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.
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
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
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
Analgesic (Pain Relieving)
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
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
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
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
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
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
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.
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
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
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
us so that we may share your experiences with others.
Disclaimer: The information contained within is for educational purposes only. It is not meant to serve as delivery of medical care. Those persons with specific medical questions should consult their dentist, doctor, or other medical care provider.