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Introduction
Stomatitis is a broad term used to describe inflammation of the mucous lining inside the mouth. It is not a disease in itself but rather a symptom or clinical manifestation of various local and systemic conditions. The inflammation can affect the cheeks, gums, tongue, lips, palate, and floor of the mouth. Stomatitis may present as painful ulcers, redness, swelling, or a burning sensation, often interfering with eating, drinking, and speaking. While the condition can affect individuals of all ages, certain groups—such as children, immunocompromised patients, and individuals with poor oral hygiene—are more susceptible.
Etiology (Causes of Stomatitis)
The causes of stomatitis can be classified into local and systemic factors:
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Infectious causes
- Viral infections: Herpes simplex virus, Coxsackie virus (hand-foot-mouth disease), Varicella-zoster virus.
- Bacterial infections: Streptococci, Treponema pallidum.
- Fungal infections: Candida albicans (oral thrush).
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Non-infectious causes
- Mechanical trauma: Ill-fitting dentures, sharp tooth edges, cheek biting.
- Chemical irritation: Tobacco, alcohol, strong mouthwashes.
- Nutritional deficiencies: Vitamin B complex, folate, iron.
- Allergic reactions: Dental materials, certain foods, toothpaste components.
- Autoimmune conditions: Behçet’s disease, lichen planus, pemphigus vulgaris.
- Systemic diseases: Diabetes mellitus, inflammatory bowel disease.
- Drug reactions: Chemotherapy agents, NSAIDs, antibiotics.
Types of Stomatitis
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Aphthous stomatitis (Canker sores):
Small, round or oval ulcers with a yellowish center and red border, usually self-limiting but recurrent in nature. -
Herpetic stomatitis:
Caused by herpes simplex virus, more common in children, presenting with multiple painful vesicles that rupture to form ulcers. -
Denture stomatitis:
Inflammation under a denture, commonly associated with Candida infection and poor denture hygiene. -
Angular stomatitis (Angular cheilitis):
Cracks and soreness at the corners of the mouth, often linked to fungal or bacterial infection and nutritional deficiencies. -
Allergic stomatitis:
Triggered by allergens in food, dental materials, or oral care products.
Clinical Features
- Pain or burning sensation in the mouth.
- Redness of the oral mucosa.
- Swelling of affected areas.
- Ulcer formation—single or multiple.
- Difficulty eating, swallowing, or speaking.
- Excessive salivation in some cases.
- Fever and malaise—especially in infectious stomatitis.
Diagnosis
Diagnosis is mainly clinical, based on patient history and examination. Additional investigations may be required to identify the underlying cause:
- Blood tests: To detect anemia, nutritional deficiencies, or systemic diseases.
- Microbiological cultures: For bacterial, viral, or fungal identification.
- Biopsy: If lesions are persistent or suspicious for malignancy.
- Allergy testing: In cases of suspected hypersensitivity reactions.
Management and Treatment
The treatment of stomatitis depends on the underlying cause and severity of the condition. Goals include pain relief, eradication of infection, and prevention of recurrence.
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General measures
- Maintain proper oral hygiene.
- Use soft-bristled toothbrushes.
- Avoid irritating foods—spicy, acidic, or salty.
- Ensure adequate hydration.
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Symptomatic relief
- Topical anesthetics (e.g., lidocaine gel).
- Anti-inflammatory mouth rinses.
- Saline or baking soda rinses.
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Treatment of specific causes
- Viral stomatitis: Antiviral agents (acyclovir) in severe cases.
- Bacterial stomatitis: Appropriate antibiotics.
- Fungal stomatitis: Antifungal agents like nystatin or fluconazole.
- Nutritional deficiencies: Vitamin or mineral supplementation.
- Allergic stomatitis: Removal of allergens and use of antihistamines.
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In severe or chronic cases
- Corticosteroid mouth rinses or gels to reduce inflammation.
- Immunosuppressive drugs for autoimmune causes.
Prevention
- Maintain good oral hygiene.
- Regular dental check-ups.
- Balanced diet rich in vitamins and minerals.
- Avoid smoking and excessive alcohol.
- Properly fitting dental prosthetics.
- Manage systemic diseases effectively.
- Avoid excessive use of harsh mouth rinses.
Complications
If untreated, stomatitis can lead to:
- Secondary infections.
- Nutritional deficiencies due to reduced food intake.
- Chronic pain and discomfort.
- Spread of infection in immunocompromised patients.
Prognosis
The prognosis for stomatitis is generally favorable, especially when the underlying cause is identified and treated promptly. Most cases resolve within one to two weeks, although recurrent forms like aphthous ulcers may require ongoing management. Chronic stomatitis linked to systemic diseases may need long-term follow-up.
Conclusion
Stomatitis is a common but often uncomfortable condition that can significantly impact quality of life. Understanding its diverse causes is essential for effective management and prevention. With proper diagnosis, targeted treatment, and good oral hygiene practices, most patients recover fully and can prevent future episodes.
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