What are the treatment options for a sore mouth?

Treatment Options for Sore Mouth

For immediate pain relief in sore mouth, use viscous lidocaine 2% (15 mL per application) as first-line therapy, combined with good oral hygiene measures including chlorhexidine rinses and dietary modifications. 1

First-Line Pain Management

Topical anesthetics provide the most rapid symptom relief:

• Viscous lidocaine 2% should be applied at 15 mL per application, held in mouth for 1-2 minutes before spitting out 1
• Benzydamine hydrochloride oral rinse should be used every 3 hours, particularly before eating for anti-inflammatory effect 1, 2
• Benzocaine-containing products can be used but should not exceed 7 days of use 3
• Avoid eating or drinking for 30 minutes after application for maximum effectiveness 1

Essential Oral Hygiene Measures

Maintaining oral hygiene is critical regardless of the underlying cause:

• Use 0.2% chlorhexidine digluconate mouthwash twice daily for all patients with oral mucosa inflammation 1, 2
• Clean the mouth daily with warm saline mouthwashes to reduce bacterial colonization 2
• Brush teeth twice daily with a soft toothbrush, or use chlorhexidine rinses if toothbrushing is too painful 1

Protective Barrier Agents

For ulcerated or raw surfaces, mucoprotectants reduce pain and promote healing:

• Gelclair mucoprotectant gel applied three times daily forms a protective coating over ulcerated surfaces 2
• White soft paraffin ointment should be applied to lips every 2 hours if affected 1, 2

Treatment of Secondary Infections

Candidal superinfection is common and should be treated when suspected:

• Nystatin oral suspension 100,000 units four times daily for 1 week 1, 2
• Alternatively, miconazole oral gel 5-10 mL held in mouth after food four times daily for 1 week 1, 2

Anti-Inflammatory Therapy for Moderate to Severe Cases

When inflammation is significant, topical corticosteroids are indicated:

• Betamethasone sodium phosphate 0.5 mg dissolved in 10 mL water as a 3-minute rinse-and-spit preparation four times daily 2
• For localized lesions, clobetasol propionate 0.05% mixed with Orabase can be applied directly to affected areas daily 1, 2
• Liquid dexamethasone 0.5 mg/5 mL elixir or fluocinonide 0.05% gel for moderate inflammation 1

Dietary and Lifestyle Modifications

Avoiding irritants accelerates healing:

• Eliminate crunchy, spicy, acidic foods and hot beverages 1
• Avoid smoking, alcohol, citrus fruits during treatment 4
• Use alcohol-free formulations to prevent additional irritation 1

Common Pitfalls

Several important caveats exist in sore mouth management:

• Chlorhexidine is not recommended for treating established oral mucositis, only for prevention 4
• Sucralfate is not recommended for prevention of radiation-induced oral mucositis 4
• Benzocaine products should not be used for more than 7 days without medical supervision 3
• If symptoms do not improve in 7 days, or if swelling, rash, or fever develops, medical evaluation is required 3

When to Escalate Care

Referral is indicated for persistent or severe symptoms:

• Consider referral to dentistry for persistent symptoms 1
• Referral to dermatology is recommended if available 1
• For refractory cases, systemic corticosteroids or intralesional triamcinolone injections may be necessary 2