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Contact stomatitis - Oral Mucosal Lesion
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Contact stomatitis - Oral Mucosal Lesion

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Contributors: Carl Allen DDS, MSD, Sook-Bin Woo MS, DMD, MMSc
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Synopsis

Contact stomatitis is an immunologic reaction of the oral mucosa to any one of a variety of materials to which the mucosa might be exposed, including (but not limited to) flavoring agents, dental amalgam, and preservatives.

There is no age, sex or racial predilection associated with contact stomatitis, although most affected patients are adults.

Patients may complain of pain, tenderness or a burning sensation, and these symptoms may vary in their intensity depending on contact with the offending agent.

Contact reactions often appear from within a few days to a few weeks of exposure to the causative agent, although in some cases, hypersensitivity may not develop until after years of exposure. Lesions remain as long as the agent is in contact with the mucosa and resolution occurs after removal of the agent. Usually resolution is seen after 1-2 weeks, however, some lesions may take as long as 1-2 months to resolve.

Codes

ICD10CM:
K12.1 – Other forms of stomatitis

SNOMEDCT:
109775009 – Contact stomatitis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Leukoplakia – A predominantly white lesion with sharply demarcated borders.
  • Hairy leukoplakia – A white patch of the lateral/ventral tongue is seen almost exclusively in immunocompromised patients, particularly HIV-infected individuals.
  • Chronic cheek chewing (morsicatio buccarum) – Results in ragged white lesions and is typically seen on the anterior buccal mucosa. No ulceration is present, and the patient usually admits to the habit upon questioning.
  • Candidiasis – Pseudomembranous candidiasis presents as white patches on the oral mucosa that can be removed by gentle scraping. Hyperplastic candidiasis usually affects the anterior buccal mucosa, and is seen as a white plaque with blending margins that cannot be removed by scraping. This lesion may require culture or biopsy to demonstrate involvement by Candida albicans, and diagnosis is established after complete resolution following antifungal therapy.
  • Lichen planus and lichenoid drug reactions – Lichen planus usually has bilaterally symmetrical involvement by interlacing fine white striations, typically on the posterior buccal mucosa. Oral mucosal lichenoid drug reactions appear as localized patches of erythema with central ulceration and radiating fine white striations. Any one of a number of prescription and over-the-counter drugs may be responsible.

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Updated: 09/04/2013
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Contact stomatitis - Oral Mucosal Lesion
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Contact stomatitis : Mouth pain, Oral erosions, Oral mucosa, Oral white plaque, Glossodynia
Clinical image of Contact stomatitis
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