What Causes Stomatitis: Main Causes in the Mouth

A sore in the mouth that makes chewing and talking difficult — everyone has dealt with this. What causes stomatitis, and could something serious be going on? We'll break down what causes exist and when you can't do without a doctor.

Where stomatitis comes from: the big picture

Stomatitis is inflammation of the oral cavity and lips. It looks different in different cases: redness of the mucosa, one ulcer or several, dryness, sensitivity of soft tissues, white or yellow coating, bleeding gums, bad breath.

The mechanism is not fully understood. Most likely, it comes down to the immune system's reaction to irritants: it fails to recognize certain molecules and attacks them with lymphocytes. The result is an ulcer. First the mucosa is damaged by trauma, a burn, infection, allergy, or hormonal imbalance, and then inflammation follows.

Most often ulcers heal on their own within a week or two. If an ulcer persists for more than three weeks, a doctor examines it.

Infectious causes of stomatitis

Microorganisms — bacteria, viruses, mycoplasmas — are one possible cause. In herpetic stomatitis, the temperature rises sharply, drowsiness appears, blisters form on the mucosa and burst after three days, and gingivitis and thick saliva develop.

Vesicular stomatitis is caused by an RNA-containing virus, and it is contagious. Catarrhal stomatitis is associated with inadequate hygiene, dry mouth, Candida fungi, and bacteria. Several ulcers at once occur in hand, foot, and mouth disease — it also causes a rash on the hands and feet; enteroviruses are named as the cause of enteroviral vesicular stomatitis. Stomatitis itself is not contagious; the cause can be contagious, such as the herpes virus.

Mucosal injuries and irritating factors

Simple single ulcers most often appear because of something you can remove from your life. You bit your cheek — there's a sore. Poorly fitted dentures, braces, rough fillings, or a sharp tooth edge rub the mucosa. You cut or burned yourself while eating: hard food, a hot drink. You damaged your gum with a hard brush or an irritating toothpaste.

According to statistics, 65% of older adults with dentures suffer from stomatitis. Dry mouth is also a factor: medications that reduce salivation make the mucosa vulnerable. Dehydration is on the list of causes — due to diarrhea, vomiting, prolonged fever, or major blood loss. Smoking and burns from e-cigarettes are considered irritants. Both insufficient and excessive hygiene are harmful.

Allergy, deficiencies, and systemic diseases

Food allergy and food intolerance are one possible cause. Ulcers are also caused by a lack of iron, zinc, folic acid, vitamins A, B, C, B12, and vitamin D, as well as anemia.

Hormonal fluctuations — pregnancy, menstruation, adolescence — change the condition of the mucosa. Genes also matter: in some families stomatitis appears more often. Fatigue, stress, and anxiety act as triggers, as does quitting smoking: ulcers may appear when a person has just stopped smoking.

Some medications cause ulcers as a side effect: certain nonsteroidal anti-inflammatory drugs, beta-blockers, nicorandil. The cause can also be a systemic disease: gastritis, helminth infestation, Crohn's disease and celiac disease, HIV and lupus with weakened immunity, chemotherapy.

Causes of stomatitis in adults and on the tongue

The causes in adults are the same: dentures, stress, hormonal fluctuations, medications, smoking. Ulcers appear on the inner side of the cheeks and lips, on the tongue, under the tongue, and deep in the throat. Aphthous stomatitis consists of round, painful aphthae with a white or beige coating in the center; they heal within 1–1.5 weeks and usually without scars.

Recurrence is a separate clue for the doctor. And sometimes no cause is found: in some cases it remains unknown.

When to look for the cause together with a doctor

Diagnosis is simple: the doctor reviews the medical history and examines the oral cavity. There are no specific tests — biopsy or culture — as yet. The doctor looks at the appearance of the ulcers, their location, and their recurrence. The tissue around an ulcer is usually healthy, without high fever or malaise.

You should see a dentist or doctor if:

• the ulcer persists for more than three weeks;
• the ulcer does not look like previous ones and is larger than usual;
• the ulcer bleeds or has become more painful and redder;
• there are also ulcers on the skin or genitals;
• the joints are painful, red, or swollen.

A long-lasting ulcer is sometimes a sign of oral cancer. In children, advanced cases can involve many ulcers and fever.

Stomatitis by itself is not a reason to call an ambulance. 103 or 112 — for a life-threatening condition, as in any emergency.

This material is for reference: it explains where stomatitis comes from, but it does not replace a consultation with a doctor who will look at your specific situation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer