What is the first line of treatment for stomatitis?

First-Line Treatment for Stomatitis

Topical corticosteroids, such as 0.1% triamcinolone acetonide in orabase applied 2-4 times daily until healing, are the first-line treatment for most types of oral ulcers (stomatitis). 1

Treatment Algorithm

First-Line Treatment:

1. Topical corticosteroids:

   • 0.1% triamcinolone acetonide in orabase, applied 2-4 times daily 1
   • Alternative options: clobetasol 0.05% ointment, betamethasone sodium phosphate, fluticasone propionate 1
   • Continue until healing, typically within 7-14 days

2. Pain management:

   • Topical anesthetics (e.g., benzocaine) 1, 2
   • Oral analgesics for more severe pain 1
   • Note: Stop using benzocaine and consult a doctor if symptoms don't improve within 7 days 2

3. Supportive measures:

   • Good oral hygiene with soft toothbrush and mild non-foaming toothpaste 1
   • Saline solution rinses 4-6 times daily 1
   • Alcohol-free mouthwash 1
   • Dietary modifications: avoid spicy, acidic, and rough foods 1
   • Stay hydrated 1

Clinical Considerations

When to Refer or Investigate Further:

• Any oral ulcer persisting beyond 2 weeks despite treatment requires further investigation 1
• Persistent red sores on the tongue need prompt evaluation with biopsy to rule out malignancy 1

Treatment Efficacy:

Recent research shows promising results with:

• Barrier methods using cellulose rubber and calcium/sodium copolymer PVM/MA 3
• Insulin and chitosan gel for pain suppression 3
• Laser therapy for immediate pain reduction 3

Common Pitfalls and Caveats

1. Misdiagnosis: Stomatitis must be differentiated from traumatic ulceration, herpes simplex virus infection, Behçet's disease, pemphigus vulgaris, and other conditions 1

2. Inadequate treatment duration: Topical treatments should be continued until complete healing, typically 7-14 days 1

3. Overlooking systemic causes: In recurrent or severe cases, consider underlying systemic conditions 4

4. Ignoring warning signs: Persistent ulcers (>2 weeks) require further investigation to rule out malignancy 1

5. Treatment resistance: For resistant cases, systemic immunomodulatory agents may be needed, but these are not first-line treatments 5

Monitoring

• Regular follow-up is essential, especially for persistent cases 1
• Monitor for pain reduction, healing progress, and potential side effects of medications 1
• If symptoms don't improve within 7 days with topical treatments like benzocaine, consult a healthcare provider 2