What are the treatment options for mouth sores?

Treatment Options for Mouth Sores

Mouth sores should be treated with a combination of basic oral care, topical medications for pain relief and inflammation reduction, and antiseptic measures to prevent secondary infection. 1

Initial Assessment and Basic Care

• Examine the mouth as part of initial assessment and continue daily monitoring during acute illness 2
• Apply white soft paraffin ointment to lips every 2 hours 2, 1
• Use mucoprotectant mouthwash three times daily (e.g., Gelclair) to protect ulcerated surfaces 2, 1
• Clean the mouth daily with warm saline mouthwashes or gentle oral sponge to reduce risk of fibrotic scars 2

Pain Management

First-Line Options

• Benzydamine hydrochloride rinse or spray every 3 hours, particularly before eating 2, 1
• Topical anesthetics such as viscous lidocaine 2% (15 mL per application) for inadequate pain control 2, 1
• Benzocaine products for temporary relief of pain associated with mouth sores, canker sores, and gum irritations 3
  • Caution: Do not use for more than 7 days unless directed by a healthcare provider
  • Avoid if allergic to "caine" anesthetics

For Moderate to Severe Pain

• Topical NSAIDs like amlexanox 5% oral paste 1
• Systemic analgesics following WHO pain ladder for severe pain 1
• Consider transdermal or intranasal routes when oral medications are difficult to administer 1

Anti-inflammatory Treatment

Topical Corticosteroids

• For mild to moderate cases: Betamethasone sodium phosphate 0.5 mg in 10 mL water as a 3-minute rinse-and-spit preparation, four times daily 2
• For severe or localized cases: Clobetasol propionate 0.05% mixed with equal amounts of Orabase, applied directly to affected areas daily 2, 1
• For widespread involvement: Dexamethasone mouth rinse (0.1 mg/mL) 1

Systemic Treatment (for severe cases)

• Prednisone/prednisolone 30-60 mg or 1 mg/kg daily for 1 week with tapering over the second week 1

Antiseptic Measures

• Use antiseptic oral rinse twice daily to reduce bacterial colonization 2, 1:
  • 1.5% hydrogen peroxide mouthwash (e.g., Peroxyl, 10 mL twice daily)
  • 0.2% chlorhexidine digluconate mouthwash (e.g., Corsodyl, 10 mL twice daily)
    • Consider diluting chlorhexidine by up to 50% to reduce soreness

Management of Secondary Infections

• Take oral and lip swabs regularly if bacterial or candidal infection is suspected 2
• For candidal infection:
  • Nystatin oral suspension 100,000 units four times daily for 1 week, or
  • Miconazole oral gel 5-10 mL held in mouth after food four times daily for 1 week 2, 1
• Monitor for herpes simplex virus as slow healing may reflect secondary infection or reactivation 2, 1

Important Considerations

• Avoid irritants such as hard, acidic, salty foods, alcohol, and carbonated drinks 4
• Discontinue treatment and seek medical attention if:
  • Symptoms don't improve within 7 days
  • Pain, irritation, or redness persists or worsens
  • Swelling, rash, or fever develops 3
• Acyclovir is not effective for prevention of recurrent aphthous stomatitis 5
• For refractory cases that don't respond to conventional therapy, consider alternative treatments such as 3% citric acid applied topically three times daily 6

Treatment Duration

• Most mouth sores are self-limiting and heal within 7-14 days 7
• For chronic recurrent oral aphthous ulcers, treatment should be tailored to frequency of ulcers, pain intensity, and response to treatment 4