My wife has started getting canker sores over the last 10 months or so, and they seem to come on a monthly basis. They are appearing to get worse with each outbreak. Pain is severe, and we have tried many analgesics including: ibuprofen, acetaminophen with and without codeine, naproxen sodium, and even Percocet. I am a Hospital Corpsman in the U.S. Navy, and I have asked many of the doctors I work for for their insight. I have gotten many different perspectives on many different treatments. My wife has tried numerous oral preparations. None have seemed to help. She has tried Valacyclovir, Acyclovir, and topical Pencyclovir with little improvement. She has also taken regimens L-lysine, B6, Ascorbic acid, Zinc, Goldenseal, Echinacea, and O2 tissue therapy just short of hydrogen peroxide injections. Although these seemed to help the most, she stills gets severe outbreaks that last 10 or more days. She has taken stress management classes, and saw a therapist a few times for help with managing stress. She has had numerous lab studies done including: CBC, Chem 7, Epstein-Barr panels, Lupus panels, HIV, Cytomegalovirus panels, Hbsag titers, throat cultures, and cultures of the sores themselves. All of them came back NEGATIVE. With the help of my wife's doctor, colleagues of mine, and my own research, I think we have covered many avenues. Can you help us? Can you suggest any methods of pain relief. Is there anything we are missing or haven't tried?

Adam

North Carolina

Dear Adam:

The one thing I did not see in your message was the use of topical corticosteroid rinses such as Decadron elixir or Celestone syrup. I am always amazed with the fact that we have come so far with medical research, but still do not know what causes aphthous ulcerations, which as your wife can attest to, can be extremely painful and debilitating.

The way we have managed our patients with aphthous ulcerations centers around dealing with the severe inflammation that accompanies these ulcers. For minor aphthous ulcerations (less than 5 mm) we normally will recommend the aforementioned topical steroids rinses with the following directions: Rinse with 1 teaspoon for 1 minute 3 to 4 times a day for 5 to 7 days or until the symptoms are under control. These rinses will initially sting, but I have many patients who swear by them. It is important that your wife not swallow the steroid and not to drink or eat for 20 minutes afterwards in order to allow the medication to work. For larger aphthous ulcerations that cannot be reached by topical therapies, such as in the posterior oropharynx (back of the throat) we use systemic prednisone 60 to 80 mg a day for 3 to 4 days and then taper down.

For immediate pain relief, there is a product known as Ulcerease which is a non-alcohol containing analgesic mouth rinse that will provide temporary relief and can be used every 2 hours or as needed.

I hope this helps!

DR