What is the treatment for buccal maceration?

Treatment of Buccal Maceration

The treatment of buccal maceration primarily involves topical corticosteroids such as 0.1% triamcinolone acetonide in orabase, applied 2-4 times daily until healing occurs, typically within 7-14 days. 1

Identification and Causes

Buccal maceration refers to the softening and breakdown of the mucosal tissue inside the cheeks due to prolonged moisture exposure. Common causes include:

• Ill-fitting dentures or oral appliances 2
• Prolonged exposure to moisture or wound exudate 3, 4
• Poor oral hygiene
• Side effects of certain medications or cancer treatments 5

Treatment Algorithm

First-Line Treatment

1. Topical corticosteroids

   • 0.1% triamcinolone acetonide in orabase, applied 2-4 times daily 1
   • Alternative options: clobetasol 0.05% ointment, betamethasone sodium phosphate, or fluticasone propionate 1

2. Pain management

   • Topical anesthetics for immediate relief
   • Oral analgesics for moderate to severe pain 1

For Denture-Related Maceration

• Disinfection of dentures in addition to antifungal therapy is strongly recommended 6
• Temporary discontinuation of denture use if possible
• Adjustment or replacement of ill-fitting dentures 2

For Fungal-Related Maceration (Candidiasis)

• For mild disease: clotrimazole troches (10 mg 5 times daily) or miconazole mucoadhesive buccal tablet (50 mg once daily) for 7-14 days 6
• For moderate to severe disease: oral fluconazole 100-200 mg daily for 7-14 days 6
• For fluconazole-refractory disease: itraconazole solution or posaconazole suspension 6

Supportive Measures

1. Oral hygiene practices

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

2. Dietary modifications

   • Avoid spicy, acidic, and rough foods
   • Stay hydrated
   • Avoid alcohol and carbonated drinks 1

Prevention Strategies

1. Regular dental check-ups to ensure proper fit of dentures or oral appliances
2. Maintain good oral hygiene to prevent bacterial and fungal overgrowth
3. Avoid known triggers such as hard, acidic, spicy, or salty foods 1
4. Regular monitoring for early signs of maceration, especially in high-risk patients (denture wearers, immunocompromised) 1

Special Considerations

• Any oral ulcer that persists beyond 2 weeks despite treatment requires further investigation to rule out serious conditions such as malignancy 1
• For patients undergoing cancer therapy, specialized protocols may be needed to manage treatment-related mucositis 5
• In cases of denture stomatitis (present in about 50% of denture wearers), both the oral mucosa and the dentures must be treated 2

Follow-up

• Regular follow-up every 3-6 months for persistent cases 1
• Monitor for signs of systemic disease
• Assess pain daily during treatment

Early intervention and appropriate treatment of buccal maceration are essential to prevent complications and promote healing of the affected mucosal tissue.