A common infection, stomatitis — inflammation of the oral mucosa — may extend to the buccal mucosa, lips, and palate. It may occur alone or as part of a systemic disease.
There are two main types: acute herpetic stomatitis and aphthous stomatitis. Acute herpetic stomatitis is common and mild. Aphthous stomatitis is common in young girls and female adolescents.
Acute herpetic stomatitis is usually short-lived and easily recognized; however, it may be severe and, in neonates, may be generalized and potentially fatal. Aphthous stomatitis usually heals spontaneously, without a scar, in 10 to 14 days.
Other oral infections include gingivitis, periodontitis, Vincent’s angina, and glossitis. (See Oral infections, pages 816 and 817.)
Acute herpetic stomatitis results from herpes simplex virus. The cause of aphthous stomatitis is unclear.
Acute herpetic stomatitis begins with burning mouth pain. In immunocompromised individuals, reactivation of the herpes simplex virus infection may be frequent and severe. Gums are swollen and bleed easily, and the mucous membranes are extremely tender. Papulovesicular ulcers appear in the mouth and throat and eventually become punched-out lesions with reddened areolae. The small vesicles rupture and form scales. Another common finding is submaxillary lymphadenitis.
Pain usually disappears from 2 to 4 days before healing of ulcers is complete.
A patient with aphthous stomatitis will typically report burning, tingling, and slight swelling of the mucous membrane. Single or multiple, small round ulcers with whitish centers and red borders appear and heal at one site but then appear at another. The painful stage lasts 7 to 10 days, with healing complete in 1 to 3 weeks.
Physical examination allows diagnosis. A smear of ulcer exudate allows identification of the causative organism.
For acute herpetic stomatitis, treatment is conservative. For local symptoms, management includes warm-water mouth rinses (antiseptic mouthwashes are contraindicated because they’re irritating) and a topical anesthetic to relieve mouth ulcer pain.
CLINICAL TIP: A course of acyclovir (200 to 800 mg, five times daily for 7 to 14 days) may shorten the course and reduce postherpetic pain.
Supplementary treatment includes bland or liquid diet and, in severe cases, I.V. fluids to maintain hydration, and bed rest. After the gums are less tender, a dentist should scale and polish the teeth and emphasize good oral hygiene.
For aphthous stomatitis, primary treatment is application of a topical anesthetic. Effective long-term treatment requires alleviation or prevention of precipitating factors.
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Copyright Details: Handbook of Diseases, Copyright © 2008 Williams & Wilkins.
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Title: Handbook of Diseases Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 1-58255-266-5 
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