Stomatitis is an inflammation inside of the mouth, usually a small sore
or ulcer. It is not a stomach problem. “Stoma” is a medical term referring to a
What is Stomatitis?
Stomatitis is a sore or inflammation in the mouth. This can be in the
cheeks, gums, inside of the lips, or on the tongue.
There are two main forms of stomatitis: herpes stomatitis and aphthous
stomatitis. Both forms usually occur more often in children and teens.
Herpes stomatitis is an infection, usually in young children between the
ages of six months and 5 years. It’s an infection of the Herpes Simplex 1 (HSV 1) virus, the same virus that causes cold
sores on the outside of the lips in adults. It is related to HSV 2, the virus
that causes genital herpes, but it is not the same virus.
Aphthous stomatitis is also called canker
sores. They are one or a cluster of small pits or ulcers in the cheeks,
gums, the inside of the lips, or on the tongue. This is also much more common
in young people, most often between 10 and 19 years old.
What Causes Stomatitis?
Herpes Stomatitis is caused by infection of the HSV1 virus in young
Aphthous stomatitis is caused by a variety of problems with oral hygiene
or damage to mucous membranes. Some potential causes include:
- dry tissues from breathing
through the mouth due to clogged nasal passages
- small injuries due
to dental work, accidental cheek bite, etc.
- sharp tooth
surfaces, dental braces, or retainers
- celiac disease (allergy
- food sensitivities
to strawberries, citrus fruits, coffee, chocolate, eggs, cheese, or nuts
- allergic response
to certain bacteria in the mouth
- inflammatory bowel
- autoimmune disease
that attacks cells in the mouth
- weakened immune
- deficiency in
Vitamin B12, folic acid, iron, or zinc
Symptoms of Stomatitis
Herpetic stomatitis is usually indicated by multiple blisters that occur
in the gums, palate, cheeks, tongue, or lip border. Eating, drinking, and
swallowing may be difficult. Dehydration is a risk. Drooling, pain, and swollen
gums can occur. The child can be very irritable.
A fever is a major marker of the HSV1 infection, which can get as high
as 104 degrees Fahrenheit. The fever occurs a few days before the blisters appear.
When the blisters pop, ulcers can form in their place. Secondary infections of
these ulcers can occur. The entire infection lasts between 7-10 days.
Aphthous stomatitis or canker sores 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 1-2 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.
Older adults may develop something called a “herpetiform” canker sore. The
HSV1 virus does not cause these. Herpetiform canker sores are tiny, but occur
in clusters of 10-100. They heal within two weeks.
What are Treatments for Stomatitis?
Herpes stomatitis can be treated with an antiviral drug acyclovir. This
can shorten the length of the infection. Dehydration is a risk with young
children, so getting them to drink enough liquid is important. A liquid diet
made up of non-acidic foods and beverages is recommended. Acetaminophen for
pain and fever is recommended.
For severe pain, topical lidocaine may be used. Lidocaine numbs the
mouth completely. It can cause problems swallowing, burns, or choking. It
should be used with care.
An HSV1 infection may become an eye infection called herpetic keratoconjunctivitis. This is
a serious complication that could lead to blindness. Seek treatment
Aphthous stomatitis is usually not severe and does not require
treatment. If pain is significant or sores are larger, topical creams with
benzocaine or another numbing agent may be applied. Mouth rinses of salt water
or a mild mouthwash may help.
Applying milk of magnesia a few times a day may be soothing. Diluting
hydrogen peroxide with equal parts of water and dabbing a bit on each sore may
relieve some inflammation.
For severe outbreaks, an oral rinse of tetracycline can speed healing.
However, it can permanently stain the developing teeth of young children.
Steroid (dexamethasone) rinses may also be used to reduce inflammation.
For large outbreaks of canker sores, medications that may be prescribed
include cimetidine, colchicine or even oral steroid medications. These are
rarely used and only for complex canker sores that repeatedly return.
Occasionally, canker sores are chemically burned away with debacterol or silver
Sores that take a long time to heal or a fever that will not go away
require medical care. Sores that return again and again might indicate a more
serious condition or secondary infection. Patients should speak with a doctor
in such cases.
Can Stomatitis be Prevented?
Herpes stomatitis is an infection that will be carried in the child’s
system for the rest of their life. 80-90 percent of the population caries the
HSV1 virus. Preventing a child 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, B6, B12) may help. Foods high
in these vitamins can also help. Proper oral hygiene is important, as is
avoiding acidic or spicy foods that may have triggered an outbreak. 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.