What is the management approach for mouth sores and oral lesions in geriatric patients?

Management of Mouth Sores and Oral Lesions in Geriatric Patients

A comprehensive oral care protocol should be the foundation for managing mouth sores and oral lesions in geriatric patients, including regular use of soft toothbrushes, alcohol-free mouthwashes, and adequate hydration to prevent complications and promote healing. 1

Assessment and Diagnosis

• Oral mucosal lesions are very common in elderly populations, with studies showing a high prevalence of conditions including irritation fibroma (10.8%), hemangioma (7.2%), burning mouth syndrome (7.2%), oral lichen planus (4.3%), and denture-related stomatitis (13.3%) 2, 3
• Careful evaluation is essential as oral lesions in geriatric patients may represent manifestations of systemic diseases, medication side effects, or potentially malignant conditions 4, 5
• Particular attention should be paid to potentially malignant lesions such as leukoplakia and erythroplakia, as squamous cell carcinoma is among the most prevalent oral lesions in geriatric populations 3

Basic Oral Care Protocol

Daily Oral Hygiene

• Use a soft toothbrush or swab after meals and before sleep to reduce risk of bleeding; replace toothbrush monthly 1
• Clean teeth with mild fluoride-containing, non-foaming toothpaste twice daily 1
• Store toothbrush properly with brush head facing upward after thorough rinsing 1
• For patients with existing interdental cleaning habits, consult dental professionals about appropriate tools; avoid starting new interdental cleaning during active oral lesions 1

Mouth Rinsing

• Rinse with alcohol-free, sodium bicarbonate-containing mouthwash upon awakening and at least four times daily after brushing 1
• For active stomatitis, increase rinsing frequency up to hourly as needed 1
• Wait 30 minutes after rinsing before eating or drinking 1

Denture Care

• Remove dentures before performing oral care 1
• Brush dentures with toothpaste and rinse thoroughly with water 1
• Limit wearing dental prostheses until oral tissues heal 1
• For hospitalized patients, soak dentures in antimicrobial solution (e.g., 0.2% chlorhexidine) for 10 minutes before insertion 1

Treatment Approaches for Specific Conditions

Pain Management

• For mild to moderate pain, use topical anesthetic mouthwashes (e.g., 2% viscous lidocaine) or coating agents 1
• For moderate pain, consider topical NSAIDs (e.g., amlexanox 5% oral paste) 1
• For severe persistent pain, consider alternative administration routes (transdermal, intranasal) when oral intake is compromised 1
• Patient-controlled analgesia with morphine is recommended for severe mucositis pain, particularly in patients undergoing cancer treatments 1

Dry Mouth Management

• Encourage sugarless chewing gum, candy, salivary substitutes, or sialogogues for patients with oral dryness 1
• Ensure adequate fluid intake to maintain oral moisture 1

Inflammatory and Ulcerative Lesions

• For ulcerative lesions, topical high-potency corticosteroids are first-line treatment: dexamethasone mouth rinse (0.1 mg/ml) for multiple or difficult-to-reach ulcers; clobetasol gel/ointment (0.05%) for limited, accessible ulcers 1
• For persistent ulcers, consider intralesional steroid injection (triamcinolone weekly; total dose 28 mg) in conjunction with topical clobetasol 1
• For highly symptomatic or recurrent ulcers, systemic corticosteroids may be used (high-dose pulse 30–60 mg or 1 mg/kg oral prednisone/prednisolone for 1 week with tapering over second week) 1

Fungal Infections

• Candida infections are common in elderly patients, particularly those with dentures or compromised immunity 1
• Appropriate antifungal therapy should be initiated promptly when fungal infection is suspected 6

Prevention Strategies

Avoid Irritants

• Eliminate exposure to smoking, alcohol, and irritating foods (tomatoes, citrus fruits, hot/spicy/raw/crusty foods) 1
• Avoid chronic use of paraffin (petrolatum) on lips as it promotes mucosal cell dehydration and increases infection risk 1

Oral Health Maintenance

• Regular dental check-ups are essential for early detection and management of oral lesions 1
• Address contributing factors such as lip biting habits or ill-fitting dental prostheses 7
• Maintain good oral hygiene to prevent secondary infection and recurrence of oral lesions 7

Special Considerations for Cancer Patients

• For patients receiving cancer treatment, additional preventive measures may be indicated:
  • Oral cryotherapy (30 minutes) for patients receiving bolus 5-fluorouracil chemotherapy 1
  • Recombinant human keratinocyte growth factor-1 (KGF-1/palifermin) for patients receiving high-dose chemotherapy and total body irradiation 1
  • Low-level laser therapy for patients undergoing HSCT with high-dose chemotherapy 1
  • Benzydamine mouthwash for head and neck cancer patients receiving moderate dose radiation therapy 1

Addressing Oral Health in Comprehensive Geriatric Care

• Oral health should be integrated into overall geriatric assessment and care planning 1
• Older adults with frailty should be specifically targeted for oral disease screening and referral programs for dental care 1
• Nutritional status and oral health are closely linked in elderly patients; poor oral health can lead to nutritional disorders 1