Treatment of Aphthous Ulcers on the Tongue

First-Line Topical Treatments

The American College of Physicians recommends applying topical corticosteroids as primary therapy, 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
Topical corticosteroids, such as fluticasone propionate nasules diluted in 10 mL of water twice daily, can be used as an alternative treatment option 2
For localized ulcers, clobetasol 0.05% ointment mixed in 50% Orabase applied twice weekly to dried mucosa can be effective 1, 2

Benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating, can be used for pain management 1, 3
Topical anesthetic preparations, such as viscous lidocaine 2% applied 3-4 times daily, can be used for more severe pain 1
Barrier preparations, such as Gengigel mouth rinse/gel or Gelclair, can be used for pain control 2

Daily cleaning of the mouth with warm saline mouthwashes can reduce bacterial colonization 1, 3
Antiseptic oral rinses, such as 0.2% chlorhexidine digluconate mouthwash, can be used twice daily 1, 3

Tacrolimus 0.1% ointment applied twice daily for 4 weeks can be used for recalcitrant ulcers 1, 2
Intralesional triamcinolone injections in conjunction with topical clobetasol can be used for ulcers that don't respond to topical treatment 1, 2

Systemic corticosteroids, such as prednisone/prednisolone 30-60 mg or 1 mg/kg for 1 week with tapering over the second week, can be used for highly symptomatic or recurrent ulcers 2, 3
Colchicine can be effective for recurrent aphthous stomatitis, especially for erythema nodosum or genital ulcers 4, 3
Azathioprine, interferon-alpha, or TNF-alpha antagonists can be considered for resistant cases 4, 3

Nystatin oral suspension 100,000 units four times daily for 1 week can be used to treat candidal infections 1
Miconazole oral gel 5-10 mL held in the mouth after food four times daily for 1 week can be used as an alternative treatment for candidal infections 1

Proper diagnosis of the type of mouth ulcer is essential before initiating treatment 1
Premature tapering of corticosteroids before disease control is established should be avoided 3
Underlying systemic conditions that may require additional treatment should be considered for patients with recurrent aphthous ulcers 1, 3