"CAINES"
Patient Counselling
Patients should apply the chosen topical agent with a cotton-swab 4 times daily before meals and at bedtime, for up to 1 week (5). If possible, patients should avoid eating, drinking, or excessive speaking for 30 minutes after application (4). Gel formulations typically contain a high alcohol content and may cause stinging on application (5). Applying ice to the sore may help prevent this side effect. It is also important to counsel patients to avoid using excessive amounts, which is a choking hazard due to difficulty swallowing. Burns may also result from hot foods as temperature sensitivity will be reduced. Discourage the use of topical anesthetics in children <2 years of age (5). Increased absorption in infants and children has resulted in cases of methemoglobenemia which can be life threatening (5). Counsel patients to monitor for signs of weakness, confusion, headache, difficulty breathing and/or pale, grey, blue colored skin, lips, and nail beds. Symptoms can occur within minutes to hours of application and upon initial application or after several uses. If symptoms occur patients should seek immediate medical attention (6).
References:
1. Descroix V, Coudert AE, Vigé A, Durand JP, Toupenay S, Molla M, Pomplgnoll M, Missika P, Allaert FA. Efficacy of Topical 1% Lidocaine in the Symptomatic Treatment of Pain Associated With Oral Mucosal Trauma or Minor Oral Aphthous Ulcer: A Randomized, Double-Blind, Placebo-Controlled, Parallel-Group, Single-Dose Study. J Orofac Pain. 2011; 25:327-332.
2. Saxen MA, Ambrosius WT, Rehemtula AKF, Russell AL, Eckert GJ. Sustained relief of oral aphthous ulcer pain from topical diclofenac in hyaluronan. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997; 84:356-61.
3. Chavan M, Jain H, Diwan N, Khedkar S, Shete A, Durkar S. Recurrent aphthous stomatitis: a review. J Oral Pathol Med. 2012; 41: 577-583
4. Hester, S. A. Pharmacist’s Letter Detail-Document, Treatment of Canker Sores. Pharmacist’s Letter/ Prescriber’s Letter. January 2013.
5. Chau-Markarian AT. Chapter 91. Aphthous Ulcers (Canker Sores). Patient Self-Care: Helping Your Patients Make Therapeutic Choices. Ottawa: Canadian Pharmacists Association, 2010. 884.
6. LexiComp online. Benzocaine. Wolters Kluwer Health. [Cited: 2013, July 11]. Available from: http://online.lexi.com.proxy.lib.uwaterloo.ca/lco/action/doc/retrieve/docid/patch_f/6432.
References:
1. Descroix V, Coudert AE, Vigé A, Durand JP, Toupenay S, Molla M, Pomplgnoll M, Missika P, Allaert FA. Efficacy of Topical 1% Lidocaine in the Symptomatic Treatment of Pain Associated With Oral Mucosal Trauma or Minor Oral Aphthous Ulcer: A Randomized, Double-Blind, Placebo-Controlled, Parallel-Group, Single-Dose Study. J Orofac Pain. 2011; 25:327-332.
2. Saxen MA, Ambrosius WT, Rehemtula AKF, Russell AL, Eckert GJ. Sustained relief of oral aphthous ulcer pain from topical diclofenac in hyaluronan. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997; 84:356-61.
3. Chavan M, Jain H, Diwan N, Khedkar S, Shete A, Durkar S. Recurrent aphthous stomatitis: a review. J Oral Pathol Med. 2012; 41: 577-583
4. Hester, S. A. Pharmacist’s Letter Detail-Document, Treatment of Canker Sores. Pharmacist’s Letter/ Prescriber’s Letter. January 2013.
5. Chau-Markarian AT. Chapter 91. Aphthous Ulcers (Canker Sores). Patient Self-Care: Helping Your Patients Make Therapeutic Choices. Ottawa: Canadian Pharmacists Association, 2010. 884.
6. LexiComp online. Benzocaine. Wolters Kluwer Health. [Cited: 2013, July 11]. Available from: http://online.lexi.com.proxy.lib.uwaterloo.ca/lco/action/doc/retrieve/docid/patch_f/6432.