Treatment Strategies for Recurrent Oral Aphthous Ulcers


Am J Health Syst Pharm. 2001;58(1) 

In This Article

Antimicrobial Mouthwashes

Antimicrobial mouthwash use in RAU is intended to control microbial contamination and secondary infection. Both antibiotic (e.g., tetracycline) and antiseptic (e.g., chlorhexidine) mouthwashes have been studied. The time required for healing of aphthous ulcers has been correlated with the ability of antimicrobial mouthwashes to reduce the population of oral mucosal flora.[16] Double-blind, placebo-controlled trials of antiseptic and antibiotic mouthwashes are summarized in Table 1.

Four double-blind, placebo-controlled trials of antiseptic mouth-washes were identified. In these studies, 197 patients were treated for at least five weeks.[16,17,18,19] In three of the studies, the patients had a history of minor RAU, with maximum ulcer-free periods of three to four weeks.[16,18,19] Concurrent therapy for RAU was prohibited in these three trials. Patients whose immune function might be compromised because of drugs or diseases were excluded from two of the trials.[16,19]

In three of the four studies, no significant differences in ulcer duration or pain severity were evident between patients treated with antiseptic mouthwash and patients given placebo.[16,18,19] In two studies, the total number of ulcers was significantly lower with antiseptic mouthwash than with placebo.[17,19] Three trials demonstrated significant benefits in both the active therapy and the placebo groups throughout the treatment course.[16,18,19] While placebo therapy with quinine sulfate may have some antimicrobial properties,[17,19] the remaining vehicles were without known activity.[16,18] Enhanced patient awareness and improved oral hygiene from study involvement may have contributed to these findings. Adverse drug reactions were reported for only two trials.[18,19] These events included nausea in one patient, inflammation of the gums in one patient, and discoloration of the teeth and gums in an unspecified number of patients. Chlorhexidine caused brown staining of the teeth and tongue after two weeks of therapy. Although frequency and severity were not addressed, the potential for staining during prolonged treatment may limit the use of chlorhexidine.

In three studies involving 81 patients, tetracycline or chlortetracycline mouthwash significantly reduced the duration and pain of RAU compared with placebo; however, the frequency of ulceration was unchanged.[20,21,22] RAU classification and criteria for recurrence were well-defined in only one trial.[20] The patients received 250-mg doses of antibiotic mouthwash four times daily and were instructed to hold the solution in the mouth for one to two minutes.[20,21,22] Aphthous ulcers were treated for 4 days to 2 weeks, and follow-up lasted 2.5-8 weeks. Adverse effects were reported only in patients using the mouthwash in excess of five days and included dysgeusia, skin reactions, thrush, angular cheilosis, and burning and soreness of the throat.[20]


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