Thrush, Cold Sores and Mouth Ulcers

Thrush of the mouth is caused by a fungus, candida albicans. It is treated with an antifungal drug such as nystatin suspension (Nystamont, Nystan) or with amphotericin lozenges (Fungilin). Miconazole oral gel (Daktarin) or fluconazole (Diflucan) are useful for severe fungal infections.

Herpes infection (cold sores) of the mouth is very difficult to treat. The antiviral drug aciclovir (in Boots Avert, Herpetad, Soothelip, Viralief, Virasorb, Zovirax cream) should be used at the first sign of a sore. A protective such as petroleum jelly (Vaseline) may help. Corticosteroid applications should not be used and drying agents may trigger secondary infection. A tetracycline rinse may help. A chlorhexidine mouthwash (Chlorohex, Corsodyl) should be used to prevent dental plaque if the mouth is too painful to use a toothbrush.

Recurrent mouth ulcers (aphthous ulcers) can be very painful and treatment very disappointing. Local treatment aimed at soothing the pain and helping healing is not usually very effective. Preparations available include:

mechanical protectives e.g. Orabase ointment (carmellose sodium, pectin and gelatin); corticosteroids in lozenges or pastes e.g. Adcortyl (triamcinolone) in Orabase paste; Corlan pellets (hydrocortisone);

local anaesthetic gels and lozenges e.g. benzocaine lozenges, benzocaine compound lozenges (contain menthol as well);

local pain-relievers such as Bonjela and Teejel (choline salicylate paste), Pyralvex (anthraquinone and salicylic acid) and Difflam (benzydamine);

antibiotic mouthwashes (e.g. tetracycline mouthwash).

Other preparations include Anbesol (cetylpyridinium, chlorocresol, lidocaine(lignocaine)), Bansor (cetimide), Bioral Gel (carbenoxolone sodium), Bonjela Pastilles (aminoacridine(aminacrine), lidocaine(lignocaine)), Frador (chlorobutanol, menthol), Medijel (aminoacridine(aminacrine), lidocaine(lignocaine)), Oragard (cetylpyridinium, lidocaine(lignocaine)), Rinstead Gel (benzocaine, chloroxylenol), Rinstead Pastilles (chloroxylenol, menthol).

Acute ulceration of the gums (Vincent’s infection) requires treatment with the antimicrobial drug metronidazole (Flagyl).

Mouth Washes and Gargles

Mouth washes and gargles clean and freshen the mouth and are helpful in the care of the mouth in debilitated patients. The mouth washes include compound sodium chloride (salt), compound thymol glycerine, hydrogen peroxide (Peroxyl) and phenol mouth washes. Brand preparations include cetylpyridinium (Merocet), chlorhexidine (Chlorohex, Corsodyl, in Eludril) which is useful for preventing plaque formation on teeth which may lead to the development of caries, hexetidine (Oraldene), povidone-iodine (Betadine) and sodium perborate (Bocasan).

Drugs Used to Treat Sore Throat

The commonest cause of a sore throat is a virus infection, for which there is no specific treatment apart from sucking a sweet or a throat lozenge and taking a pain-reliever such as paracetamol or ibuprofen.

Antiseptic throat sprays and lozenges, while very popular have very little evidence to support their use. They can cause irritation and sore tongue and lips. Some of these medicines contain local anaesthetics which relieve pain but may cause sensitisation.

A list of these preparations include:

The commonest bacterial infection of the throat is caused by a streptococcal infection (a strep sore throat). This infection can cause tonsillitis and complications such as rheumatic fever and kidney disease. It needs treating quickly and effectively with phenoxymethylpenicillin(penicillin V) (Aspin, Tenkicin) by mouth for ten days. If the infection is severe an initial injection of benzylpenicillin(penicillin G) (Crystapen) should be given into a muscle. Amoxycillin by mouth is an alternative to phenoxymethylpenicillin. If the patient is allergic to penicillin, erythromycin (Arpimycin, Erymax, Erythrocin, Erythroped, Ilosone, Rommix, Tiloryth) should be used.

Treatment of Laryngitis

Laryngitis is an inflammation of the voice box which affects the vocal cords, producing a hoarse voice. Acute laryngitis is often due to a virus infection (e.g. a cold virus). It may also occur from shouting, over-singing, allergy and inhaling irritant fumes. Chronic laryngitis is often due to shouting or over-singing, what the specialists politely call ‘vocal abuse’. It occurs particularly by straining the voice during an acute attack of laryngitis. It is made worse by coughing and smoking.

The best treatment for acute laryngitis is to rest the voice, inhale steam and avoid irritants (e.g. smoking). If hoarseness persists for more than a week or so you should ask your doctor to send you to see an ear, nose and throat specialist for a check-up.