to the editor: Years ago I learned from my father, who was also a physician, a simple and highly effective way to manage aphthous ulcers—touch them with a silver nitrate stick. Obviously, one needs to be sure there is no other apparent etiology but, because the most common cause is not related to underlying disease, the silver nitrate stick works wonders, and patients walk out of the office pain free.
The procedure is simple: wet the tip of the stick and gently touch it to the ulcer. When the ulcer turns white, remove the stick. Have patients swish out the silver nitrate and send them home. You should warn them that the procedure may sting for a moment but, considering that they are already in pain, they don't really notice much difference. Although silver nitrate cautery may cause more tissue necrosis and longer healing time if it is left in place too long, I have not found this to be a problem.