What is the treatment for a sore on the gums in children?

Treatment of Gum Sores in Children

For most gum sores in children, supportive care with gentle oral hygiene, soft diet, and topical pain relief is the primary treatment approach, with dental referral reserved for severe cases or signs of infection.

Initial Assessment

When evaluating a child with a gum sore, examine the wound systematically to determine 1, 2:

• Depth and extent of the lesion 1, 2
• Active bleeding 1, 2
• Associated dental injuries (tooth mobility, displacement, fractures) 1, 2
• Signs of infection (swelling, purulent drainage, fever) 1

Important caveat: In any child younger than 5 years with trauma affecting the gums, lips, tongue, or palate, assess for possible child abuse, as the mechanism of injury must be consistent with the child's developmental stage 1, 3, 2.

Supportive Care Measures

Oral Hygiene and Wound Care

• Maintain good oral hygiene with gentle cleaning to optimize healing 1, 2
• Clean the mouth daily with warm saline mouthwashes or an oral sponge, sweeping gently to reduce risk of fibrotic scars 4
• Control any active bleeding with direct pressure using clean gauze 2

Dietary Modifications

• Provide a soft diet for 10 days following injury, avoiding hard, sharp, or irritating foods that could disrupt healing 1, 2
• Restrict pacifier or digit sucking for the first 10 days to avoid disrupting healing 1, 2

Pain Management

For pain relief, several options are available:

• Topical benzocaine can temporarily relieve pain associated with gum irritations, sore gums, and canker sores 5
• Benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating 4
• Viscous lidocaine 2% (15 mL per application) may be used as an alternative for inadequate pain control 4

Important warning: When using benzocaine products, do not exceed recommended dosage, do not use for more than 7 days unless directed by a dentist or doctor, and avoid in children with history of allergy to local anesthetics 5.

Antiseptic Measures

• Use antiseptic oral rinse twice daily to reduce bacterial colonization 4
• Options include 1.5% hydrogen peroxide mouthwash (10 mL twice daily) or 0.2% chlorhexidine digluconate mouthwash (10 mL twice daily) 4
• Diluting chlorhexidine mouthwash by up to 50% will reduce soreness 4

Note: The American Academy of Pediatrics guidelines make no specific recommendation for topical antiseptic application to traumatic oral injuries, as most heal spontaneously with minimal intervention 2.

Antibiotic Use

No routine systemic antibiotics are indicated for gum sores or primary tooth trauma unless the child's medical condition specifically requires coverage 2. However, if bacterial or candidal secondary infection is suspected 4:

• Take oral swabs regularly 4
• Treat candidal infection with 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 for 1 week 4

When to Refer to a Dentist

Immediate Dental Referral Required 1, 2:

• Extensive gingival or facial swelling 1, 2
• Multiple teeth affected or displaced together 1, 2
• Tooth displacement interfering with bite/occlusion 1, 2
• Visible pulp exposure in fractured tooth 1, 2
• Concern for deeper tissue involvement requiring reconstruction 1, 2
• Signs of infection not responding to conservative management 1

Delayed Referral (Within Few Days) 1, 3:

• Development of signs of pulpal necrosis: gray tooth discoloration, gingival swelling near affected tooth, parulis, increased tooth mobility 3
• Delayed healing beyond 10-14 days 1

Monitoring for Complications

Educate caregivers to watch for 1:

• Signs of infection: gingival swelling, increased pain, purulent drainage, or fever 1
• Delayed healing beyond 10-14 days 1
• Signs of pulpal necrosis over subsequent weeks (gray tooth discoloration, gingival swelling, parulis, increased tooth mobility) 3

Critical point: Stop treatment and seek dental evaluation if sore mouth symptoms do not improve in 7 days, or if irritation, pain, redness persists or worsens 5.

Special Considerations for Medically Compromised Children

Children who are immunocompromised from disease and/or therapy are at increased risk of developing systemic complications from dental infections, which may prove fatal 6. These children require closer monitoring and lower threshold for dental referral 6.