Treatment of Frequent Mouth Ulcers in Senior Citizens

First-Line Topical Treatments

The American College of Physicians recommends applying topical corticosteroids as primary therapy for oral aphthous ulcers in elderly patients, with options including betamethasone sodium phosphate 0.5 mg dissolved in 10 mL water as a rinse-and-spit solution four times daily 1, 2, 3
Fluticasone propionate nasules can be diluted in 10 mL of water twice daily for oral aphthous ulcers in elderly patients 1, 3
Clobetasol 0.05% ointment mixed in 50% Orabase can be applied twice weekly to dried mucosa for localized ulcers 1, 2

Benzydamine hydrochloride oral rinse or spray can be used every 3 hours, particularly before eating, for pain management in elderly patients with mouth ulcers 2, 3
Topical anesthetic preparations such as viscous lidocaine 2% can be applied 3-4 times daily for pain relief in adults and children over 12 years 2
Barrier preparations such as Gengigel mouth rinse/gel or Gelclair can be used for pain control and protection of ulcerated surfaces 1, 2

Cleaning the mouth daily with warm saline mouthwashes can reduce bacterial colonization in elderly patients with mouth ulcers 2, 3
Antiseptic oral rinses such as 0.2% chlorhexidine digluconate mouthwash can be used twice daily for oral hygiene in elderly patients 2, 3

If candidal infection is suspected, treatment with nystatin oral suspension 100,000 units four times daily for 1 week can be effective 2, 4
Miconazole oral gel 5-10 mL can be held in the mouth after food four times daily for 1 week for candidal infections 2

High protein oral nutritional supplements may be beneficial for elderly patients with mouth ulcers, especially those at risk of malnutrition 5

Tacrolimus 0.1% ointment can be applied twice daily for 4 weeks for recalcitrant ulcers 1, 3, 6
Intralesional triamcinolone injections in conjunction with topical clobetasol can be used for ulcers that don't respond to topical treatment 1, 3

Systemic corticosteroids such as prednisone/prednisolone 30-60 mg or 1 mg/kg for 1 week with tapering over the second week can be considered for highly symptomatic or recurrent ulcers 1, 3

Proper diagnosis of the type of mouth ulcer is essential before initiating treatment, as oral ulcers can be related to a wide range of conditions 2