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
- 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.
Severe herpes simplex infection
Toxic epidermal necrolysis
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.
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: