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Definition

Inflammation of the mucous lining of any of the structures in the mouth, which may involve the cheeks, gums, tongue, lips, and roof or floor of the mouth. The word "stomatitis" literally means inflammation of the mouth. The inflammation can be caused by conditions in the mouth itself, such as poor oral hygiene, poorly fitted dentures, or from mouth burns from hot food or drinks, or by conditions that affect the entire body, such as medications, allergic reactions, or infections.

Description

Stomatitis is an inflammation of the lining of any of the soft-tissue structures of the mouth. Stomatitis is usually a painful condition, associated with redness, swelling, and occasional bleeding from the affected area. Bad breath (halitosis) may also accompany the condition. Stomatitis affects all age groups, from the infant to the elderly.

Causes and symptoms

A number of factors can cause stomatitis; it is a fairly common problem in the general adult population in North America. Poorly fitted oral appliances, cheek biting, or jagged teeth can persistently irritate the oral structures. Chronic mouth breathing due to plugged nasal airways can cause dryness of the mouth tissues, which in turn leads to irritation. Drinking beverages that are too hot can burn the mouth, leading to irritation and pain. Diseases, such as herpetic infections (the common cold sore), gonorrhea, measles, leukemia, AIDS, and lack of vitamin C can present with oral signs. Other systemic diseases associated with stomatitis include inflammatory bowel disease (IBD) and Behçet's syndrome, an inflammatory multisystem disorder of unknown cause.

Aphthous stomatitis, also known as recurrent aphthous ulcers (RAU) or canker sores, is a specific type of stomatitis that presents with shallow, painful ulcers that are usually located on the lips, cheeks, gums, or roof or floor of the mouth. These ulcers can range from pinpoint size to up to 1 in (2.5 cm) or more in diameter. Though the causes of canker sores are unknown, nutritional deficiencies, especially of vitamin B₁₂, folate, or iron is suspected. Generalized or contact stomatitis can result from excessive use of alcohol, spices, hot food, or tobacco products. Sensitivity to mouthwashes, toothpastes, and lipstick can irritate the lining of the mouth. Exposure to heavy metals, such as mercury, lead, or bismuth can cause stomatitis. Thrush, a fungal infection, is a type of stomatitis.

Diagnosis

Diagnosis of stomatitis can be difficult. A patient's history may disclose a dietary deficiency, a systemic disease, or contact with materials causing an allergic reaction. A physical examination is done to evaluate the oral lesions and other skin problems. Blood tests may be done to determine if any infection is present. Scrapings of the lining of the mouth may be sent to the laboratory for microscopic evaluation, or cultures of the mouth may be done to determine if an infectious agent may be the cause of the problem.

Treatment

The treatment of stomatitis is based on the problem causing it. Local cleansing and good oral hygiene are fundamental. Sharp-edged foods such as peanuts, tacos, and potato chips should be avoided. A soft-bristled toothbrush should be used, and the teeth and gums should be brushed carefully; the patient should avoid banging the toothbrush into the gums. Local factors, such as ill-fitting dental appliances or sharp teeth, can be corrected by a dentist. An infectious cause can usually be treated with medication. Systemic problems, such as AIDS, leukemia, and anemia are treated by the appropriate medical specialist. Minor mouth burns from hot beverages or hot foods will usually resolve on their own in a week or so. Chronic problems with aphthous stomatitis are treated by first correcting any vitamin B₁₂, iron, or folate deficiencies. If those therapies are unsuccessful, medication can be prescribed which can be applied to each aphthous ulcer with a cotton-tipped applicator. This therapy is successful with a limited number of patients. More recently, low-power treatment with a carbon dioxide laser has been found to relieve the discomfort of recurrent aphthae. Major outbreaks of aphthous stomatitis can be treated with tetracycline antibiotics or corticosteroids. Valacyclovir has been shown to be effective in treating stomatitis caused by herpesviruses.

Patients may also be given topical anesthetics (usually a 2% lidocaine gel) to relieve pain and a protective paste (Orabase) or a coating agent like Kaopectate to protect eroded areas from further irritation from dentures, braces, or teeth.

Alternative treatment

Alternate treatment of stomatitis mainly involves prevention of the problem. Patients with such dental appliances as dentures should visit their dentist on a regular basis. Patients with systemic diseases or chronic medical problems need to ask their health care provider what types of oral problems they can expect from their particular disease. These patients must also contact their medical clinic at the first sign of problems. Common sense needs to be exercised when consuming hot foods or drinks. Use of tobacco products should be discouraged. Alcohol should be used in moderation. Mouthwashes and toothpastes known to the patient to cause problems should be avoided.

Botanical medicine can assist in resolving stomatitis. One herb, calendula (Calendula officinalis), in tincture form (an alcohol-based herbal extract) and diluted for a mouth rinse, can be quite effective in treating aphthous stomatitis and other manifestations of stomatitis.

More recently, a group of researchers in Brazil have reported that an extract made from the leaves of Trichilia glabra, a plant found in South America, is effective in killing several viruses that cause stomatitis.

Prognosis

The prognosis for the resolution of stomatitis is based on the cause of the problem. Many local factors can be modified, treated, or avoided. Infectious causes of stomatitis can usually be managed with medication, or, if the problem is being caused by a certain drug, by changing the offending agent.

Prevention

Stomatitis caused by local irritants can be prevented by good oral hygiene, regular dental checkups, and good dietary habits. Problems with stomatitis caused by systemic disease can be minimized by good oral hygiene and closely following the medical therapy prescribed by the patient's health care provider.

Key Terms

Aphthous stomatitis

A specific type of stomatitis presenting with shallow, painful ulcers. Also known as .

Stomatitis

Inflammation of the lining of the mouth, gums, or tongue.

Thrush

A form of stomatitis caused by fungi and characterized by cream-colored or bluish patches on the tongue, mouth, or pharynx.

For Your Information

Resources

Books

• Beers, Mark H., MD, and Robert Berkow, MD., editors. "Disorders of the Oral Region." In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

• Cella, M., D. A. Riva, F. C. Coulombie, and S. E. Mersich. "Virucidal Activity Presence in Trichilia glabra Leaves." Revista Argentina de microbiologia 36 (July-September 2004): 136-138.
• Miller, C. S., L. L. Cunningham, J. E. Lindroth, and S. A. Avdiushko. "The Efficacy of Valacyclovir in Preventing Recurrent Herpes Simplex Virus Infections Associated with Dental Procedures." Journal of the American Dental Association 135 (September 2004): 1311-1318.
• Mirowski, Ginat W., DMD, MD, and Christy L. Nebesio. "Aphthous Stomatitis." eMedicine September 24, 2004.
• Sciubba, James J., DMD, PhD. "Denture Stomatitis." eMedicine June 11, 2002.
• Shulman, J. D., M. M. Beach, and F. Rivera-Hidalgo. "The Prevalence of Oral Mucosal Lesions in U.S. Adults: Data from the Third National Health and Nutrition Examination Survey, 1988-1994." Journal of the American Dental Association 135 (September 2004): 1279-1286.
• Wohlschlaeger, A. "Prevention and Treatment of Mucositis: A Guide for Nurses." Journal of Pediatric Oncology Nursing 21 (September-October 2004): 281-287.

• American Dental Association. 211 E. Chicago Ave., Chicago, IL 60611. (312) 440-2500.
• American Medical Association. 515 N. State St., Chicago, IL 60612. (312) 464-5000.

This article was updated on 08-14-2006