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) 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.
  • Cimetidine 200 - 400 mg. BD.
  • Colchicine 500 μg. OD. 2/52, reduce to 250 μg. FBC after 1/12; then every
    3/12.
  • Dapsone 1 - 2 mg / kg body weight. OD.
  • Disodium chromoglygate 100 mg capsules as rinse for > 3 mins & then
    swallowed.
  • Salazopyrin (Sulphasalazine) 250 - 500 mg (up to 1000 mg) daily.
  • Synalar (Fluocinolone) gel. 0.25%. Apply to ulcers. Nocté.
  • Clobestasol.  0.05%.  Apply to ulcers. Nocté.
  • Gengigel
  • Soluble Aspirin tablets 300mg (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) 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.


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.
  • Biotène products.
  • Aquoral products.
  • Caphosol products.


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).


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
British National Formulary Medications for Oral Conditions

Emedicine Medications for Oral Ulceration
Last Updated 6th September 2015