What is the treatment for oral crusting?

Treatment for Oral Crusting

The treatment for oral crusting includes regular application of water-based lubricants, gentle cleaning with saline solution, and maintaining good oral hygiene with a soft toothbrush and mild fluoride toothpaste. 1

Causes and Assessment

Oral crusting can result from various conditions including:

• Medication side effects
• Dehydration
• Oral mucositis (especially in cancer patients)
• Stevens-Johnson syndrome/Toxic epidermal necrolysis
• Factitious disorders
• Angular cheilitis
• Erythema multiforme

Treatment Protocol

Lip Care

• Apply water-based lubricants to lips every 2 hours during acute illness 1
  • Use animal or plant-based oils such as beeswax, cocoa butter, or lanolin
  • Avoid petroleum-based products as they promote mucosal cell dehydration and can lead to secondary infections 1

Oral Hygiene

• Clean the mouth daily with warm saline solution (1 teaspoon salt, 1 teaspoon baking soda in 4 cups of water) 1

  • Rinse, swish, and spit several times daily
  • For severe cases, use a soft oral sponge to gently clean the mouth

• Brushing technique:

  • Use a soft toothbrush or swab after meals and before sleep 1
  • Clean with mild fluoride-containing, non-foaming toothpaste
  • Brush twice daily using the Bass or modified Bass method
  • Replace toothbrush monthly 1

Mouth Rinses

• Use alcohol-free mouthwash 4+ times daily after brushing 1
  • Rinse for approximately 1 minute with 15ml of solution
  • Avoid eating or drinking for 30 minutes after rinsing
  • For painful ulcerations, consider benzydamine mouthwash for anti-inflammatory effects 1

For Denture Wearers

• Remove dentures before oral care
• Brush dentures with toothpaste and rinse with water
• Clean gums thoroughly
• Consider deferring denture wear until oral tissues heal
• If hospitalized, soak dentures in antimicrobial solution (e.g., chlorhexidine 0.2%) for 10 minutes before insertion 1

Pain Management

• For painful crusting, consider:
  • Topical anesthetics (e.g., lidocaine viscous 2% solution)
  • Barrier preparations (e.g., Gengigel, Gelclair)
  • Mucoprotectant mouthwash three times daily 1, 2

Specific Conditions

For Angular Cheilitis

• Consider combination antifungal/corticosteroid ointment (e.g., 1% isoconazole nitrate with 0.1% diflucortolone valerate) 3

For Stevens-Johnson Syndrome/TEN

• Apply white soft paraffin to lips every 2 hours
• Use mucoprotectant mouthwash three times daily
• Consider anti-inflammatory oral rinses containing benzydamine hydrochloride every 3 hours 1

Prevention and Monitoring

Dietary Modifications

• Stay hydrated - drink ample fluids to keep the mouth moist 1
• Avoid irritants such as:
  • Smoking
  • Alcohol
  • Spicy foods
  • Hot drinks
  • Acidic foods (e.g., tomatoes, citrus fruits)
  • Raw or crusty foods 1, 2

Follow-up

• Monitor for persistent crusting beyond 2 weeks
• Consider specialist referral if crusting does not improve with treatment
• Regular dental check-ups every 6 months 1

Common Pitfalls to Avoid

1. Using petroleum-based products on lips (causes drying and potential infection)
2. Using alcohol-based mouthwashes (irritates and dries mucosa)
3. Using glycerin or lemon-glycerin swabs (causes drying)
4. Starting interdental cleaning during active inflammation (can break epithelial barrier)
5. Ignoring persistent crusting (may indicate underlying serious condition)
6. Using carbonated beverages (contains carbonic acids) 1, 2

For factitious lip crusting, which presents with bizarre hemorrhagic or keratotic crusts, psychiatric evaluation may be necessary alongside the physical treatments 4, 5.