Several diseases/disorders can affect the mouth, including the tongue, gums, teeth, jaw, lips, and oral mucosa, the soft tissue lining the inside of the mouth. Mouth problems can be due to infection, injury, hygiene, other health issues, or medications such as chemotherapy. They can affect your ability to eat and drink, speak, breathe, and show emotion (ex.-smiling). Treatment of mouth problems can involve medications and several non-medication therapies and may require help from a doctor or dentist. Non-medication treatments include changes in eating and drinking habits, improved oral hygiene practices, hot and cold compresses for pain and swelling, and dental procedures. Medications can be used to help control symptoms and cure infections. Tooth problems include cavities, tooth decay and erosion, tooth sensitivity, and knocked out or broken teeth. These problems usually require a dentist and dental procedures for repair, or the affected tooth may need to be extracted/pulled out. Other medical problems affecting the mouth include denture stomatitis (“stomatitis” means “mouth inflammation”), Burning Mouth Syndrome, dry mouth, periodontal/gum disease, geographic tongue, mouth cancer, lichen planus, cold sores/oral herpes, temporomandibular joint (TMJ) disorder, and mouth ulcers/canker sores.
Pain relievers (also called “analgesics”) can be used to ease discomfort associated with many mouth problems. Non-Steroidal Anti-inflammatory Drugs (NSAIDs) work by blocking an enzyme in the body involved in pain and inflammation and can also act as fever reducers in cases of infection. Examples of NSAIDs commonly used for mouth pain include ibuprofen and naproxen. Acetaminophen is another common pain reliever. Opioid pain medications may sometimes be prescribed short-term for severe pain after dental procedures. Examples of opioids include hydrocodone, codeine, and oxycodone.
Numbing agents and anaesthetics are used for temporary relief of mouth/tooth pain before dentist interventions and to provide local anaesthesia/numbing to the affected area before and during dental procedures. These medications can be applied topically for local pain relief or injected into the gums before dental work. Often, a topical numbing agent will be applied for patient comfort before injection with a needle. Anaesthetics and numbing agents work by blocking nerve impulses that cause sensation and pain. Examples include benzocaine, lidocaine, tetracaine, prilocaine, and cetacaine. Many of these medications can be found in over the counter (OTC) products to relieve toothache pain and mouth pain from conditions like canker sores, burning mouth syndrome, denture stomatitis, and lichen planus.
Many mouth problems, including thrush, cold sores, abscesses, and sometimes canker sores/mouth ulcers and stomatitis, are caused by infectious pathogens, usually fungi, viruses, or bacteria, and require treatment with anti-infective medications. These are usually given as oral medications (pills or liquids), or as mouthwashes/oral rinses, and sometimes topical gels or oral lozenges.
Antifungals treat mouth conditions such as oral candidiasis (aka “thrush”). They may also be used in certain types of stomatitis/mouth ulcers. These medications work by disrupting a part of the fungal growth/reproductive cycle. Examples of antifungals used to treat mouth conditions include fluconazole tablets, nystatin suspension, and clotrimazole troches/lozenges.
Antivirals are most often used to treat mouth conditions caused by the herpes simplex virus, usually cold sores on the lips. This virus can also contribute to stomatitis and gum disease. It is important to note that mouth sores may be caused by several other viruses that do not require antiviral treatment and will go away on their own. Examples of medications used for viral mouth infections include acyclovir and valacyclovir tablets, acyclovir suspension, acyclovir cream/ointment, penciclovir cream, and docosanol ointment. There are a few antiviral creams that may be available OTC, but it is important that you confirm a diagnosis of cold sores caused by herpes simplex virus before self-treating.
Antibacterials/Antibiotics are used to treat and prevent bacterial infections of the mouth such as tooth abscesses, some types of mouth ulcers and stomatitis, gingivitis, impetigo (a bacterial infection around the lips), and some sexually transmitted diseases that can affect the mouth (ex.-syphilis, gonorrhoea). Antibiotics are sometimes given before and after dental procedures to prevent infection. Bacterial infections of the teeth and mouth can be particularly dangerous because they increase the risk of bloodstream infections and a serious infection of the heart called endocarditis. Antibacterial medications work by killing bacteria or limiting their growth. Examples of antibiotic medications used in mouth infections include penicillin, amoxicillin, amoxicillin/clavulanate, clindamycin, cephalexin, and metronidazole. An antibacterial mouth rinse, chlorhexidine gluconate, is frequently prescribed for mouth infections. Topical antibiotic ointments such as triple antibiotic ointment, bacitracin, and mupirocin may be used for external mouth infections involving the lips.
Corticosteroids are used to treat inflammation in the mouth, including burning mouth syndrome, chronic ulcers and canker sores, lichen planus, geographic tongue, and stomatitis. They work by blocking inflammatory pathways in the body. These can be given as oral medications that are swallowed to work systemically (inside the body), or as topical creams/ointments. Examples include prednisone, methylprednisolone, dexamethasone, triamcinolone, and hydrocortisone.
Compounded Mouth Washes/Rinses, commonly called “Magic Mouthwash” or “Miracle Mouthwash” may be prescribed by your doctor or dentist with multiple ingredients mixed by the pharmacist that may include a combination of steroids, antibiotics or antifungals, numbing agents, pain relievers, antihistamines, and/or antacid suspensions (to coat the inside of the mouth) to relieve symptoms and help treat many painful mouth conditions. It is important to take these exactly as prescribed. Depending on the ingredients, they may be swished around the mouth and swallowed OR swished and spit out.
Vitamins and Supplements can help heal and prevent many cases of mouth sores and inflammation, as vitamin or nutrient deficiencies may cause or contribute to these conditions. Supplements are taken orally and are sometimes available in topical creams for cold sores. Examples of supplements given for mouth problems include vitamin C, vitamin B12, vitamin B6, iron, zinc, and lysine, an amino acid that can help heal cold sores.
Are to be expected with medication treatments. Common side effects you may experience while taking medications for mouth problems include nausea, diarrhoea, headache, dizziness, drowsiness, and local irritation (topical medications). Antibacterial agents may increase the risk of fungal infections such as yeast infections and thrush. Serious side effects associated with select medications are discussed below.
Bleeding is a serious side effect of NSAID use. If you have unusual or unexplained bruising, or blood in your urine, vomit, or stool (can be bright red, pink, brown, or black and tarry stool, or coffee ground appearing in vomit), seek medical attention right away.
Neurological or Cardiac Issues can be a serious side effect of anaesthetics/numbing agents, especially if they are swallowed in large amounts. This is why it is important to take these medications exactly as prescribed. If you or your child experience a seizure, poor coordination, shaking/twitching, extreme tingling, chest pain, weakness, and/or shortness of breath while taking these medications, seek medical help right away.
Clostridium difficile (C. diff) Infection is a serious side effect of antibiotic use. This is a dangerous bacterial infection that can develop due to antibiotics killing “good” bacteria that keep this “bad” one in check. If you experience severe and/or bloody diarrhoea while taking antibiotics, seek treatment right away.
Mouth disorders can be particularly troublesome, but there are many treatments available. Seek advice from a doctor, dentist, or pharmacist for help managing these problems. Good oral hygiene, including flossing, brushing teeth thoroughly twice a day, mouthwashes, and a balanced diet that avoids excessive sugar, acidic, or spicy foods can help prevent many mouth problems.