From the Guidelines
The most effective treatment for oral sores involves a combination of pain management, promoting healing, and addressing underlying causes, with a focus on using topical anesthetics like viscous lidocaine 2% and antiseptic oral rinses like 0.2% chlorhexidine digluconate mouthwash, as recommended by the British Journal of Dermatology in 2016 1. To manage oral sores, consider the following approaches:
- Pain relief: Use topical anesthetics like viscous lidocaine 2% or cocaine mouthwashes 2%–5% for severe oral discomfort, as suggested by 1.
- Promoting healing: Maintain good oral hygiene by gently brushing with a soft toothbrush and using antiseptic oral rinses like 0.2% chlorhexidine digluconate mouthwash or 1.5% hydrogen peroxide mouthwash, as recommended by 1.
- Addressing underlying causes: Identify and treat any underlying infections, such as candidal or bacterial infections, with medications like nystatin oral suspension or miconazole oral gel, as suggested by 1.
- Dietary adjustments: Eat soft, moist, non-irritating food that is easy to chew and swallow, and avoid acidic, spicy, salty, or rough/coarse food, as recommended by 1.
- Additional measures: Use lip balm for dry lips, numb the mouth with ice chips or ice pops as needed, and practice good dental and mouth hygiene, as suggested by 1. It is essential to note that the treatment approach may vary depending on the severity and underlying cause of the oral sores, and medical attention is warranted if sores persist beyond two weeks, are unusually large or painful, cause difficulty eating or drinking, or are accompanied by fever.
From the FDA Drug Label
Patients should be advised to initiate treatment at the earliest symptom of a cold sore (e.g., tingling, itching, or burning). There are no data on the effectiveness of treatment initiated after the development of clinical signs of a cold sore (e.g., papule, vesicle, or ulcer). Patients should be instructed that treatment for cold sores should not exceed 1 day (2 doses) and that their doses should be taken about 12 hours apart.
The treatment for oral sores (cold sores) is to initiate valacyclovir treatment at the earliest symptom, such as tingling, itching, or burning, and to take the doses about 12 hours apart, for a maximum of 1 day (2 doses) 2.
From the Research
Treatment Options for Oral Sores
- The treatment for oral sores, also known as acute oral lesions, may vary depending on the cause and severity of the condition 3.
- In some cases, oral sores may be self-limiting and require only assessment and reassurance 3.
- For recurrent aphthous stomatitis (canker sores), oral acyclovir has been shown to be ineffective in preventing recurrences 4.
- Topical acyclovir therapy has been shown to be effective in reducing the duration of vesiculation and total healing time in patients with recurrent orofacial herpes simplex infections 5.
- A combination of topical 5% acyclovir and 1% hydrocortisone cream (Xerese™) has been shown to be safe and effective in the treatment of recurrent herpes simplex labialis (cold sores) 6.
Management of Acyclovir-Resistant Herpes Simplex Virus
- In immunocompromised patients, treatment of acyclovir-resistant herpes simplex virus is limited and may require alternative regimens 7.
- A treatment protocol for acyclovir-resistant herpes simplex virus may include increasing the dose of oral acyclovir, using topical trifluridine (TFT) or intravenous foscarnet, or considering the use of intravenous cidofovir or vidarabine 7.
- It is essential to develop regimens to deal with both receptive and refractory HSV disease, and to consider new treatment options for patients with documented HSV resistance 7.