Stomatitis in children - symptoms, causes and treatment.

Inflammatory gum disease in adults and children is called gingivitis. It is most often observed in children a few months from birth to 13 years of age, which is explained by the characteristics of the child’s body and poor oral hygiene.

According to statistics, in a child from 2 to 4 years old, gum inflammation occurs in 2% of cases, and by the age of 13, the proportion of this disease in children reaches 80%. Gingivitis cured in time does not become chronic, but if left untreated it can cause the development of periodontitis.

Causes of stomatitis

Inflammation of the oral mucosa can be caused by various reasons.

Mucosal injury6.
Viral, bacterial or fungal infection6.
Allergy2.
Immunity disorders (autoallergy, that is, a reaction to one’s own altered tissues2).
Diseases of the blood, digestive, cardiovascular, nervous and endocrine systems2.
Hypovitaminosis - lack of vitamins C, B1, B12, E, D32.
Common infectious processes: measles, rubella, scarlet fever and diphtheria, infectious mononucleosis, tuberculosis and others1.

Only a specialist can understand the causes of stomatitis. Therefore, if symptoms of the disease appear, you should definitely contact your dentist.

Inflammatory diseases of the oral cavity can occur in a child of any age6. Immaturity of the body is the primary factor predisposing to the occurrence of stomatitis in children under one year of age. The mucous membrane of the oral cavity during this period of a child’s life is very vulnerable, its natural protective properties are reduced. The immunity received from the mother during fetal development and which protected the baby immediately after birth weakens every day. Therefore, the infection easily penetrates the mucous membrane and causes its inflammation. Most often at this age, candidal stomatitis occurs, commonly called thrush1,6.

From the age of one to 3 years, children actively develop immune mechanisms to protect the oral mucosa (local immunity), but its permeability to viruses remains extremely high. Therefore, in a 2-3 year old child, stomatitis is more likely to be viral, in the vast majority of cases - herpetic1,3,4.

From 4 to 12 years of age, stomatitis in children is more often caused by allergic and autoimmune reactions. In particular, chronic aphthous forms of the disease occur during this period1.

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If the causative tooth is still a baby tooth -

When writing this section, we used the “National Guide to Pediatric Therapeutic Dentistry” (edited by Professor V.K. Leontyev). Let's figure out what parents need to know... The presence of a swelling/bump on the gum, or a fistula, indicates the development of acute periodontitis, or an exacerbation of chronic periodontitis. In the vast majority of cases, baby teeth that have caused the appearance of ulcers on the gums must be subject to mandatory removal. The fact is that in most cases the roots of baby teeth will either not yet be formed or will already have signs of resorption (see photo below).

In both cases, this will not allow for high-quality obturation (filling) of the root canal lumen with filling material. Poor quality filling will certainly lead to the development of purulent inflammation, and in severe cases, sepsis, which even poses a threat to life. Injury to the permanent tooth germ is also possible, both during root canal treatment and as a result of the development of purulent inflammation in the area of the apex of the roots of a baby tooth.

Milk teeth for removal (with signs of resorption) –

But the physiological immaturity of the immune system of children also poses a problem for the treatment of such teeth, which in this situation also contributes to the development of purulent complications. Therefore, to determine the possibility of treatment, we first need a targeted Rg image, which will show the degree of resorption, as well as the presence of foci of inflammation at the apex of the roots of a baby tooth. Below we will list when such teeth require mandatory removal, and in what situations you can try endodontic root canal treatment in baby teeth.

Indications for mandatory removal:

if there are less than 2 years left before the physiological change,
if the tooth crown is severely damaged and cannot be restored,
the tooth has degree II-III mobility,
in the presence of a fistula tract,
if the x-ray shows signs of root resorption (we are talking not only about external root resorption, but also about internal one),
if the image shows a pronounced inflammatory focus of bone tissue destruction (at the apex of the root of a baby tooth), i.e. we are talking about an exacerbation of chronic granulating periodontitis,
if the child belongs to health groups III, IV, V,
if the child has caries in the area of most teeth (decompensated form of the carious process).

Possibility of endodontic treatment:

if the root of the baby tooth is formed and does not show signs of resorption,
in the absence of tooth mobility,
in the absence of a fistula tract,
if the focus of inflammatory destruction at the apex of the root of a baby tooth is very small in size, and at the same time is separated from the permanent tooth germ by a layer of unchanged bone tissue. Filling the canals of a baby tooth (before and after photos) –

Important: you should also take into account that such treatment is very complex and requires a highly qualified pediatric dentist, as well as a large amount of time per patient. Therefore, this is unlikely to be a good idea – if we are talking about public medicine. Also, endodontic treatment will require several visits, and subsequently regular follow-up with radiography (parents must be prepared for this). You also need to consider how important this tooth is in terms of preventing malocclusion.

Filling canals in a baby tooth (video):

In the video below you can see the process of filling root canals in the 1st primary molar. Please note that mechanical treatment of root canals was performed using an endodontic tip and modern rotary files (created specifically for children's teeth). The most modern paste based on calcium hydroxide and iodoform was used as a material for filling root canals in baby teeth. At the end of the video, you will be able to see an x-ray that shows the quality of root canal filling. In this case, I would like to say about the excellent work of the doctor.

A few more things parents should know:

Unfortunately, in recent years, due to the deterioration in the quality of training of doctors, you can hear that many pediatric dentists recommend not removing such teeth, citing the fact that removal will cause malocclusion. And therefore, very often children continue to walk with chronic inflammation at the roots of their baby teeth. In part, the effect of early removal of baby teeth on the bite is true (but primarily only in relation to baby molars, the removal of which can lead to a shift in the rudiments of permanent teeth). But this is not the only thing to consider.

The fact is that the purulent focus of inflammation in the area of the roots of a baby tooth is separated from the permanent tooth germ by only 1-2 mm of bone (Fig. 6). Studies have shown that disruption of the eruption of permanent teeth is caused not only by the early removal of baby teeth, but also by the influence of pyogenic bacteria and their toxins on the rudiments of permanent teeth. For example, you did not remove a child’s baby tooth with inflammation at the apex of the root, and this will also delay the eruption of a permanent tooth. In addition, inflammation at the root of a baby tooth can even lead to the death of a permanent tooth germ (this happens especially often if inflammation occurs before the start of mineralization processes in the permanent tooth germ).

Important: you also need to take into account the effect of a pyogenic infection on the general health of the child. For example, the fact that infection from the source of inflammation will constantly enter the submandibular lymph nodes, causing the development of lymphadenitis. In addition, once in the blood, waste products of pyogenic bacteria affect the entire body as a whole - they increase the risk of developing allergies, bronchial asthma, diabetes, heart and joint diseases.

If purulent inflammation is accompanied by the formation of a fistula, then you must understand that pus will constantly enter the oral cavity through the fistula, the child will swallow it, and this will lead to the colonization of the tonsils with a pyogenic infection and the development of chronic tonsillitis. And in this case, the development of a sore throat or constant regular exacerbations of chronic tonsillitis is guaranteed for the child.

Traumatic stomatitis

Inflammation of the mucous membrane in the mouth can be preceded by trauma: mechanical, thermal, chemical, radiation1,6.

Small children who put everything in their mouths can injure the mucous membranes with the sharp edges of toys or household items. Injuries often occur due to inept use of cutlery as a result of falls. In older children, stomatitis may be associated with a thermal burn, blows to the teeth, or the bad habit of chewing a pencil or pen. Sometimes the cause of inflammation is dental diseases and their treatment: sharp edges of damaged teeth and fillings, braces and aligners1.

When stomatitis develops in a child on the gum, on the inner surface of the cheek or in another place, the mucous membrane becomes red and swollen, and a painful erosion or ulcer may appear in the area of damage. Since there are many microorganisms in the mouth, there is always a risk of a bacterial or fungal infection1.

If the mucous membrane is constantly injured, painless whitish or whitish-gray layers may form on it.

In children under 1 year of age, stomatitis can be the result of using the wrong nipples: long, tight, irregularly shaped. The resulting Bednar aphthae are located in the area of the transition of the soft palate to the hard palate and are round erosions or ulcers1.

Treatment of traumatic stomatitis in children includes:

elimination of traumatic factors;
rinsing the mouth, irrigating the mucous membranes and treating wounds with drugs with an analgesic and antiseptic effect1.

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Causes of purulent-inflammatory pathologies

Gingivitis

Gingivitis in children occurs due to regular poor oral hygiene, accumulation of plaque, and deposition of stones. The situation is aggravated by factors such as crowded teeth, malocclusion, installed braces and other orthodontic structures.

Ulcers are formed due to untreated caries and improper oral care.

A fistula is the result of neglected infectious processes, a consequence of improper treatment of dental diseases.

What symptoms should parents be wary of?

The first signs of unhealthy gums are bad breath and bleeding when brushing your teeth.
Upon examination, you can see reddened areas above the teeth. Pus does not always provoke a rise in overall body temperature. Swelling of the face or pain in the initial stages is mild or absent.

Abscess

An abscess on the gum of a child is distinguished by the specificity of its symptoms - a feeling of local distension, pain, the formation of a tubercle, where decay products gradually accumulate in the form of a foul-smelling liquid. As the disease progresses, physical activity decreases and appetite disappears.

Treatment methods

Important! Self-treatment of a fistula on the gum of a child, or other diseases in the form of rinses, lotions, and ointments is unacceptable. This is dangerous due to such consequences as gumboil, loosening and loss of permanent teeth, and periodontal disease. In severe cases - transition to a chronic condition, decreased immunity, frequent viral infections of the body, partial or complete paralysis of the facial nerve.

Fistula

At the dental clinic "Podmoskovye" we take a professional approach to treatment, which includes the following stages:

detailed diagnostics - examination, instrumental examination;
drawing up a treatment plan in a clinical setting;
Recommendations for caring for your oral cavity at home.

Only an integrated approach will preserve the health of the oral cavity until the dental system is fully formed.

Read more about our pediatric dentistry in the Pediatric Dentistry section

Viral stomatitis

About 80% of all stomatitis in children is caused by herpes viruses3,5. In approximately 70% of cases, the disease develops in children aged 1 to 3 years3,4.

The disease can occur in mild, moderate and severe forms.

With mild herpetic stomatitis, the general condition is practically not disturbed. Body temperature does not exceed 37-37.50 C. Symptoms of inflammation are limited to swelling of the gums and usually the simultaneous appearance of single painful herpetic blisters and erosions on the mucous membrane (no more than 6). After 1-2 days, the contours of the lesions are blurred, the rashes turn pale, and the erosions heal without scarring3.

With moderate stomatitis, the child’s temperature reaches 38-390 C and lasts until rashes continue to appear. General intoxication manifests itself in the form of weakness, headache, nausea. The child becomes capricious, lethargic, refuses to eat and play3.

As the temperature rises, the oral mucosa becomes red and swollen, and the gums begin to bleed. The number of herpetic elements reaches 20-25, repeated rashes are accompanied by fever3.

Severe stomatitis in children looks like a common acute infectious disease and is accompanied by severe intoxication: fever 39-400 C, chills, headache, aching muscles and joints, heart rhythm disturbances, nosebleeds, nausea and vomiting. The number of herpetic elements can reach 100; they are located not only in the mouth, but also on the skin of the face, on the eyelids and conjunctiva of the eyes, and earlobes. In addition, upper respiratory tract symptoms may be present.3

Treatment includes treating the affected area with painkillers and antiseptic drugs, antiviral therapy, drinking plenty of fluids, a balanced diet and proper nutrition3,5.

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How to distinguish stomatitis from other diseases

Since stomatitis can appear for a variety of reasons, and the forms of its manifestation can be very different, it is highly not recommended to self-medicate, since in this case you can only aggravate the course of the disease and cause the appearance of new symptoms. Due to such diversity, methods of treatment and prevention of this disease can also be very different.

Manifestations of stomatitis may be similar to a number of diseases, from each of which a doctor, when examining a patient, will definitely be able to distinguish this ailment:

Sore throat or stomatitis: you can determine a sore throat, which may be similar to stomatitis, by damage not only to the mucous membranes of the mouth, but also to the pharynx. It is very painful for the patient to swallow.
Herpes or stomatitis: In the case of herpes, the rashes first look like blisters and appear later.
Cancer or stomatitis: the first disease is distinguished by the fact that ulcers appear, which grow together over time. As a result, one ulcer forms and begins to grow.
Thrush or stomatitis: when examining the mouth, if there is a disease such as candidiasis, a yellow or white coating is detected, redness, the wounds are round in shape, and the ulcers are small.
Syphilis or stomatitis: the first disease is distinguished by the nature of the ulcers. They appear in the form of eosis and do not hurt. Sometimes there is a depression in the center of the wound.

The doctor selects the treatment for stomatitis based on the cause of the disease, the complexity of its course, the form of manifestation, the individual characteristics of the body, and so on - in general, you will have to take into account a lot of things in order to choose the correct and most effective treatment. A specialist usually easily determines that it is stomatitis and not another disease.

Candidal stomatitis

In 80% of healthy children, Candida fungi can be found in the oral cavity. They get there during childbirth, from nipples and pacifiers, from care products, in contact with the mother's skin, with food during eating and usually do not cause any problems. Candidal stomatitis, or thrush, occurs when immunity decreases1.

Predispose to the disease:

prematurity and postmaturity;
developmental defects and concomitant diseases;
treatment with antibiotics and hormones;
artificial feeding;
poor care and poor feeding hygiene;
Using the wrong nipples1.

What does candidal stomatitis look like? In children's mouths, whitish or whitish-gray dotted formations appear on the reddened mucous membrane. They merge into films of a cheesy nature; when the films are rejected, bright red painful erosions are formed. Because of the pain, the baby becomes restless, cries often, sleeps poorly, and refuses to eat1.

In severe cases of candidiasis, a cheesy coating may appear on the palate and on the lateral surfaces of the tongue, on the tonsils and the back wall of the pharynx - candidal tonsillitis and pharyngitis develop1.

If your child has a fungal infection, you should always consult a doctor; he will tell you how and what to treat the mucous membrane with candidal stomatitis, so that the child does not have complications and recovers faster. Treatment, as a rule, involves treating the oral cavity with drugs with antifungal activity (chlorhexidine, hexethidine). In severe cases of the disease, antifungal agents, probiotics and immunomodulators are prescribed1.

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Allergic stomatitis

Allergic damage to the mucous membrane most often occurs in the form of contact stomatitis and chronic aphthous form of the disease1.

Allergens can include medications, food products, varnishes and paints that coat toys, toothpastes, mouth rinses, chewing gum, and dental metals included in braces1,2.

With allergic stomatitis in children, erosions and ulcers may appear in the mouth, but more often the matter is limited to redness and swelling of the mucous membrane1.

Treatment is avoiding contact with the allergen, rinsing or irrigating the mouth with antiseptic solutions to prevent infection. If necessary, doctors recommend taking antihistamines1,2.

Chronic recurrent aphthous stomatitis often occurs in schoolchildren and adolescents due to allergies2. In addition, its development can be provoked by diseases of the gastrointestinal tract, upper respiratory tract infections, disorders of the nervous system, and hypovitaminosis1,2.

With aphthous stomatitis in children, itching and burning first appear in the oral cavity. The mucous membrane at the site of the lesion becomes red and swollen, then an aphtha forms on it - a round or oval erosion 0.5-1 cm in diameter rising above the surrounding tissues with a red rim along the periphery and a bottom covered with a grayish-white coating. Aphthae are extremely painful, and if many of them form, they cause significant distress to the child1,2.

How many days does aphthous stomatitis last in children? With a mild course of the disease, the elements of inflammation persist for up to 5-7 days, then they heal without scar formation2 and do not appear for quite a long time. However, in severe cases, aphthae can occur constantly, and then many elements of inflammation can be found on the mucosa at different stages of development1,2.

To treat aphthous stomatitis, doctors use:

antihistamines;
immunomodulatory drugs;
vitamins;
probiotics2.

As a local therapy, it is recommended to treat the mucous membrane with drugs with analgesic, antiseptic, proteolytic (protein-breaking), anti-inflammatory and regenerating effects2.

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How to treat

If a child has a white sore on his gum, you can resort to drug treatment to achieve a quick therapeutic effect. It is recommended to give preference to the following medicinal formulations:

Metrogyl Denta is a dental gel that has an antimicrobial effect. Allowed for use in children over six years of age. The drug is prescribed for the treatment of gingivitis, periodontitis, bacterial aphthous stomatitis, inflammation of the hood under the wisdom tooth, and periodontal abscess. Sores should be treated twice a day after meals and subsequent treatment of the oral cavity with antiseptic compounds.
Cholisal is a dental gel that has antimicrobial, anti-inflammatory and analgesic effects. This drug is perfect for children, because it has no age restrictions. The ulcers should be treated with the drug twice a day for a duration of treatment of about 10 days.
Kamistad is a combined drug for topical use that has a local anesthetic, antimicrobial, and anti-inflammatory effect. For children over the age of three months, it is recommended to apply the composition to the sores three times a day, keeping the strip length to 5 mm.
Chlorhexidine is an antiseptic solution used for hygienic treatment of the oral cavity. Has a detrimental effect on bacteria and other harmful microorganisms.
Acyclovir is a drug prescribed for the treatment of formations on the oral mucosa associated with herpes infection. The medicinal composition helps accelerate the healing of formations, relieve pain, and provide an immunostimulating effect. It is recommended to treat ulcers with cream about 5 times a day for a treatment duration of 5 to 10 days.
Benzydamine is a medicinal non-steroidal anti-inflammatory composition that has local antiseptic, analgesic and antipyretic effects. Available in the form of lozenges, creams, and solutions. As part of complex therapy, the drug is indicated for stomatitis, pharyngitis, aphthous ulcers, tonsillitis, and gingivitis. The medicine can only be used after reaching 12 years of age.

Chlorhexidine solution.

Hexoral in the treatment of stomatitis

For local treatment of stomatitis in children, drugs from the HEXORAL® line can be used.

For irrigation of the oral cavity, the doctor may recommend aerosol HEXORAL® based on hexethidine, which has antiseptic properties7. Thanks to the fine spray, the drug is evenly distributed over the entire surface of the mucosa7. A solution of HEXORAL®8, similar in composition, is intended for rinsing the mouth. Both medications can be used to treat children 3 years of age and older.

Mint-flavored lozenges HEXORAL® TABS based on chlorhexidine and benzocaine may be suitable for boys and girls over 4 years of age9.

For patients with stomatitis over 6 years of age - HEXORAL® TABS CLASSIC based on the antiseptic amylmetacresol. The assortment includes tablets with lemon, orange, black currant, lemon and honey flavors10.

HEXORAL® TABS EXTRA may be suitable for adolescents aged 12 years and older. The lidocaine it contains can relieve even severe pain11.

The information in this article is for reference only and does not replace professional advice from a doctor. To make a diagnosis and prescribe treatment, consult a qualified specialist.

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Principles of treatment of childhood stomatitis

Doctors do not recommend treating childhood stomatitis at home, since in this case there is an extremely high probability of causing serious harm to the child’s health with drugs that are not intended for the treatment of children, especially for an unconfirmed diagnosis. At the clinic, the child will be examined by a dentist, make an accurate diagnosis and prescribe effective treatment. Treatment is often based on stages such as:

isolation of a sick child from other children;
disinfection of objects with which he came into contact;
drawing up a suitable daily diet (it is important to minimize the amount of carbohydrates);
ensuring oral hygiene to prevent secondary infections.

Features of treatment of different types of childhood stomatitis

There are several types of childhood stomatitis. Most often, specialists encounter the following:

vesicular (viral) - appears due to the influence of bacteria; transparent bubbles form on the larynx, lips, cheeks, tongue;
herpetic - the herpes virus enters the child’s mouth;
aphthous - occurs due to allergic effects;
candidiasis - appears due to the proliferation of Candida fungi in the mouth.

Any type of stomatitis should be treated under the supervision of a doctor. The treatment process for each type of disease has its own characteristics.

If it is important for you that the treatment of stomatitis has a positive effect, then you can contact the Moscow Region clinic. For your child, our specialists will develop the most effective treatment plan and select the most appropriate medications. You can find a complete list of the cost of services in the pediatric dentistry department. We are always happy to be useful to each member of your family!

Literature

Khomenko L. A. Therapeutic dentistry of children. Textbook for university / ed. 2007 – pp. 643-722.
Ismailova G. T. Chronic recurrent aphthous stomatitis // Bulletin of surgery of Kazakhstan. - 2011. - No. 4. — P. 124-125.
Drobotko L.N., Strakhova S.Yu. Acute stomatitis in children // Issues of modern pediatrics. - 2010. - T. 9. - No. 2. - P. 146-149.
Suerkulov E. S., Yuldashev I. M., Mamyraliev A. B., Toktosunova S. A., Tsepeleva A. S., Sooronbaev A. A. Prevalence and structure of the incidence of stomatitis in children // Bulletin of Science and Practice. 2022. T. 4. No. 11. — P. 91-96.
Suerkulov E. S., Yuldashev I. M., Mamyraliev A. B., Zhumashova N. K., Yuldasheva G. I. Complex therapy of inflammatory diseases of the oral mucosa in children // Bulletin of Science and Practice. 2022. T. 5. No. 5. — P. 96-104.
Pankrusheva T.A., Maravina I.N., Chekmareva M.S. Research on the development of the composition and technology of tablets for the treatment of stomatitis // Scientific result. Medicine and pharmacy. – T.4, No. 1, 2022. – P. 78-87.
Instructions for medical use of the drug HEXORAL® aerosol: , .
Instructions for medical use of the drug HEXORAL® solution: , .
Instructions for medical use of the drug HEXORAL® TABS: , .
Instructions for medical use of the drug HEXORAL® TABS CLASSIC: , .
Instructions for medical use of the drug HEXORAL® TABS EXTRA: , .

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