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Mouth Diseases

Mouth Sores and Sore Throat

08/23/2010

Question:

My 20 year old came down with an extremely sore throat. This proceeded to include sores and swelling of the gums. Both her throat and mouth are quite painful. She saw a medical dr and also her dentist. She was given something called magic mouth wash which contains a mix of lidocaine/maalox and diphenh. This was to be used to numb the inside of the moutn. Her condition was called a hermetic virus I think. About how long will this condition last, and is there an additional treatment that will help with the healing? Will rinsing mouth with salt water help or hurt?

Answer:

Your daughter probably has a “Herpetic infection” caused by Herpes Simples Virus (probably HSV1). The virus normally affects the attached mucosa and border of the lips, (vermillion border) the pharynx, intraoral sites, eyes and skin. HSV infections exhibit 2 clinical infectivity patters referred to as “Primary infection” and secondary or Recrudescent infection”. Most primary infections occur in children between the ages of 6 months and five years, are associated with minimal symptoms (head ache, nausea, anorexia, fever and possibly minor oral lesions). Secondary infection occurs later after the primary infection, after the virus has been able to establish a viral reservoir on the sensory nerves adjacent to the area of inoculation. Reactivation of the latent or resting virus occurs after some form of stimulation (UV exposure, stress, trauma, menstruation, allergy to list just a few).

Reoccurrence is common and affects the epithelium in the form of vesicle formation and lesions in the approximate area of initial infection. The secondary infection is generally preceded by a prodromal set of symptoms (most people know when the lesions will occur or that they know they are going to get a cold sore). The chances are that based upon your daughters symptoms, (pharyngitis/ sore throat, lesions on the gums (Gingiva) and throat) may be associated with an adult presentation of primary HSV infection.

The usual symptoms are headache, malaise, low grade fever, sore throat, and multiple vesicle in the mouth and throat that rupture and appear as pin point ulcerations that can be very painful.

Another possibility is herpangina or enterovirus infection (coxsackievirus infection). The symptoms include: headache, sore throat, cough, runny nose, myalgia, anorexia vomiting, diarrhea, and oral ulcerations in the posterior aspect of the throat and oral mucosa. The symptoms last for 7-10 days (like HSV infection). This disease is common in the late spring and summer, and early fall, and is associated and rampant at camps and day care facilities.

Treatment for both is generally palliative or taking care of the symptoms. In the case of HSV, antiviral medications can provide relief at the first set of symptoms (prodromal symptoms) and lessen the length of infection and possibly the severity and intensity of lesions and pain associated with them.

The “magic rinse” you described is what we used in my Oral Medicine training for treating the symptoms of patients that had problems with eating and swallowing as a result of oral ulcerations. Topical lidocane temporarily anesthetizes the tissues, Maalox acts as a mucosal coating and the Benadryl (diphenhydramine) is a topical antihistamine and decreases inflammation. At best, you get about 30-45 minutes of relief. Warm salt water is fine. Hydration and OTC analgesics (Ibuprofen or Acetaminophen) would also be helpful for the associated symptoms.

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Response by:

Richard J Jurevic, DDS, PhD Richard J Jurevic, DDS, PhD
Formerly, Assistant Professor of Biological Sciences
School of Dental Medicine
Case Western Reserve University