Stomatitis

Stomatitis is a topic covered in the 5-Minute Pediatric Consult.

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Basics

Description

  • Inflammation of the mucous membranes of the mouth including the cheeks, gingiva, tongue, lips, hard palate, and soft palate
  • Also called gingivostomatitis when the gums are specifically involved
  • Enteroviruses (causing herpangina and hand-foot-and-mouth disease) and herpes simplex type 1 (HSV-1) are the most common infectious causes of stomatitis.
  • Recurrent aphthous stomatitis (or canker sores) is also common in children. The etiology of recurrent aphthous stomatitis is unknown.

Epidemiology

  • Enteroviruses (including coxsackie viruses)
    • Infections are more common in the summer and fall months in temperate climates but occur year-round in the tropics.
    • Herpangina and hand-foot-and-mouth disease are most common in infants, toddlers, and young children.
  • HSV-1:
    • Infections occur throughout the year.
    • Most primary HSV infections in childhood after the neonatal period are asymptomatic.
    • Primary herpetic gingivostomatitis is most common in infants, toddlers, and young children.
    • Recurrent HSV-1 infections can occur any time after the primary infection.
    • Seroprevalence of HSV-1 in the United States: >25% by age 7 years; >40% by age 21 years
  • Recurrent aphthous stomatitis is most common in older children and adolescents.

General Prevention

  • Wash hands after contact with the infected individual to help prevent spread of viral stomatitis.
  • Disinfect surfaces, toys, and other objects used by an infected child to decrease spread of illness. Enteroviruses can survive on surfaces long enough to allow transmission of infection.
  • Use contact precautions for hospitalized patients with viral stomatitis.

Pathophysiology

  • Enteroviral infections:
    • Spread by fecal–oral and respiratory routes; can also be passed from mother to infant prenatally, in the peripartum period, and perhaps via breast milk
    • Result in viremia which spreads virus to target organs
  • HSV-1 infections:
    • Spread via contact with mucous membranes or open skin
    • Travel from the skin to the trigeminal sensory ganglion where infection persists for life; reactivates causing recurrent symptoms

Etiology

  • Herpangina—most often coxsackie A viruses; also caused by other enteroviruses
  • Hand-foot-and-mouth disease—most often coxsackie A viruses; also coxsackie B, enterovirus 71, and echoviruses
  • Primary herpetic gingivostomatitis—typically HSV-1; can also be caused by HSV-2
  • Recurrent aphthous stomatitis—possible causative factors: physical and chemical trauma, foods, nutrient deficiencies, immunodeficiency, systemic illness, infections, genetic predisposition, smoking, stress, medications

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