What is the treatment for oral sores in adults?

Treatment of Oral Sores in Adults

The treatment of oral sores in adults should follow a comprehensive approach including topical medications, oral rinses, and pain management, with specific interventions determined by the underlying cause of the sores. 1

General Treatment Approach

Initial Management

• Apply white soft paraffin ointment to the lips every 2 hours throughout the acute illness to protect and moisturize 1
• Clean the mouth daily with warm saline mouthwashes or a gentle oral sponge to reduce bacterial load and promote healing 1
• Use a mucoprotectant mouthwash three times daily (e.g., Gelclair) to protect ulcerated mucosal surfaces 1

Pain Management

• Use an anti-inflammatory oral rinse or spray containing benzydamine hydrochloride every 3 hours, particularly before eating, to reduce pain and inflammation 1
• For inadequate pain control, consider topical anesthetic preparations such as viscous lidocaine 2% (15 mL per application) 1
• For severe oral discomfort, cocaine mouthwashes 2%-5% can be used three times daily 1

Infection Control

• Use an antiseptic oral rinse twice daily to reduce bacterial colonization - options include:
  • 1.5% hydrogen peroxide mouthwash (10 mL twice daily) 1
  • 0.2% chlorhexidine digluconate mouthwash (10 mL twice daily), which can be diluted by up to 50% to reduce soreness 1
• Take oral and lip swabs regularly if bacterial or candidal secondary infection is suspected 1

Specific Treatments Based on Cause

For Fungal Infections (e.g., Candidiasis, Angular Cheilitis)

• Treat with nystatin oral suspension 100,000 units four times daily for 1 week 1, 2
• Alternative: miconazole oral gel 5-10 mL held in the mouth after food four times daily for 1 week 1, 2

For Viral Infections (e.g., Herpes Labialis/Cold Sores)

• Valacyclovir is indicated for treatment of cold sores (herpes labialis) 3
• Treatment should be initiated at the earliest symptoms and prior to any signs of a cold sore for maximum effectiveness 3
• Standard dosing: Valacyclovir 2 grams twice daily on Day 1 followed by 1 gram twice daily on Day 2 3

For Inflammatory Conditions

• Consider using a topical corticosteroid four times daily (e.g., betamethasone sodium phosphate 0.5 mg in 10 mL water as a rinse-and-spit preparation) 1
• For more potent treatment, clobetasol propionate 0.05% mixed in equal amounts with Orabase can be applied directly to the sulci, labial or buccal mucosae daily during the acute phase 1

For Refractory Cases

• For ulcers unresponsive to conventional therapy, 3% citric acid applied topically three times daily may be considered as an alternative treatment 4
• Be aware that some oral ulcerations may be drug-induced and might resolve with discontinuation of the causative medication 5

Special Considerations

Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

• Daily oral review is necessary during the acute illness 1
• Follow comprehensive management protocol including all measures listed above 1
• Consider specialized care in severe cases with extensive mucosal involvement 1

Monitoring and Follow-up

• Evaluate treatment response within 2 weeks 2
• If no improvement is seen, reevaluate for correct diagnosis or consider alternative treatments 2
• Be vigilant for signs of secondary infection or complications 1

Common Pitfalls to Avoid

• Failing to identify drug-induced oral ulcerations, particularly in patients on multiple medications 5
• Delaying treatment for herpes labialis beyond the prodromal stage, which significantly reduces efficacy 3, 6
• Using alcohol-containing mouthwashes which can cause additional pain and irritation 1
• Overlooking the need for adequate pain management, which can impact nutrition and hydration 1