What is the treatment for a patient with a roof of mouth burn?

Treatment for Roof of Mouth (Palate) Burns

For a typical thermal burn to the roof of the mouth, immediately rinse with cool water, apply white soft paraffin ointment to the affected area every 2 hours, use warm saline mouth rinses daily, and consider benzydamine hydrochloride spray every 3 hours particularly before eating for pain relief. 1

Immediate Management

Cool the burn immediately:

• Rinse the mouth with cool (15-25°C) water as soon as possible and continue until pain is relieved 2
• This cooling reduces pain by affecting the inflammatory cascade and limits tissue damage 3

Initial wound care:

• Clean the mouth daily with warm saline mouthwashes or an oral sponge 1
• Thoroughly irrigate the affected area with warm or room temperature water 2

Topical Treatment Protocol

Primary topical therapy (apply in this order):

• Apply white soft paraffin ointment to the affected palatal area every 2 hours during the acute phase 1
• Use an anti-inflammatory oral rinse or spray containing benzydamine hydrochloride every 3 hours, particularly before eating 1
• Use an antiseptic oral rinse containing chlorhexidine twice daily 1
• Apply a potent topical corticosteroid mouthwash (e.g., betamethasone sodium phosphate) four times daily 1

Alternative topical options:

• High potency topical steroids in gel or dental paste form can be used for moderate to severe oral pain 1
• Viscous lidocaine provides direct topical anesthesia for pain relief 1
• Aloe vera gel or medical-grade honey may promote healing and reduce pain 4

Pain Management

Systemic analgesia:

• Administer over-the-counter oral analgesics such as acetaminophen or NSAIDs for pain relief 4
• Consider multimodal analgesia with both acetaminophen and NSAIDs if pain is significant 4
• For severe pain, gabapentin may be considered based on evidence from oral dysesthesia management 1

Adequate pain control is essential:

• Use validated pain assessment tools to monitor pain levels 1
• Additional analgesia may be needed before eating or drinking 1

Dietary Modifications

Avoid irritating foods and beverages:

• Avoid crunchy, spicy, acidic, or hot food/drink as appropriate for comfort 1
• Limit caffeine intake which can worsen oral discomfort 1
• Improve hydration with frequent water sips 1

When to Seek Medical Attention

Escalate care if:

• Burns are extensive or involve multiple oral sites 4
• Signs of infection develop (increased pain, purulent discharge, fever) 4
• Severe pain is unresponsive to first-line treatments 4
• Difficulty swallowing or breathing occurs 4
• Symptoms persist beyond 7-10 days without improvement 1

Common Pitfalls to Avoid

Do not:

• Apply ice directly to the burn as it can cause tissue ischemia 2
• Use prolonged cold exposure which may cause further tissue injury 2
• Apply topical antimicrobials prophylactically without signs of infection, as this may promote fungal colonization 1
• Use preparations containing sensitizers or irritants 1

Special Considerations

For patients with sulfa allergies:

• Use petrolatum-based antibiotic ointments without sulfonamides, such as polymyxin B or bacitracin 4, 5
• Bacitracin is FDA-approved for first aid to help prevent infection and provide temporary pain relief in minor burns 5

Monitor for complications:

• Daily oral review is necessary during the acute phase 1
• Watch for signs of secondary infection, particularly with Staphylococcus aureus or Candida albicans 1
• Assess for delayed healing or wound conversion requiring specialist referral 1