TEAM
4.2 |
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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 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. | |||||||
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