relieve pain, inflammation (redness), discomfort and accelerate healing. A small amount of paste is pressed or dabbed on the affected area. Do not rub. These pastes are best applied at bedtime (allowing the paste to work throughout the night) but depending on how severe your symptoms are, it may be necessary to apply it 2 to 3 times a day, preferably after meals. 

Pain relievers applied to the area (also called local analgesics)

Pain relievers applied to the affected area may be in the form of mouthwash, spray, gel or lozenges. They offer pain relief to the area, in and around the ulcer. They have a limited role in the management of mouth ulcers because they work for only a short duration. Examples of local analgesics include:

  • Lidocaine (Xylocaine®Mucosoothe) gel, which can be applied thinly to the ulcer using a cotton bud.
  • Benzydamine (Difflam®) mouthwash or spray may reduce pain from mouth ulcers or mucositis (inflamation of mucous membranes) after radiation therapy. Some people find the full-strength mouthwash stings; it can be diluted with an equal volume of water if needed.
  • Choline salicylate dental gel (such as Bonjela® and Ora-sed®) may relieve discomfort. Before applying the gel, wipe the surface free of mucous, then apply a small amount of gel (cover the tip of the index finger) and rub into affected area not more often than every 3 hours. Avoid getting on dentures – wait at least 30 minutes after use before putting dentures back in. 

Creams for cold sores

Some ulcers around the mouth are caused by the herpes simplex virus (also called cold sores or fever blisters). Antiviral creams can be used to treat cold sores on the lips – do not use these creams inside your mouth. Antiviral creams can be purchased from a pharmacy, eg, acyclovir cream (Cold Sore Relief®, Viraban®, Viratac®, Zovirax®). Cold sore creams reduce the severity and duration of cold sore symptoms when they appear. Cold sore creams do not get rid of the virus from your body, so they cannot prevent cold sores from coming back. You should only use cold sore creams if your doctor or pharmacist has told you that your cold sores are caused by the Herpes simplex virus.   

References

  1. Drugs for oral ulceration and inflammation New Zealand Formulary 
  2. Oral ulceration – causes and management The Pharmaceutical Journal, March 2019 
Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 12 Apr 2019