Mouth sores

An inflamed oral mucosa is notably reddened, swollen and tends to bleed (stomatitis simplex). Saliva production increases and oral pain is felt. If the micro-organisms that triggered the inflammation enter deeper into the oral mucous membrane, purulent inflammations may occur. This is frequently caused by local irritation due to poorly fitting dentures, calculus deposits or mechanical injuries. Stomatitis simplex can also occur as an attendant symptom from other infectious diseases, for instance tonsillitis or pneumonia, or as a consequence of vitamin deficiency (vitamin A and C, B-vitamins).

Pharmaceutical technical assistants and pharmacists should ask if the customer knows the possible cause of the inflammation. Mechanical injuries usually heal by themselves. If the patient complains about dentures which do not fit properly in the mouth the dentist will have to take action. If the customer complains about frequent gum bleeding and recurring inflammations, a dentist should be consulted. It would be a mistake to stop dental hygiene because of gum bleeding or soreness as the bacteria that causes sickness can reproduce and spread faster. To help the customer immediately and to bridge the time gap until being cured or visiting the doctor, medication for inflammation and pain can be recommended.

Local anaesthetics like lidocaine, benzocaine or xylocaine have an effect on the pain. Astringents support quick healing. Aluminium salts such as extracts from myrrh, ratanhia or rhubarb roots are commonly used.

Anti-inflammatory and antiseptic mouthwashes contain for example chlorohexidine, hexidine, dequalinium or iodine-povidone. Products containing dexpanthenol can assist the healing process. A film covering the affec­ted area is created by local treatment with hyaluronan, protecting it from irrita­tion.

If the painful area has a boundary and is easily accessible the patient should, using cotton swabs, apply ­either a pea sized amount of gel or a few drops of tincture and carefully rub it in. This should be repeated several times a day. If the area isn’t accessible or if the inflammation affects the ­entire mouth it would make sense to use mouth washes.

Aphthae are a special form of mucosa inflammation. The source of their origin has not been completely determined. The lesions heal without leaving any scars after one to three weeks. In that time period, pain can be relieved by using local anaesthetics in form of gels or lozenges. Patients should consult a doctor if the aphthae are too large, are joined or if they occur frequently. One therapeutic option is for instance the use of triamcinolonacetonid. To prevent secondary infections while using a triamcinolon therapy, thorough mouth hygiene is particularly important.

Similar symptoms to those caused by aphthae arise in the case of infections with herpes simplex viruses (HSV-1), stomatitis aphthosa or oral thrush. Many small blisters on the oral mucosa and sometimes also on the lips burst resulting in painful mucosa injuries the size of a pinhead or lentil with whitish or yellowish-greyish coating having a reddish boundary. The illness usually heals in two weeks’ time. Especially ­local anaesthetics and astringents will help relieve the severe pain. Para­cetamol is used for children. Only in very severe cases a systemically effective virostatic agent is necessary.

One of the most common reasons for small blisters and lesions in small children’s mouths is the hand-foot-and-mouth disease, caused by coxackie-A-viruses. Small blisters appear in the throat, on the oral mucosa, the lips and the tongue, burst and turn into little painful ulcers. In the course of one to two days a non-itching rash on the palms and soles will come along. Children often have an increased saliva production, feel weak and get a temperature. The illness is usually overcome in seven to ten days.

Sore gums are not always the result of bad dental hygiene. Also hormone imbalances, metabolic disorders, malign illnesses such as leukaemia and a weak immune system can change the plaque composition and thus support a gingivitis or parodontitis. Additionally, gum irritation resulting from defective or not properly fitting dentures can cause gingivitis.

If the immune system is weakened, a metabolic disorder exists and/or the tissue has already been damaged a fungus candida albicans can spread unduly over the physical skin or mucosa. Apart from that an antibiotic therapy can destroy the oral flora balance in the same way. The illness oral thrush or oral candidiasis is characterised by small speckled wipeable coating on the inner cheek mucosa and on the tongue. Affected persons often complain about a furry or burning feeling in the mouth, a dry mouth, severe thirst as well as an unpleasant taste. Infants, aged people or people with a weakened immune system are especially prone to oral thrush. Asthmatics, regularly taking asthma-spray containing corticoids also are at risk. They should always wash out their mouths with water after inhaling.

Oral thrush must be treated to stop other parts of the body from being infected. People with an impaired immune system are especially endangered. Apart from that, the infection may be unpleasant but not dangerous. It is mostly treated by local application of miconazol or nystatin. In severe cases a doctor may prescribe local amphotericin B or a systemically effective antimycotic like fluconazol. Normal therapy takes about eight to ten days and need not be pursued if a coating is no longer visible.