There are conditions that cause mouth sores or irritation inside the mouth.  Most of these conditions are benign in children.  the most common of these are known as canker sores or at the us ulcers.  Approximately 20% of the normal US population experiences recurrent canker sores.  The most common condition inside the mouth of infants is thrush.  Thrush is also called oral candidiasis and is easily treated with anti-yeast medicine.  Cold sores are caused by the herpes simplex virus, usually type I (HSV–1).  About one third of the normal adult population has experienced cold sores at least one time.  Gingivitis is inflammation of the gums.  nearly 90% of older children and adults will experience gingivitis on at least one occasion.  Rarely, oral sores or lesions may represent a more serious condition.  It is a good idea to have your physician see a typical lesion on at least one occasion.

What is stomatitis?

Stomatitis is the medical term for inflammation within or near the mouth.  There are many causes of stomatitis and most of them are mild or benign conditions.

What causes stomatitis (mouth sores)?

Mouth sores may be cause for several different reasons, including: infections, trauma, chemical irritation, or unknown reasons.  Some lesions are actually anatomical differences.

• bacteria (i.e., streptococcus mutans and other bacteria contribute to gingivitis)
• viruses (i.e., HSV-1, coxsackie virus, and others)
• yeast (i.e., candida albicans causes thrush)
• trauma (i.e., biting the inside of the cheek)
• chemical irritation (i.e., chewing tobacco may cause keratosis or leukoplakia)
• unknown (i.e., aphthous ulcers or canker sores may be due to a mild overreaction of the immune system)
• anatomical differences (i.e., torus palatinus, ankyloglossia, fissured tongue)

Who gets stomatitis?

Babies:

• Ankyloglossia (tongue-tie) - approximately 5% of newborns
• Fissured tongue (a normal variant) - about 2% of people of all ages
• Geographic tongue ( a normal variant) - up to 2% of children
• Oral candidiasis (also called thrush) - about 35% of normal newborns and young infants

Older children and adults:

• Gingivitis - as much as 90% of the normal adult population has experienced gingivitis on at least one occasion
• Aphthous ulcers ( also called canker sores) - nearly all children and adults have experienced an aphthous ulcer on at least one occasion.  About 25% of the US population experiences recurrent aphthous ulcers.
• Benign migratory glossitis - caused by the loss of the tiny finger-like projections on the tongue called the papillae
• Oral herpes lesions (also called cold sores) - up to 40% of the normal adult population has experienced cold sores on at least one occasion
• Mucocele or salivary cyst - a benign collection of saliva or fluid beneath the mucosal surface
• Tobacco associated keratosis ( from using smokeless tobacco) - affects more than 300,000 US children
• Leukoplakia ( from using smokeless tobacco) - a premalignant condition that affects about half of smokeless tobacco users
• Oral cancer ( extremely rare in childhood) - more common in adults and those who use oral tobacco

What are some common oral masses?

• Gingival cysts (a small collection of fluid around around the gums of the teeth) - about 75% of newborns
• Congenital epulis - a benign overgrowth of tissue that presents as a mass in an infant's oral cavity.  large masses may interrupt breathing or eating.
• Epstein pearls - small, yellow, white papules on the hard palate of newborn infants that are of no clinical significance
• Vascular malformations ( rare) - a bulging of soft red, purple, or blue tissue that represents a collection of abnormal blood vessels under the surface mucosa
• Lymphatic malformations ( rare) - a bulging of soft pink tissue that represents a collection of abnormal lymphatic vessels under the surface mucosa

What is the thrush?

Thrush is the overgrowth of Candida albicans, a yeast, in the mouth of a baby or young child.  It is extremely common and easy to treat with an antiyeast medicine, such as nystatin or Diflucan.  if left untreated, thrush can cause painful irritation and disrupt eating and drinking.  However, thrush is typically a mild or benign condition.

What is tongue tie?

The medical term for tongue tie is ankyloglossia.  This is caused by an unusually short frenulum under the tongue.  The frenulum is the tissue that attaches the bottom of the tongue to the floor of the mouth at the tongue's midline. Mild tongue tie has no clinical significance.  If the frenulum is excessively short it may disrupt speech or eating in infants and young children.  A simple surgery can be performed to cut the frenulum. This procedure must be performed with care to prevent excess bleeding.

What are the categories of mouth lesions?

Neonatal or other developmental lesions

• gingival cysts
• Epstein pearls
• congenital fabulous
• fissured tongue
• geographic tongue
• benign migratory glossitis

Trauma

• self bites
• other injuries

Infectious

• viruses (i.e., HSV-1, Coxsackievirus A, etc.)
• bacteria (i.e., actinomyces, Streptococcus mutans, etc.)
• yeast (i.e., Candida albicans, etc.)

Other

• drug-induced hyperplasia of the gums
• arteriovenous malformations
• lymphatic malformations
• cancer

How will my doctor evaluate mouth sores?

History

Your doctor will likely ask questions such as:

• How long is your child had the lesions?
• Is the lesion painful?
• Was the area injured?
• Has the child been sick or had a fever?
• How has your child been acting and eating?
• Has your child been on any medications?

Physical

A simple examination of the mouth with a flashlight should be extremely helpful.

Laboratory

Lab testing is usually not necessary.  However, HSV and thrush can be detected by obtaining a cotton swab rubbing of the lesion.  Biopsies are rarely necessary.

Imaging

Imaging is rarely necessary.  Vascular and lymphatic malformations can be detected with CT scan.

How is stomatitis treated?

The treatment depends on the cause of the lesion.  Most lesions will resolve without treatment. Some examples of potential treatments are listed below:

• HSV : acyclovir (an antiviral medicine)
• Thrush : Nystatin or Diflucan (an anti-yeast medicine)
• Painful lesions : Motrin or Tylenol ( an oral pain medicine), over-the-counter topical anesthetic agents (in older children only)
• Gingivitis : appropriate dental care and mouth rinses
• Dehydration : in young children, painful mouth sores may cause them not to drink or eat well.  If a child cannot tolerate adequate oral fluids, she may require hospital admission for IV fluids.

What is the prognosis for stomatitis (mouth sores)?

the prognosis depends on the specific cause of the lesion.  Most mouth sores resolve without treatment.  However, you should discuss this with your doctor.

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