Stomatitis

Written by Christine Case-Lo
Medically Reviewed by George Krucik, MD, MBA on June 6, 2013

Stomatitis Overview

Stomatitis is an inflammation inside of the mouth, usually a small sore or ulcer. It is not a stomach problem. “Stoma” is a medical term referring to a “mouth-like” opening.

What is Stomatitis?

Stomatitis is a sore or inflammation in the mouth. This can be in the cheeks, gums, inside of the lips, or on the tongue.

There are two main forms of stomatitis: herpes stomatitis and aphthous stomatitis. Both forms usually occur more often in children and teens.

Herpes stomatitis is an infection, usually in young children between the ages of six months and 5 years. It’s an infection of the Herpes Simplex 1 (HSV 1) virus, the same virus that causes cold sores on the outside of the lips in adults. It is related to HSV 2, the virus that causes genital herpes, but it is not the same virus.

Aphthous stomatitis is also called canker sores. They are one or a cluster of small pits or ulcers in the cheeks, gums, the inside of the lips, or on the tongue. This is also much more common in young people, most often between 10 and 19 years old.

What Causes Stomatitis?

Herpes Stomatitis is caused by infection of the HSV1 virus in young children.

Aphthous stomatitis is caused by a variety of problems with oral hygiene or damage to mucous membranes. Some potential causes include:

  • dry tissues from breathing through the mouth due to clogged nasal passages
  • small injuries due to dental work, accidental cheek bite, etc.
  • sharp tooth surfaces, dental braces, or retainers
  • celiac disease (allergy to gluten)
  • food sensitivities to strawberries, citrus fruits, coffee, chocolate, eggs, cheese, or nuts
  • allergic response to certain bacteria in the mouth
  • inflammatory bowel diseases
  • autoimmune disease that attacks cells in the mouth
  • HIV/AIDS
  • weakened immune system
  • deficiency in Vitamin B12, folic acid, iron, or zinc
  • certain medications
  • stress

Symptoms of Stomatitis

Herpetic stomatitis is usually indicated by multiple blisters that occur in the gums, palate, cheeks, tongue, or lip border. Eating, drinking, and swallowing may be difficult. Dehydration is a risk. Drooling, pain, and swollen gums can occur. The child can be very irritable.

A fever is a major marker of the HSV1 infection, which can get as high as 104 degrees Fahrenheit. The fever occurs a few days before the blisters appear. When the blisters pop, ulcers can form in their place. Secondary infections of these ulcers can occur. The entire infection lasts between 7-10 days.

Aphthous stomatitis or canker sores are round or oval ulcers with a red, inflamed border. The center is usually white or yellow. Most canker sores are small and oval, and heal within 1-2 weeks without scarring. Larger, irregular sores can occur with extensive injury and take six or more weeks to heal. These can leave scars in the mouth.

Older adults may develop something called a “herpetiform” canker sore. The HSV1 virus does not cause these. Herpetiform canker sores are tiny, but occur in clusters of 10-100. They heal within two weeks.

What are Treatments for Stomatitis?

Herpes stomatitis can be treated with an antiviral drug acyclovir. This can shorten the length of the infection. Dehydration is a risk with young children, so getting them to drink enough liquid is important. A liquid diet made up of non-acidic foods and beverages is recommended. Acetaminophen for pain and fever is recommended.

For severe pain, topical lidocaine may be used. Lidocaine numbs the mouth completely. It can cause problems swallowing, burns, or choking. It should be used with care.

An HSV1 infection may become an eye infection called herpetic keratoconjunctivitis. This is a serious complication that could lead to blindness. Seek treatment immediately.

Aphthous stomatitis is usually not severe and does not require treatment. If pain is significant or sores are larger, topical creams with benzocaine or another numbing agent may be applied. Mouth rinses of salt water or a mild mouthwash may help.

Applying milk of magnesia a few times a day may be soothing. Diluting hydrogen peroxide with equal parts of water and dabbing a bit on each sore may relieve some inflammation.

For severe outbreaks, an oral rinse of tetracycline can speed healing. However, it can permanently stain the developing teeth of young children. Steroid (dexamethasone) rinses may also be used to reduce inflammation.

For large outbreaks of canker sores, medications that may be prescribed include cimetidine, colchicine or even oral steroid medications. These are rarely used and only for complex canker sores that repeatedly return. Occasionally, canker sores are chemically burned away with debacterol or silver nitrate.

Sores that take a long time to heal or a fever that will not go away require medical care. Sores that return again and again might indicate a more serious condition or secondary infection. Patients should speak with a doctor in such cases.

Can Stomatitis be Prevented?

Herpes stomatitis is an infection that will be carried in the child’s system for the rest of their life. 80-90 percent of the population caries the HSV1 virus. Preventing a child from kissing or sharing eating utensils with someone with an open cold sore can help prevent the spread of infection.

For aphthous stomatitis, certain nutritional supplements like B vitamins (folate, B6, B12) may help.  Foods high in these vitamins can also help. Proper oral hygiene is important, as is avoiding acidic or spicy foods that may have triggered an outbreak. Another way to avoid an outbreak is to not speak while eating, as this increases the chance of biting the cheek. Dental wax can smooth the edges of dental appliances like retainers or braces. If stress appears to be a trigger, relaxation exercises can help. 

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