What are the best ways to relieve mouth pain?

Management of Mouth Pain

For acute mouth pain relief, start with viscous lidocaine 2% (15 mL swished for 1-2 minutes before spitting), which can be repeated every 3 hours, particularly before meals, and avoid eating or drinking for 30 minutes after application. 1, 2, 3

Immediate Pain Control Strategy

First-Line Topical Anesthetics

• Viscous lidocaine 2% is the primary recommendation: use 15 mL per application, hold in mouth for 1-2 minutes, then spit out 1, 2, 3
• Can be repeated every 3 hours as needed, especially before eating 2
• Maximum effectiveness requires avoiding food/drink for 30 minutes post-application 2, 3
• Benzocaine topical provides temporary relief for toothache, sore gums, canker sores, and minor dental procedures 4

Supportive Oral Care (Essential for All Patients)

• Sodium bicarbonate mouthwash (bland, non-alcoholic): rinse 4-6 times daily for prevention, increase to hourly if pain worsens 1
• Saline rinses with warm salt water: use daily to reduce inflammation and microbial load 2, 5
• Maintain oral hygiene with a soft toothbrush after meals 1, 2, 3
• Apply white petroleum jelly to lips every 2 hours to prevent cracking 2, 3

Escalation for Moderate to Severe Pain

Moderate Pain Management

• Topical NSAIDs: amlexanox 5% oral paste applied directly to painful areas 1
• Benzydamine oral rinse: anti-inflammatory properties, use every 3 hours before eating 1, 3
• Acetaminophen as maintenance therapy combined with immediate-release oral opioid for breakthrough pain 1

Severe or Persistent Pain

• Fast-acting fentanyl preparations (e.g., 50 μg nasal spray) for short-term relief before meals in opioid-tolerant patients 1
• Consider transdermal or intranasal routes when oral administration is too painful 1
• Patient-controlled analgesia with morphine is the treatment of choice for severe mucositis pain, particularly in hematopoietic stem cell transplant patients 1

Special Formulations and Adjuncts

"Magic Mouthwash" Components

The evidence for multi-ingredient formulations is mixed, but bland rinses are preferred 1, 3:

• Base: viscous lidocaine 2% (15 mL) 3
• Add nystatin suspension (100,000 units) if fungal infection suspected 2, 3
• Include sodium bicarbonate to neutralize oral environment 3
• For severe inflammation: add clobetasol propionate 0.05% mixed with Orabase 2, 3

Important caveat: Avoid alcohol-based mouth rinses as they cause additional irritation 1, 3

Anti-Infective Measures

• Chlorhexidine 0.2%: 10 mL twice daily to prevent secondary bacterial infection 2, 3
• Hydrogen peroxide 1.5%: 10 mL twice daily as alternative antimicrobial 2
• Nystatin oral suspension: 100,000 units four times daily for 1 week if candidiasis present 2, 3
• Miconazole oral gel: 5-10 mL held in mouth after meals, four times daily for 1 week 2, 3

Dietary and Lifestyle Modifications

• Avoid crunchy, spicy, acidic foods and hot beverages 3
• Use sugarless gum or candy, salivary substitutes for oral dryness 1
• Consider oral cryotherapy (ice chips) if receiving chemotherapy known to cause mucositis (e.g., 5-fluorouracil, melphalan) 1

When to Escalate Care

• Seek medical attention if symptoms don't improve in 7 days, or if irritation, pain, redness worsens, or swelling/rash/fever develops 4
• Refer to dentistry for persistent symptoms despite treatment 3
• Refer to dermatology if available for complex or refractory cases 3

Critical Pitfalls to Avoid

• Never use chlorhexidine for prevention in head and neck radiation patients—it's not effective and may cause harm 1
• Don't rely solely on antimicrobial lozenges for radiation-induced mucositis—they're ineffective 1
• Avoid metoclopramide in complete bowel obstruction (though acceptable for partial obstruction) 1
• Regular oral examinations are essential to monitor for secondary infections that may complicate treatment 3