Stomatitis aphthosa and herpetica

Stomatitis is an inflammation of the oral mucosa and can affect the cheeks, gums, lips and palate.


Types of stomatitis

Mycotic stomatitis (also called oral candidiasis or oral thrush) is an infection of the mouth and throat with Candida fungi.
It is very common in newborns and can occur in adults especially after antibiotic treatment.
Immunocompromised people are particularly vulnerable.

Stomatitis nicotina is caused by smoking cigarettes, cigars and pipes. You can recognize them by red bumps on the palate.

Stomatitis herpetica or gingivostomatitis is caused by a viral infection of the mouth and is characterized by blisters that later develop into ulcers on:

  • Tongue
  • Gums
  • Lips.

It usually occurs in children between 6 months and 5 years.
It is an infection caused by the herpes simplex virus type 1″ (HSV-1), the same virus responsible for cold sores on the outside of the lips in adults.
HSV-2 causes genital herpes and is related to type 1.

Aphthosa stomatitis leads to the formation of small ulcers (aphthae):

Pregnancy is a risk factor for this disorder.

Recurrent aphthosa stomatitis is a disease of unknown cause that can cause at least one painful, superficial ulcer of the mucous membranes.

Chronic ulcerative stomatitis is a disease characterized by:

  • Ache
  • recurrent ulcers with a whitish coating at the level of the gums and the inside of the lips,
  • Fever
  • enlarged cervical lymph nodes,
  • Halitosis.

Stomatitis uraemica is a rare complication of uremia that can occur due to advanced renal insufficiency.
It is an oral manifestation of uremia and causes:

  • skin redness (erythema) of varying severity,
  • accumulation of flammable fluid (exudate),
  • Ulcers
  • decreased salivation,
  • Bleeding
  • bad breath (breath smells of ammonia),
  • burning sensation.

Stomatitis angularis is the inflammation of the lip surface with the following effects:

  • Swelling
  • Incisions
  • Desquamation
  • Wounds
  • Ulcers on both sides of the mouth.

Gangrenous stomatitis (also called noma, water cancer or cheek burn) is caused by malnutrition or particularly debilitating diseases (e.g. malaria). The result is the destruction of the oral mucosa, up to the exposure of parts of the interior of the mouth, such as the teeth.

What are the causes of stomatitis?

List of possible causes

Bacterial infection

  • Necrotizing periodontitis
  • Infection by mycoplasma
  • Syphilis
  • Gonorrhea
  • rare: actinomycosis, tuberculosis


  • Infection by Candida albicans (oral thrush, oral candidiasis)
  • rare: blastomycosis, cryptococcosis, zygomycosis


  • Infection by herpes simple virus
  • Infection by varicella-zoster virus
  • Infection by enterovirus – hand-foot-and-mouth disease or herpangina
  • Infection by Epstein-Barr virus or glandular fever (infectious mononucleosis)
  • Measles, can cause Koplik spots in the mouth

Systemic diseases

  • Under-nourishment/malnutrition, iron deficiency and deficiency of vitamins from the B-complex (pellagra) and vitamin C (scurvy)
  • Infectious diseases of the intestine (such as Crohn’s disease)
  • Scarlet fever
  • Behçet’s disease
  • Kawasaki syndrome
  • Erythema multiforme
  • Toxic epidermal necrolysis and Stevens-Johnson syndrome

Drugs and pollutants

  • Stomatitis nicotina
  • Chemotherapy
  • Radiotherapy
  • Lichen-planus-like rash

Physical irritation

  • Burns
  • Stomatitis caused by dentures (e.g. braces, loose-fitting dentition, inappropriate or sharp-edged dentures)

Risk of infection in stomatitis

Depending on the cause, stomatitis may or may not be contagious.
Stomatitis caused by the herpes virus is considered contagious.
In children, infection usually occurs through:

  • Kisses
  • eating together,
  • Play with close physical contact with other infected children.

The incubation period of stomatitis herpetica is from 2 to 12 days.
The child is contagious about 2 days before blisters form until the blisters stop.
Aphthosa stomatitis is not contagious.

Symptoms of stomatitis

  • blisters in the mouth, especially on the tongue or cheeks
  • Children cry and eat less, even though they are hungry
  • difficulty swallowing (dysphagia)
  • excessive salivation
  • high fever (up to 40°C) 1-2 days before the appearance of blisters and ulcers
  • Irritability
  • Pain in the mouth, including when chewing, speaking or moving the lips
  • swollen, bleeding gums
  • Ulcers in the oral cavity, especially on the tongue, cheeks, usually after the rupture of the blisters.

How is the diagnosis of aphthous stomatitis carried out?

The diagnosis is made on the basis of medical history and physical examination.
The medical assessment is sufficient for the diagnosis.
As a rule, only one ulcer is present.
To confirm the diagnosis of stomatitis and exclude other diseases, the doctor may order the following examinations:

  1. Blood analysis to measure the levels of zinc, ferritin, serum iron, folic acid, vitamin B12.
  2. Biopsy of the ulcer, for this a small sample of tissue is taken and examined under a microscope.

How is stomatitis treated?

The treatment goals for recurrent aphthae are:

  • Symptom relief
  • Reduction of healing times
  • Preventing future outbreaks

Stomatitis usually heals on its own.
The doctor may prescribe medication for wound treatment.
One can prevent a new outbreak by avoiding the triggering factors, e.g. certain foods such as: nuts and pineapple.

Treatment of recurrent aphthosis should be determined based on the severity of the disease.
Patients often report severe pain, although the examination reveals only a small ulcer (smaller than 1-2 mm in diameter).
In addition, the frequency and intensity of symptoms are taken into account when choosing the best method of treatment.

Drug treatment of stomatitis

Often prescribed are:

  1. Anti-inflammatory drugs from the group of nonsteroidal anti-inflammatory drugs (eg benzydamine) or cortisone-containing agents and immunomodulators (eg cyclosporine) in the first stages of the disease.
    Anti-inflammatories are available as:
    – gargle solution, – ointment, – paste, – oil, – spray (tantum verde),
    – topical gel.In case of a viral infection,

    the doctor prescribes drugs to fight the virus (antivirals). Acyclovir is the most commonly used.

  2. Gargle solutions reduce the bacterial load, thus alleviating bacterial infections:
    – inflammation,
    – accelerate the healing process.One representative is chlorhexidine digluconate.
    Topically applied lidocaine or benzocaine are anesthetics used to relieve pain.
  3. A concentrated, bioadhesive gel (GELCLAIR)® forms a protective film to relieve the pain.
  4. Patients may need a medication for pain management and fever reduction, paracetamol (such as ben-u-ron) is recommended.

Treatment of stomatitis herpetica

If a child is affected by stomatitis caused by herpes, the parents are challenged, they must ensure that the child drinks enough.
Drink mild fluids, such as:

  • Water
  • Apple juice.

Water ice or sorbet relieves the pain.
With severe stomatitis, the doctor may administer fluid intravenously to avoid dehydration.
The doctor may prescribe paracetamol if the fever rises above 38.5°C.
Medications used to numb the mouth, such as lidocaine or topical anesthetics, only work for a short time, in addition, the child may bite or injure the ulcers if he does not feel anything.
Antibiotics do not help if the stomatitis was caused by the herpes virus or Candida fungus. However, in severe cases, the doctor may use a virus-fighting agent, such as acyclovir, in the first few days of the disease to speed up healing.

Treatment of aphthosa stomatitis

As a rule, aphthous stomatitis does not need to be treated with medication, except in the following cases:

  1. The aphthae are larger than 1 cm.
  2. They persist for more than 2 weeks. In this case, treatment and medical evaluation may be necessary.

Usually, oral or topical tretracycline (antibiotic) is prescribed.

Tetracylines are not prescribed during the development of permanent teeth because they irreversibly fuse with the dentin and lead to gray, yellow or brown discoloration.

A gentle mouthwash with salt water or over-the-counter gargle solutions can help.
Over-the-counter local agents are applied directly to the ulcers to relieve the discomfort in this region.
To prevent bacterial infections in children, parents should encourage children to use a toothbrush and floss daily.

Home remedies and prevention

  • With all types of stomatitis, hygiene and thorough oral care is fundamental. Wash your hands and those of your child before meals.
  • Chilled drinks can relieve the pain in the child’s mouth.
    Ice cubes also bring relief. If the child has blisters on the lips or on the tongue, a straw should be used.
  • Rinse the child’s mouth with lukewarm water after eating.
  • The doctor may recommend mouthwashes with salt water or bicarbonate.
  • Use a toothbrush with soft bristles, teeth and gums must be carefully brushed off.
  • Twice a day, spread a few drops of tea tree oil with a cotton swab on the aphthae.

Herbal remedies include:

  • Mallow – according to the theories of the blood group diet, it is suitable for everyone and acts on the stomach, intestines, mouth and throat. Soak a handful of mallow flowers and leaves in water for one night; Heat on low heat without cooking, filtering and drinking.
  • Propolis – a natural antibiotic with wound closure abilities. Take 20 drops of mother tincture three times a day.

What to eat? Diet and nutrition for stomatitis

  • Do not drink fruit juices made from citrus fruits (e.g. orange or lemon juice) or carbonated drinks (soda water), as these could increase the pain in the mouth.
  • The child can eat soft foods more easily.
    In the case of stomatitis, the following are suitable:

    • Yoghurt
    • Mashed potatoes
    • fruit ice cream without gluten and milk,
    • Applesauce and porridge.
  • Spicy, hard and salty foods are unsuitable.
    Sharp foods such as tortilla chips, pretzel sticks and French fries should be avoided.

According to the blood group diet, stomatitis and cold sores can be provoked by:

  • pigmeat or sausages,
  • milk and dairy products, such as yoghurt, cheese and milk chocolate,
  • excessive consumption of nuts, almonds and seeds.

Lezaeta’s natural medicine and natural hygiene recommend a plant-based diet, of which at least 50% is raw.
Stomatitis could act as a kind of drain valve through which the body rids itself of toxins.
It is also possible to occur:

  • during fasting,
  • during a slimming diet,
  • when changing your diet, when you start eating raw and natural foods.

The organism uses natural and effective defense mechanisms for detoxification.
According to this theory, one should not act against the body and thus wait until the disorder passes on its own, without medication or ointments.

How long are the healing times?

The prognosis for recovery in stomatitis depends on the cause of the disease.
Many ulcers are benign and heal on their own without special treatment.
Stomatitis caused by herpes virus heals on its own within about 10 days.
Acyclovir can speed up healing.
In most cases, aphthous stomatitis is short-lived, recurrences are rare and last only a few days.

Possible complications

Keratoconjunctivitis herpetica is a secondary infection of the eye that can develop as a result of stomatitis herpetica.
The disease is a medical emergency because it can lead to blindness.
The patient, especially if it is a child, can dehydrate if he does not want to eat and drink to escape the pain.

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