Overview

There are many types of irritation of the mouth or stomatitis, such as:

• Canker sore – Known also as the aphthous ulcer, a canker sore is a single yellow or pale ulcer characterized by having a red outer ring, or it could be a cluster of such ulcers in the mouth. Canker sore usually appears on the tongue, cheeks, or inside the lips.
• Cold sores – Also known as fever blisters, they are fluid-filled sores that appear on or around the lips. They seldom form on the roof of the mouth or the gums. Cold sores develop a crust with a scab. They are often associated with tenderness, tingling, or burning before their actual appearance.
• Mouth irritation – They can be caused by:

• Biting your cheek, lip, or tongue
• Wearing braces or other dental apparatus, or having a broken or sharp tooth
• Chewing tobacco
• Burning one’s mouth from hot food or drinks
• Having gum disease or other types of mouth infection
• Having hypersensitivity to certain things, such as foods or medicines
• Taking certain drugs such as antibiotics, chemotherapy, rheumatoid arthritis medications, or epilepsy medications.
• Having certain autoimmune diseases that affect the mucosal lining of the mouth, such as Crohn’s disease, lupus, or Behcet’s disease
• Receiving radiation as part of cancer treatment

Characteristics of stomatitis

Canker sores have the following characteristics:

• They are painful
• They usually last from 5 to 10 days
• They are generally associated with fever
• They tend to come back

Cold sores have the following characteristics:

• They are painful
• They usually disappear in 7 to 10 days
• They are mostly associated with cold or flu-like symptoms

Symptoms of irritation of the mouth or stomatitis

Herpetic stomatitis is typically indicated by multiple blisters occurring in the:

• Palate
• Gums
• Tongue
• Cheeks
• Lip border

The blisters may make it difficult or painful to drink, eat, or swallow. Dehydration is a common risk when drinking becomes uncomfortable. Swollen gums, pain, and drooling may also occur. Cold sores can cause irritability.

If you notice that your child is getting irritable, not eating or drinking, he may be about to develop a cold sore. 

A fever is another symptom of the infection. Fever can go as high as 104°F, occurring a few days before the appearance of the blisters. After the blisters ruptures, ulcers may form in their place. It is possible for those ulcers to have secondary infections. Expect the entire infection to lasts from 7 to 10 days. 

Causes of Canker sores

The exact causes of canker sores are not known, but there several factors may contribute to their development, including certain medications, poor nutrition, trauma to the mouth, bacteria or viruses, stress, sudden weight loss, lack of sleep, and certain foods such a citrus fruits, potatoes, chocolate, coffee, nuts, and cheese.

The occurrence of canker sores may be related to a temporarily reduced immune system due to cold or flu, low levels of vitamin B12, or hormonal changes. Canker sores can also be triggered by biting inside the cheek or chewing a sharp piece of food.

Canker sores could also result from a genetic predisposition and are, therefore, considered a disease of the autoimmune system. Canker sores are not contagious. About 20% of the population get canker sores at some point during their lifetime. More women get canker sores than men. It is more common in young people, mostly between the ages of 10 and 19.

Other causes of canker sores of aphthous stomatitis include:

• Dry tissues from breathing through the mouth when the nasal passages are blocked
• Small injuries due to dental work, accidental bite, or other injuries
• Celiac disease
• Allergic response to certain bacteria in the mouth
• Inflammatory bowel disease and inflammation of the nose
• HIV/AIDS
• An autoimmune disease that attacks the cells in the mouth
• Candida albicans infection

Cold sores

Cold sores are caused by the herpes simplex type 1 virus. Cold sores, unlike canker sores, are contagious beginning the time the blister ruptures until it is completely healed. The initial cold sore infection usually occurs before adulthood and is often confused with a cold or the flu. Once a person is infected with the virus, the virus stays in the body, becoming dormant and is activated by certain conditions such as fever, stress, hormonal change, trauma, and exposure to sunlight.

When cold sores reappear, they tend to occur in the same location. Cold sores can spread to other people but it may also spread to another body part of the same person, such as the genitals or the eyes.

Diagnosis and Treatment

The diagnosis of irritation of the mouth or stomatitis largely depends on what is causing the condition. An investigation of the cause may include a physical examination, from which a doctor can learn a lot by looking at the appearance and distribution of ulcers.

Other tests might include:

• Swabs, bacterial and viral
• Biopsy, or the removal of cells or tissues for further study
• Tissue scrapings or swabs for fungal infections
• Blood tests
• Patch tests to identify allergy

The doctor will also review the person’s medical history to see if a current or previous medication has caused stomatitis.  The doctor will also inquire about the person’s sexual history and if he has ever smoked and check for impotence.

Many other conditions can cause stomatitis, so investigation and diagnosis will be vital to ensure the doctor gives the correct treatment.

Treatment

There is no cure for cold sores. You can only take some treatments to minimize the symptoms. Taking L-lysine tablets may help, as might other prescription antiviral medications.  Some experts believe that some drugs like oxybutynin could curb the presence of the blisters.

• A dose of valacyclovir at first sign of attack. 
• Coating the lesions with a protective ointment such as an antiviral agent.
• Applying ice to the lesion.

Treatment for irritation of the mouth or stomatitis will depend on the underlying cause. Treatment of the root cause of the condition is important for stomatitis caused by the following:

• Allergy – If stomatitis is caused by an allergic reaction, the doctor will attempt to identify the allergen and look to eliminate its effects.
• Infection – Stomatitis caused by an infection may require specialized treatment and medication depending on what the infection is.
• Disease – If a specific disease is causing stomatitis, the doctor will try to identify it and recommend treatment.
• Nutritional deficiency – A doctor will identify and address any nutritional problem with proper medication or diet.

Topical treatment

This type of treatment is applied directly to the skin. They have been found to lessen the pain and speed up healing. Types of topical treatment for stomatitis include:

• Topical corticosteroids – Usually in the form of a rinse, corticosteroids aim to eliminate the symptoms to allow the person to drink eat, and speak without any pain or discomfort.
• Topical antibiotics – They usually come in the form of a rinse or a gel and have both antibiotic and anti-inflammatory properties.
• Topical anesthetics – These are medications that numb. They are usually available by prescription that may be applied directly to the sores for temporary relief of pain.
• Kanka – It is an over-the-counter product that provides a layer of a barrier to mouth sores to give the person temporary relief from pain.

Prevention

People can take some basic precautions to try stopping stomatitis from returning, including:

• The use of an antiseptic and non-alcoholic mouthwash
• Using a soft toothbrush
• Treating a chronic dry mouth
• Receiving routine dental care
• Maintaining proper hydration and nutrition.

People infected with the HSV-1 virus will have the virus for the rest of their lives. The virus is found in about 90 percent of adults worldwide. The spread of the infection can be avoided by refraining from kissing or sharing eating utensils with someone with an open cold sore. 

For aphthous stomatitis or canker sores, some nutritional supplements such as B vitamins may help. Foods high in these vitamins can help prevent its occurrence. Some foods high in B vitamin include:

• Bell peppers
• Broccoli
• Spinach
• Calf’s liver
• Beets
• Asparagus
• Lentils

Maintaining proper oral hygiene also helps. People must avoid spicy or acidic foods if they have triggered an outbreak before. Another way of avoiding an outbreak is refraining from speaking while eating, which increases the chance of biting the inner cheek. Dental wax can help smooth the edges of dental appliances such as braces or retainers. If stress seems to be the trigger of an outbreak, learn how to relax. Exercising can also help.

Risks of Having Irritation of the Mouth

The common risk factors for stomatitis include:

• Smoking
• Alcohol consumption
• Poor oral hygiene
• Trauma
• H. pylori
• Psychological stress
• Nutritional abnormalities
• Sensitivity to food
• Immunologic deficiencies
• Chemotherapy or radiotherapy
• Genetic factors

When to Seek Medical Attention

Some mouth sores or irritations can be harmful. Schedule an appointment with your doctor if your mouth sores or irritations have not healed within two weeks.

Table of Medications

• triamcinolone
• dexamethasone
• Oralone
• FIRST Mouthwash BLM
• benzocaine
• Orajel
• Anbesol
• Trianex
• De-Sone LA
• Pediaderm TA