Overview

Key points

  1. Cold sores and canker sores are two common types of stomatitis.
  2. Cold sores, or herpes stomatitis, are highly contagious. Canker sores, or aphthous stomatitis, are not contagious.
  3. If you have mouth sores, identifying the type of sore is important for knowing how to treat and prevent the spread of them.

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

The two main forms of stomatitis are herpes stomatitis, also known as a cold sore, and aphthous stomatitis, also known as a canker sore.

Keep reading to learn more about these two forms of stomatitis.

What causes stomatitis?

Causes

An infection of the herpes simplex 1 (HSV-1) virus cases herpes stomatitis. It is more common in young children between the ages of 6 months and 5 years. People exposed to HSV-1 may develop cold sores later in life as a result of the virus. HSV-1 is related to HSV-2, the virus that causes genital herpes, but it isn’t the same virus.

Aphthous stomatitis can be one or a cluster of small pits or ulcers in the cheeks, gums, the inside of the lips, or on the tongue. It’s more common in young people, most often between 10 and 19 years of age.

Aphthous stomatitis is not caused by a virus and is not contagious. Instead, it’s caused by problems with oral hygiene or damage to mucous membranes. Some causes include:

  • dry tissues from breathing through the mouth due to clogged nasal passages
  • small injuries due to dental work, accidental cheek bite, or other injuries
  • sharp tooth surfaces, dental braces, dentures, or retainers
  • celiac disease
  • food sensitivities to strawberries, citrus fruits, coffee, chocolate, eggs, cheese, or nuts
  • allergic response to certain bacteria in the mouth
  • inflammatory bowel diseases
  • autoimmune diseases that attack cells in the mouth
  • HIV/AIDS
  • weakened immune system
  • deficiency in vitamin B-12, folic acid, iron, or zinc
  • certain medications
  • stress
  • Candida albicans infection

Symptoms of stomatitis

Symptoms

Herpetic stomatitis is usually indicated by multiple blisters that occur in the:

  • gums
  • palate
  • cheeks
  • tongue
  • lip border

The blisters may make it difficult or painful to eat, drink, or swallow. Dehydration is a risk if drinking is uncomfortable. Drooling, pain, and swollen gums can also occur. And cold sores can also cause irritability.

If your child is irritable and not eating or drinking, that may be a sign that they are about to develop a cold sore.

stomatitis information

A fever is another symptom of the HSV-1 infection, and it can get as high as 104°F (40°C). The fever occurs a few days before the blisters appear. After the blisters pop, ulcers can form in their place. Secondary infections of these ulcers can occur. The entire infection lasts between seven and 10 days.

Aphthous stomatitis 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 one to two 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.

stomatitis information

Older adults may develop something called a “herpetiform” canker sore. The HSV-1 virus does not cause these. Herpetiform canker sores are tiny, but occur in clusters of 10 to 100. They heal within two weeks.

What are treatments for stomatitis?

Treatment

Treatment will depend on the type of stomatitis you have.

Herpes stomatitis treatment

The antiviral drug acyclovir (Zovirax) can treat herpes stomatitis. Taking this drug can shorten the length of the infection.

Dehydration is a risk with young children, so have them drink enough liquid. A liquid diet of nonacidic foods and beverages is recommended. Acetaminophen (Tylenol) can be used to reduce pain and fever.

For severe pain, topical lidocaine (AneCream, RectiCare, LMX 4, LMX 5, RectaSmoothe) may be used. Lidocaine numbs the mouth, so it can cause problems with swallowing, burns, or choking. It should be used with care.

An HSV-1 infection may become an eye infection called herpetic keratoconjunctivitis. This is a serious complication that could lead to blindness. Seek treatment immediately if you experience eye pain, blurry vision, and eye discharge.

Aphthous stomatitis treatment

Aphthous stomatitis is usually not severe and does not need treatment. If pain is significant or sores are larger, topical creams with benzocaine (Anbesol, Zilactin-B) or another numbing agent may be applied.

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

Sores that take a long time to heal or sores accompanied by a fever that will not go away need medical care. Sores that return again and again might show a more serious condition or a secondary infection. Speak with a doctor if you regularly develop canker sores.

What’s the outlook?

Outlook

If you have mouth sores, identifying the type of sore is important for knowing how to treat and prevent the spread of them. If you have a cold sore, or herpes stomatitis, avoid sharing cups or utensils with people while you have an outbreak. You should also avoid kissing people. There’s no treatment for herpes stomatitis, but you may be able to take medication to reduce your symptoms.

Aphthous stomatitis is not contagious. You may be able to prevent or reduce your risk for canker sores through lifestyle changes. You may not need medical treatment for canker sores.

Can you prevent stomatitis?

Prevention

Once infected with the HSV-1 virus, you will have the virus for the rest of your life. It’s found in about 90 percent of adults worldwide. Refraining 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, B-6, B-12) may help. Foods high in these vitamins can also help. Some foods high in B vitamins include:

  • broccoli
  • bell peppers
  • spinach
  • beets
  • calf’s liver
  • lentils
  • asparagus

Proper oral hygiene is also important. You should also avoid acidic or spicy foods if those foods have triggered outbreaks in the past. And 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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