What is the treatment for a painful sore on the gum inside the mouth?

Treatment of Painful Gum Sores

Start with topical anesthetic mouthwashes (2% viscous lidocaine) applied directly to the lesion for immediate pain relief, combined with alcohol-free sodium bicarbonate mouthwash 4-6 times daily to maintain oral hygiene and promote healing. 1, 2

Immediate Pain Management

First-Line Topical Anesthetics

• Apply 2% viscous lidocaine directly to the painful area for rapid pain relief 1, 3
• Alternatively, use benzocaine topical preparations which temporarily relieve pain from sore gums, canker sores, and minor dental procedures 4
• Benzydamine hydrochloride oral rinses or sprays every 3 hours, particularly before eating, reduce both pain and inflammation 1, 3
• Hold the anesthetic in contact with the sore for 1-2 minutes before spitting out, and avoid eating or drinking for 30 minutes after application for maximum effectiveness 3

Escalation for Moderate Pain

• If topical anesthetics are insufficient, add amlexanox 5% oral paste applied directly to the lesion 5, 1
• For persistent moderate pain, consider systemic acetaminophen as maintenance therapy combined with immediate-release oral opioids for breakthrough pain 5

Severe Pain Management

• Use systemic analgesics following the WHO pain management ladder, considering alternative routes (transdermal, intranasal) when oral intake is too painful 5, 2
• Fast-acting fentanyl preparations (e.g., 50 μg nasal spray) may provide short-term relief before meals 5

Basic Oral Care Protocol

Mouth Rinsing Regimen

• Rinse with warm saline or alcohol-free sodium bicarbonate mouthwash 4-6 times daily to reduce bacterial colonization and maintain cleanliness 1, 2
• For active painful sores, increase rinsing frequency up to every hour as needed 5, 2
• Wait 30 minutes after rinsing before eating or drinking 2

Gentle Oral Hygiene

• Use a soft toothbrush or oral swab after meals and before sleep to avoid additional trauma 1, 2
• Clean teeth with mild, non-foaming fluoride toothpaste twice daily 2
• Replace toothbrush monthly and store with brush head facing upward after thorough rinsing 2

Hydration and Lubrication

• Drink ample fluids throughout the day to keep the mouth moist and prevent dehydration 1
• Apply lip balm if lips are affected, but avoid long-term petroleum jelly use as it promotes mucosal dehydration 1

Dietary Modifications

Foods to Avoid

• Eliminate hot, spicy, acidic, or rough-textured foods that aggravate the sore 1, 2
• Avoid citrus fruits, tomatoes, hot beverages, and alcohol 1, 2

Recommended Foods

• Choose cool, soft, bland foods that are easier to tolerate 1
• Consider cold foods like popsicles or ice cream which provide temporary numbing effects 1

Treatment for Specific Underlying Causes

If Ulcerative Lesions Present

• Apply topical high-potency corticosteroids as first-line treatment: dexamethasone mouth rinse (0.1 mg/ml) for multiple or hard-to-reach ulcers, or clobetasol gel/ointment (0.05%) for limited accessible ulcers 5, 2
• For persistent ulcers not responding to topical steroids, consider intralesional triamcinolone injection (weekly; total dose 28 mg) combined with topical clobetasol 5, 2
• For highly symptomatic or recurrent ulcers, use systemic corticosteroids: high-dose pulse 30-60 mg oral prednisone for 1 week followed by tapering over the second week 5, 2

If Secondary Infection Suspected

• For fungal infection signs (white patches, persistent soreness despite treatment), use nystatin oral suspension (100,000 units) four times daily for 1 week or miconazole oral gel 5-10 mL held in mouth after food four times daily 3, 2
• For bacterial infection concerns, use antiseptic oral rinses like 0.2% chlorhexidine digluconate or 1.5% hydrogen peroxide mouthwash twice daily 1

If Denture-Related

• Remove dentures to allow tissue healing 2
• Brush dentures with toothpaste and rinse thoroughly with water 2
• Limit wearing dental prostheses until oral tissues heal 2
• Improperly fitting dentures are a common cause and require professional adjustment to prevent recurrence 6

Treatment Algorithm

Step 1: Begin with topical anesthetic (2% viscous lidocaine or benzydamine rinses) plus sodium bicarbonate mouthwash 4-6 times daily 1, 3

Step 2: If pain persists after 48 hours, add topical NSAID (amlexanox 5% paste) 1

Step 3: For severe pain unresponsive to topical measures, escalate to systemic analgesics following WHO pain ladder 1, 2

Step 4: If ulceration is present or worsening after 5-7 days, initiate topical corticosteroids (dexamethasone rinse or clobetasol gel) 5, 2

Step 5: Add antimicrobial therapy (antifungal or antibacterial) if secondary infection develops 1, 2

Throughout: Maintain basic oral care protocol with frequent saline rinses, soft diet, adequate hydration, and gentle oral hygiene 1, 2

Critical Pitfalls to Avoid

• Do not use alcohol-containing mouthwashes as they cause additional irritation 5, 2
• Avoid chronic petroleum jelly use on lips as it promotes mucosal cell dehydration and increases infection risk 2
• Do not delay dental evaluation if the sore persists beyond 2 weeks, as solitary ulcers can represent squamous cell carcinoma requiring biopsy 7
• Do not start new interdental cleaning during active oral lesions as this causes additional trauma 2

When to Seek Professional Evaluation

• Sores persisting beyond 2 weeks require dental or medical examination to rule out malignancy or systemic disease 5, 7
• Constitutional symptoms (fever, malaise) suggest systemic infection requiring urgent evaluation 8
• Rapidly spreading lesions or severe pain unresponsive to initial treatment warrant immediate professional assessment 9