Stomatitis
Definition
Stomatitis is an inflammation of the mucous lining of 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.
Description
Stomatitis is an inflammation of the lining of any of the soft-tissue structures of the mouth. It is usually a painful condition, associated with redness, swelling, and occasional bleeding from the affected area. The inflammation may be caused by conditions in the mouth itself, such as poor hygiene, from burns from hot food or drinks, or by conditions that affect the entire body, such as medications, allergic reactions, or infections. Children may develop stomatitis at any point in their development, from infancy to adolescence . The two most common types seen in children are herpes stomatitis, which is caused by the herpes simplex virus, and aphthous stomatitis, more often referred to as canker sores .
Transmission
Depending upon its cause, stomatitis may or may not be contagious. Herpes stomatitis is considered contagious. Children may be exposed through kissing, sharing food, or playing in close contact with others who have an active herpes infection, such as a cold sore . Aphthous stomatitis is not contagious.
Demographics
Though stomatitis may occur at any time during a child's growth, different types affect children at different times. Herpes stomatitis can occur anywhere between six months and five years of age but is most common in children one to two years old who have not been exposed to the herpes virus before. Aphthous stomatitis begins in childhood or adolescence, with peak onset in those aged ten to 19 years. Aphthous ulcers may be more common in females than males. Children of higher socioeconomic status may be more affected than those who are from lower socioeconomic groups.
Causes and symptoms
Causes
A number of factors can cause stomatitis. Cheek biting, braces, or jagged teeth may persistently irritate the oral structures. Chronic mouth breathing due to plugged nasal airways may cause dryness of the mouth tissues, which in turn leads to irritation. The cause of herpes stomatitis is the herpes virus type 1 (not to be confused with genital herpes, which is caused by the herpes virus type 2 and is a sexually transmitted disease). The cause of aphthous stomatitis is unknown, although several factors are suspected. There may be an inherited tendency to develop canker sores and there may also be an immune system link. In addition, they may be triggered by emotional stress; nutritional deficiencies of iron, folic acid , or vitamin B12; menstrual periods; food allergies ; or viral infections. They may occur with no identifiable cause.
Symptoms
Stomatitis is characterized by pain or discomfort in the mouth and the presence of open sores or ulcers in the mouth. Herpes stomatitis may cause the following symptoms:
- fever , sometimes as high as 101–104°F (38.3–40°C), which may precede the appearance of blisters and ulcers by one or two days
- irritability and restlessness
- blisters in the mouth, often on the tongue or cheeks or roof of the mouth, which then pop and form ulcers (These ulcers are usually small [about one to five millimeters in diameter], grayish white in the middle, and red around the edges.)
- swollen gums, which may be irritated and bleed
- pain in the mouth
- drooling
- difficulty swallowing
- foul-smelling breath
Aphthous stomatitis may cause the following symptoms:
- burning or tingling sensation in the mouth prior to the onset of other symptoms
- skin lesions on the mucous membranes of the mouth, which begin as a red spot or bump, then develop into an open ulcer, which is usually small (one to two millimeters to one centimeter in diameter) (The ulcers can be single or break out in clusters. The ulcers are painful, and the center appears white or yellow with a fibrous texture. The border of the sore may be bright red.)
When to call the doctor
Parents should call the doctor if any of the following occur:
- inability to drink or swallow
- high temperature
- fussiness and inability to settle down
- symptoms not improved after three days
If the child appears dehydrated, parents should seek immediate medical attention. Signs include dry lips, the absence of tears when crying, a sinking soft spot on an infant's head, and no urination in eight hours or very dark urine. Parents should also seek care if the child is very weak, tired, or difficult to waken.
Diagnosis
Stomatitis is diagnosed by the doctor based primarily upon the appearance of the mouth sores. Both herpes and aphthous stomatitis have lesions that are unique in appearance. Although laboratory studies are seldom performed, the physician may order further blood tests or cultures of the lesions in order to confirm the diagnosis and rule out other causes.
Treatment
The treatment of stomatitis is based upon the problem causing it. For all types, local cleansing and good oral hygiene is 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. If toothbrushing is too painful, the child should rinse out his mouth with plain water after each meal. Local factors, such as sharp teeth or braces, can be addressed by a dentist or orthodontist.
Herpes stomatitis treatment
In herpes stomatitis, the most important part of treatment is for parents to keep their child drinking as normally as possible. Bland fluids such as apple juice, liquid flavored gelatin, or lukewarm broth are easiest to drink. Sucking on a Popsicle or sherbet may be soothing. Citrus juices and spicy or salty foods should be avoided. In the event of severe disease, the doctor may use intravenous fluids to prevent dehydration . Acetaminophen may be used for temperatures over 101°F (38.3°C) and to address pain. Medicines that numb the mouth, like viscous lidocaine or topical anesthetics only last for a brief time and, by numbing the mouth, may cause your child to further injure damaged tissues without knowing it. Antibiotics are of no help in treating herpes stomatitis. However, if the case is particularly severe, the doctor may prescribe an antiviral medication such as acyclovir which, if given at the beginning of the outbreak, may help clear things up faster.
Aphthous stomatitis treatment
Medical treatment is usually not necessary for aphthous stomatitis, unless the ulcers are severe (larger than one centimeter or lasting longer than two weeks). In this case medical evaluation and treatment may be indicated, and topical or oral tetracycline may be given. However, tetracycline is usually not prescribed for children until after all of their permanent teeth have erupted, as it can permanently discolor teeth that are still forming. Avoid hot or spicy foods to minimize discomfort. Mild mouth washes such as salt water or over-the-counter mouthwashes may help. Over-the-counter topical medications applied to the ulcerated area may reduce discomfort and sooth the area. To prevent bacterial infections from developing, parents should encourage their child to brush and floss teeth regularly.
Alternative treatment
Placing a spent tea bag on a canker sore may provide comfort. Sodium lauryl sulfate (SLS), a component of some toothpastes, is a potential cause of canker sores. In one study, most recurrent canker sores were eliminated just by avoiding SLS-containing toothpaste for three months.
Nutritional concerns
Some physicians may recommend a variety of dietary measures to treat stomatitis. These may include eating cottage cheese, buttermilk, and yogurt, as well as foods high in B vitamins . Some doctors may recommend supplementation with folic acid, iron, or vitamin B12.
Prognosis
The prognosis for the resolution of stomatitis is based upon the cause of the problem. Many mouth ulcers are benign and resolve without specific treatment. In the case of herpes stomatitis, complete recovery is expected within ten days without any medical intervention. Oral acyclovir may speed up recovery. Most children are minimally inconvenienced by aphthous stomatitis, because attacks are usually infrequent and only last a few days.
Prevention
Stomatitis caused by irritants can be prevented by good oral hygiene, regular dental checkups, and good dietary habits. Because so many adults and children carry the herpes virus, and because they can pass it on even if they have no symptoms, there is no practical way to prevent herpes stomatitis. Parents can, however, discourage their child from kissing, sharing food, or playing in close contact with people who have an active herpes infection.
Canker sores may be minimized by teaching children to avoid trauma, even minor trauma, to the mouth, such as hard toothbrushes and rough foods. If the doctor has determined that the child has a nutritional deficiency, parents can insure that the child is taking the appropriate supplements and eating the recommended foods. Avoiding stressful situations may also be beneficial.
Parental concerns
Most cases of stomatitis in children are benign and resolve within a relatively short period of time. Children with herpes stomatitis may return to school or day care when their fever is gone and the mouth sores are healed. Since aphthous stomatitis is not contagious, there is no need to curtail a child's activities unless they have developed signs of complications, such as infection.
See also Canker sores .
Resources
PERIODICALS
Vander Schaaf, Rachelle. "Cool Relief for Canker Sores." Parenting 17, no. 6 (August 1, 2003): 38.
ORGANIZATIONS
American Dental Association. 211 E. Chicago Ave., Chicago, IL 60612. Web site: http://www.ada.org.
WEB SITES
"Medical Encyclopedia: Herpetic Stomatitis." Medline Plus January 16, 2004. Available online at http://www.nlm.nih.gov/medlineplus/print/ency/article/001383.htm (accessed October 14, 2004).
Stine, Annie. "Gingivostomatitis (herpes mouth sores)." Babycenter.com 2004. Available online at http://www.babycenter.com/refcap/toddler/toddlerills/todthroatprobs/1201460.htm (accessed October 14, 2004).
Deanna M. Swartout-Corbeil, RN Joseph Knight, PA
KEY TERMS
Aphthous stomatitis —A specific type of stomatitis presenting with shallow, painful ulcers. Also known as canker sores.
Herpes stomatitis —A form of stomatitis caused by the herpes 1 virus, usually seen in young children.
Stomatitis —Inflammation of the mucous lining of any of the structures of the mouth, including the cheeks, gums, tongue, lips, and roof or floor of the mouth.