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.
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
, 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 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.
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
. 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.
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.
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.
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.
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. http://www.emedicine.com/derm/topic486.htm.
Sciubba, James J., DMD, PhD. "Denture Stomatitis." eMedicine June 11, 2002. http://www.emedicine.com/derm/topic642.htm.
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. http://www.ada.org.
American Medical Association. 515 N. State St., Chicago, IL 60612. (312) 464-5000. http://www.ama-assn.org.
— A specific type of stomatitis presenting with shallow, painful ulcers. Also known as canker sores
— Inflammation of the lining of the mouth, gums, or tongue.
— A form of stomatitis caused by Candida
fungi and characterized by cream-colored or bluish patches on the tongue, mouth, or pharynx.
stomatitis (sto-ma-tit'is) [ stomato- + -itis]
STOMATITIS: As caused by herpes simplex virus
Inflammation of the mouth (including the lips, tongue, and mucous membranes). See: illustration
Stomatitis may be associated with viral infections, chemical irritation, radiation therapy, mouth breathing, paralysis of nerves supplying the oral area, chemotherapy that damages or destroys the mucous membranes, adverse reactions to other medicines, or acute sun damage to the lips. The nasal and oral mucosa are esp. vulnerable to trauma from dental appliances, nasal cannula, nasotracheal tubes, or catheters administering nutrients. These areas may also be damaged during surgery when an endotracheal tube is in place.
Symptoms include oral pain, esp. when eating or drinking, bad breath, or difficulty in swallowing. Findings include oral ulcers, friability of the mucous membranes, swollen cervical lymph nodes, and sometimes fever.
Treatment depends on the cause but is often symptomatic. The mucous membranes should be kept moist and clear of tenacious secretions. Care of the teeth and gingival tissues should be comprehensive and include flossing. The pain of stomatitis may be alleviated by systemic analgesics or application of anesthetic preparations to painful lesions. It is important for patients with dentures to clean their dentures thoroughly. Dentures should be removed from unconscious or stuporous patient. See: toothbrushing
aphthous stomatitisAphthous ulcer.
Stomatitis resulting from intentional or accidental exposure to corrosive substances.
Synonym: chronic atrophic candidiasis
Stomatitis on the oral mucosa covered by full or partial dentures, most commonly seen on the palate although the inflammation may also be seen overlying the mandible.
Although most patients are asymptomatic (the finding is noticed by dental professionals during oral examination, rather than by the patient), the condition should be treated to prevent progression to more serious oral diseases. Removal of plaque from dentures (as by brushing them carefully), removal of dentures at night, and sanitizing dentures regularly (as with an overnight soak in a chlorhexidine solution) all prevent the condition from occurring. Antifungal medications are used if fungi are isolated on culture swabs.
Stomatitis caused by infection with Corynebacterium diphtheriae. See: diphtheria
Stomatitis seen with primary infection with herpes simplex virus.
major aphthous stomatitis
Stomatitis in which large recurring or migrating painful ulcers appear within the oral cavity (on the gingiva and soft palate) and sometimes on the lips.
Stomatitis accompanied by the formation of a false or adventitious membrane.
Stomatitiss seen in those exposed to elemental mercury or mercury vapors.
nicotine stomatitis, stomatitis nicotina
Fissuring and the formation of hyperkeratotic papules on the palate, usually caused by habitual pipe smoking. It is a form of precancer.
Stomatitis occurring in patches on the mucous membranes.
Stomatitis resulting from mechanical injury as from ill-fitting dentures, sharp jagged teeth, or biting the cheek.
ulcerative stomatitisNecrotizing ulcerative gingivitis.
vesicular stomatitisAphthous ulcer.
Vincent stomatitisNecrotizing ulcerative gingivitis.
n inflammation of the soft tissues of the oral cavity occurring as a result of mechanical, chemical, thermal, bacterial, viral, electrical, or radiation injury or reactions to allergens or as secondary manifestations of systemic disease.
stomatitis, acute herpetic
n (acute herpetic gingivostomatitis), the manifestations of clinically apparent primary herpes simplex characterized by regional lymphadenopathy, sore throat, and high temperature, followed by localized itching and burning, with the formation of small vesicles of an erythematous base that give way to plaques and then painful herpetic ulcers. The gingivae are swollen and erythematous, and they bleed easily. Manifestations subside in 7 to 10 days, and recovery usually occurs within 2 weeks.
(aphthae, canker sore),
n refers to recurrent ulcers of the oral cavity that are limited to nonkeratinized mucosa and are thought to be immune related.
n oral manifestation of arsenic poisoning. The oral mucosa is dry, red, and painful. Ulceration, purpura, and mobility of teeth also may occur.
n.pr a stomatitis considered by some to be associated with the use of the antimalarial and anthelmintic drug quinacrine hydrochloride (Atabrine) and characterized by oral changes simulating lichen planus.
n a stomatitis resulting from systemic use of bismuth compounds over prolonged periods. Sulfides of bismuth are deposited in the gingival tissue, resulting in bluish-black pigmentation known as a bismuth line. Oral manifestations of bismuth poisoning include gingivostomatitis similar to that of Vincent's infection, a blue-black line on the inner aspect of the gingival sulcus or pigmentation of the buccal mucosa, a sore tongue, metallic taste, and a burning sensation of the oral cavity.
(cancrum oris, noma),
n an inflammation of the oral mucosa caused by gonococci.
the oral manifestation of primary herpes simplex infection. The term also is used by some for herpetiform ulcers considered to be oral manifestations of secondary or recurrent herpes simplex. See also ulcer, aphthous, recurrent
inflammation of the oral mucosa caused by herpesvirus. See also gingivostomatitis, herpetic.
n an oral manifestation of lead poisoning. Included are a bluish line along the free gingival margin, pigmentation of the mucosa in contact with the teeth, metallic taste, excessive salivation, and swelling of the salivary glands.
n an allergic response of the oral mucosa to a systemically administered drug. Possible manifestations include asthma, skin rashes, urticaria, pruritus, leukopenia, lymph-adenopathy, thrombocytopenic purpura, and oral lesions (erythema, ulcerative lesions, vesicles, bullae, and angioneurotic edema).
n an inflammation of the oral cavity, accompanied by the formation of a pseudomembrane.
n an oral manifestation of mercury poisoning, consisting of hypersalivation, metallic taste, ulceration and necrosis of the gingivae with a tendency to spread posteriorly and to the buccal mucosa and palate, glossodynia, and periodontitis with loosening of the teeth in severe cases of chronic intoxication.
an infection of the oral mucosa by a fungus, most commonly C. albicans,
which produces moniliasis (thrush). See also moniliasis.
an inflammation of the palatal minor salivary ducts caused by irritation by tobacco smoke or hot fluids and characterized by raised small palatal lesions with red centers and white borders. The palatal mucosa usually has a generalized keratosis accompanying the smaller lesions. Also called stomatitis nicotina
n recurrent manifestation of herpes simplex involving the lips and labial and buccal mucosa (fever blisters, cold sores). Episodes may result from fever, sunlight, menses, trauma, and gastrointestinal upset. Lesions begin as clear vesicles with an erythematous base that give way to ulcers and superficial crusts if the outer surfaces of the lips and skin are involved.
an oral manifestation of uremia, consisting of varying degrees of erythema, exudation, ulceration, pseudomembrane formation, foul breath, and burning sensations. See also gingivitis, nephritic.
n an inflammation of the oral mucosa as the result of contact allergy. The most common causative agents are volatile oils, iodides, dentifrices, mouthwashes, denture powders, and topical anesthetics. Possible manifestations include erythema, angioneurotic edema, burning sensations, ulcerations, and vesicles.