Stomatitis

Overview

Stomatitis is inflammation of the mouth mucosa. Causes include fungal, viral, and bacterial infection, vitamin deficiency, trauma, and other irritation.

Painful or prolonged stomatitis can reduce intake, causing dehydration or undernutrition, especially in children.

Initial care in all cases

• Maintain hydration and feeding.
• Offer soft, non-acidic foods that do not irritate the mouth.
• Use nasogastric feeding for a short period if pain prevents eating and clinical support is available.
• Keep the mouth clean to prevent complications and recurrence.
• Examine the mouth of infants with breast refusal or difficulty sucking.

Major causes to identify

• Oral or oropharyngeal candidiasis.
• Primary or recurrent oral herpes.
• Other infectious causes such as pharyngitis, diphtheria, or measles.
• Scurvy from vitamin C deficiency.
• Other nutritional deficiencies, including riboflavin, niacin, pyridoxine, and iron deficiency.
• Trauma, caustic or thermal injury, medicine reaction, severe systemic infection, HIV, diabetes, and severe malnutrition should be considered when the presentation is extensive, recurrent, or atypical.

Complications, prevention, and handover

• Complications include dehydration, undernutrition, secondary bacterial infection, inability to breastfeed, missed diphtheria or measles, oesophageal candidiasis, eye involvement in herpes, and severe underlying disease.
• Prevention depends on oral hygiene, safe feeding, correcting nutritional deficiencies, reducing unnecessary antibiotics, rinsing after high-dose inhaled corticosteroids, vaccination for relevant infections, and management of HIV, diabetes, or malnutrition.
• Handover should include duration, lesion type and distribution, pain severity, feeding/drinking ability, hydration status, infant sucking, fever, recurrence, immune/nutrition risks, suspected cause, treatment started, and follow-up plan.