What is the treatment for stomatitis?

Treatment of Stomatitis

Topical corticosteroid preparations, such as clobetasol 0.05% ointment, betamethasone sodium phosphate, or fluticasone propionate, are recommended as the most effective first-line treatment for stomatitis. 1

Diagnosis and Classification

Before initiating treatment, proper diagnosis is crucial to distinguish between different types of stomatitis:

• Aphthous ulcers (canker sores): Most common form, classified as:

  • Minor (80-85%): <1cm, healing in 7-14 days
  • Major: Larger, more painful, longer healing time
  • Herpetiform: Multiple small ulcers

• Rule out other causes: Herpes simplex virus, Coxsackie virus, candidiasis, or systemic conditions 1, 2

Treatment Algorithm

First-Line Therapy (Topical)

1. Topical corticosteroids:

   • Clobetasol 0.05% ointment
   • Betamethasone sodium phosphate
   • Fluticasone propionate
   • Triamcinolone acetonide 0.1%

2. Pain management:

   • Lidocaine viscous 2% solution: 15 mL swished and expectorated every 3 hours (max 8 doses/24 hours) 1
   • Topical anesthetics and oral analgesics as needed

3. Barrier preparations:

   • Gengigel or Gelclair for pain control 1

Second-Line Options

1. Alternative topical agents:

   • Tacrolimus 0.1% ointment (twice daily) - comparable efficacy to triamcinolone 1
   • Amlexanox (anti-inflammatory) 3
   • Tetracycline antibiotics (topical) 3
   • Ciclosporin mouthwash (expensive, unpleasant taste) 1

2. For severe cases:

   • Intralesional triamcinolone acetonide injections 1

Systemic Therapy (For Severe/Resistant Cases)

For constant and aggressive outbreaks with intense pain where topical treatments fail:

• Systemic corticosteroids (prednisone)
• Thalidomide (in carefully selected cases) 3

Special Considerations

Denture-Related Stomatitis

• Remove dentures before applying treatments
• Clean dentures thoroughly with toothpaste and rinse with water
• Soak dentures in antimicrobial solution for 10 minutes before reinsertion
• Consider adhesives to improve fit
• Remove dentures at night 1, 4

Prevention Measures

• Use soft toothbrush and mild non-foaming toothpaste
• Rinse with saline solution 4-6 times daily
• Avoid triggers: spicy, acidic, rough foods, toothpastes containing sodium lauryl sulfate
• Stay hydrated
• Apply medicated lip balm regularly 1

Monitoring and Follow-up

• Assess pain daily
• Monitor for signs of infection or inflammation
• Regular follow-up every 3-6 months for persistent cases 1

Important Caveats

• Most cases of stomatitis in children are self-limiting viral infections 2
• Dehydration is a common complication, especially in children, and can be prevented with proper pain management 2
• Laboratory investigations (complete blood count, vitamin B12, folate, iron, ferritin levels) may be indicated if recurrent or severe 1
• No curative treatment exists for recurrent aphthous stomatitis; management focuses on symptom control and reducing duration 5

The treatment approach should follow a stepwise progression from topical to systemic therapies based on severity, with corticosteroids being the mainstay of treatment for significant symptoms.