Exodontia.Info
Treatment of Oral Diseases
Oral Ulcers


Relief of Pain

  • Non-Steroidal Anti-Inflammatory Drugs (NSAID's)
  • Paracetamol.  1g.  QDS.
  • Codeine.  30 - 60 mg.  4 hourly.
  • Merocaine / Dequacaine (Benzocaine) lozenges.  
  • Xylocaine 2% gel.
  • Lidocaine 5% ointment / lozenges or 10% solution spray.
  • Difflam (Benzydamine) M/W. 0.15%.  4 - 8 sprays onto affected area.  1.5 - 3 hourly.
  • Flurbiprofen lozenges.  8.75 mg.  Allow 1 tablet to slowly dissolve in mouth.  For maximum of 3 days.
  • Bonjela (Choline Salicylate) Dental Gel.  8.7%.  Apply gel to area & gently massage.  3 hourly at most.


Healing of Ulcers

  • Tetracycline 250 mg capsules QDS M/W. Dissolve in 10 mls water and hold in mouth > 2 mins. Also used for herpetiform oral
    ulceration
  • Doxycycline 100 mg capsules QDS M/W.  Dissolve in small amount of water and gargle for 2 - 3 minutes, repeat QDS for 3 days
  • Mysteclin analogue: 1 Tetracycline capsule in 10 mls water + 1 ml Nystatin suspension
  • Corsodyl (Chlorhexidine) M/W.  10 mls.  TDS.  Stains teeth & prolonged use can affect sense of taste.


Prevention of New Ulcers

  • Corlan (Hydrocortisone) 2.5 mg lozenges. Sucked QDS. Initially for 2 - 3 months
  • Adcortyl in Orabase (Triamcinolone). Applied to individual ulcers & nocté. Best anteriorly
  • Betnesol (Betamethasone) 0.5 mg tablets dissolved in water & hold in mouth > 3 mins. QDS
  • Bextasol (Betamethasone valerate) spray & Becotide (Beclomethasone) inhaler. 1 puff TDS / QDS to affected area.
  • Prednesol (Prednisolone) Soluble 5 mg tablets dissolved in water & hold in mouth > 3 mins. QDS.
  • Prednisolone 5 mg tablets. Start at 40 mg for 4/7 and reduce over 2/52 to a maintenance dose of 10 mg. Steroid screen at 1/7, 1/12
    & 3/12.
  • Azathioprine 50 mg tablets. In combination with Prednisolone. 100 mg OD. Hæmatological screen 1/7, 2/12 & every 3/12.


Miscellaneous

  • Carbenoxolone 20 mg. OD / BD.
  • Ciclosporin  100 - 1500 mg / ml mouthwash.  TDS / QDS
  • Cimetidine 200 - 400 mg. BD.
  • Colchicine 500 μg. OD - TDS. 2/52, reduce to 250 μg. FBC after 1/12; then every 3/12.
  • Dapsone 1 - 2 mg / kg body weight. OD.  Given also with vitamin E.
  • Disodium chromoglygate 100 mg capsules as rinse for > 3 mins & then swallowed.
  • Levamisole  50mg TDS.  For 3 days only.
  • Pentoxifylline  400mg BD.
  • Salazopyrin (Sulphasalazine) 250 - 500 mg (up to 1000 mg) daily.
  • Synalar (Fluocinolone) gel. 0.25%. Apply to ulcers. Nocté.
  • Tacrolimus  100 μg / kg. OD.
  • Clobestasol.  0.05%.  Apply to ulcers. Nocté.
  • Gengigel
  • Soluble Aspirin tablets 300 mg (1 - 2 tablets dissolved in small amount of water).  Used as M/W.  QDS.  If not contra-indicated can be
    swallowed.
  • Gelclair.  Use 30 - 60 minutes before eating or drinking.  Use 3x daily or PRN.  Also used for Oral Mucositis.
  • Orabase (Carboxymethylcellulose).  Powder / paste used to protect ulcers from further trauma (when eating for example)


Lichen Planus

  • Betnesol (Betamethasone) 0.5 mg tablets dissolved in water & hold in mouth > 3 mins. QDS.
  • Bextasol (Betamethasone valerate) spray & Becotide (Beclomethasone) inhaler. 1 puff TDS / QDS to affected area.
  • Prednesol (Prednisolone) Soluble 5 mg tablets dissolved in water & hold in mouth > 3 mins. QDS.
  • Corlan (Hydrocortisone) 2.5 mg lozenges. Sucked QDS.  Initially for 2 - 3 months.
  • Adcortyl in Orabase (Triamcinolone). Applied to individual ulcers & nocté. Best anteriorly.
  • Prednisolone 5 mg tablets. Start at 40 mg for 4/7 and reduce over 2/52 to a maintenance dose of 10 mg. Steroid screen at 1/7, 1/12
    & 3/12.
  • Azathioprine 50 mg tablets. In combination with Prednisolone. 100 mg OD. Hæmatological screen 1/7, 2/12 & every 3/12.


Behçet's Syndrome

  • Colchicine 500 μg. OD. 2/52, reduce to 250 μg. FBC after 1/12; then every 3/12.
  • Prednisolone 5 mg tablets. Start at 40 mg for 4/7 and reduce over 2/52 to a maintenance dose of 10 - 20 mg. Steroid screen at 1/7,
    1/12 & 3/12.
  • Azathioprine 50 mg tablets. In combination with Prednisolone.  (Prednisolone 10 mg alternate days, Azathioprine, 50 mg OD). 50 -
    100 mg OD. Hæmatological screen 1/7, 2/12 & every 3/12.


Pemphigus, Pemphigoid & Erythema Multiforme

  • Prednisolone 5 mg tablets. Start at 40 mg for 4/7 & reduce over 2/52 to a maintenance dose of 10 - 20 mg. Steroid screen at 1/7,
    1/12 & 3/12.
  • Azathioprine 50 mg tablets. In combination with Prednisolone.  (Prednisolone 10mg alternate days, Azathioprine, 50 mg OD). 50 -
    100 mg OD. Hæmatological screen 1/7, 2/12 & every 3/12.


Oral Crohn's

  • Salazopyrin (Sulphasalazine) 250 - 500 mg (up to 1000 mg) daily.


Antifungals

  • Fluconazole. 50 - 100 mg. OD. 10 - 14/7.
  • Miconazole gel. 25 mg / ml.  QDS. 10 - 14/7.  Apply to lip / denture / tongue.  Useful if combined with Amphoteracin.
  • Nystatin pastilles. 100k units. QDS. 10 - 14/7.
  • Nystatin suspension.  100k units / ml. 1ml QDS. 10 - 14/7.
  • Amphoteracin 10mg lozenge, 100 mg / ml suspension.


Saliva Substitutes & Sialogogues

  • Saliva Orthana. Spray & lozenges. Spray onto tongue & buccal mucosa PRN.
  • Polyethylene Oxide (Polyox) tablets. 150 mg lozenges. Suck one PRN.
  • Hypromellose M/W. 500 ml. 5 mls PRN.
  • Glandosane.  Aerosol spray.  Spray onto tongue & buccal mucosa PRN.
  • Luborant.  Oral spray.  2 - 3 sprays onto oral mucosa, up to 4x daily.
  • Salinum.  Liquid.  2 ml rinsed around mouth & swallowed.  PRN.
  • Saliveze. Oral spray.  PRN.
  • Salivix.  Pastilles.  PRN.
  • SST.  Tablets.  Allow 1 tablet to slowly dissolve in mouth.  PRN.
  • Pilocarpine.  15 - 30 mg daily (normally 5 mg TDS).
  • Cevimeline.  30 mg.  TDS.
  • Anethole trithione.  75 mg.  TDS.
  • Human Interferon alpha (IFN-α) lozenges.  150 IU. TDS.
  • Biotène products.
  • Aquoral products.
  • Caphosol products.
  • Carboxymethyl / hydroxy-ethylcellulose solutions: Entertainer’s Secret spray; Moi-Stir Oral Rinse / Spray; Optimoist spray; Saliva
    Substitute liquid; Salivart ærosol; Oralube Salivary Substitute liquid; Xero-Lube spray / rinse
  • Mucopolysaccharide Solutions (novel thickening agents in hopes of providing longer retention on the mucosal surface): MouthKote
    spray; Linseed Polysaccharide (Salinum); Xanthan Gum Polysaccharide; Natrol Dry Mouth Relief (anhydrous crystalline maltose)


Atypical Facial Pain & Burning Mouth Syndrome


  • Dothiepin (Dosulepin). 25 - 75 mg. Nocté.
  • Nortriptyline 30 mg & Fluphenazine 1.5 mg. 2 tablets. Nocté.
  • Nortriptyline 10 mg & Fluphenazine 0.5 mg. 2 - 3 tablets. Nocté. Minimum of 6 - 8/52.
  • SSRI's.  Sertraline (50 mg OD) & Paroxetine (20 mg OD).
  • Topical local anaesthetics.  Merocaine / Dequacaine (Benzocaine) lozenges, Xylocaine 2% gel, Lidocaine 5% ointment / lozenges
    or 10% solution spray.
  • Gabapentin.  100 mg before bed & increasing as tolerated or required (up to 2400 mg / day).
  • Baclofen (see below)
  • Lamotrigine (see below)
  • Capsaisin.  0.025% or 0.075% strength cream.  
  • Clonazepam.  Systemic (0.25mg - 3mg / day) or topical (1mg TDS sucked / dissolve on tongue).
  • Zinc (see below)
  • Antifungals (see above)
  • Salivary Substitutes (see above)
  • α-Lipoic Acid


Trigeminal Neuralgia

  • Tegretol (Carbamazepine). 800 - 1200 mg daily (200 mg QDS). Monitor plasma levels 4 - 12 mg / l. Start at 100 mg BD & increase
    slowly until best result achieved.
  • Phenytoin.  2nd line therapy.  300 - 600 mg / daily.
  • Gabapentin (see above)
  • Baclofen.  2nd line therapy.  60 - 80 mg / daily.  The starting dosage is 10 mg / daily, which can be increased, if needed, to 60 - 80
    mg / daily administered 3 - 4 x per day (it has a short half-life of 3 - 4 hour).  The dose of carbamazepine can be reduced to 500 mg /
    daily to maintain a putative synergistic effect.
  • Oxcarbazepine.  
  • Valproate.
  • Clonazepam.
  • Lamotrigine.  2nd line therapy.  100 - 400 mg / daily.  The dosage should be increased slowly for better tolerance (eg 25 mg daily
    dose each week; up to 250 mg BD).
  • Antidepressants (see above).



Post-Herpetic Neuralgia

  • Axsain (Capsaicin). 0.075% & 0.025% creams.  TDS - QDS.  Apply to affected area.
  • Lidocaine 5% medicated plasters.  Cut to desired shape & apply to area.  Can be kept on for 12 hours & then needs 12 hours
    uncovered.
  • Antidepressants (Nortryptiline 10 - 125mg / day & Duloxetine 60 - 120mg / day)
  • Anticonvulsants (Gabapentin 300 600mg mg TDS & Pregabalin 150 - 300mg / day)
  • Tramadol. 50 - 100 mg 4 - 6 hourly
  • Amantidine. 100 mg BD for 2/52 to be continued for another 2/52 if necessary



Iron & Vitamins

  • Ferrous Sulphate. 200 mg. BD. 4 - 6/52.
  • Ferrous Fumarate. 200 mg. BD. 4 - 6/52.
  • Ferrous Gluconate. 300 mg. OD.  4 - 6/52.
  • Folic Acid. 5 mg. OD. 4 - 6/52.
  • B12 (Hydroxycobalamin). 1 mg. TDS 2/52; then 1 mg every 2 - 3/12.  Given by 3 monthly injection.
  • Zinc.  Adult & child > 30 kg, 1 tablet in water 1 - 3 times daily after food.  Effervescent zinc sulphate tablets contain 125 mg of zinc
    sulphate (45 mg zinc), every 3 - 6 hours.  Apply to ulcers. Nocté.


Oral Mucositis

    Some of the medications used for Oral Mucositis can be used for Oral Ulceration.

  • Interventions to reduce the mucosal toxicity of chemotherapy drugs

    Allupurinol M/W 1 mg/ml was administered 1, 2 & 3 h after chemotherapy & 3 consecutive nights or 5 mg / ml of allopurinol in water,
    2 – 4x daily for the 3 days subsequent to methotrexate administration; 3mg / mL 4 - 6 daily for at least 6 days.

    Oral cryotherapy (holding ice water in the mouth) is suggested to be used to prevent oral mucositis in patients receiving high-dose
    melphalan / 5 FU.


  • Mouthwashes with mixed action


  • Immunomodulatory agents

   Recombinant human Keratinocyte Growth Factor-1 (Palifermin) is recommended to be used to prevent oral mucositis in patients
   receiving
autologous HSCT.


  • Topical anaesthetics

  • Antiseptic mouthwashes

   Corsodyl (Chlorhexidine) M/W.  10 mls.  TDS.  Stains teeth & prolonged use can affect sense of taste.


  • Antibacterial, Antifungal & Antiviral agents


    Nystatin, Clotrimazole & PTA lozenges (Polymixin E, Tobramycin & Amphotericin B) QDS.

    BCoG (Bacitracin, Clotrimazole & Gentamycin) lozenges.  QDS


  • Mucosal barriers & coating agents

    Topical Hyaluronic gel 0.2% act as a barrier

    Sucralfate (see above)

    Orabase (see above)

    Gelclair Bioadherent oral gel (see above)

    Cyanoacrylate skin adhesives

    Caphosol (see above)

    Episil Gel

    Oralife Gel


  • Cytoprotectants

    β-carotene (pro-vitamin A), Vitamin E, Oxpentifylline, Azelastine, Prostaglandins E1 & E2




  • Mucosal cell stimulants

    Low level laser therapy (at a specific setting: 650nm, 40mW, time required to deliver each cm2 energy of 2J/cm2) is recommended
    to be used to prevent oral mucositis in patients treated with high-dose chemotherapy for HSCT.

    Glutamine iv / m/w.  4g glutamine dissolved in water & used QDS.


  • Psychotherapy

    Cognitive Behaviour Training, Relaxation & Imagery Training, Hypnosis & Therapist Support


  • Analgesics
British National Formulary Medications for Oral Conditions

Emedicine Medications for Oral Ulceration
Last Updated 7th March 2020