Editors

MerjaHelminen

Stomatitis in Children

Infant stomatitis with Candida albicans as the most common causative agent
Light-coloured patches or coatings mainly on the tongue
Mild oral candidiasis requires no drug treatment. Lemon juice, for example, may be used for self-treatment.
Drug therapy consists usually of topical antimycotics (miconazole gel, nystatin mixture Ehttp://www.dynamed.com/condition/oral-candidiasis-in-infants#TREATMENT_OF_ORAL_CANDIDIASIS_IN_HEALTHY_INFANTS).
It is advisable to change the pacifiers of an infant.
If the candidiasis is persistent and refractory to treatment, the possibility of immune deficiency should be kept in mind.
In severe cases, e.g., in immunocompromised children, systemic fluconazole may be used Ehttp://www.dynamed.com/condition/oral-candidiasis-in-infants#TREATMENT_OF_ORAL_CANDIDIASIS_REFRACTORY_TO_TREATMENT_OR_IN_IMMUNOCOMPROMISED_INFANTS.

See Viral Infections of the Oral Mucosa.
Herpes simplex virus is the causative agent.
The general symptoms of a primary infection include fever, malaise, and headache.
Herpetiform vesicles can be detected on the buccal mucosa, lips, and tongue; the vesicles often break and result in a small erosion.
The gingivae are red, swollen, and often bleeding. The mouth is extremely sore, and the child may not want to eat.
The patient recovers spontaneously: the fever disappears after the fourth day, and the vesicles resolve a couple of days later.
Acyclovir is beneficial if the treatment is started during the first days after onset.

The causative agents belong to the genus of enteroviruses. The most common organism causing hand-foot-and-mouth disease is coxsackievirus A16 Enterovirus Infections. The diseases usually occur in late summer and early autumn.
Vesicles can be detected in the posterior part of the mouth, on the palate, tonsils, and posterior pharynx, in hand-foot-and-mouth disease also in the hands and feet Ehttp://www.dynamed.com/condition/hand-foot-and-mouth-disease#MAKING_THE_DIAGNOSIS.
The disease is usually mild. The symptoms are milder than in stomatitis caused by herpes virus. Unlike herpes infections, enteroviral infections rarely cause gingivitis (gum bleeding). The general symptoms include fever, mouth pain, and unwillingness to eat.
Treatment is symptomatic.

See Assessment of Oral Mucosal Changes
The condition is characterized by recurring painful ulcers in the mouth in an otherwise healthy child, usually 1 to 5 ulcers at a time.
The aetiology is unknown. E.g. stress, anaemia or certain food stuffs may act as predisposing factors. In some cases, toothpastes containing sodium lauryl sulfate may trigger off the condition.
The doctor should also exclude systemic diseases that may be associated with similar oral changes: neutropenia, inflammatory bowel disease, coeliac disease, immune deficiency, Behçet's disease Ehttp://www.dynamed.com/condition/aphthous-stomatitis#DIFFERENTIAL_DIAGNOSIS.
Unlike herpes infection, there are no blisters at the onset or general symptoms (e.g. fever).
Topical corticosteroids may provide some benefit Ehttp://www.dynamed.com/condition/aphthous-stomatitis#TOPICAL_CORTICOSTEROIDS; see Assessment of Oral Mucosal Changes. Antibacterial mouthwashes may also help.

Give NSAIDs as solutions or rectal suppositories for fever and pain.
Local anaestetic gels and solutions usually containing lidocaine are available (special regulations for prescription may apply). They must be used cautiously in small children so as not to exceed the maximum lidocaine dose (3 mg/kg/24 h orally).
Occasionally viral stomatitis becomes prolonged, resulting in a disturbance of fluid and electrolyte balance so that hospitalization is necessary.
There is some evidence that acyclovir (and valacyclovir) may shorten the duration of symptoms in stomatitis caused by herpes. It can be used on patients with severe symptoms within three days after onset of symptoms Ehttp://www.dynamed.com/condition/oral-herpes#ANTIVIRALMEDS.

Amir J. Clinical aspects and antiviral therapy in primary herpetic gingivostomatitis. Paediatr Drugs 2001;3(8):593-7. [PubMed]
Scully C. Clinical practice. Aphthous ulceration. N Engl J Med 2006 Jul 13;355(2):165-72. [PubMed]