From the Guidelines
Multiple mouth sores are most commonly caused by viral infections, with herpes simplex (cold sores) being a primary cause, as supported by the study 1 published in the Journal of Clinical Virology in 2012. The etiology of multiple mouth sores can be multifactorial, including:
- Recurrent aphthous stomatitis (canker sores)
- Viral infections like herpes simplex (cold sores) 1
- Fungal infections such as candidiasis
- Bacterial infections
- Nutritional deficiencies, particularly of vitamins B12, folate, iron, and zinc
- Autoimmune conditions including Behçet's disease, lupus, and inflammatory bowel disease
- Certain medications like chemotherapy drugs, NSAIDs, and some antibiotics as side effects
- Physical trauma from dental appliances, accidental biting, or burns
Treatment depends on the underlying cause but may include:
- Topical corticosteroids (such as triamcinolone 0.1% paste applied 2-3 times daily)
- Antimicrobial mouthwashes like chlorhexidine 0.12% rinse twice daily 1
- Antiviral medications for herpes (acyclovir 400mg five times daily for 5 days) 1
- Antifungals for candidiasis (nystatin suspension 100,000 units/mL, 4-6mL swished and swallowed four times daily) 1
- Pain management with benzocaine gels or rinses containing lidocaine can provide temporary relief Patients should maintain good oral hygiene, avoid spicy or acidic foods that may exacerbate symptoms, and stay hydrated. If mouth sores persist beyond two weeks, are extremely painful, or are accompanied by fever or difficulty swallowing, medical evaluation is necessary to rule out more serious conditions like oral cancer. According to the study 1 published in the British Journal of Dermatology in 2016, topical anaesthetic preparations like viscous lidocaine 2% and antiseptic oral rinses can be used to manage symptoms.
From the FDA Drug Label
Temporarily relieves pain associated with the following mouth and gum irritations: toothache sore gums canker sores braces minor dental procedures The FDA drug label does not answer the question.
From the Research
Etiology of Multiple Mouth Sores
The etiology of multiple mouth sores can be attributed to various factors, including:
- Infections, such as herpes simplex virus 2, 3
- Autoimmune diseases, like pemphigus vulgaris 4
- Nutritional deficiencies, including vitamin B12 and folate 5
- Systemic drugs, such as anticonvulsants, sulfonamides, nonsteroidal anti-inflammatory drugs, and antibiotics 2
- Genetic predisposition and immunologic aspects 6
- Mechanical injuries and stress 6
Specific Conditions
Some specific conditions that can cause multiple mouth sores include:
- Erythema multiforme (EM), which can manifest as oral erosions or mucocutaneous lesions 2
- Recurrent aphthous stomatitis (RAS), a chronic inflammatory disease of the oral mucosa 6, 5
- Pemphigus vulgaris, an autoimmune disease characterized by blisters in the oral cavity and skin 4
- Acute necrotizing ulcerative gingivitis, which may be caused by herpes simplex virus 3
Role of Herpes Simplex Virus
Herpes simplex virus has been implicated in the etiology of multiple mouth sores, particularly in cases of EM minor and intraoral ulcers excluding the soft palate 2, 3. Prophylaxis with acyclovir has been shown to reduce the incidence of oral ulcers in patients with acute myeloid leukemia 3.