From the Guidelines
Stomatitis should be managed with preventive measures, including eliminating sources of trauma, avoiding painful stimuli, and maintaining effective oral hygiene, as recommended by the ESMO clinical practice guidelines 1. To manage stomatitis, it is essential to identify and address the underlying cause. The treatment approach may vary depending on the cause, but general measures include:
- Good oral hygiene
- Avoiding spicy, acidic, or rough foods that can irritate the mouth
- Using saltwater rinses (1/2 teaspoon salt in 1 cup warm water) 4-6 times daily
- Applying topical analgesics or anti-inflammatory agents, such as benzocaine gels or topical NSAIDs, to relieve pain
- Considering prescription options, including topical corticosteroids like triamcinolone dental paste or magic mouthwash, for more severe cases According to the ESMO clinical practice guidelines, preventive measures are crucial in reducing the severity of stomatitis 1. Additionally, expert opinion suggests that basic oral care protocols, including sodium bicarbonate containing mouthwash, can help prevent and treat stomatitis 1. For pain relief, the WHO pain management ladder can be followed, and options like anesthetic mouthwashes, coating agents, or systemic analgesics may be considered 1. It is also important to note that stomatitis can be caused by various factors, including immune reactions, infections, nutritional deficiencies, or medication side effects, and medical evaluation is necessary to identify and treat the underlying cause if symptoms persist or worsen 1.
From the FDA Drug Label
Stop use and ask doctor or dentist if sore mouth symptoms do not improve in 7 days irritation, pain or redness persists or worsens swelling, rash or fever develops If you experience stomatitis and use benzocaine (TOP), you should stop use and consult a doctor or dentist if:
- Sore mouth symptoms do not improve in 7 days
- Irritation, pain, or redness persists or worsens
- Swelling, rash, or fever develops 2
From the Research
Definition and Causes of Stomatitis
- Stomatitis refers to a painful and often recurrent inflammatory process of the oral mucosa, which can appear secondary to various well-defined disease processes 3.
- The exact etiology of recurrent aphthous stomatitis (RAS) remains unknown, but it is one of the most common oral diseases worldwide 4.
Treatment Options for Stomatitis
- Topical agents, including over-the-counter preparations, prescribed corticosteroids, or antimicrobial agents, are sufficient to control the disease in most patients with RAS 4.
- Systemic agents, such as corticosteroids, colchicine, dapsone, pentoxifylline, and thalidomide, may be used to control the disease in patients with frequent exacerbations or severe forms of RAS that are unresponsive to topical treatments 4.
- Vitamin B12 has been proposed as a potential treatment for RAS, with some studies suggesting that a daily dose of 1000 μg of vitamin B12 sublingually for six months can be effective in reducing outbreaks, number, and duration of ulcers 5.
- A single application of topical doxycycline has been shown to be effective in alleviating signs and symptoms of RAS, with a statistically significant decrease in healing time compared to control groups 6.
Management and Prevention of Stomatitis
- A thorough history and review of systems can assist clinicians in determining whether stomatitis is related to a systemic inflammatory process or truly idiopathic 3.
- Management of aphthous stomatitis is challenging, and first-line treatment consists of topical medications with use of systemic medications as necessary 3.
- Nystatin, a common antifungal agent, has been shown to be effective in treating oral candidiasis, a common opportunistic fungal infection that can cause stomatitis 7.