Stomatitis pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2], Usama Talib, BSc, MD [3]


Stomatitis is the inflammation of the mucosal surfaces in the mouth. Various factors can contribute to the pathogenesis of stomatitis depending on the type of stomatitis.[1]


Different mechanism are understood to cause different types of stomatitis:[1]

Infectious Causes

Non-infectious Types

  • Denture stomatitis:
    • Denture stomatitis effects upto 67% of denture wearers. It moct commonly affects the palatal mucosa.[16] The material used in fillings and dentures are porous because of the chemicals used and to give it a better grip. Pathogens like candida albicans can colonize such suitable sites, leading to an inflammatory response and thus denture stomatitis. The irritating effect of the foreign denture material can also contribute to the pathogenesis.[17][18]
  • Pyostomatitis vegetans:
    • Pyostomatitis vegetans is characterized by numerous painless, yellow, superficial pinpoint pustules with edema of the mucosa of the mouth. It is found in patients with ulcerative colitis. The vesicles can combine and involve the vermillion border of the upper as well as the lower lips. Snail track ulcerations are characteristic of pyostomatitis vegetans.[19][20]
    • The involvement of skin along with the oral mucosa is characteristic of an entity called pyodermatitis pyostomatitis vegetans.[21]
  • Nicotinic stomatitis:
    • As the name indicates, nicotinic stomatitis is caused by use of nicotine in cigarette or pipe smokers. It normally occurs on the hard palate of individuals who use pipes to smoke. The pathogenesis is explained by the heat and not the tobacco, and thus there is no malignant potential. The condition improves within 1 to 2 weeks of smoking cessation.[22][23][24]
  • Contact stomatitis:
    • Allergic substances present in products used for oral hygiene can lead to contact stomatitis. The pathogenesis of contact stomatitis involves an allergic response to the aromatic substances in the oral, cosmetic, or hygiene products.[25]


Though the genetics of stomatitis have not been studied extensively, it is understood that genetic polymorphisms are associated with the occurrence of stomatitis. Inherited epidermolysis bullosa is a known inherited disease and is associated with weak epithelium. [26]

Associated Conditions

The following conditions can be associated with stomatitis.[2][27][1]

Gross Pathology

The gross pathology of stomatitis can vary from redness and inflammation to presence of vesicles or pustules. Oral candidiasis for example may present a hyperplastic picture, erythematous picture or whitish pseudomembrane (thrush).

Herpetic Stomatitis

Herpetic stomatitis. Source: Wikimedia Commons[28]

Aphthous stomatitis

Aphthous stomatitis with visible mucosal lesion. Source:Wikimedia Commons[29]

Microscopic Pathology

The microscopic pathology helps to confirm the diagnosis and to differentiate different types of stomatitis.[30]

Vesicular stomatitis virus

Source:Wikimedia commons[31]


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  2. 2.0 2.1 Kolokotronis A, Doumas S (2006). "Herpes simplex virus infection, with particular reference to the progression and complications of primary herpetic gingivostomatitis". Clin Microbiol Infect. 12 (3): 202–11. doi:10.1111/j.1469-0691.2005.01336.x. PMID 16451405.
  3. Mandell; Gouglas, Gordon; Bennett, John. Principles and Practice of Infectious Diseases. Harvard Medical School: WILEY MEDICAL. p. 383. ISBN 0-471-87643-7. Unknown parameter |firs1t= ignored (help)
  4. Sharif S, Nakatani Y, Wise L, Corbett M, Real NC, Stuart GS; et al. (2016). "A Broad-Spectrum Chemokine-Binding Protein of Bovine Papular Stomatitis Virus Inhibits Neutrophil and Monocyte Infiltration in Inflammatory and Wound Models of Mouse Skin". PLoS One. 11 (12): e0168007. doi:10.1371/journal.pone.0168007. PMC 5148066. PMID 27936239.
  5. Mandell; Gouglas, Gordon; Bennett, John. Principles and Practice of Infectious Diseases. Harvard Medical School: WILEY MEDICAL. p. 988. ISBN 0-471-87643-7. Unknown parameter |firs1t= ignored (help)
  6. Hu J, Kent P, Lennon JM, Logan LK (2015). "Acute necrotising ulcerative gingivitis in an immunocompromised young adult". BMJ Case Rep. 2015. doi:10.1136/bcr-2015-211092. PMID 26376700.
  7. Mizrahi Y (2014). "[NUG--necrotizing ulcerative gingivitis: a review]". Refuat Hapeh Vehashinayim (1993). 31 (3): 41–7, 62. PMID 25219100.
  8. ROBINSON CR, RHODES AJ (1961). "Vesicular exanthem and stomatitis. Report of an epidemic due to Coxsacke virus Group A, Type 16". N Engl J Med. 265: 1104–5. doi:10.1056/NEJM196111302652207. PMID 14492892.
  9. Zhou PR, Hua H, Liu XS (2017). "Quantity of Candida Colonies in Saliva: 
A Diagnostic Evaluation for Oral Candidiasis". Chin J Dent Res. 20 (1): 27–32. doi:10.3290/j.cjdr.a37739. PMID 28232964.
  10. Lapins J, Gaines H, Lindbäck S, Lidbrink P, Emtestam L (1997). "Skin and mucosal characteristics of symptomatic primary HIV-1 infection". AIDS Patient Care STDS. 11 (2): 67–70. doi:10.1089/apc.1997.11.67. PMID 11361765.
  11. Sarti GM, Haddy RI, Schaffer D, Kihm J (1990). "Black hairy tongue". Am Fam Physician. 41 (6): 1751–5. PMID 2190456.
  12. Ramírez-Amador V, Esquivel-Pedraza L, Sierra-Madero J, Anaya-Saavedra G, González-Ramírez I, Ponce-de-León S (2003). "The Changing Clinical Spectrum of Human Immunodeficiency Virus (HIV)-Related Oral Lesions in 1,000 Consecutive Patients: A 12-Year Study in a Referral Center in Mexico". Medicine (Baltimore). 82 (1): 39–50. PMID 12544709.
  13. Ship JA (1996). "Recurrent aphthous stomatitis. An update". Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 81 (2): 141–7. PMID 8665304.
  14. Dalghous AM, Freysdottir J, Fortune F (2006). "Expression of cytokines, chemokines, and chemokine receptors in oral ulcers of patients with Behcet's disease (BD) and recurrent aphthous stomatitis is Th1-associated, although Th2-association is also observed in patients with BD". Scand J Rheumatol. 35 (6): 472–5. PMID 17343257.
  15. Murray LN, Amedee RG (2000). "Recurrent aphthous stomatitis". J La State Med Soc. 152 (1): 10–4. PMID 10668310.
  16. Arendorf TM, Walker DM (1987). "Denture stomatitis: a review". J Oral Rehabil. 14 (3): 217–27. PMID 3298586.
  17. Abduljabbar T, Al-Askar M, Baig MK, AlSowygh ZH, Kellesarian SV, Vohra F (2017). "Efficacy of photodynamic therapy in the inactivation of oral fungal colonization among cigarette smokers and non-smokers with denture stomatitis". Photodiagnosis Photodyn Ther. doi:10.1016/j.pdpdt.2017.01.182. PMID 28130176.
  18. Marinoski J, Bokor-Bratić M, Čanković M (2014). "Is denture stomatitis always related with candida infection? A case control study". Med Glas (Zenica). 11 (2): 379–84. PMID 25082257.
  19. Magliocca KR, Fitzpatrick SG (2017). "Autoimmune Disease Manifestations in the Oral Cavity". Surg Pathol Clin. 10 (1): 57–88. doi:10.1016/j.path.2016.11.001. PMID 28153136.
  20. Pellicer Z, Santiago JM, Rodriguez A, Alonso V, Antón R, Bosca MM (2012). "Management of cutaneous disorders related to inflammatory bowel disease". Ann Gastroenterol. 25 (1): 21–26. PMC 3959344. PMID 24713996.
  21. Matias Fde A, Rosa DJ, Carvalho MT, Castañon MC (2011). "Pyodermatitis-pyostomatitis vegetans: case report and review of medical literature". An Bras Dermatol. 86 (4 Suppl 1): S137–40. PMID 22068794.
  22. "Oral pathology quiz. Case number 2. Nicotine stomatitis". J N J Dent Assoc. 81 (1): 15, 19. 2010. PMID 20455505.
  23. Dreyer WP, de Waal J (2009). "Oral medicine case book 23. Case 1--snuff dipper's lesion, Case 2--nicotinic stomatitis". SADJ. 64 (10): 490–1. PMID 20306871 : 20306871 Check |pmid= value (help).
  24. Taybos G (2003). "Oral changes associated with tobacco use". Am J Med Sci. 326 (4): 179–82. PMID 14557730.
  25. Larsen KR, Johansen JD, Reibel J, Zachariae C, Pedersen AM (2017). "Symptomatic oral lesions may be associated with contact allergy to substances in oral hygiene products". Clin Oral Investig. doi:10.1007/s00784-017-2053-y. PMID 28084550.
  26. Gomes CC, Gomez RS, Zina LG, Amaral FR (2016). "Recurrent aphthous stomatitis and Helicobacter pylori". Med Oral Patol Oral Cir Bucal. 21 (2): e187–91. PMC 4788798. PMID 26827061.
  27. R. Morgan, J. Tsang, N. Harrington & L. Fook (2001). "Survey of hospital doctors' attitudes and knowledge of oral conditions in older patients". Postgraduate medical journal. 77 (908): 392–394. PMID 11375454. Unknown parameter |month= ignored (help)
  28. title="By Klaus D. Peter, Gummersbach, Germany (Own work) [CC BY 3.0 de (], via Wikimedia Commons" href=""><img width="512" alt="Stomatitis herpetica" src=""
  29. title="By Farhan 9909 (Own work) [CC BY-SA 4.0 (], via Wikimedia Commons" href=""><img width="512" alt="Aphthous stomatitis on the labial mucosa" src=""
  30. title="By Klaus D. Peter, Gummersbach, Germany (Own work) [CC BY 3.0 de (], via Wikimedia Commons" href=""><img width="512" alt="Stomatitis herpetica" src=""
  31. title="By Klaus D. Peter, Gummersbach, Germany (Own work) [CC BY 3.0 de (], via Wikimedia Commons" href=""><img width="512" alt="Stomatitis herpetica" src=""