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canker sores

Nurses   (9,466 Views | 26 Replies)

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I've had a rash of patients lately that have had terribly sore mouths. Some from antibiotics, some from stomatitis, and some from an exacerbation of psoriasis. Most look like canker sores, definately not thrush. These people really suffer!

We've gone through the hydrogen peroxide/lidocaine swishes and spits to the troches. Nothing is helping.

Do you know of any medicinal (Dr. would have to order) or non-medicinal treatments (that a nurse could use without an order) that may make these patients more comfortable?

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Antikigirl has 13 years experience as a ASN, RN and specializes in Education, Acute, Med/Surg, Tele, etc.

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I don't know if this will help, but I always remember a very wise micro teacher that taught me this...

Canker sores are a virus that is latent and comes out in times of stress...a herpies! She told us to watch for midterms and finals times and see who had them.....she was right! This latent herpies virus comes when you are stressed or ill or both!

So..how do you overcome it in the future..realize the potential and take care of yourself! How do you solve it...well if you have it too late...NOW try taking care of yourself and realize your risk factors individually! Hey that baby is going to be with you for life...better know what brings it to the surface! (like Eddie Murphy once said "herpies..you keep that like old luggage!"...which is true of any type of herpies!...

For those with canker sores..I find tried and true old fashioned common sense works...salt water gargles, lower stress, anusol for pain or even tylenol...or even dabbing a bit of clove oil on the wound to numb it...watch for signs it has gone too far (puss, swelling) and call md!

In this day and age..all pain is considered an emergency that needs medical help..even a sore in the mouth that will pass in a day or two (the mouth heals quick!). So if I get a case of a single canker sore bothering a patient...oh yes I am sympathitic..but still wonder "omg if you hurt from this and can't figure out how to take care of it...what is this world comming to?"...

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pcicurn7 specializes in PCICU.

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ooh i just had a pretty nasty one (i was dealing with finals, then the HESI, then the NCLEX...stress? hahaha)...my dentist told me to get the OTC stuff, i got the Kanka soft brush gel (20% benzocaine). The only sucky part is that it numbs your entire mouth, but that only lasts for a few minutes. The gel is sweet-tasting, so its not that big of a deal. And the brush really helped cause i barely had to touch the sore to apply the gel.

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192 Posts; 4,040 Profile Views

Triage, I know where your coming from. I use your advice myself.

What I have here are compromised patients that are in oral pain for days. The pain meds, the swishes, the troches arn't touching it. For some we've gone to bland pureed and liquid diets. A few just plumb can't eat. The Docs are aware and trying to treat.

We've tried cold packs to the outside of the cheeks and lips with minimal results. Some take ice chips to help with numbing.

Today I gave live culture yogurt to two patients in hopes that it would soothe the mouth and eventually provide relief by encouraging the growth of normal oral flora. Of course, they'd have to continue taking yogurt daily to have this occur.

Any other ideas?

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45 Posts; 1,840 Profile Views

from repeated experience... zinc lozenges, held against the sore and allowed to dissolve there have really helped me.

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maolin has 2 years experience and specializes in IMC, ICU, Telemetry.

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I personally suffer from chronic, terribly painful mouth ulcers. Still don't quite understand the etiology - vitamin deficiency, stress, viral, trauma (often erupt where I've bitten my cheek). I've had them for as long as I can remember. They are often so bad, I can't eat for several days - often lasting 7-10 days from onset to complete healing (w/o tx). I tried all the OTC preparations - found most to make it even worse - alcohol based, sting & slow healing. My doc rx'd a Kenalog/Orabase .1% paste (triamcinolone acetonide). This has been a MIRACLE solution for me. It doesn't sting (gelatin/pectin base). Apply at HS. coats the sore & speeds healing - usually completely recovered in 3-4 days.

From insert: Triamcinolone Acetonide is a synthetic corticosteriod which possesses antiinflammatory, antipruritic and antiallergic action. Emollient dental paste acts as an adhesive vehicle for apply the active medication to the oral tissues. Vehicle provides protective covering which may serve to temporarily deduce pain associated w/ oral irritation.

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meownsmile is a BSN, RN and specializes in Med/Surg, Ortho.

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Hey triage,, just a thought,, maybe anBesol,, not aNusol,, dont want rectal creme in my mouth. LOL :) I know what ya ment,, but just in case others might not have.

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672 Posts; 7,735 Profile Views

With our chemo pts, we use salt water (just 0.9 NS) as a swich and spt. If it's really bad, we use the magic mouthwash, viscous xylocaine, or nystatin swish if it's yeasty.

One thing that I've tried and works really well for me - dab some maalox on it with a Q-tip. Think about it...ulcers in the stomach, ulcers in the mouth...provides instant relief for me. Only problem is that you really can't drink for awhile or you'll wash it away. Sometimes it works better than other times, but it always helps me at least a little bit!

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Antikigirl has 13 years experience as a ASN, RN and specializes in Education, Acute, Med/Surg, Tele, etc.

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LOL!!!!!!!!!! THere I go forgetting my ends! Meown you crack me up!

Oh lordie...people get so ticked at any mouth sore that lasts more that 12 hours..it takes time, and this is the area of the body that heals fastest!?

For those WITHOUT chronic probelms in the mouth I say stick it out and deal with a bit of discomfort for a part of the anatomy you have used and abused for umteen years that finally has a probelm. It will heal, and a few days of discomfort vs a livetime of servitude....hm?

Those with bigger probelms...I have NEVER seen any mouthwash or magic mouthwash that has helped when their natual immunity couldn't faster. I am sorry...I have a friend that gets chronic thrust with no known reason so far (she brushes, and helps her mouth so much...I told her maybe too much..that natural flora is there for a reason..but doesn't seem to help much even though!). Go natural....let the body help, yeah it takes a few days...but it wont come back if the body does it...does if we force it with meds!

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83 Posts; 2,230 Profile Views

Are any of the patients on proton pump inhibitors? If not lying down and acid reflux will cause this. Especially with meds that affect stomach acid. Something like prilosec or prevacaid would help this.

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SteveNNP has 9 years experience as a MSN, NP and specializes in Neonatal ICU (Cardiothoracic).

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Mine flare up when I eat too much sugar or carbs..... They also usually take at least a week to heal. While the pain may seem overrated to the caregivers of people with canker sores, it really is a serious pain. I get my ulcers below the inside of my lower lip, hence every time I eat, speak or move my lower jaw, the sore rubs against my teeth. I get stress headaches from the pain. I usually use a peroxide based oral debrider, and follow with a dab of anbesol on a q-tip. It usually numbs it effectively for a while. I saw a commercial the other day for a new prescription drug for canker sores that allows them to heal in 2-3 days. I forget the name, but you can bet I'll have that on hand for my next bout with the 'ol canker sore.

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while some peoples sores are caused by a Herpes virus, that is not always the case, and is often misdiagnosed as Herpes. For many people, there is a sensitivity to a cleaning agent in toothpaste called Sodium Lauryl Sulfate (SLS). It causes a weakening of the mucous membranes in the mouth that results in even the slightest injury (scratch from eating potato chips for example) to end up in an sore. Using toothpastes that do not use SLS can lead to a 60-80% reduction in the occurances and numbers of sores. Of course, avoid sharp foods, like chips which can cause minor injuries to the membranes as well. Once the sores start, topical solutions such as Kanka are best to allow for eating.

There are very few toothpaste I know of that do not have SLS in them, but one for sure is RembrandT Canker Sore, which can normally be found at CVS. Not all stores carry it. I recommend this to anybody who suffers from them, and well as eliminating any food with possible sharp edges from the diet. I've heard positive results as well from chemo patients, they still suffer, but usually not as many sores.

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