OVERVIEW

What is stomatitis?

Stomatitis is a general term for inflammatory diseases of the oral mucosa, which can occur locally on the lips, tongue, gums, or simultaneously in multiple areas of the mucosa.

The commonly referred to "recurrent oral ulcers" (recurrent aphthous ulcers) in daily life are a type of stomatitis.

Stomatitis often manifests as papules, blisters, erosions, ulcers, or scabs^[1].

In most cases, stomatitis is relatively easy to treat and does not lead to serious adverse outcomes. However, some types may recur frequently, while others can cause complications if left untreated. For example, stomatitis caused by herpes virus infection may lead to meningitis if not treated promptly^[1-3].

What are the types of stomatitis?

Based on the cause, stomatitis can be broadly classified into infectious and non-infectious types:

Infectious stomatitis refers to oral inflammation caused by bacterial, fungal, or viral infections, such as herpes simplex caused by herpes virus infection or thrush caused by Candida infection.

Non-infectious stomatitis includes traumatic, radiation-induced, allergic, and idiopathic oral inflammations^[4].
1) Traumatic stomatitis: Usually caused by physical injury, such as inflammation due to a fishbone scratching the oral mucosa.
2) Radiation-induced stomatitis: Typically caused by exposure to radiation, such as chronic radiation-induced stomatitis in cancer patients undergoing radiotherapy.
3) Allergic stomatitis: Caused by exposure to allergens (e.g., certain antibiotics), such as drug-induced allergic stomatitis.
4) Idiopathic stomatitis: Cases where the specific cause of oral inflammation cannot be identified, such as the commonly seen "recurrent oral ulcers."

Is stomatitis contagious?

Not necessarily.

Stomatitis encompasses a broad range of conditions. Infectious stomatitis may be contagious, such as herpes simplex, which can spread through direct contact (e.g., kissing) or indirect contact (e.g., sharing utensils or towels)^[2]. On the other hand, non-infectious stomatitis is not contagious and does not spread among people.

Is stomatitis common? How common is it?

Very common.

Since stomatitis is a broad category of diseases, it is difficult to determine its exact prevalence. However, "recurrent oral ulcers" (recurrent aphthous ulcers) are the most common oral mucosal ulcerative condition, affecting many people at some point.

Studies suggest that this condition occurs in about 20% of the general population, meaning roughly 1 in 5 people may experience oral ulcers, regardless of age^[1,4].

Can stomatitis heal on its own?

Whether stomatitis can heal on its own depends on its severity and underlying cause.

Generally, minor and superficial traumatic ulcers heal quickly, as do aphthous ulcers, which typically resolve within 7–10 days^[1].

However, larger, deeper lesions or stomatitis with a clear infectious cause (e.g., major aphthous ulcers or thrush) usually require medical treatment and do not resolve on their own.

Therefore, if oral mucosal damage or inflammation occurs and the cause cannot be determined, it is advisable to seek medical attention promptly at a reputable hospital.

SYMPTOMS

What are the common manifestations of stomatitis?

In addition to common symptoms such as pain and redness, stomatitis may also present with papules, blisters, erosions, ulcers, and crusts^[1]. The manifestations vary depending on the type and stage of stomatitis. Below is a brief overview:

Papules: Papules are small, solid, visible, and palpable bumps that may be flat or pointed.

Blisters: Blisters are raised, round vesicles often filled with clear fluid.

Erosions: Erosions are superficial defects of varying sizes and shapes with indistinct borders, often occurring after blisters or papules rupture.

Ulcers: Ulcers are deeper than erosions, with noticeable depressions that can be felt with the tongue or observed visually. (Touching is not recommended to avoid bacterial infection.)

Crusts: Crusts form when fluid from damaged mucosa or skin dries, similar to scabs, but commonly appear on the lips.

What severe complications can stomatitis cause?

Infectious stomatitis may lead to other diseases due to bacterial or viral infections, while allergic stomatitis can cause more severe symptoms due to drug allergies. Examples include^[2.3]:

Meningitis: In some cases, herpes viruses can infect the central nervous system, leading to herpes meningitis.

Systemic toxic symptoms: Severe allergic stomatitis may cause widespread blisters, high fever, and headaches. If secondary bacterial infection occurs, it may lead to liver or kidney dysfunction, electrolyte imbalances (hyperlink), or even death.

CAUSES

What are the causes of stomatitis?

The causes of stomatitis vary depending on the type. Common causes include^[2,3]:

Infection: Exposure to viruses (e.g., herpes simplex virus), fungi (e.g., Candida albicans), or bacteria (e.g., Staphylococcus aureus) can lead to localized growth and reproduction of pathogens in the oral cavity, resulting in stomatitis symptoms.

Trauma: Physical, chemical, or mechanical irritation of the oral mucosa can cause localized damage and inflammation.

Allergies: An excessive immune response to allergens, such as drug or food allergies, may trigger inflammation.

Radiation exposure: Radiation can damage tissue cells, leading to a series of reactions and injuries, commonly seen in patients undergoing radiotherapy for head and neck tumors.

Additionally, nutritional deficiencies (e.g., vitamins, trace elements), weakened immunity, genetic factors, and psychological stress may also contribute to the development of stomatitis^[1].

Who is more likely to develop stomatitis?

• People with weakened immunity

Infants, young children, and individuals with conditions like HIV/AIDS have reduced immune defenses, making them more susceptible to infections caused by bacteria or viruses.

• People with hypersensitivity

Hypersensitive individuals overreact to allergens (e.g., certain medications, pollen, microbes), leading to physiological dysfunction, tissue damage, and stomatitis.

• Poor oral hygiene

The oral cavity naturally harbors various pathogenic bacteria. Poor hygiene practices, such as infrequent brushing or rinsing after meals, can promote bacterial overgrowth and localized inflammation^[2,3].

DIAGNOSIS

How do doctors diagnose stomatitis?

Generally, doctors can make a preliminary diagnosis based on the symptoms in the patient's oral cavity, combined with factors such as diet before the illness and places visited (to determine possible exposure to pathogenic bacteria or viruses and identify the cause of the disease).

However, some cases of stomatitis present atypical symptoms, making it necessary to identify the specific type for targeted treatment. In such cases, additional tests may be ordered, such as histopathological examination, blood tests, immunological tests, etc.^[1].

How to determine if you or someone else has stomatitis?

If you notice abnormal manifestations in the oral mucosa, such as swelling, blisters, erosions, or ulcers, accompanied by pain or a burning sensation, stomatitis should be suspected.

Since most people cannot accurately determine the type of stomatitis or whether it is contagious, medical attention should be sought promptly if the oral lesions are extensive, pain is severe, or symptoms like headache or fever are present.

Infants and young children who cannot speak or express themselves clearly require extra attention from parents. If blisters, erosions, or fever are observed, the child should be taken to a doctor immediately.

What tests are needed to diagnose stomatitis?

Typically, stomatitis can be diagnosed based on characteristic symptoms and medical history. However, when symptoms are atypical, additional tests such as blood tests, allergen testing, or pathological examinations may be required to identify the specific type of stomatitis^[1].

Blood test: Helps determine whether an infection is present and whether it is bacterial or viral.

Allergen testing: Helps identify potential allergic reactions.

Pathological examination: For example, a biopsy can rule out malignancy and confirm the specific disease type.

Other possible tests include differential white blood cell count, erythrocyte sedimentation rate, trace element analysis, antigen-antibody testing, and microbial culture. These auxiliary tests help clarify the cause and guide targeted treatment^[1].

TREATMENT

When should you seek medical attention for stomatitis?

1. Abnormal changes appear in the oral cavity, such as blisters, erosions, or ulcers, and you cannot determine the cause of the condition.

2. The symptoms are severe, such as large ulcer surfaces or intense pain.

3. Existing symptoms worsen, such as small ulcers turning into large ones, single ulcers becoming multiple, or accompanying symptoms like headaches or fever.

These situations often require diagnosis and treatment by a doctor, so do not delay and seek medical attention promptly.

If it's a simple fishbone scratch or a minor wound, or if you frequently experience recurrent oral ulcers and have been diagnosed with mild "recurrent aphthous ulcers" by a doctor, and the same mild symptoms reappear, such stomatitis can usually heal on its own without needing hospital treatment.

However, if mild symptoms persist for 3–5 days without improvement or even show signs of worsening, you should seek medical attention promptly.

What are the treatment methods for stomatitis?

The treatment plan for stomatitis is generally determined by a doctor based on the cause. It mainly includes drug therapy and non-drug therapy. Below are some common treatment methods and their purposes for general understanding. Specific treatment plans should follow the doctor's advice.

Drug therapy: This is the most important and commonly used approach. Common medications include antibiotics, antiviral drugs, antifungal drugs, corticosteroids, antihistamines, vitamins, etc.^[1].

• Antibiotics: Such as penicillin, cephalosporins, and tetracyclines. These are mainly used for bacterial infections, and different antibiotics vary in effectiveness against different bacteria.
• Antiviral drugs: Such as acyclovir and valacyclovir. These target viral infections, and different antiviral drugs vary in effectiveness against different viruses.
• Antifungal drugs: Such as itraconazole and miconazole. These target fungal infections.
• Corticosteroids: Such as hydrocortisone and prednisone. These help with anti-inflammatory, anti-toxin (bacterial endotoxin), and anti-shock effects. However, long-term or excessive use may lead to adverse effects like obesity or aggravated infections, so they must be used strictly as prescribed by a doctor.
• Antihistamines: Such as diphenhydramine and cetirizine. These mainly address allergic reactions, reducing swelling or rashes caused by allergies.
• Vitamins: Such as vitamin A and vitamin B. These are mainly used for vitamin deficiencies or as adjunctive therapy.

Additionally, if pain is significant, painkillers may be used. To improve the oral environment and reduce bacterial count, mouthwashes may also be prescribed.

Non-drug therapy: Includes laser therapy, phototherapy, ultrasonic nebulization therapy, microwave therapy, cryotherapy, etc. These aim to improve local blood circulation, enhance immune function, and promote inflammation healing^[5-8].

Moreover, for stomatitis with unknown causes or patients with psychological issues, doctors may combine medication, physical therapy, and psychotherapy.

What happens if stomatitis is not treated promptly?

If stomatitis is not treated promptly, symptoms may worsen, prolonging the illness and leading to complications or sequelae, such as herpes virus-induced meningitis or severe ulcer scarring.

These conditions not only harm the body but also affect the quality of daily life.

Additionally, if the stomatitis is contagious, it may spread to others, causing disease transmission.

DIET & LIFESTYLE

How to Reduce the Recurrence of Stomatitis?

1. Remove the Cause: For stomatitis with a clear cause, such as infectious stomatitis or traumatic stomatitis, recurrence can generally be prevented by eliminating irritants and avoiding infection. For example, bacterial or viral infections should be treated with medication; if orthodontic appliances frequently cause oral injuries, consult a dentist promptly; poor oral hygiene can be addressed by brushing and rinsing more frequently.

2. Timely Treatment: For stomatitis with an unknown cause, such as recurrent aphthous stomatitis, symptoms may recur. Prompt symptomatic treatment (e.g., pain relief, mouthwash for oral cleaning) can help alleviate symptoms or reduce the frequency of outbreaks, though a complete cure may not be possible.

3. Other Measures:

   • Maintain a balanced diet, avoiding picky eating, and ensure adequate intake of essential nutrients.

   • Reduce consumption of irritating foods, such as overly spicy or excessively hot items^[9].

   • Ensure sufficient sleep (7–8 hours per night for adults) and avoid staying up late.

   • Engage in moderate exercise, such as jogging or swimming, adjusting the intensity to a level that causes slight sweating without significant breathlessness.

What Dietary Precautions Should Be Taken for Stomatitis?

1. Avoid rough, hard, overly hot, or spicy foods to prevent further mucosal damage and promote healing.

2. Strive for a balanced diet, ensuring daily intake of proteins, carbohydrates, fats, and various vitamins, while avoiding selective eating habits.

3. Maintain regular eating habits with three meals a day at fixed times and in appropriate portions, avoiding overeating^[1,9].

PREVENTION

Can Stomatitis Be Prevented? How to Prevent It?

Stomatitis with a clear cause can be prevented by avoiding exposure to the causative factors. For example, ordinary people should avoid contact with infectious individuals, while infectious patients should practice isolation. When taking medication, pay attention to allergy warnings and strictly follow medical advice. Maintain oral hygiene, such as rinsing the mouth promptly after meals^[1].

Some types of stomatitis cannot be completely avoided, but their occurrence can be reduced by boosting immunity^[1] to help the body resist external pathogens. For example:

1. Maintain a balanced diet, avoid picky eating, and ensure adequate intake of essential nutrients;

2. Reduce the consumption of irritating foods, such as overly spicy or excessively hot items^[9];

3. Ensure sufficient sleep (generally 7–8 hours for adults) and avoid staying up late;

4. Engage in moderate exercise, such as jogging or swimming. Adjust daily activity levels based on personal condition, ideally until mild sweating occurs without significant breathlessness.