Stomatitis is a type of infection or inflammation that appears inside the mouth. In its mildest form, nothing is visible but there is a burning feeling in the area. Usually, parts of the mouth are red and swollen. It can be a painful condition and sometimes the affected areas turn into open ulcers.

Stomatitis can be caused by a number of various diseases. The most common triggers are aphthous ulcers, also known as canker sores. These are very visible and painful ulcers located on the inner mouth or the tongue, consisting of a red inflamed area covered with a yellow substance. These ulcers are unpleasant but not connected to other serious diseases and disappear on their own in about two weeks. The condition normally starts after the age of 10 and the ulcers might appear several times afterwards.

Overall, stomatitis can be a painful and annoying condition. The symptoms are different from one case to another, depending on the cause and the severity of the outbreak. The common aphthous ulcers have a red base with a yellow or white coating and can be found on the tongue or inner lips or cheek. These ulcers heal themselves after 4 to 14 days but often appear again after a while. Lesions can also look like red areas or blisters. Other possible symptoms are swelling inside the mouth or a burning sensation, known as oral dysaesthesia in medical terms.

The condition has multiple causes, sometimes more than one can be present at one time. These can be divided into local causes, due to factors inside the mouth, and wider problems (also known as systemic causes).

Local causes can be diseases such as aphthous ulcers. A bad immunity system, due to various causes, can lead to infections. These can be started by bacteria, like in the case of syphilis or yeast infections. The infection can also be viral, like the Coxsackie virus, herpes simplex as well as ulcers caused by hand-foot-and-mouth disease. Some aggressive drugs like a number of antibiotics, sulfa drugs or antiepileptics, are also able to cause skin lesions. Other common causes include wounds due to bad fitting dentures or other dental appliances, as well as the corrosive action of chemical compounds.

Systemic causes are more general problems or diseases of the body that cause stomatitis as a side effect. These include sexually transmitted diseases such as syphilis, gonorrhea, any condition which is associated with xerostomia as well as stress. Other possible causes are diseases such as Behcet's disease, celiac disease, lupus and other vasculitic illnesses, aggressive chemotherapy cures against cancer, strong allergic reactions as well as a wide array of various infections, like acute necrotizing ulcerative gingivitis.

Stomatitis is usually divided in two main types. The most common lesions are canker sores, also named aphthous ulcers. Their base is red and remains visible as an exterior ring, while the lesion is covered by a yellow or white secretion. They usually appear on the tongue, inside lips or inside cheeks. They can emerge isolated or in small groups.

This type of lesion can be very painful but the acute period is brief. Normally, canker sores heal after an interval of 4 days to 2 weeks. About 10% of all stomatitis cases are more severe and the lesions need a longer period to heal, a maximum of 6 weeks.

There seems to be a genetic vulnerability to canker sores, since they affect entire families. They can't be transmitted to another person. Women, youngsters, teenagers and people in the 20s have an increased risk to be affected by this condition.

The second main type of stomatitis is known as cold sores. Also known as herpes stomatitis, this condition is caused by an infection with the herpes virus (HSV). The lesions are small and full of fluid but can be very tender and painful. Cold sores usually appear around the mouth or on the lips.

Sometimes, a sensation of burning or tenderness can be experienced in the area where a cold sore is about to emerge. An individual sore needs about 5-7 days to heal but more of them can appear in the same location. The fluid inside the sores is extremely contagious. After a few days, the cold sores dry up and are covered by a yellow crust, which falls off as soon as the skin under it is fully healed.

There is also another classification of stomatitis, depending on the affected area of the mouth. Scientists distinguish four separate types: inflammation of the gums (gingivitis), inflammation of the tongue (glossitis), inflammation of the lips and around the mouth (cheilitis) and inflammation of the back of the mouth (pharyngitis).

Treatment options

Since stomatitis can have various causes, the treatment depends on the specific problem. For example, if the condition is caused by medication, like when there is an allergic reaction to it, it has to be stopped. In some cases, there are no options and the treatment must be continued even if stomatitis is a side effect. Chemotherapy is such an example.

If stomatitis has an infectious nature, specific counters have to be used. These include antibiotics for streptococcal attacks, as well as topical antifungal or oral antifungal agents in cases of Candida. It is also possible that stomatitis is an effect of a nutritional problem, which has to be first identified and then fixed. If the lesions are caused by methotrexate for example, folic acid is a possible cure. Finally, systemic corticosteroids or other immunosuppressive measures are required in cases of stomatitis with an immune system origin.

Regardless of the cause, the lesions can be treated locally. Several products can relieve the symptoms, such as local anesthetic mouthwashes and sprays, oral painkillers, topical corticosteroids, antiseptic mouthwash or protective pastes.

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