Dental

Oral Ulcers (Aphthous Ulcers)

منہ کے چھالے

Painful oral cavity, irritation with salty or spicy food, unable to eat or drink; previous history of fever or stress. Round sores, one or multiple, with inflammation of the mucosa.

ICD-10: —
Source: OPD handbook pp.130–131
Status: Draft

Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.

Symptoms

Painful oral cavity
Irritation by salty / spicy food
Unable to eat or drink
Previous history of fever or stress

Red flags Refer urgently if any are present

Old age
Black, irregular margin
Recurrent (rule out diabetes)
Pan / chewer addict

Diagnosis

Round sores, one or multiple
Inflammation of the mucosa around the skin

Treatment

Step 1 of 5

Step 1: Antibiotic

Metronidazole as prophylaxis for anaerobes

Prescription

MetronidazoleAntiprotozoal / antibacterial

Dose1+1+1

Brand Tab Flagyl 400 mg 5 days (sample)

Step 2 of 5

Step 2: Folic acid and B-complex

Aid in healing
Diet is also a cause of oral ulcers

Prescription

Iron + Folic acidHaematinic

Dose1 daily

Brand Tab Iberet-Folic 5 days (sample)

B-complex syrupVitamin supplement

Doseas per book (folic acid + Neurobion)

Brand Neurobion

Also sold as Leaderplex, Neurobion

Step 3 of 5

Step 3: Topical gels / drops

Somogel: relief for pain
Daktarin gel / Nilstat drops: prevent superadded fungal infection

Prescription

Somogel (oral topical gel for pain relief)Topical oral analgesic gel

DoseApply to the affected site morning, noon and evening

Brand Somogel

Miconazole oral gelTopical antifungal

DoseAs directed

Brand Daktarin gel

Also sold as Daktarin gel, Daktarin

Nystatin dropsTopical antifungal

DoseAs directed

Brand Nilstat drops

Also sold as Nilstat drops, Nilstat

Step 4 of 5

Step 4: PPI

Prescription

OmeprazoleProton pump inhibitor

Dose40 mg 1+0

Brand Teph / Ruling

Also sold as Risek, Teph, Ruling, Ruling sachet, Omega

Step 5 of 5

Counselling (Urdu notes)

Take care of oral hygiene
Avoid spicy foods
Mouth ulcers heal in 1–2 weeks and are not an indication of a heart problem
If ulcers occur in the mouth and do not heal, consult a specialist (the last lines of this note are partly illegible)

Sample prescription from the book (patient details removed)

Female, 40 y, painful oral cavity, unable to feed; simple inflamed ulcer; diabetes and hypertension negative: Tab Flagyl 400 mg 1+1+1 for 5 days; Somogel applied on the affected site morning, noon and evening; Tab Iberet-Folic daily; Cap Ruling 40 mg 1+0.