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Stomatitis refers to inflammation of the mouth. It appears as either a red and swollen appearance of the mouth, with pain, or as discrete ulcers. Rarely, there are no ulcers, but only a burning sensation inside the mouth.
Aphthous ulcers are the most common cause of stomatitis. These are acute painful ulcers on the tongue, or the inside of the lips or cheeks. They are also called canker sores, and have a reddish base, with a yellowish covering. They are not associated with other symptoms, and heal in a week or two. They usually appear first after the age of 10 years, and may reappear on and off over the next few years.
Stomatitis in general has several possible causes, which may overlap or interact with each other.
Local causes of stomatitis include factors such as:
Systemic causes include:
Diagnosis depends on a careful history and examination. A lot of information can be obtained by carefully noting the type and distribution of the ulcers, what their appearance is related to, other symptoms which may indicate the presence of systemic disease, a history of sexual contact with multiple partners, the medications the patient is on, or has taken in the past, and a history of tobacco use.
Certain diseases cause recurrent oral ulcers, such as RAS, herpes simplex and Behcet’s disease. On the other hand, yeast infection as a cause of stomatitis should be suspected in the presence of diabetes, HIV infection, or any other condition which causes weakened immunity.
Some diseases have associated findings, such as:
Conditions which present with both skin and oral ulceration include:
Conditions which manifest with oral ulcers alone include:
In the absence of systemic symptoms, diagnosis of primary ulceration is easy, and no testing is required. If such symptoms are present, or ulcers persist without obvious cause, testing and sometimes, biopsy, should be done.
Treatment includes eliminating or treating any obvious local or systemic causes, good oral hygiene, salt-water rinses, use of a soft toothbrush, and the use of mouthwashes which, preferably, do not contain alcohol. Topical treatments include the use of anesthetics, substances which coat the ulcer, steroids or cauterization.