Oral Ulcers

• Topical Antiseptic mouthwash, chlorhexidine, >12yrs only
• Bonjela and Iglu topical coating agents and analgesics
• Topical corticosteroids e.g hydrocortisone buccal tablets or betamethasone sodium phosphate (betnesol) mouthwash
• Immunomodulators- Prednisolone, Colchicine,Dapsone
• Mostly caused by different types of trauma:

  • Physical e.g orthodontic appliances
  • Thermal e.g hot food or drinks
  • Medications e.g aspirin or biphosphonates
• They an also be caused by infections such as viral or bacterial
• Drugs can also cause ulcers:

  • Nicorandil
  • Methotrexate
  • NSAIDS
  • Steroids
  • Irradiation
• Mild ulcers- antiseptic chlorohexidine mouthwash followed by bonjela or some topical analgesic
• Refer more severe ulcers for POMs e.g topical corticosteroids or topical antibiotics
• Review with dentist/gp for ongoing treatment/investigations
• Urgent referral : Systemically unwell, widespread, dehydration
• Red flags : Bleeding, rolled margins, asymmetry, red patch or red and white speckled lesions
• Oral cancer : Non resolving, unexplained swelling, systematic symptoms and swollen lymph nodes