Topic: Stomatitis

Subject: AHN

Learning objectives

• At the end the learners will be able to;• Define stomatitis.• Describe causes of stomatitis.• Enlist signs and symptoms of stomatitis.• Discuss types of stomatitis.• Discuss management of stomatitis.

StomatitisDefinition : Stomatitis is an inflammation of the

mucous lining of the mouth , which may involve the cheeks, gums ,tongue ,lips , and roof or floor of the mouth. The word“ stomatitis “ literally means inflammation of the mouth.

Description

Stomatitis is an inflammation of the lining of any of the soft-tissue structures of the mouth.

It is usually a painful condition ,associated with redness, swelling ,and occasional bleeding from the affected area.

The inflammation may be caused by conditions in the mouth itself , such as poor hygiene , from burns from hot food or drinks,

or by conditions that affect the entire body , such as medications , allergic reactions , or infections.

Stomatitis

Causes of stomatitis • Chemotherapy • Radiotherapy • Loose-fitting dental prosthetics • Trauma • Poor dental hygiene • Smoking • Hematologic malignancies (stomatitis develops at 2to

3 times the rate of solid tumor) • Infection (viral , fungal ,and bacterial) • Dehydration • Medications

Medications associated with stomatitis

• Chemotherapy. • Antihypertensive. • Opioids .• Antibiotics (indirect) •Diuretics (increase risk of dehydration in compromised

state) • Anticholinergic .• Antihistamines and decongestants. • Steroids. • Antidepressants.

Signs and symptoms • Pain or discomfort in the mouth. • The presence of open sores or ulcers in the mouth. • Fever ,sometimes as high as 101– 104°F .• Irritability and restlessness .• Blisters in the mouth .• Swollen gums , which may be irritated and bleed. • Drooling. • Dysphagia.• Foul-smelling breath.

Types of stomatitis

• Nutritional deficiency stomatitis •Aphthous stomatitis •Angular stomatitis •Denture-related stomatitis •Allergic contact stomatitis •Migratory stomatitis •Herpetic gingivostomatitis

Nutritional deficiency• Malnutrition (improper dietary intake) or

malabsorption (poor absorption of nutrients into the body) can lead to nutritional deficiency states, several of which can lead to stomatitis. For example, deficiencies of iron, vitamin B2 (riboflavin), vitamin B3 (niacin), vitamin B6 (pyridoxine), vitamin B9 (folic acid) or vitamin B12 (cobalamine) may all manifest as stomatitis.

Aphthous stomatitis

• Aphthous stomatitis (canker sores) is the recurrent appearance of mouth ulcers in otherwise healthy individuals. The cause is not completely understood, but it is thought that the condition represents a T cell mediated immune response which is triggered by a variety of factors. The individual ulcers (aphthae) recur periodically and heal completely, although in the more severe forms new ulcers may appear in other parts of the mouth before the old ones have finished healing.

Angular stomatitis

• Inflammation of the corners (angles) of the lips is termed angular stomatitis or angular cheilitis. In children a frequent cause is repeated lip-licking, and in adults it may be a sign of underlying iron deficiency anemia, or vitamin B deficiencies (e.g., B2-riboflavin, B9-folate, or B12-cobalamin, which in turn may be evidence of poor diets or malnutrition such as celiac disease).

Denture-related stomatitis

• this is a common condition present in denture wearers. It appears as reddened but painless mucosa beneath the denture. 90% of cases are associated with Candida species, and it is the most common form of oral candidiasis. Treatment is by antifungal medication and improved dental hygiene, such as not wearing the denture during sleep.

Allergic contact stomatitis

• Allergic contact stomatitis (also termed "allergic gingivostomatitis" or "allergic contact gingivostomatitis") is a type IV (delayed) hypersensitivity reaction that occurs in susceptible atopic individuals when allergens penetrate the skin or mucosa.

Migratory stomatitis

• Migratory stomatitis (or geographic stomatitis) is an atypical presentation of a condition which normally presents on the tongue, termed geographic tongue. Geographic tongue is so named because there are atrophic, erythematous areas of depapillation that migrate over time, giving a map-like appearance.

Herpetic gingivostomatitis

• This is inflammation of the mouth caused by herpes simplex virus.

Management

• Coating agents such as bismuth salicylate , sucralfate , or other antacids

• Water-soluble lubricants for mouth and lips • Topical analgesics , such as benzamine

hydrochloride • Topical anesthetics ,such as lidocaine viscous

(might impair gag reflex for a short period) • Oral or parenteral analgesics, including opioids if

needed , for pain not controlled with above.

Conti…

• Antiseptic mouthwash• Protective pastes • Local anesthetic mouthwash or spray • Oral analgesics (painkillers) • Topical corticosteroids.

References

• Zaoutis,[editedby]Jeffrey M.Bergelson,Samir S.Shah, Theoklis E. (2008). Pediatric infectious diseases.Philadelphia: Mosby/Elsevier. ISBN 9780323076333. • Jump up^ MichaelG. Stewart,SamuelSelesnick (editors) (2010-10-04)."35". Differentialdiagnosis inotolaryngology – head andneck surgery.NewYork: Thieme. ISBN 9781604062793 • Jump up Yamada T,Alpers DH,etal.(2009). Textbook of gastroenterology (5thed.).Chichester,WestSussex: Blackwell Pub. ISBN 978-1 -4051 -6911 -0.sites. Eur J Cancer B Oral Oncol.1993;29B(1