Treatment of Oral Sores in Adults

General Treatment Approach

The British Journal of Dermatology recommends applying white soft paraffin ointment to the lips every 2 hours throughout the acute illness to protect and moisturize 1, 2
Cleaning the mouth daily with warm saline mouthwashes or a gentle oral sponge is recommended to reduce bacterial load and promote healing 1, 3
Using a mucoprotectant mouthwash three times daily (e.g., Gelclair) is suggested to protect ulcerated mucosal surfaces 1
An anti-inflammatory oral rinse or spray containing benzydamine hydrochloride can be used every 3 hours, particularly before eating, to reduce pain and inflammation 1, 2
For inadequate pain control, consider topical anesthetic preparations such as viscous lidocaine 2% (15 mL per application) 1
An antiseptic oral rinse, such as 1.5% hydrogen peroxide mouthwash (10 mL twice daily) or 0.2% chlorhexidine digluconate mouthwash (10 mL twice daily), can be used twice daily to reduce bacterial colonization 1, 2

For fungal infections, the British Journal of Dermatology recommends treating with nystatin oral suspension 100,000 units four times daily for 1 week 1, 4
Alternative treatment for fungal infections includes miconazole oral gel 5-10 mL held in the mouth after food four times daily for 1 week 1, 4
For inflammatory conditions, consider using a topical corticosteroid four times daily (e.g., betamethasone sodium phosphate 0.5 mg in 10 mL water as a rinse-and-spit preparation) 1, 2

Daily oral review is necessary during the acute illness for patients with Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis 1, 5, 2
Comprehensive management protocol, including all measures listed above, should be followed for patients with Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis 1
Evaluate treatment response within 2 weeks, and if no improvement is seen, reevaluate for correct diagnosis or consider alternative treatments 4
Be vigilant for signs of secondary infection or complications 1
Avoid using alcohol-containing mouthwashes, which can cause additional pain and irritation 6
Overlooking the need for adequate pain management can impact nutrition and hydration, according to the British Journal of Dermatology and the Annals of Oncology 1, 6

The British Association of Dermatologists recommends petroleum jelly as a substitute for white soft paraffin ointment, providing equivalent barrier protection and moisturization for oral ulcers, applied to the lips every 2 hours 7
Petroleum jelly is the most direct substitute for white soft paraffin, offering the same occlusive barrier function and can be applied with identical frequency (every 2 hours during acute phase) 7

The British Association of Dermatologists suggests applying topical corticosteroid mouthwash (betamethasone sodium phosphate 0.5 mg in 10 mL water) four times daily as rinse-and-spit preparation for severe inflammation 7
For localized lesions, consider clobetasol propionate 0.05% cream/ointment applied directly to affected areas 7

Perform daily oral review during acute phase to assess healing and detect complications 7