What is the treatment for mouth blisters?

Treatment for Mouth Blisters

The treatment for mouth blisters depends on the underlying cause, but generally includes topical corticosteroids, protective gels, antiseptic mouthwashes, and proper blister management techniques to promote healing and reduce pain. 1

Diagnosis and Classification

Before treatment, it's important to identify the type of mouth blister:

• Aphthous ulcers: Most common (80-85%), typically <1cm, heal within 7-14 days
• Pemphigus Vulgaris: Autoimmune blistering disease, often starts in oral mucosa
• Bullous Pemphigoid: Tense blisters, commonly affects elderly patients
• Angina bullosa hemorrhagica: Sudden hemorrhagic blisters on oral mucosa, especially soft palate 2

Treatment Algorithm

1. Blister Management

• For intact blisters:
  • Leave small and medium blisters intact
  • Decompress larger blisters by piercing and draining while leaving the roof intact as a biological dressing 3
  • Pierce at the base with a sterile needle (bevel facing up) to allow drainage by gravity 3
  • Apply gentle pressure with sterile gauze to facilitate drainage 3
  • Do not remove the blister roof 3
  • Cleanse with antimicrobial solution after drainage 3

2. Topical Treatments

• Topical corticosteroids:

  • For oral pemphigus: Betamethasone sodium phosphate 0.5mg dissolved in 10mL water as a rinse-and-spit solution 1-4 times daily 3
  • Alternative: Fluticasone propionate nasules diluted in 10mL water twice daily 3
  • For localized lesions: Clobetasol 0.05% ointment mixed in 50% Orabase applied to dried mucosa twice weekly 3

• Antiseptic mouthwashes:

  • Chlorhexidine gluconate 0.2% (Corsodyl) to prevent secondary infection 1
  • Clean mouth daily with warm saline mouthwashes 3

• Pain management:

  • Benzydamine hydrochloride 0.15% (Difflam) oral rinse every 2-4 hours, particularly before eating 3, 1
  • Topical anesthetics containing benzocaine for adults and children over 2 years, up to 4 times daily 4
  • Protective gels like Gengigel or Gelclair to form a barrier over ulcers 3, 1

3. Lip Care

• Apply white soft paraffin ointment to lips every 2 hours during acute phase 3
• Use medicated lip balm containing natural moisturizers (beeswax, cocoa butter) regularly 1

4. Advanced Treatments for Persistent Cases

• For recalcitrant oral pemphigus:
  • Topical ciclosporin mouthwash (100 mg/mL, 5mL three times daily) 3
  • Intralesional triamcinolone acetonide injections 3
  • Topical prostaglandin E2 applied twice daily 3

Oral Hygiene and Prevention

• Use soft toothbrush to minimize trauma
• Maintain adequate hydration
• Avoid known triggers (certain foods, stress)
• Inspect oral mucosa daily for abnormalities 1

When to Seek Further Medical Attention

• If sore mouth symptoms do not improve within 7 days 4
• If irritation, pain, or redness persists or worsens 4
• If swelling, rash, or fever develops 4
• If an ulcer persists beyond 2 weeks despite treatment (biopsy may be needed to rule out malignancy) 1

Special Considerations

• For denture wearers:

  • Remove dentures at night
  • Clean dentures thoroughly daily
  • Consider denture adhesives to improve fit 1

• For children:

  • Children under 12 should be supervised when using topical treatments 4
  • Children under 2 years require consultation with a dentist or doctor 4

Monitoring

• Monitor for signs of infection throughout treatment
• For persistent cases, follow-up every 3-6 months 1
• Document number and location of new blisters on a daily chart during acute phase 3

This approach prioritizes proper blister management, pain control, and prevention of secondary infection while promoting healing of the oral mucosa.