Stomatitis is an infection of the oral cavity which can affect the lips, the tongue, the gums, the palatal as well as the buccal area.

It’s a painful situation which causes discomfort to the patient while eating or talking. In its widest meaning, stomatitis can have a multitude of different causes and appearances. Common causes include fungal infections, viruses, nutritional deficiencies, allergic reactions, radiotherapy, and many others.

The most common types of stomatis are:

1. Aphthous stomatitis or recurrent aphthous stomatitis: recurrent appearance of mouth ulcers in the oral mucosa or the tongue. The cause is not completely understood but it usually appears due to stress or weakened immune system. This type is not contagious. It can last up to two weeks but the pain gradually decreases since the 4^th day. There is no cure for aphthous stomatitis and therapies are aimed at alleviating the pain, reducing the inflammation and promoting healing of the ulcers. Most of the times gels are mouthwashes are being used. During the symptoms cold and soft food should be consumed and anything salty or sour should be avoided.

2. Angular stomatitis or angular cheilitis: Inflammation of one or both the corners (angles) of the lips. It occurs as a tear in the area of the lips that can lead to ulceration and bleeding. It is combined with pain when the patient opens his mouth. In adults it may be a sign of underlying iron deficiency anemia, or vitamin B deficiencies, which in turn may be evidence of poor diets or malnutrition, poor denture fit, cold environment or Candida Albicans. Less common causes may be allergies in toothpaste, lipsticks or other cosmetics.  Particularly aggravating is the licking of the dried lips. Treatment usually involves the administration of topical nystatin or similar antifungal agents, B12 or iron supplements. If the cause is hypervitaminosis the patient should stop the use of vitamin supplements.

3. Herpetic stomatitis: the major symptoms include ulcers in the oral cavity, increased saliva flow, pain, gingival swelling and discomfort. It is an inflammation of the oral cavity caused by herpes simplex virus which causes two types of infection, primary and secondary herpetic stomatitis.  The primary appears during the first infection of the virus usually during the first three years of life with local or generalized symptoms.  The ulcers are painful and cause discomfort in eating. The symptoms are decreasing even without medication after 2 weeks. In adulthood the symptoms are milder. After the primary infection the virus remains inactive in the organism until the immune system is weakened when it becomes active again and causes secondary herpetic stomatitis. There is no special medication and symptoms can last up to 2 weeks. Painkillers and mouthwashes are used to alleviate the pain as well as vitamin B and C supplements are recommended. The patient should consume liquid or soft food to avoid the pain.

4. Stomatitis caused by Candida Albicans: the fungal stomatitis appears as white plaques in the mouth or throat, which can become detached during lunch or brushing of the teeth. The parts of the oral cavity that may be affected are the buccal area, the tongue, the gums, the palate and the pharynx. Other symptoms that may occur include loss of taste or unpleasant taste in the mouth, redness in the mouth and throat, and burning or pain. Diabetes, poor fit and poor cleaning of dentures, the use of antibiotics / inhaled or topical corticosteroids for a long time, xerostomia and poor oral hygiene predispose the development of fungal stomatitis. Finally, the treatment of fungal stomatitis involves the use of local miconazole gel or, alternatively, the use of nystatin . Local gels can be used in adults, children and newborns older than 4 months.

Stomatitis as complication of cancer treatment:

It is one of the most common side effects of chemotherapy and radiotherapy. Appears as an inflammatory reaction of mucous membranes of the oral cavity and is characterized by red, corrosive and ulcerative lesions. It is a short-term situation. Appears 3-5 days after the first chemotherapy and the peak of the symptoms occurs on the 7th-14th day. Early diagnosis of problems in oral cavity in cancer patients can improve their quality of life during treatment. Patients should be informed about proper oral hygiene before starting treatment. Patients should brush their teeth at least twice a day. The toothbrush should be changed every 3 months. It should also be replaced in every patient's episode of infection. If the patient's mouth has ulcers, use of a soft toothbrush with a small head is recommended. The need to reduce food and beverages that contain sugar needs to be understood by patients. Care of the oral cavity in cancer patients should be continued after treatment is complete.