What are the causes of stomatitis?

Causes of Stomatitis

Stomatitis can be caused by various conditions including autoimmune disorders, infections, physical and environmental factors, cancer treatments, and systemic conditions, requiring a comprehensive diagnostic approach to identify the specific etiology. 1

Primary Causes of Stomatitis

Infectious Causes

• Viral infections:

  • Herpes simplex virus (herpes gingivostomatitis)
  • Coxsackie virus (herpangina, hand-foot-mouth disease)
  • Varicella-zoster virus (chickenpox)
  • Epstein-Barr virus (infectious mononucleosis) 2

• Fungal infections:

  • Candida albicans (oral thrush) - particularly common in infants and immunocompromised patients
  • Can present as ulcers without apparent inflammation in immunocompromised patients or those with uncontrolled diabetes 1

• Bacterial infections:

  • Usually secondary to viral infections
  • Tuberculosis can present as oral ulcerations on the buccal mucosa 1, 2

Denture-Related Causes

• Denture stomatitis affects 11-67% of complete denture wearers 3
  • Newton's Type I: Focal inflammation caused by trauma
  • Newton's Types II and III: Diffuse involvement of denture-bearing mucosa with multifactorial etiology
  • Primary factors:
    • Candida albicans colonization of denture surface
    • Continuous denture wearing
    • Poor oral and denture hygiene
    • Ill-fitting dentures causing mechanical trauma 3, 4

Contact-Related Causes

• Irritant contact stomatitis:

  • Heat
  • Frictional trauma
  • Chemical irritants 5

• Allergic contact stomatitis:

  • Oral flavorings
  • Preservatives
  • Dental materials 5

Autoimmune and Inflammatory Causes

• Recurrent aphthous stomatitis (RAS):

  • Hereditary component
  • Immune reaction against oral mucosa
  • Characterized by round, shallow ulcerations surrounded by inflammation 6

• Other autoimmune conditions:

  • Pemphigus Vulgaris - caused by IgG autoantibodies targeting desmoglein 3
  • Bullous Pemphigoid - autoantibodies against basement membrane components 1

Cancer Treatment-Related Causes

• Mucositis from cancer therapy:
  • Chemotherapy
  • Radiation therapy (particularly head and neck)
  • Targeted therapies
  • Risk increases with combination therapy 7

Systemic Disease-Related Causes

• Gastrointestinal disorders:

  • Crohn's Disease - can present with recurrent oral ulcers on the buccal mucosa 1

• Hematological disorders:

  • Agranulocytosis
  • Cyclic neutropenia
  • Leukemia 1, 2

• Other systemic conditions:

  • Behçet's syndrome
  • Systemic lupus erythematosus
  • Nutritional deficiencies 2, 6

Risk Factors

• Patient-related factors:

  • Malnutrition
  • Salivary hypofunction/xerostomia
  • Genetic polymorphisms
  • Poor oral hygiene
  • Female gender (for denture stomatitis) 7, 3

• Environmental factors:

  • Continuous denture wearing (especially overnight)
  • Trauma from sharp edges or ill-fitting prostheses
  • Hot foods and drinks
  • Hard, sharp, or spicy foods 7, 3

• Medication-related:

  • Anti-emetic drugs
  • Anti-cholinergic medications 7

Diagnostic Approach

When evaluating stomatitis, consider:

• Duration of lesions (persistent ulcers >2 weeks warrant further investigation)
• Distribution pattern (focal vs. diffuse)
• Associated symptoms (pain, fever, systemic manifestations)
• Patient demographics (age, denture use, medical history)
• Response to previous treatments 1, 2

For persistent or severe cases, consider biopsy to rule out malignancy or specialized testing for specific etiologies like tuberculosis or fungal infections 1.