From the Guidelines
Stomatitis is inflammation of the mouth and lips that can be treated with a combination of home remedies and medical interventions, with the goal of reducing morbidity, mortality, and improving quality of life. For mild cases, the most recent and highest quality study suggests rinsing the mouth with a bland non-alcoholic, sodium bicarbonate containing mouthwash four to six times a day to prevent stomatitis 1. Some key points to consider in the treatment of stomatitis include:
- Maintaining good oral hygiene and staying hydrated
- Avoiding spicy, acidic, or rough foods
- Using a soft-bristled toothbrush
- Applying over-the-counter topical anesthetics like benzocaine gel to painful areas For more severe cases, see a doctor who may prescribe:
- Topical corticosteroids like triamcinolone dental paste, applied 2-3 times daily
- Antiviral medications like acyclovir for viral causes
- Antifungal treatments like nystatin for fungal infections It is also important to note that stomatitis can have various causes including viral infections, nutritional deficiencies, or autoimmune conditions, and treatment aims to reduce inflammation, relieve pain, and address the underlying cause, allowing the mouth tissues to heal naturally 1. In terms of specific treatments, the use of topical corticosteroid preparations, such as betamethasone sodium phosphate 0.5 mg dissolved in 10 mL of water as a 2–3-min rinse-and-spit solution one to four times a day, may be beneficial in reducing inflammation and relieving pain 1. Overall, the treatment of stomatitis should prioritize reducing morbidity, mortality, and improving quality of life, and should be guided by the most recent and highest quality evidence available 1.
From the FDA Drug Label
INDICATIONS AND USAGE Nystatin Oral Suspension, USP, is indicated for the treatment of candidiasis in the oral cavity. The diagnosis of stomatitis is not directly addressed in the label, but the treatment for candidiasis in the oral cavity can be treated with nystatin (PO).
- The label does not provide information on the diagnosis of stomatitis.
- Nystatin (PO) is indicated for the treatment of candidiasis, which may be a cause of stomatitis, but the label does not explicitly state this. 2
From the Research
Diagnosis of Stomatitis
- Stomatitis, also known as recurrent aphthous stomatitis (RAS), is a common chronic disease in the oral mucosa that affects about 20% of the population 3.
- It is characterized by solitary or multiple, recurrent, small ulcers with erythematous haloes and yellow/gray floors 3.
- The exact etiology of RAS remains unknown, but it may have an immunogenetic background owing to cross-reactivity with Streptococcus sanguis or heat shock protein 4.
- Predisposing factors seen in a minority include haematinic (iron, folate or vitamin B12) deficiency, stress, food allergies, and HIV infection 4.
Treatment of Stomatitis
- First-line treatment options include topical medications in the form of corticosteroids (triamcinolone acetonide), anti-inflammatory drugs (amlexanox), antibiotics (doxycycline), and antiseptics (lidocaine) 3.
- In more severe cases of RAS, systemic drugs in the form of corticosteroids (prednisone), immunomodulatory drugs (thalidomide), and antibiotics/antimicrobials (clofazimine) can prove effective 3.
- Topical corticosteroids remain the mainstay for therapy, with other immunomodulatory modalities now available 4.
- Curcumin has strong antioxidant, anti-inflammatory, immunomodulatory, and analgesic properties, which can be used as an effective alternative to steroids in treatment of RAS 5.
- Combination therapy with topical dexamethasone mouthrinse and oral azathioprine tablets has also been shown to be effective in treating severe major aphthous stomatitis 6.
- Systemic agents, including corticosteroids, colchicine, dapsone, pentoxifylline, and thalidomide, may be used for patients with frequent exacerbations or those with a severe form of RAS that is unresponsive to topical treatments 7.