Stomatitis

Stomatitis refers to generalized inflammation of the oral mucosa, which may involve the cheeks, lips, tongue, palate, floor of the mouth, and gingiva. The condition results from multiple etiologies including infections, mechanical trauma, chemical irritation, radiation exposure, systemic disease, nutritional deficiencies, drug reactions, or hypersensitivity reactions.

Stomatitis may present as erythema, edema, ulceration, or painful mucosal lesions that interfere with feeding, speech, and oral hygiene.

Etiology

Common causes include:

Infectious Causes

• Viral infections (Herpes simplex virus)

• Fungal infections (Candida albicans)

• Bacterial infections

Non-Infectious Causes

• Chemical burns (medications, toothpaste reactions)

• Thermal injury from hot foods

• Radiation therapy

• Allergic reactions

• Poor oral hygiene

• Ill-fitting dentures

• Nutritional deficiencies (iron, folate, vitamin B12)

• Drug-induced mucositis

• Autoimmune disorders

Risk Factors

• Poor oral hygiene

• Malnutrition

• Immunosuppression (HIV/AIDS, chemotherapy)

• Diabetes mellitus

• Smoking and alcohol use

• Xerostomia (reduced saliva)

• Use of dentures or orthodontic appliances

• Recent antibiotic therapy

Pathophysiology

Inflammation of oral mucosa occurs following epithelial injury or microbial invasion leading to:

1. Disruption of mucosal barrier integrity.

2. Activation of inflammatory mediators.

3. Increased vascular permeability causing erythema and edema.

4. Ulcer formation due to epithelial breakdown.

5. Secondary infection may prolong healing.

Pain results from exposure of sensory nerve endings within ulcerated mucosa.

Signs and Symptoms

• Painful oral sores or ulcers

• Red inflamed oral mucosa

• Burning sensation in the mouth

• Difficulty chewing or swallowing

• Increased salivation or dry mouth

• Bleeding mucosa

• Bad breath

• Feeding difficulty especially in children

• Fever (in infectious causes)

Diagnostic Criteria

Diagnosis is mainly clinical based on:

• Presence of oral sores or ulceration

• Generalized mucosal inflammation

• Pain aggravated by eating or speaking

• Absence of localized odontogenic infection

Investigations

Routine investigations are usually not required.

Investigations may be considered in recurrent or severe disease:

• Full blood count (nutritional deficiency or infection)

• Blood glucose level

• HIV testing where indicated

• Oral swab for fungal or viral infection

• Biopsy for persistent non-healing lesions (>2 weeks)

Management

Treatment Principles

Management focuses on:

• Relief of pain

• Control of inflammation

• Treatment of underlying cause

• Prevention of secondary infection

• Maintenance of oral hygiene

Non-Pharmacological Management

• Maintain good oral hygiene using soft toothbrush

• Avoid spicy, acidic, or very hot foods

• Encourage adequate fluid intake

• Avoid alcohol and tobacco use

• Remove local irritants (sharp teeth, dentures)

• Use soft diet during painful phase

• Nutritional correction where deficiency exists

Pharmacological Management

Topical Mouth Care

Mouthwash therapy:

• Hydrogen peroxide solution 3% used every 6 hours for at least 5 days

OR

• Chlorhexidine gluconate 0.2% topical oral gel applied every 12 hours

Important Notes

• Mouthwash and gel should NOT be used simultaneously.

• Solutions must NOT be swallowed.

Analgesics

For pain control:

• Paracetamol 1 g orally every 8 hours for at least 3 days

OR

• Ibuprofen 400 mg orally every 8 hours for at least 3 days

OR

• Diclofenac 50 mg orally every 8 hours for at least 3 days

(As recommended in Tanzania Standard Treatment Guidelines)

Specific Therapy (When Indicated)

Depending on etiology:

• Antifungal agents for candidiasis

• Antiviral therapy for herpetic stomatitis

• Vitamin supplementation for deficiency states

• Withdrawal of offending drugs or allergens

Complications

• Secondary oral infection

• Feeding difficulty in infants and elderly

• Dehydration

• Malnutrition

• Chronic mucosal inflammation

• Recurrent stomatitis

• Opportunistic infections in immunocompromised patients

Prevention

• Regular oral hygiene practices

• Balanced nutritional intake

• Proper denture hygiene and fitting

• Avoid chemical or thermal oral injury

• Early treatment of oral infections

• Regular dental evaluation

• Control of systemic diseases such as diabetes

Patient Education

• Maintain daily oral hygiene

• Avoid self-medication with unknown oral chemicals

• Seek medical care if ulcers persist beyond two weeks

• Maintain adequate hydration and nutrition

• Avoid irritant foods during healing

Prognosis

Most cases resolve within 7–14 days with supportive care. Persistent or recurrent stomatitis requires evaluation for systemic or immunological disease.