Follow-Up Recommendations

Patient Monitoring Lesions need to be followed until resolved. If they fail to resolve, continuously recur, or appear suspicious, biopsy may be needed.

Diet

May need to avoid spicy, acidic, sharp, hard, and dry foods

Patient Education

Patient handouts:

• Aphthous ulcers (English and Spanish): http://www.aafp.prg/afp/20701/160ph.html
• Gingivostomatitis: http://www.nlm.nih.gov/medlineplus/ency/article/152.htm
• Mouth sores (English and Spanish): http://www.nlm. nih.gov/medlineplus/ency/article/003059.html
• Mouth problems in infants and children: http://familydoctor.org/online/famdocen/home/tools/symptom/510.html

Prognosis

• Herpetic: Self-limited, with resolution in 7–14 days
• Hand-foot-mouth disease: Same as for herpetic
• RAS: 7–14-day course per episode
• Vincent: May progress to fascial space infection with airway compromise or sepsis
• Nicotinic: Resolves with cessation of smoking
• Denture: Resolves with proper fitting, careful oral hygiene, and daytime-only denture wear
• Erythema multiforme: Resolution in 2–3 weeks
• Stevens-Johnson: Resolution in about 6 weeks with adequate supportive care
• Recurrent ulcerative: As the name implies, recurs over time, but the overall prognosis is good
• Recurrent scarifying: Occasional patients suffer continuous ulcers; others have recurrence with eventual scarring. The prognosis is otherwise good.
• Behçet disease may recur for several years. Overall prognosis is related to other aspects of the disease.
• Angular: After correction of mechanical problems, allergic disorders, and nutritional deficiencies, the prognosis is good.
• Gangrenous: The most serious stomatitis, requiring aggressive treatment with IV antibiotics and débridement to avoid death
• Scarlatina: The prognosis is related to other manifestations of the disease.
• Herpangina: 7–14-day course with total resolution
• Uremic: Depends on the underlying renal disease

Complications

• Recurrent scarifying stomatitis may result in intraoral scarring with restriction of oral mobility.
• Behçet disease may result in visual loss, pneumonia, colitis, vasculitis, large-artery aneurysms, thrombophlebitis, or encephalitis.
• Gangrenous stomatitis may lead to facial disfigurement and even death.
• Scarlet fever may result in cardiac disease.
• Herpetic stomatitis may be complicated by ocular or CNS involvement.