What are the treatment options for sores on the lips and swollen gums?

Treatment of Lip Sores and Swollen Gums

For lip sores and swollen gums, immediately begin applying white soft paraffin ointment to the lips every 2 hours, use warm saline mouthwashes daily, and apply topical corticosteroids (betamethasone sodium phosphate 0.5 mg in 10 mL water as rinse-and-spit) four times daily, while determining the underlying cause to guide additional therapy. 1, 2, 3

Immediate First-Line Management

Lip Protection and Moisturization

• Apply white soft paraffin ointment to the lips every 2 hours to protect and moisturize the affected areas 1, 2
• Avoid chronic use of petroleum-based products as they can promote mucosal dehydration and increase infection risk 4
• Use lip balm or lip cream as alternatives for longer-term management 4

Oral Hygiene and Cleansing

• Clean the mouth daily with warm saline mouthwashes to reduce bacterial load and promote healing 1, 2
• Use a soft toothbrush or swab after meals and before sleep to minimize trauma 4
• Avoid alcohol-containing mouthwashes, which cause additional pain and irritation 4, 2

Pain and Inflammation Control

• Use benzydamine hydrochloride oral rinse or spray every 2-4 hours, particularly before eating, for pain relief 1, 2
• Apply barrier preparations such as Gengigel mouth rinse/gel or Gelclair three times daily to protect ulcerated surfaces 2, 3
• For inadequate pain control, consider topical anesthetic preparations such as viscous lidocaine 2% (15 mL per application) or benzocaine 2, 5

Cause-Specific Treatment

For Inflammatory Conditions (Aphthous Ulcers, Gingivitis)

• Apply topical corticosteroids four times daily using betamethasone sodium phosphate 0.5 mg dissolved in 10 mL water as a 2-3 minute rinse-and-spit solution 2, 3
• For localized lesions, use clobetasol 0.05% ointment mixed in 50% Orabase applied twice weekly to dried mucosa 3
• If topical treatment fails, consider weekly intralesional triamcinolone (total dose 28 mg) in conjunction with topical clobetasol 3
• For severe or recurrent cases, use systemic corticosteroids: prednisone 30-60 mg or 1 mg/kg daily for 1 week, then taper over the second week 3

For Infectious Causes

Viral (Herpes Labialis):

• Initiate oral antiviral therapy within the first 24 hours of lesion onset for optimal benefit, as peak viral titers occur early 4, 6
• Use oral acyclovir, valacyclovir, or famciclovir for acute recurrences 4, 6
• Topical antivirals (acyclovir, penciclovir, docosanol) are less effective than oral treatment but can be used if oral therapy is not available 4, 6
• For severe or frequent recurrences, consider daily oral acyclovir or valacyclovir for prophylaxis 4, 6

Fungal (Candidiasis):

• Treat with nystatin oral suspension 100,000 units four times daily for 1 week 2, 3
• Alternative: miconazole oral gel 5-10 mL held in the mouth after food four times daily for 1 week 2

Bacterial:

• Use antiseptic oral rinse such as 0.2% chlorhexidine digluconate mouthwash (10 mL twice daily) or 1.5% hydrogen peroxide mouthwash (10 mL twice daily) 1, 2
• When bacterial infection is suspected, obtain cultures and administer appropriate antibiotics for at least 14 days 1

For Angular Cheilitis

• Use combination therapy with antifungal and corticosteroid components to address both Candida infection and inflammation 1
• Apply white soft paraffin ointment every 2-4 hours to soothe and protect the lips 1

Critical Monitoring and Follow-Up

• Evaluate treatment response within 2 weeks; if no improvement, reevaluate the diagnosis or consider alternative treatments 1, 2
• Stop treatment and seek medical evaluation if symptoms do not improve in 7 days, or if irritation, pain, redness persists or worsens 5
• Be vigilant for signs of secondary infection, swelling, rash, or fever 2, 5
• Immunocompromised patients require more aggressive and prolonged therapy 1

Prevention Strategies

• Avoid frequent washing with hot water and skin irritants such as over-the-counter anti-acne medications, solvents, or disinfectants 1
• Use alcohol-free moisturizing creams or ointments twice daily 1
• Apply sunscreen SPF 15 on lips, reapplying every 2 hours when outside, to prevent sun-triggered herpes reactivation 4, 1
• For herpes labialis, avoid known triggers including ultraviolet light exposure, fever, psychological stress 4

Common Pitfalls to Avoid

• Do not delay antiviral treatment for herpes labialis—therapy must begin within 24 hours of lesion onset for maximum effectiveness 4
• Do not overlook adequate pain management, as this impacts nutrition and hydration 2
• Do not use petroleum-based products chronically, as they promote dehydration and infection risk 4
• Do not assume all lip and gum lesions are benign—evaluate for premalignant or malignant changes, especially in persistent lesions 7