Management of Sore Gums and Canker Sores

Initial Clinical Assessment

The American College of Oral Medicine recommends documenting the duration of symptoms, as ulcers persisting beyond 2 weeks require more aggressive workup 1
A systematic visual inspection of the entire oral cavity should be performed to identify all affected areas 3
Identify and document sources of mechanical trauma such as ill-fitting dentures, fractured teeth, or sharp dental restorations that may be contributing to gingival irritation 2, 4
Assess ulcer morphology: recurrent aphthous ulcers typically present as well-demarcated, oval or round ulcers with white or yellow pseudomembrane and surrounding erythematous halo 1

Brush teeth twice daily using a small, ultra-soft-headed, rounded-end bristle toothbrush with prescription-strength fluoride toothpaste 5, 2
Rinse vigorously with bland rinse (1 teaspoon salt, 1 teaspoon baking soda in 4 cups water) at least 4 times daily 5, 2
Avoid commercial mouthwashes with alcohol base as they cause additional pain, irritation, and impair healing 5, 2

Blood tests should be obtained before biopsy for ulcers that do not respond to 1-2 weeks of treatment or have duration exceeding 2 weeks 1
Required blood work includes complete blood count, coagulation studies, fasting blood glucose, HIV antibody, and syphilis serology 1

Use only animal or plant-based oils such as beeswax, cocoa butter, and lanolin for lip lubrication 5
Avoid petroleum-based products as they promote mucosal dehydration and create an occlusive environment increasing secondary infection risk 5, 2

Have dental team eliminate sources of mechanical trauma including ill-fitting dentures or fractured teeth 2, 4
Counsel patients to avoid conscious cheek biting or tongue thrusting against oral mucosa 4

Evaluate treatment response within 2 weeks 2
If no improvement is seen after 1-2 weeks of treatment, reevaluate for correct diagnosis and consider biopsy 1, 2

Do not rely solely on clinical appearance for diagnosis, as many conditions can mimic aphthous ulcers including bullous diseases, infections, drug reactions, and malignancies 1
Chronic use of petroleum-based lip products creates an occlusive environment that increases infection risk 5, 2