Stomatitis Disease

DESCRIPTION

Generalized inflammation of the oral mucosa of many possible etiologies

System(s) affected: Skin/Exocrine
Genetics: N/A
Incidence/Prevalence in USA:
- Herpetic stomatitis, hand-foot-and-mouth disease, and recurrent aphthous stomatitis are very common
- Herpangina is fairly common as are nicotinic and denture related stomatitis. The remaining causes are uncommon or rare.
Predominant age:
- Herpetic-primary infections - children
- Hand-foot-and-mouth disease - children
- Vincent's stomatitis - teenagers and young adults
- Behçet's disease - young adults
- Herpangina - children
- Others - N/A
Predominant sex: Male = Female

SIGNS AND SYMPTOMS

General:
- Depends on etiology
- Varies from minimal to severe pain
- Many have multiple intraoral ulcers from 1 mm to several centimeters in diameter
- Some with constitutional symptoms - fever, malaise, headache
Allergic stomatitis:
- Intense shiny erythema
- Slight swelling
- Itching
- Dryness
- Burning
Vincent's infection:
- Necrotic ulceration of interdental papillae and mucous membrane
Thrush (candidiasis):
- White patches, slightly raised (resembling milk curds)
- Distribution - tongue, buccal mucosa, palate, gums, tonsils, larynx, pharynx, GI tract, skin; commonly seen in infants, immunocompromised patients; patients on long-term antibiotics, corticosteroids, and anti-neoplastic treatment
Pseudomembranous stomatitis:
- Membrane-like exudate
Mucous lesions accompanying systemic disease:
- Mucous patches (syphilis)
- Strawberry (measles)
- Koplik's spots (measles)
- Ulcers (erythema multiforme)
- Smooth, fire-red, painful (pellagra)

CAUSES

Allergy - foods, drugs, contact (some erythema multiforme)
Vitamin deficiency - riboflavin (angular stomatitis)
Viral - herpes simplex I and II (herpetic stomatitis), Coxsackie A (herpangina and hand-foot-and-mouth disease)
Smoking (nicotinic stomatitis)
Hormonal (possibly recurrent ulcerative stomatitis)
Uncertain (recurrent aphthous stomatitis, Vincent's stomatitis, recurrent scarifying stomatitis, Behçet's disease, angular stomatitis, gangrenous stomatitis, erythema multiforme)
Bacterial (scarlatina)
Uremic (uremic/nephritic)
Dentures

RISK FACTORS

Listed with Causes

LABORATORY

Hematologic profile
Tzanck test of historic interest only
Serologic test for syphilis

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Biopsy suspicious lesions or lesions that fail to heal or chronically recur to rule out cancer or vasculitis

SPECIAL TESTS

N/A

IMAGING

N/A

DIAGNOSTIC PROCEDURES

Biopsy if persistent/recurrent/suspicious

APPROPRIATE HEALTH CARE

Outpatient, unless severe

GENERAL MEASURES

In most cases treatment is symptomatic only
Severe cases may require parenteral fluids, particularly in children
Topical anesthesia
Analgesics
Oral rinses such as 1/2 strength hydrogen peroxide
Mycostatin, if superinfected with candida
Stop smoking

SURGICAL MEASURES

N/A

ACTIVITY

As tolerated by patient

DIET

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

PATIENT EDUCATION

Griffith: Instructions for Patients; Philadelphia, W.B. Saunders Co.

PREVENTION/AVOIDANCE

Avoid causative factors

POSSIBLE COMPLICATIONS

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

EXPECTED COURSE AND PROGNOSIS

Herpetic - self-limited with resolution in 7-14 days
Hand-foot-and-mouth disease - same as herpetic
Recurrent aphthous - 7-14 day course per episode
Vincent's - may progress to fascial space infection with airway compromise or sepsis
Nicotinic - will resolve with cessation of smoking
Denture - will resolve with careful oral hygiene and daytime denture wear only
Erythema multiforme - resolution in 2-3 weeks
Stevens-Johnson - resolution in about 6 weeks with adequate supportive care
Recurrent ulcerative - as the name implies, these recur over time, but the overall prognosis is good
Recurrent scarifying - occasional patients suffer continuous ulcers, others recur with eventual scarring; the prognosis is otherwise good
Behçet's disease - may recur for several years; prognosis for vision is poor; 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 - most serious stomatitis, requiring aggressive treatment with IV antibiotics and débridement to avoid death
Scarlatina - prognosis is related to other manifestations of the disease
Herpangina - 7-14 day course with total resolution
Uremic - depends on the underlying renal disease

ASSOCIATED CONDITIONS

AIDS - associated with severe lesions

AGE-RELATED FACTORS

Pediatric: Certain etiologies more likely in the pediatric population: Herpetic-primary, hand-foot-and-mouth disease, herpangina
Geriatric: Certain etiologies more likely in the geriatric population, e.g., dentures
Others: N/A

PREGNANCY

May bring on recurrent ulcerative stomatitis

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

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