What is the treatment for viral stomatitis?

Treatment for Viral Stomatitis

The treatment for viral stomatitis primarily consists of supportive care with bland non-alcoholic sodium bicarbonate mouthwash used four to six times daily, along with good oral hygiene and pain management. 1

Prevention and Basic Management

• Maintain good oral hygiene with non-alcoholic mouthwashes to prevent and manage stomatitis 1
• Evaluate dental appliances (braces, dentures, retainers) before treatment as they can aggravate oral mucositis 1
• Consume soft, moist, non-irritating foods that are easy to chew and swallow 1
• Drink plenty of water and use lip balm for dry lips 1
• Use ice chips or ice pops as needed to numb the mouth 1

Treatment Approach Based on Severity

Mild Stomatitis (Grade 1)

• Use 0.9% saline or sodium bicarbonate rinses to soothe the mouth 1
• Consider prophylaxis against fungal, viral and/or bacterial infections 1
• Treat any secondary infections with appropriate topical or systemic antimicrobials 1
• Continue regular oral care with non-alcoholic mouthwash 1

Moderate Stomatitis (Grade 2)

• Increase frequency of sodium bicarbonate mouthwash up to hourly if necessary 1
• For oral dryness, use sugarless chewing gum, candy, or salivary substitutes 1
• For pain management:
  • Topical anesthetics (viscous lidocaine 2%) 1
  • Mucosal coating agents 1
  • Benzydamine HCl for pain relief 1
  • Topical NSAIDs (e.g., amlexanox 5% oral paste) for moderate pain 1
  • When NSAIDs aren't tolerated, consider acetaminophen (paracetamol) 1

Severe Stomatitis (Grade 3-4)

• For highly symptomatic ulcers, consider systemic corticosteroids (high-dose pulse 30-60 mg or 1 mg/kg oral prednisone/prednisolone for 1 week followed by tapering over the second week) 1
• For persistent severe pain, consider more aggressive pain management with alternative administration routes (transdermal, intranasal) 1
• Hospitalization may be indicated for severe cases 1

Specific Viral Stomatitis Management

Herpes Simplex Virus (HSV) Stomatitis

• For HSV stomatitis, antiviral therapy with acyclovir is recommended 2
• Acyclovir has been shown to reduce the duration of viral shedding and promote faster healing 2
• For immunocompromised patients or those with severe symptoms, consider prophylactic antiviral therapy 1

Important Considerations and Pitfalls

• Viral stomatitis is often self-limiting, but dehydration is a common complication that should be prevented with adequate pain control 3
• Distinguish between viral stomatitis and more serious conditions like Stevens-Johnson Syndrome, which requires specialist assessment 1
• Secondary bacterial infections can complicate viral stomatitis and may require specific antimicrobial treatment 4
• Most cases of viral stomatitis in children are self-limiting, but parents should be educated about the importance of maintaining hydration 3

Follow-up

• Monitor for resolution of symptoms and lesion healing 1
• Assess for potential complications or recurrence 1
• Continue preventive oral hygiene measures even after resolution 1