What are the treatment guidelines for common mouth illnesses such as toothaches, gum infections, and oral thrush?

Treatment Guidelines for Common Mouth Illnesses

The most effective treatment approach for common mouth illnesses includes topical corticosteroids for mouth ulcers, antimicrobial therapy for gum infections, and antifungal medications for oral thrush, with treatment selection based on severity and specific diagnosis. 1

Toothaches and Gum Infections

Diagnosis and Initial Management

• Inspect oral mucosa daily to identify early signs of infection or inflammation 2
• For dental and periodontal abscesses:
  • Mild/Moderate infections: Amoxicillin 500 mg every 12 hours or 250 mg every 8 hours 3
  • Severe infections: Amoxicillin 875 mg every 12 hours or 500 mg every 8 hours 3
  • Treatment should continue for a minimum of 48-72 hours beyond symptom resolution 3

Oral Hygiene Protocol

• Brush teeth and gums with a soft toothbrush four times daily 2
• Use mild fluoride-containing, non-foaming toothpaste 2
• Rinse with alcohol-free mouthwash at least four times daily 2
• Replace toothbrush monthly to prevent bacterial accumulation 1

Prevention of Secondary Infection

• Chlorhexidine gluconate 0.2% rinse twice daily can prevent secondary infection and promote healing 1
• Avoid painful stimuli including smoking, alcohol, and acidic/spicy foods 2

Mouth Ulcers (Canker Sores)

Classification and Treatment Based on Severity

1. Mild Ulcers

   • Apply protective gels (Gengigel or Gelclair) to form a protective barrier 1
   • Use topical anesthetics (benzocaine-containing products) for pain relief 1

2. Moderate Ulcers

   • Topical corticosteroids: betamethasone rinse (0.5 mg dissolved in 10 mL water, 1-4 times daily) 1
   • Alternative: fluticasone propionate nasules diluted in 10 mL water, twice daily 1

3. Severe or Persistent Ulcers

   • Clobetasol 0.05% in Orabase applied to dried mucosa, twice weekly 1
   • Tacrolimus 0.1% ointment applied twice daily 1
   • For recalcitrant cases, consider topical ciclosporin 1

Important Considerations

• Treatment should last at least 10 days for infections caused by Streptococcus pyogenes to prevent acute rheumatic fever 3
• Persistent ulcers lasting >2 weeks should prompt investigation for systemic diseases like Crohn's disease 1
• Monitor for nutritional deficiencies (vitamin B12, folic acid, ferritin) which are associated with recurrent aphthous stomatitis 4

Oral Thrush (Candidiasis)

Risk Factors and Diagnosis

• Most commonly caused by Candida albicans (76.8% of infections) 4
• Higher prevalence in immunosuppressed patients and those with salivary gland hypofunction 4
• Common symptoms include oral burning and dysgeusia (altered taste) 4
• Risk factors include antibiotic use and underlying oral mucosal disorders 4

Treatment Approach

• Address underlying risk factors (dry mouth, immunosuppression) 4
• First-line treatment: Topical antifungal medications 4
• For denture wearers:
  • Remove dentures before performing oral care 2
  • Clean dentures with toothpaste and rinse with water 2
  • Soak dentures in antimicrobial solution (e.g., chlorhexidine 0.2%) for 10 minutes before reinsertion 2

Special Considerations

Dry Mouth Management

• Mechanical salivary stimulants and oral moisturizers 4
• Drink ample fluids to keep the mouth moist 2
• Untreated dry mouth increases risk of oral candidiasis by 11.5% 4

Denture Care

• Defer wearing dental prostheses until oral tissues heal 2
• Clean gums thoroughly and maintain proper denture hygiene 2

Pain Management

• Topical anesthetics for immediate relief 1
• Oral analgesics for more severe pain 1
• Avoid known triggers (hard, acidic, spicy foods; toothpastes with sodium lauryl sulfate) 1

Treatment Duration and Follow-up

• For bacterial infections: Continue treatment 48-72 hours beyond symptom resolution 3
• For S. pyogenes infections: Minimum 10-day treatment course 3
• Regular follow-up every 3-6 months for persistent symptomatic cases 1

Pitfalls and Caveats

• Failure to identify underlying systemic conditions can lead to treatment failure
• Antibiotic overuse contributes to bacterial resistance; use only when clearly indicated 5
• White patches that don't rub off or bleed may indicate hyperkeratosis rather than candidiasis and may require biopsy if persistent 6
• Suspicious lesions that persist despite treatment should be biopsied to rule out squamous cell carcinoma, which accounts for 95% of oral cancers 6