From the Guidelines
Painful mouth sores in an old woman are most likely caused by a combination of local and systemic factors, including traumatic, infectious, allergic factors, and may be associated with skin disease, autoimmune disease, tumor, inflammatory bowel disease, and so on, as stated in the expert consensus guideline for diagnosis 1. The diagnosis of painful mouth sores in elderly women can be challenging due to the diversity and complexity of oral ulcerations. According to the study published in the International Journal of Oral Science 1, oral ulceration is characterized by the persistent defect or destruction in the integrity of the oral epithelium, accompanied by variable loss of the underlying connective tissue, resulting in a crateriform appearance. The causes of oral ulcers are related to traumatic, infectious, allergic factors, and may be associated with skin disease, autoimmune disease, tumor, inflammatory bowel disease, and so on.
Some common causes of painful mouth sores in elderly women include:
- Recurrent aphthous ulcers (RAU) which may be caused by disturbed immune response, genetic predisposition, nutrient deficiency, oral trauma, anxiety or stress 1
- Traumatic ulceration which is easily diagnosed according to the location and the shape of ulcer corresponding to the stimulating factor 1
- Tuberculosis ulcer which is stellate with undermined edges and clear boundary 1
- Other conditions such as vitamin deficiencies, particularly B12, folate, and iron, can lead to painful mouth ulcers
- Medication side effects from drugs like chemotherapy agents, certain antibiotics, or NSAIDs may cause oral sores
- Denture-related injuries often occur with ill-fitting appliances
It is essential to conduct a comprehensive assessment, including a detailed clinical medical history inquiry, histopathological examination, and ulceration-related systemic diseases screening, to improve the diagnostic accuracy and timeliness, especially to improve outcomes and survival of those patients with oral ulceration caused by systemic precursor 1. Treatment options may include topical benzocaine gels, prescription corticosteroid rinses, or antifungal medications, as well as natural relief methods like salt water rinses. However, medical evaluation is crucial as mouth sores can sometimes indicate more serious conditions like autoimmune disorders or oral cancer, particularly in elderly patients when sores persist beyond two weeks.
From the Research
Possible Causes of Painful Mouth Sores
- Drug-induced oral ulcerations, which can be caused by direct contact between drugs and oral mucosa, inducing chemical burn or local hypersensitivity 2
- Systemic conditions such as gastrointestinal dysfunction, malignancy, immunologic abnormality, or cutaneous disease 3
- Recurrent aphthous stomatitis (RAS) or recurrent oral ulceration (ROU) secondary to known or unknown systemic disease 4
Factors to Consider in Diagnosis
- Medical history, including current medications and potential side effects 2
- Presence of other symptoms such as burning mouth, metallic taste, dysgueusia, or agueusia 2
- Physical examination and differential diagnosis to rule out other conditions 3, 4
Treatment Options
- Discontinuation of the offending drug, if applicable 2
- Topical treatments such as vitamin B12 ointment, which has been shown to be effective in relieving pain in aphthous ulcers 5
- Combination treatment with mecobalamin and vitamin E, which has been shown to be effective in reducing pain and improving quality of life in patients with recurrent oral ulcers 6