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Aphthous stomatitis, or mouth ulcer, is a very common, often painful problem most people experience. Also known as "canker sores," mouth ulcers are shallow sores found on the inner cheeks, lips, or gums. They often appear white, yellow, or red in color and may occur in clusters. Approximately 20% of the population may experience recurrent mouth ulcers.
Mouth ulcers generally are not caused by infection and therefore are not contagious. Most will heal without treatment in 1 to 2 weeks. When active, however, sores can be very painful, causing the patient discomfort when eating, speaking, or swallowing. Some commercial products are available to treat mouth ulcers, and, due to the challenges of effectively treating pain or trauma in the oral cavity, a compounding pharmacist may be able to produce a particularly helpful remedy.
Types and Causes of Mouth Ulcers
There are 3 types of recurrent aphthous stomatitis (RAS): minor, major, and herpetiform.
Although the exact cause of RAS is unknown, several factors appear to trigger it. In most cases, these factors may be identified and avoided by the patient to prevent or reduce outbreaks. In rare cases, however, RAS is caused by a disease or condition outside the patient's control. Factors affecting RAS outbreaks include the following:
Treating Mouth Ulcers
Treatment of RAS typically is palliative, although supplementing the diet with lysine or the aforementioned nutrients may work as a preventive measure. There are some OTC and prescription treatments that can be effective in relieving the pain of mouth ulcers. A dentist or physician always should be consulted prior to beginning any new type of treatment.
Several treatments using common OTC medications or household items may offer pain relief. They include:
When OTC products do not provide sufficient symptom relief, a prescription treatment may be appropriate. Commercial preparations include:
When commercial products prove less effective, in some cases a compounding pharmacist can prepare medications in special bases that adhere to the site, as well as some unique treatments and dosage forms. The range of treatment possibilities is greater, and the dose may be tailored to the needs of the patient.
One particularly effective preparation, polyphenol sulfonic acid complex, is applied directly to the site. Although it burns upon application, the sore is essentially cauterized, and in most cases no further symptoms are reported, although in some situations an additional application is needed.
Another highly effective compounded treatment is a preparation of misoprostol mucoadhesive anesthetic powder. This is a dry powder blend of misoprostol and dyclonine, which, when applied to the site, forms a sticky gel that adheres to the sore and forms a protective barrier. This gel is more resistant to friction, and, because the sore is protected, pain and irritation are greatly reduced.
Other compounded options for treating RAS include tetracaine, lidocaine, or benzocaine lollipops or sprays to numb the area, and the incorporation of commercially available products into a more adherent base or a mouth rinse.
Ms. Fields is with the International Journal of Pharmaceutical Compounding and is a pharmacy technician at Innovative Pharmacy Services in Edmond, Okla.