What are the management options for mouth sores?

Management Options for Mouth Sores

Topical corticosteroids, such as 0.1% triamcinolone acetonide in orabase applied 2-4 times daily, are the first-line treatment for most types of oral ulcers. 1

Diagnosis and Assessment

Before initiating treatment, proper identification of the type of mouth sore is essential:

• Assess ulcer characteristics: duration, shape, location, number, and appearance
• Rule out serious causes including malignancy if an ulcer persists beyond 2 weeks
• Consider biopsy for persistent lesions, especially with red flags such as:
  • Induration or fixation
  • Unexplained bleeding
  • Cervical lymphadenopathy
  • Lesion growth despite treatment
  • Persistent numbness or paresthesia
  • History of tobacco or heavy alcohol use with persistent lesion 1

Treatment Algorithm

First-Line Treatments

1. Topical Corticosteroids

   • 0.1% triamcinolone acetonide in orabase, 2-4 times daily until healing (typically 7-14 days) 1
   • Alternative options: clobetasol 0.05% ointment, betamethasone sodium phosphate, fluticasone propionate 1

2. Topical Anesthetics

   • Benzocaine for temporary pain relief (for toothache, sore gums, canker sores, braces, minor dental procedures) 2
   • Lidocaine viscous 2% solution 1
   • Note: Do not use benzocaine for more than 7 days unless directed by a dentist or doctor 2

3. Barrier Preparations

   • Products like Gengigel or Gelclair to manage pain and promote healing 1

Second-Line Treatments

For resistant cases that don't respond to first-line therapy:

1. Alternative Topical Agents

   • Tacrolimus 0.1% ointment 1
   • Intralesional triamcinolone acetonide injections 1
   • Sucralfate suspension 1
   • 3% citric acid (for chronic ulcers unresponsive to conventional treatment) 3

2. Systemic Treatments (for severe or recurrent cases)

   • Colchicine (particularly effective for erythema nodosum lesions) 1
   • Pentoxifylline 1
   • Short courses of systemic corticosteroids 1, 4

Pain Management

• Topical anesthetics (benzocaine, lidocaine) 1, 2
• Oral analgesics as needed 1
• For severe cases: patient-controlled analgesia with morphine 1

Supportive Measures

Oral Hygiene

• Use a soft toothbrush and mild non-foaming toothpaste
• Rinse with saline solution 4-6 times daily
• Use alcohol-free mouthwash 1

Dietary Modifications

• Avoid spicy, acidic, and rough foods
• Stay hydrated
• Avoid known triggers (hard, acidic, spicy, or salty foods)
• Avoid toothpastes containing sodium lauryl sulfate
• Avoid alcohol and carbonated drinks 1

Monitoring and Follow-up

• Regular monitoring is essential, especially for persistent cases
• Assess pain daily
• Regular follow-up every 3-6 months for persistent symptomatic cases 1
• Important warning signs requiring immediate medical attention:
  • Sore mouth symptoms not improving in 7 days
  • Irritation, pain, or redness persisting or worsening
  • Development of swelling, rash, or fever 2
  • Red sore on the tongue persisting beyond 2 weeks (requires prompt evaluation with biopsy) 1

Special Considerations

• Allergy warning: Do not use benzocaine products if there is a history of allergy to local anesthetics such as procaine, butacaine, benzocaine, or other "caine" anesthetics 2
• Immunocompromised patients: May present with more severe variants of oral ulcers or chronic oral candidiasis, requiring more aggressive treatment 5
• Systemic diseases: Some oral ulcers may be manifestations of systemic conditions (Behçet's disease, inflammatory bowel disease, etc.) and require treatment of the underlying condition 1