Drug Therapy for Mouth Disorders: Cold and Canker Sores
The goals of treatment are to control discomfort, allow healing, prevent spread to others, and prevent complications. The cold sore should be kept moist to prevent drying and cracking that may make it more susceptible to secondary bacterial infections. Docosanol (Abreva) is the only FDA-approved product clinically proven to shorten healing time as well as the duration of the symptoms such as tingling, pain, burning and itching. It must be applied five time daily starting at the firs sign of outbreak (e.g., tingling, pain, burning, itching). Local anesthetics (e.g., benzocaine, dibucaine, lidocaine) in emollient creams, petrolatum, or protectants (e.g., TheraPatch Cold Sire [lidocaine 4%, camphor, eucalyptus oil, glycerin]) can temporarily relieve the pain and itching prevent drying of the lesion. Topical analgesics (e.g., Blistex [allantoin, menthol, camphor, phenol]) are safe and effective in temporarily reducing pain. Oral analgesics (e.g., aspirin, acetaminophen, ibuprofen, naproxen) may also provide significant pain relief. Broad-brimmed hats and ultraviolet blockers (e.g., Chapstick Lip Moisturizer Ultra, Natural Ice) wuth a sun protection factor (SPF) of at least 15 can be used for patients whose cold sores occur with sun exposure. Secondary infections can be treated with a topical antibiotic ointment such as Neosporin.
The goals of treatment are similar to those for cold sores: to control discomfort and promote healing. Topical amlexanox paste 5% (Aphthasol) is a an anti-inflammatory agent that hastens healing when compared with placebo. The paste should be applied to each lesion as soon as possible after noting the symptoms of a canker sore. The patient should continue to use the paste four times daily, preferably following oral hygiene after breakfast, lunch, and dinner and at bedtime. Protectants such as hydroxypropyl cellulose film (Zilactin) may also reduce friction. Topica anesthetics to control discomfort, such as benzocaine (Orabase-B [benzocaine 20% in plasticized hydrocarbon gel]) or bucataine, are particularly effective if applied just before eating or performing oral hygiene. Oral analgesics (e.g., aspirin, acetaminophen, ibuprofen, naproxen) may also provide significant pain relief. Aspirin should not be placed on the lesions because of the high risk of severe chemical burns with necrosis. Oxygen-releasing agents (carbamide peroxide, hydrogen peroxide, perborates) can be used as debriding and cleaning agents up to four times daily for 7 days. Long term safety has not been established, and tissue irritation and black hairy tongue have been reported. Saline rinses (1 to 3 teaspoons of table salt) in 4 to 8 ounces of warm tap water may be soothing and can be used before topical application of medication. Sustained use of products containing menthol, phenol, camphor, and eugenol should be discouraged because they can cause tissue irritation and damage or systemic toxicity if overused. Silver nitrate should not be used to “cauterize” lesions because it may damage healthy tissue surrounding the lesion and presdispose the area to later infection.