The Meaning Behind Sensitive Oral Mucosa

Patients sometimes present to the dental office with a complaint of sensitive gingiva or oral mucosa. While dentists are aware that this is not a physiological presentation, underlying causes should be investigated.

Patients with such a symptom may be impacted by the following:

1. Infections (viral, bacterial, or fungal)
2. Nutritional deficits (vitamin B6/​B12, C, and other essential minerals, vitamins and co-factors)
3. Injury/​trauma blood dyscrasias
4. Autoimmune diseases
5. Hypersensitivity to food additives or chlorhexidine¹
6. Nonspecific mucositis²

Low Abrasive Toothpaste

In the meantime, toothpastes with a moderate or low relative dentine abrasion value between 30 and 70 are recommended.³ Nonfoaming toothpastes are also very helpful because, even though detergents such as sodium lauryl sulphate improve cleansing action, they are dehydrating agents and can irritate the mucosa.

Addressing Dryness

Dehydration and xerostomia can also contribute to sensitive gingiva. Mouthrinses, oral gels, and pastes containing mucin, carboxymethylcellulose, hydroxymethylcellulose, xanthan, linseed oil, and polyethylene oxide can improve viscosity and wettability.⁴ Some evidence suggests patients with xerostomia may be helped by edible oils, such as olive or vegetable oils, as well as milk products. Probiotics may address hyposalivation.⁵ While they are not long-term solutions, saliva substitutes can assist in managing the symptoms associated with dry mouth.⁶

There have been reports of treating sensitive oral mucosa, especially in those with radiation-induced mucositis, with an anti-inflammatory chemical — benzydamine — which also works as an analgesic and antimicrobial.⁷

References

1. Kotsailidi EA, Kalogirou EM, Michelogiannakis D, Vlachodimitropoulos D, Tosios KI. Hypersensitivity reaction of the gingiva to chlorhexidine: case report and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2020;130:156–160.
2. Holmstrup P. Non-plaque-induced gingival lesions. Ann Periodontol. 1999;4:20–31.
3. Panagakos FS, Migliorati CA. Concepts of Oral Hygiene Maintenance that Would Apply for the Different Groups of Patients. In: Migliorati CA, ed. Diagnosis and Management of Oral Lesions and Conditions: A Resource Handbook for the Clinician. London: IntechOpen; 2014.
4. Scully C, Felix DH. Oral medicine—update for the dental practitioner: dry mouth and disorders of salivation. Br Dent J. 2005;199:423–427.
5. Meurman JH, Grönroos L. Oral and dental health care of oral cancer patients: hyposalivation, caries and infections. Oral Oncol. 2010;46:464–467.
6. Kandaswamy E, Kumar PS. Oral effects of cancer treatment. Dimensions of Dental Hygiene. 2018;16(10):45–48.
7. Hitz Lindenmüller I, Lambrecht, JT. Oral care. Curr Probl Dermatol. 2011;40:107–115.

From Decisions in Dentistry. July/August 2023;9(7/8):46.