What are the management options for stomatitis?

Management of Stomatitis

Topical corticosteroids are the first-line treatment for most types of oral ulcers, with 0.1% triamcinolone acetonide in orabase applied 2-4 times daily until healing occurs, typically within 7-14 days. 1

Initial Treatment Approach

First-Line Therapies:

• Topical corticosteroids:
  • 0.1% triamcinolone acetonide in orabase (2-4 times daily)
  • Alternative options: clobetasol 0.05% ointment, betamethasone sodium phosphate, fluticasone propionate 1

Pain Management:

• Topical anesthetics:
  • Dyclonine hydrochloride 1.0% provides the most effective pain relief (approximately 50 minutes duration) 2
  • Viscous lidocaine (with or without 1% cocaine) also provides extended pain relief 2
  • 2% viscous lidocaine for symptomatic relief 3

Supportive Care:

• Oral hygiene:

  • Soft toothbrush and mild non-foaming toothpaste
  • Saline solution rinses 4-6 times daily
  • Alcohol-free mouthwash 1

• Dietary modifications:

  • Avoid spicy, acidic, and rough foods
  • Stay well-hydrated
  • Avoid known triggers (hard, acidic, spicy, salty foods)
  • Avoid toothpastes containing sodium lauryl sulfate 1

Management Based on Etiology

Infectious Causes:

• Viral stomatitis (herpes simplex, Coxsackie virus, chickenpox):

  • Most are self-limiting
  • Focus on pain management and hydration 4
  • Monitor for dehydration, which is a common complication

• Candidiasis (thrush):

  • Common in infants and immunocompromised patients
  • Antifungal treatments as appropriate 4

Recurrent Aphthous Stomatitis (RAS):

• Mild to moderate cases:

  • Topical tetracycline hydrochloride applications 3
  • Amlexanox (over-the-counter) 5
  • Topical antimicrobial agents 5

• Severe or frequent cases:

  • Systemic therapies may be required:
    • Corticosteroids
    • Colchicine
    • Dapsone
    • Pentoxifylline
    • Thalidomide (for refractory cases) 5
  • Cyclical estrogens for premenstrual aphthosis 3

Special Considerations

Radiation or Chemotherapy-Induced Stomatitis:

• Focus on pain management with topical anesthetics
• Dyclonine hydrochloride 1.0% provides superior pain relief 2

When to Consider Biopsy:

• Any oral ulcer persisting beyond 2 weeks despite treatment
• Ulcers with different morphological characteristics
• Red sores on the tongue persisting beyond 2 weeks 1

Follow-Up and Monitoring

• Regular monitoring for persistent cases
• Assess pain daily
• Follow-up every 3-6 months for persistent symptomatic cases
• Monitor for signs of systemic disease 1

Diagnostic Considerations

• Complete blood count to evaluate for underlying conditions
• Fasting blood glucose (elevated levels predispose to fungal infections)
• HIV antibody test for unexplained or recurrent cases
• Consider syphilis serology 1

It's important to note that while most stomatitis cases in children are benign and self-limiting, some may indicate more serious underlying conditions. Proper pain management with analgesics can often prevent complications such as dehydration that might otherwise require hospitalization 4.