What are the treatment options for mouth sores?

Treatment Options for Mouth Sores

The primary treatment for mouth sores depends on the specific type, with antiviral medications recommended for herpetic stomatitis and topical agents for aphthous ulcers (canker sores). 1

Diagnosis and Classification of Mouth Sores

Before initiating treatment, it's essential to identify the type of mouth sore:

1. Herpetic stomatitis/cold sores - Caused by herpes simplex virus
2. Aphthous stomatitis (canker sores) - Non-infectious inflammatory lesions
3. Candidiasis - Fungal infection
4. Traumatic ulcers - Due to physical injury

Treatment Approaches by Type

Herpetic Stomatitis (Cold Sores)

• First-line treatment: Oral antiviral medications

  • Acyclovir (200-400 mg five times daily for 7-10 days)
  • Valacyclovir (500 mg twice daily or 1 g twice daily for 7-10 days)
  • Famciclovir (250 mg three times daily for 7-10 days) 1

• Critical timing: Initiate antiviral therapy within first 3 days of onset for maximum effectiveness

• Important caution: Topical antivirals alone are ineffective; oral therapy is required 1

• Note: Acyclovir is not effective for prevention of recurrent aphthous stomatitis (canker sores) 2

Aphthous Stomatitis (Canker Sores)

• Topical corticosteroids:

  • Triamcinolone acetonide 0.1% in Orabase adhesive paste (apply to dried mucosa 2-4 times daily)
  • Clobetasol 0.05% ointment mixed in 50% Orabase (twice weekly for severe cases) 1
  • Dexamethasone mouth rinse (0.1 mg/ml) 1

• Topical anesthetics for pain relief:

  • Benzocaine - temporarily relieves pain from canker sores, toothaches, and sore gums 3
  • Viscous lidocaine 2% for moderate pain 1
  • 2.5% lidocaine ointment (use cautiously) 1

• Warning for benzocaine use:

  • Do not use if allergic to "caine" anesthetics
  • Avoid contact with eyes
  • Do not exceed recommended dosage
  • Do not use for more than 7 days unless directed by a dentist or doctor 3

Pain Management Protocol

1. Mild pain: Oral acetaminophen 1
2. Moderate pain: Topical anesthetics (benzocaine, lidocaine) 1, 3
3. Severe pain: Follow WHO pain management ladder; consider patient-controlled analgesia with morphine for severe mucositis pain 1

Supportive Care Measures

Oral Hygiene

• Brush teeth four times daily with a soft toothbrush
• Use alcohol-free mouthwashes (alcohol-based rinses can cause further irritation)
• Saline-containing mouthwashes are preferred over plain water 1

Dietary Modifications

• Choose soft, moist, non-irritating foods
• Avoid:
  • Acidic foods and beverages
  • Spicy foods
  • Salty foods
  • Rough/coarse foods
  • Alcohol
  • Hot foods that may cause pain 1

Alternative Approaches for Refractory Cases

• For chronic oral ulcers unresponsive to conventional treatment, 3% citric acid applied topically three times daily has shown promise 4
• Systemic medications for severe cases:
  • Colchicine
  • Pentoxifylline
  • Prednisolone 5

Monitoring and Follow-up

• Assess pain at least once daily using an appropriate pain scale
• Examine the mouth for color changes, surface changes, swelling
• Seek medical attention if:
  • Symptoms do not improve in 7 days
  • Pain, irritation, or redness persists or worsens
  • Swelling, rash, or fever develops 1, 3
• Follow-up every 3-6 months for persistent cases 1

Special Considerations

• Infants have more sensitive oral mucosa and are at higher risk for systemic absorption of topical medications
• Use minimal amounts of topical anesthetics in children to avoid potential toxicity 1
• Prolonged use of topical corticosteroids (>2 weeks) should be avoided to prevent mucosal atrophy 1
• Consider immunodeficiency in patients with severe recurrent herpes simplex labialis or chronic oral candidiasis 6