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The following are recommendations based on extensive Web research. Please refer to treatments (pharmacological and non-pharmacological) for more detailed information.

Literature indicates that there is no cure for recurrent aphthous ulcers. However, there are various clinical tests, prevention techniques and symptom controlling medication can decrease the discomfort and reoccurrence. 

Perform a full blood count and film and measure inflammatory and haematinic markers to identify or rule out haematinic deficiencies (diagnosis)

All possible contributing factors should be examined and the underlying pathophysiology treated accordingly. Efforts in areas such as smoking cessation, gentle brushing of the teeth, stress/relaxation techniques, correction of malabsorption/vitamin deficiencies etc. should be addressed. The patient should be counseled on these and other risk factors of RAU/RAS and encouraged to avoid these.

If trigger factors have not been established suggest the use of a mouth ulcer diary and other preventative measures

During exacerbation ensure that the patient is receiving adequate nutrition despite painful symptoms

There appears to be no commercial betamethasone spray manufactured for the use as a topical oral agent in Australia , though several products are available in the United Stated and Canada . Information suggests that topical preparations should not be used internally. There is no Australian indication for the used of betamethasone spray for idiopathic aphthous ulcers though other topical betamethasone products may be indicated for RAS/RAU (13,14). 

For anti-inflammatory treatment use Aphthasol paste directly on the  mouth ulcers four times daily (after each meal and before bedtime) until healing has occurred.

Consider the use of a Anti-microbial mouthwash such as chlorhexidine 0.2% mouthwash 10 mL held in the mouth for 1 minute, 8 to 12-hourly while the ulcers are present.

If pain persists use a topical analgesic such as 2% lignocaine gel every 3 hours for short term pain relief 

If microorganisms are still suspected to be exacerbating ulceration consider the use of broad spectrum antibiotic Tetracycline (mouth rinse- dissolve soluble tetracycline capsule 250 mg in 5-10 mL water and rinsed)

If topical therapy fails, systemic prednisolone (link to corticosteroid section) is indicated, though there are risks of systemic adverse effects.

Page created: 20/10/04 Last modified:27/10/04