Stomatitis

What is stomatitis?

Stomatitis, or oral mucositis, is inflammation in the mucous membranes (mucosa) that line your mouth or lips. It’s a type of mucositis, which includes inflammation involving your oral mucosa or any of the mucous membranes lining your gastrointestinal (GI) tract.

Inflammation is your body’s natural response to an injury, which means that most anything that damages the mucosa in your mouth can lead to stomatitis. This is why it’s important to know the signs. Many causes of the inflammation aren’t serious and heal on their own. But others require prescriptions or other treatments that involve seeing a healthcare provider.

Types of stomatitis

The two most common types of stomatitis are canker sores and cold sores. Canker sores (aphthous stomatitis) appear inside your mouth, in places like your inner lip. Cold sores (herpetic stomatitis) are fluid-filled blisters that appear alone or in clusters on your lip or around your mouth.

Less common types of stomatitis include:

• Angular cheilitis (angular stomatitis): Involves irritation, cracks and sores in the corners (“angles”) of your mouth.
• Thrush (candidal stomatitis): Involves an overgrowth of candida fungi in your mouth.
• Contact stomatitis: Involves inflammation that happens inside your mouth because of an allergic reaction.
• Denture stomatitis: Involves irritation in your mouth that often happens alongside candidal stomatitis. It mostly affects people who wear dentures.
• Gingivostomatitis: A viral or bacterial infection that leads to inflammation of your mouth or gums.
• Nicotine stomatitis: Affects people who smoke or use tobacco. Signs include white, cobblestone-like patches of tissue in the roof of your mouth.

What are the symptoms of stomatitis?

Signs and symptoms of stomatitis include:

• Redness and swelling inside your mouth.
• A tiny blister (or cluster of blisters) that appears on or around your lips.
• One or more sores inside your mouth that are usually white, gray or yellow, with a red border.
• White or gray patches on your tongue, the roof of your mouth or inside your cheeks.
• The sensation that your tongue and the roof of your mouth are burning.
• Mild to severe pain or discomfort that may make it difficult to eat, swallow or talk.

What causes stomatitis?

Stomatitis can have many causes, including viral infections, mouth injuries and immune system conditions — among others

• Infections: The most common infectious disease that causes stomatitis is HSV-1, the herpes virus that causes cold sores. But other viral infections, as well as bacterial and fungal infections, can also cause stomatitis.
• Mouth injuries: Most anything that damages the delicate mucous membrane inside your mouth triggers your body’s healing response, causing inflammation. Causes range from ill-fitting dentures that scrape the inside of your mouth to heat damage from smoking cigarettes.
• Allergic reactions or mouth irritation: Substances that you’re allergic to or that irritate your mouth can cause oral mucositis. Causes may include ingredients in dental products (like mouthwash), cosmetics (like lipstick) or spicy foods.
• Treatments: Oral mucositis is a common cancer treatment side effect. Treatments like chemotherapy and radiation therapy kill cancer cells, but they can damage healthy cells in the process. The cells in the mucous membranes lining your mouth are particularly vulnerable.
• Medications: Certain types of medications associated with oral mucositis include beta-blockers, immunosuppressants and nonsteroidal anti-inflammatory drugs (NSAIDs).
• Systemic conditions: Conditions that impact entire body systems can cause stomatitis. These include inflammatory diseases, like Behçet’s disease and celiac disease. Skin conditions, like Bullous pemphigoid and lichen planus, can also cause stomatitis.
• Nutritional deficiencies: Not getting enough of the nutrients your body needs to repair damaged mucosa in your mouth can lead to stomatitis. This includes deficiencies in folate, iron, vitamins B12 and C, and zinc.

Risk factors for stomatitis

You’re more at risk of developing stomatitis if you:

• Don’t regularly clean your teeth: Neglecting dental care increases your risk of infections.
• Have dry mouth: Saliva (spit) provides a protective layer for your mucosa. Not having enough of it increases your risk of injury and infection.

What are the complications of stomatitis?

Sometimes, the pain and swelling from stomatitis are so bad that it hurts to eat or drink. Sometimes, that’s all the encouragement needed to skip meals. But not getting the nutrients or fluid you need can pose serious health risks like malnutrition and dehydration.

Although infections can cause stomatitis, they’re also a potential complication. Having an injured mucosa makes you more vulnerable to germs that can trigger more inflammation and tissue damage.

It’s important to see a healthcare provider and get treated to prevent things from getting worse.

How is stomatitis diagnosed?

Your provider will likely be able to recognize most types of stomatitis, like canker sores and cold sores, just by looking. Reviewing your medical history and symptoms helps, too. For example, knowing that you’re getting cancer treatment may suggest that your oral mucositis is a treatment side effect. Symptoms impacting parts of your body other than your mouth may suggest a systemic disease.

You may also need tests to diagnose stomatitis, including:

• Tests to check for viruses, bacteria or fungi.
• Blood tests to check your overall health or for signs of systemic diseases.
• Allergy tests to check for allergens causing stomatitis.
• Biopsy to check for unusual cells that may be signs of a more serious condition (rarely, only when the other tests don’t lead to a diagnosis).

It may take some trial and error if what’s causing your oral mucositis is a reaction to a chemical or other irritant. For example, if your provider suspects your mouthwash is causing the inflammation, they may recommend switching brands to see if your mouth heals.

How is stomatitis treated?

Treatment for stomatitis depends on what’s causing it. The only way to cure stomatitis is to treat or manage the issue that’s creating problems. Treatments include:

• Over-the-counter (OTC) medications for canker sores and cold sores.
• Prescription medications for infections, like antivirals, antibiotics and antifungals.
• Vitamins or supplements so you’re getting the nutrients you need.
• Steering clear of foods or products triggering your inflammation.
• Practicing good oral hygiene to keep your mouth free of harmful bacteria while your mouth heals.

In the meantime, your healthcare provider may recommend treatments to manage pain, including topical anesthetics, magic mouthwash and corticosteroids.

Can oral mucositis be prevented?

You can’t prevent all causes of stomatitis, but you can reduce your risk by:

• Brushing twice a day, flossing daily and getting regular dental cleanings.
• Eating balanced meals and getting enough water daily.
• Choosing not to smoke or use tobacco (or quitting if you do).
• Avoiding shared foods, drinks or lip balm and intimate contact (kissing, oral sex) with someone with a cold sore.

What can I expect if I have stomatitis?

Some types of stomatitis go away on their own. For example, both canker sores and cold sores usually clear up on their own within two weeks, often without treatment. Medications can speed healing. Since there’s no cure for the herpes virus that causes mouth sores, outbreaks usually come and go throughout life. But they’re usually not serious.

For other types of stomatitis, your outlook depends on what’s causing it. Most causes are treatable or manageable.

When should I see my healthcare provider?

Contact your provider if you have a mouth sore and you’re immunocompromised. If you’re a parent or caregiver of a newborn and notice they have a cold sore, contact their pediatrician right away. Stomatitis can lead to serious infections in these instances.

You should also schedule an appointment if you have a mouth sore that doesn’t get better within 10 days and you’re noticing other signs and symptoms, like:

• A fever higher than 100.4 degrees Fahrenheit (38 degrees Celsius).
• A blister or rash on your skin.
• Eye pain, redness, blurred vision or swelling.

What questions should I ask my healthcare provider?

Questions to ask include:

• What’s causing my stomatitis?
• Will it heal on its own?
• What treatments will I need to cure it?
• What treatments can help relieve symptoms while the inflammation heals?