Stomatitis

What is stomatitis?

Stomatitis refers to inflammation of the mucous membrane of the mouth, including the inner aspect of the lips, cheeks, gums, tongue and throat. It is a type of mucositis. It can be acute or chronic, mild or serious.

Inflammation of the vermilion of the lips is known as cheilitis, inflammation of the tongue is glossitis, inflammation of the gums is gingivitis, and inflammation of the back of the mouth is pharyngitis.

What are the symptoms of stomatitis?

Stomatitis results in pain, stinging and soreness. It can present with:

• Red patches
• Mouth ulcers
• Blisters
• Peeling
• Swelling
• Oral dysaesthesia (numbness)
• Burning mouth syndrome – soreness despite normal appearance

These can lead to dehydration and malnutrition.

What causes stomatitis?

Stomatitis can be due to injury, infection, allergy, systemic or skin disease. Most commonly, it is due to:

• Dry mouth / xerostomia
• Viral infection
• Candida albicans infection
• Trauma including surgery
• Smoking tobacco
• Toxicity of chemotherapy drugs – including methotrexate used for psoriasis and other skin disorders
• Therapeutic radiation e.g. for oral cancer

Some of the causes of stomatitis are listed in the table below.

Clinical presentations of stomatitis

Oral candidiasis	Severe herpes simplex infection	Radiation stomatitis
Toxic epidermal necrolysis	Contact allergy	Erosive lichen planus

What investigations should be undertaken?

Relevant investigations depend on the likely cause of stomatitis and whether it is accompanied by other symptoms internally or skin rashes.

They may include:

• Bacterial swabs
• Viral swabs
• Tissue scrapings for mycology
• Biopsy for histology and direct immunofluorescence
• Blood tests
• Patch tests to identify contact allergy

What is the treatment of stomatitis?

Treatment for stomatitis depends on the cause. If it is due to allergy to a medication, the medication must be promptly stopped. However, it may be necessary to continue a causative medication when stomatitis arises as an expected adverse reaction to chemotherapy.

Infections may require specific treatment such as antibiotics for streptococcal pharyngitis, topical antifungal or oral antifungal agent for candida infection.

Nutritional deficiencies should be identified and corrected, for example, folic acid can reduce methotrexate-induced stomatitis.

Immunobullous diseases may be treated with systemic corticosteroids or other immunosuppressive treatments.

Symptomatic treatment may include:

• Antiseptic mouthwash
• Protective pastes
• Local anaesthetic mouthwash or spray
• Oral analgesics (pain killers)
• Topical corticosteroids