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 Below we discuss the various treatments for RAS. This information is based on review of research literature, experience with our patients, and feedback we have received from you the viewer. We hope this helps to bring some relief.

Recurrent Aphthous Stomatitis = RAS = canker sores = aphthous ulcers = oral ulcers

Recurrent Aphthous Stomatitis (RAS) is the medical term used for the occurrence of canker sores in the mouth. These cankers sores are also commonly called oral ulcers or aphthous ulcers. In the preceding articles, we use the term Recurrent Aphthous Stomatitis or its abbreviation RAS as well as the term canker sore.

Currently several options exist for treating RAS (canker sores). You no longer have to suffer the severe pain often associated with these mouth ulcers. Often, however, you may need to try several treatments to determine which one works the best for you. What is effective for one person may not work for another.

With this said, certain treatments seem to work well for a large percentage of people. Topically applied corticosteroids, for example, work extremely well for many people.


Corticosteroids act by treating the inflammation associated with RAS. These corticosteroids often come in gel or cream form and are usually applied three to four times per day. A significant number of our patients benefit from using corticosteroid gels / creams. Ask your dentist or doctor for either of the following prescriptions:

.05% Lidex (Fluocinonide) gel. This is the corticosteroid formulation we prescribe for our patients.

Triamcinolone acetonide, commonly known as Kenalog in orabase. This is another extremely effective corticosteroid product.

Analgesic (Pain Relieving) Compounds:

An analgesic compound is any compound which relieves pain. Several of these are available over the counter at your local drug store. The effects of analgesic compounds are quite variable. For people with mild RAS pain, these compounds may be sufficient. For others, these compounds may provide little if any benefit.

Active ingredients often found in these compounds include benzocaine or Diphenhydramine HCL. In addition to providing pain relief, several of these analgesic compounds form an adhesive film over the canker sore. This protects the sore from mouth acids and foods. Zilactin and Oragel are two such products.

If over the counter analgesic products do not provide relief for you, consider a prescription analgesic. These are much stronger and often provide relief for RAS sufferers. Particularly effective are prescription medications containing 2% lidocaine.

Anti-Microbial Mouthwashes:

Although RAS is not caused by a virus or bacteria, anti-microbial (anti-bacterial) mouthwashes have been shown to be very beneficial in reducing pain in RAS sufferers.

Be careful, however, because most mouthwashes are in fact not anti-microbial. Listerine and special medicated mouthwashes are the only mouthwashes which have been clinically shown to be anti-microbial.

In particular, studies have shown that medicated mouthwashes containing Chlorhexidine gluconate (Peridex) are especially effective in helping RAS sufferers. A study by Dr. Hunter and Dr Addy (1) showed that chlorhexidine gluconate mouthwash used three times a day reduced the total number of ulcer days experienced by patients by approximately 20 percent.

Mouthwashes containing chlorhexidine gluconate, however, should only be used in patients who normally experience moderate to severe cases of RAS as this mouthwash can stain teeth.


One of the biggest advances in the treatment of RAS has been the introduction of a new medication called Apthasol (amlexanox oral paste, 5%). Introduced by the Block Drug Company, this medication recently gained FDA approval here in the US.

Clinical trials of the drug have proved very promising. In four separate multi-center trial studies (2)utilizing over 1200 subjects, Apthasol (amlexanox oral paste, 5%) was shown to reduce pain, and shorten the healing time for RAS sufferers.

While this treatment appears very promising, we are waiting to hear from people who have used the medication. If you have any experience with Apthasol feel free to e-mail us.

Salt-Water Rinses

The effectiveness of salt-water rinses is variable. In a British study(3), subjects rated salt water rinses the least effective of several avaliable treatment options. Some people, however, do benefit from salt water rinses.

Because this treatment option is so inexpensive it is worth trying. Simply mix a teaspoon of salt into a cup of warm water. Wash with the salt water for about a minute before spitting the salt-water back out.

Acemannan Hydrogel Patch

An issue of the Journal of the American Dental Association (4) reported on a new patch containing an aloe vera derivative. The patch can be applied to canker sores.

According to research (5) at the Baylor College of Dentistry in Dallas, Texas, the patch containing the aloe vera derivative (acemannan hydrogel) reduced healing time as well as pain associated with the canker sores. The Acemannan patch has received FDA approval and is currently being sold as the Carrington Patch. More information is available at the Carrington Patch website.

Cautery Agents

We must strongly recommend against the use of chemical cautery agents such as silver nitrate. Cautery agents act by burning (cauterizing) the canker sore causing it to scab over. Although cauterization is supposed to speed healing time, this claim is very questionable.

With cautery agents it is simply to easy to miss the canker sore and injury healthy oral tissue as well as your lips and gums.


Ultrasound has been used in medicine for years. In particular, ultrasound is used to help heal bones, tendons, and skin wounds. Based on this principal, a study (6) conducted at the University of Colorado, investigated whether or not low intensity ultrasound produced by an ultra-sonic toothbrush could help people with RAS.

The study concluded that" twice daily application of low-intensity ultrasound has a modest beneficial effect on RAS, both from the standpoint of decreasing the duration of RAS lesions as well as of decreasing the number of lesions that develop."

We must stress that this is only one study and other studies may be performed which contradict these findings. We have not had any experience with patients who have switched to ultra-sonic toothbrushes in order to prevent RAS. If you have any experience with ultra-sonic toothbrushes and RAS, feel free to e-mail us so that we may share your experiences with others.

- Dr. Eric Spieler