Important note: Information in this article was accurate in 2005. The state of the art may have changed since the publication date. I recently went to the doctor with a very painful ulcer on the side on my tongue and my throat was very sore as well. The doctor that I saw was not an Infectious Disease doctor and I told him that I was HIV+ with a CD4 of 206. He discussed the possibility that I probably had "Apthous Ulcers", and prescribed Viscous Lidocaine for pain. I believe that he also told me that had I come to him earlier that he could have done more . The pain and ulcers were very slow to heal, about two weeks. Since then I have done a bit of research on the web about this topic and I have read some about the drug "thalidomide" that seems to indicate that this drug may help with Apthous Ulcers in some way.
My questions are:
Dear Reader:
There are many approaches to aphthous ulcers (canker sores), probably because there are multiple causes of canker sores. And of all the treatments available, I would say that thalidomide is the last to be used. This is due to the fact that it takes a lot of extra work to get it. As you may recall thalidomide was used as a sedative in the 1950's and cause birth defects. It was withdrawn from the market until a few years ago. It often works well for atypical large ulcers anywhere from the mouth through the GI tract to the colon. So it is now available with very restricted access. Special forms must be signed by patient and doctor. Special counselling must occur if women of childbearing age are in the household, etc. So most of us use
other things first.
To answer your other questions:
The sooner you start the medications they sooner your canker sores will resolve.
You called this an OI, but it is not. It is just one of those things that happens.
Other medications that might work include herpes medications, topical cortisone pastes or rinses, or finally a short course of systemic cortisones. It is also important to look for other causes. Twice this month I have seen canker sores from people taking high dose (2000mg) vitamin C. This also includes too much citrus fruit. Also too much chocolate is a common cause, as well as too much stress. Sometimes the peppermint or spearmint in oral hygiene products can do this. Sometimes recent dental work will upset the balance in the month and a canker sore will just pop up.
Anyone can treat these sores - family physicians, ID docs, or ENT specialists.
Finally, you take the meds until the sores are gone.
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