Canker sores are a common complaint, with 80% of the population getting them at some point in their lives. In most cases they go away on their own and occur infrequently. For some individuals, however, they can become chronic. The best canker sore treatment is usually a compounded formulation with multiple effective ingredients. For both those who get an occasional sore and those that have them regularly, a compounded treatment often provides the best pain relief and fastest healing time.
Canker sore mouthwashes use different types of ingredients. These include:
- Anti-inflammatory steroids like betamethasone and dexamethasone.
- Anti-histamines like diphenhydramine that reduce inflammation.
- Antibiotics like tetracycline that reduce pain and promote healing. These ingredients are not so much used for their antibacterial properties as their ability to inhibit collagenase. The breakdown of collagen that leads to ulcers is slowed when collagenase is inhibited.
- Products that form a protective coating over the ulcer to prevent irritation.
- Anesthetics to provide symptomatic relief – higher strengths are available from a compounding pharmacy than in over-the-counter numbing products.
- Mild cauterizing agents (not usually in the form of a mouthwash, but instead applied directly to the ulcers with a dropper).
What are Canker Sores?
Canker sores are a type of oral ulcer. It is important to note the differences between them and other types of oral ulcers because treatments can be much different. The two common types of oral ulcers:
- Recurrent minor aphthous ulcers (canker sores): Caused by irritation, trauma, etc.
- Herpetic oral lesions (cold sores/fever blisters): Caused by the herpes virus.
Canker sores appear as an ulcer with a red border and whitish center. They can be small or large and usually appear on the inside of the lip and cheek or on the tongue. These sores are not the same as cold sores, or herpetic oral lesions. Lesions caused by the herpes virus are contagious and appear on the lips and skin surfaces. Canker sores are not contagious and are limited to the inside of the mouth. Even though aphthous ulcers are not caused by a virus they can still become chronic for some individuals. In most cases, sores will heal on their own in 7-10 days after which new ones may reappear.
What Causes Canker Sores?
The exact cause of canker sores is not known, but a few precipitating factors have been identified. These include:
- Trauma to the oral mucosa from an injury or repeated mechanical irritation.
- Allergic reactions or food sensitivities – acidic foods in particular can trigger sores.
- The use of certain medications.
- Hormonal changes – for women they are more common during their menstrual cycle.
- Nutritional deficiencies, especially B-12, folic acid, iron, and zinc.
Preventative measures to avoid canker sores include avoiding mechanical irritation to the mouth, avoiding known triggers, and keeping a healthy diet. If an individual is susceptible to getting them however, these painful sores may not be completely preventable.
What is the Best Canker Sore Treatment?
A quick online search will provide plenty of home remedies for treating canker sores. Some of these may actually provide relief and increase healing time while other will not work at all. Rinsing with warm salt water generally will reduce swelling of the sore and improve healing. Taking certain vitamins like vitamin B12, folic acid, iron, and zinc can decrease the risk of developing canker sores. Over-the-counter numbing gels are made with low strengths of anesthetic that are not always effective.
OTC products do not have the combinations of effective, prescription-strength ingredients combined into one medication. These combination mouthwashes for canker sores can only be obtained from a compounding pharmacy. Compound prescription mouthwashes can treat canker sores in multiple ways. They can reduce inflammation, provide pain relief, and speed healing time.
- Magic Mouthwash: Magic mouthwash is sometimes used for treating oral ulcers. The typical magic mouthwash prescription includes 1 part viscous lidocaine, 1 part diphenhydramine, and 1 part Maalox or alternative. This combination of ingredients numbs the oral mucosa and decreases inflammation to reduce pain. The Maalox helps the other ingredients stay in the mouth longer and also provides a protective coating to the canker sores. Magic mouthwash can include tetracycline as well to prevent sores from growing larger.
- Cauterizing Agents: Negatan is no longer available commercially. Negatan is a polyphenol sulfonic acid complex that when applied to a canker sore cauterizes it. It will temporarily burn when it is first applied but soon after there is significant pain relief. Healing times may also improve even after one use.
Choosing a Compounding Pharmacy
Mouthwashes with combinations of prescription drugs are only available from a compounding pharmacy. A compounding pharmacy can provide medicated treatments that are not commercially available. Discontinued medications can still be prescribed and obtained from a compounding pharmacy.