Stomatitis Symptoms, Causes, and Treatments

Stomatitis is inflammation of the mucosal tissue of the mouth (inner cheeks, tongue, and/or gums). It can be caused by an infection, irritation, trauma to the mouth, or allergies. Stomatitis can be painful and may lead to canker sores or cold sores, which may make talking and eating uncomfortable or even difficult.

Aphthous stomatitis is a common condition in which canker sores caused by stomatitis come back on a fairly regular basis.

This article discusses what stomatitis is, why it occurs, and how it can be treated.

Stomatitis Symptoms

The severity of symptoms in stomatitis varies widely and may be related to the underlying cause of stomatitis.

For some people, stomatitis may just be annoying or mildly bothersome. For others, it may be quite painful and make it difficult to eat and drink normally.

These are some common symptoms of stomatitis:

• Pain or irritation on the lips, cheeks, gums, tongue, or sides of the mouth
• A "burning sensation" in the mouth
• Red patches in the mouth
• Ulcers, sores, or blisters inside the mouth or on the lips
  

Ulcers and Sores

In cases when stomatitis causes a canker sore, you may notice a lesion with a red base and yellow top, though this can vary.

Canker sores can range in severity from annoying to extremely painful, and typically last one to two weeks before they heal. They also vary in size, but the majority of canker sores are quite small.

When stomatitis causes a cold sore, you may first notice an area that feels itchy or tingly. This usually progresses to a fluid-filled sore which will eventually burst and ooze. After that, a yellow crust will form on top of the sore which will then scab and heal.

Cold sores last on average seven to 10 days before they heal, usually without treatment, and are extremely contagious. People who get cold sores often get them in the exact same place repeatedly.

Stomatitis Causes

There are many potential causes of stomatitis including:

• Injury from surgery
• Orthotics (such as braces or dentures)
• Biting the tongue or cheek
• Burns from hot food or drinks
• Thrush
• Chronic dry mouth
• Tobacco use
• Sexually transmitted diseases
• Herpes viruses
• Side effects of chemotherapy, radiation, or other medications
• Chemical exposure
• Certain allergies
• Stress or a weakened immune system
• Bacterial infections
• Nutritional deficiencies (specifically iron, zinc, folic acid, and vitamins B1, B2, B6, and B12 )
• Behçet syndrome
• Crohn's disease
• Lupus

Diagnosis

Many cases of stomatitis, especially canker sores or cold sores, can be diagnosed through a physical exam and a medical history including a history of your symptoms and any medications you are taking.

In other cases, blood work or allergy testing may be necessary. In more complicated cases your healthcare provider may take a biopsy or a skin scraping of the lesion for testing to determine exactly what is causing your stomatitis.

Because it involves the mouth, stomatitis is sometimes first diagnosed by a dentist rather than a medical healthcare provider. Although, your dentist may send you to your regular healthcare provider for follow-up.

Stomatitis Treatment

Some cases of stomatitis—such as a mild case of canker sores—require no treatment. Simple canker sores will usually heal on their own within one to two weeks. If a sore becomes painful, you can use an over-the-counter (OTC) oral care product that numbs the affected area to reduce pain. Also, home remedies like a saltwater solution can speed up healing.

When needed, treatment addresses the underlying cause. For example, if stomatitis is caused by tobacco use, then you will be advised to stop smoking. An underlying allergy or infection may need to be identified and treated accordingly.

Medication

Although each case is different, your healthcare provider may recommend some of the following treatments to ease pain or aid in healing stomatitis:

• OTC pain relievers (e.g., acetaminophen, ibuprofen)
• OTC topical medications (e.g., Anbesol, Zilactin-B, Blistex Medicated Lip Ointment) to help with pain, itching, inflammation, and discomfort
• OTC gels (e.g., Kank-A, Canker-X, Campho-Phenique Cold Sore) which form a protective film over mouth lesions for pain relief
  
• Prescription antiviral creams (e.g., acyclovir), which are applied as soon as you feel a cold sore coming on
  
• Prescription medications (e.g., triamcinolone) to treat itching, redness, and discomfort

Dietary Changes

In addition to medication, drinking more fluids (like water and green tea) will help keep your mucous membranes well-hydrated for faster healing. Avoiding spicy, acidic, or very hot foods will prevent further irritation and pain.

Good Oral and Dental Hygiene 

Good oral hygiene is important while healing from stomatitis. Brush at least twice a day using a soft toothbrush or your finger, if your mouth is too sore for bristles.

To ease stomatitis pain, you can try using a simple salt water rinse. Mix 1 teaspoon baking soda and ½ teaspoon salt with a quart of water; rinse several times per day, but don't swallow the mix. Alcohol-based mouthwashes should be avoided, but mouth rinses containing hydrogen peroxide (e.g., Peroxyl) help heal oral sores.

Chronic atrophic candidiasis (or denture stomatitis) affects between 17% and 75% of denture wearers. Those with full dentures are more likely to develop stomatitis than partial denture wearers. It's important to take proper care of dentures to avoid this condition.

Wax-based products (orthodontic wax) can be applied to braces or dental appliances that rub or irritate gums to create a buffer for your gums. This will help to prevent and heal stomatitis.

When to See a Healthcare Provider

You should see a healthcare provider if you have unexplained symptoms of stomatitis or symptoms that last longer than a week or two. Also, seek medical attention if you are having trouble eating and drinking and could be in danger of dehydration.

Other reasons to see a healthcare provider may include white patches on the tongue or sores in the mouth accompanied by a high fever. Do not hesitate to seek help for worrisome symptoms.

Summary

Stomatitis has many potential causes including injury, allergies, bacterial infection, and nutritional deficiencies. The condition comes with varying symptoms—most notably ulcers, sores, or blisters on lips or inside the mouth. Most cases can be diagnosed with a physical exam and a review of your medical history.

Treatment options include OTC and prescription medications in either pill or topical cream/gel form. By paying attention to oral and dental hygiene and making a few dietary changes, you can speed healing and avoid unnecessary pain. See your doctor if you have stomatitis symptoms for more than a couple of weeks, have extreme pain, or run a high fever.