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Stomatitis – Causes, Symptoms & Treatment

Stomatitis is an inflammation of the oral mucosa that causes painful sores, redness, and swelling. It can be triggered by infections, irritants, nutritional deficiencies, or systemic diseases.

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Things worth knowing about "Stomatitis"

Stomatitis is an inflammation of the oral mucosa that causes painful sores, redness, and swelling. It can be triggered by infections, irritants, nutritional deficiencies, or systemic diseases.

What is Stomatitis?

Stomatitis refers to inflammation of the mucous membrane lining the mouth (oral mucosa). It can affect the gums, inner cheeks, tongue, lips, and palate. The condition typically presents with painful sores or ulcers, redness, and swelling, and may make eating, drinking, and speaking uncomfortable. Stomatitis can occur in acute or chronic forms and affects individuals of all ages.

Causes

Stomatitis can result from a wide range of causes:

Infections: Bacteria (e.g., streptococci), viruses (e.g., herpes simplex virus, coxsackievirus), or fungi (e.g., Candida albicans causing oral thrush) are common culprits.
Mechanical irritation: Ill-fitting dentures, braces, or accidental biting of the cheek or tongue can injure the mucosal lining.
Chemical and physical irritants: Alcohol, tobacco, spicy or acidic foods, hot beverages, or harsh mouthwashes may trigger inflammation.
Medication side effects: Certain drugs, especially chemotherapy agents, can cause mucositis as a side effect.
Nutritional deficiencies: Low levels of vitamin B12, folate, iron, or zinc can increase susceptibility to oral inflammation.
Systemic diseases: Conditions such as Crohn's disease, celiac disease, Behçet's disease, and immunodeficiency disorders are associated with stomatitis.
Allergic reactions: Responses to food, dental materials, or oral hygiene products can cause mucosal inflammation.

Symptoms

Symptoms of stomatitis vary depending on the underlying cause and severity:

Painful red or whitish sores and ulcers in the mouth (aphthae)
Burning or tingling sensation in the oral cavity
Swelling and redness of the mucous membranes
Increased saliva production
Pain when chewing, swallowing, or speaking
Bad breath (halitosis)
Fever and general malaise (in infectious forms)

Types of Stomatitis

Aphthous Stomatitis

The most common form, characterized by small, oval ulcers with a whitish coating and a red border. These are known as canker sores or aphthae. They are not contagious and usually heal within 1 to 2 weeks. Recurrent episodes are referred to as recurrent aphthous stomatitis (RAS).

Herpetic Stomatitis

Caused by herpes simplex virus type 1 (HSV-1), this form frequently occurs in young children as a primary infection. It presents with clusters of blisters and ulcers, often accompanied by fever and swollen lymph nodes.

Candidal Stomatitis (Oral Thrush)

A fungal infection caused by Candida albicans, resulting in creamy white patches on the oral mucosa. It is most common in infants, the elderly, and immunocompromised individuals.

Denture-Related Stomatitis

Chronic irritation and inflammation of the oral mucosa caused by poorly fitting or inadequately cleaned dentures. This is one of the most prevalent forms among denture wearers.

Diagnosis

Stomatitis is primarily diagnosed through a clinical examination by a physician or dentist. Additional tests may include:

Swab and culture: To identify causative bacteria or fungi
Blood tests: To detect nutritional deficiencies, immune disorders, or systemic conditions
Biopsy: For persistent or atypical lesions to rule out malignancy
Allergy testing: If an allergic cause is suspected

Treatment

Treatment depends on the underlying cause of stomatitis:

Local treatment: Topical analgesics (e.g., lidocaine gels), antiseptic mouthwashes (e.g., chlorhexidine), and anti-inflammatory agents
Anti-infective therapy: Antifungals (e.g., nystatin) for fungal infections, antivirals (e.g., acyclovir) for herpes infections, antibiotics for bacterial causes
Nutritional supplementation: Correction of deficiencies in vitamin B12, iron, or folate
Denture adjustment: Proper fitting and cleaning of dentures to eliminate mechanical triggers
General measures: Good oral hygiene, avoidance of alcohol and tobacco, mild diet, and adequate fluid intake

References

Greenberg, M.S., Glick, M., Ship, J.A. (2008). Burket's Oral Medicine. 11th edition. BC Decker Inc.
World Health Organization (WHO): Oral health. Available at: https://www.who.int/health-topics/oral-health
Scully, C. (2013). Oral and Maxillofacial Medicine. Churchill Livingstone, 3rd edition. Elsevier.

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