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Stomatitis

Introduction

Stomatitis is a clinical term used for inflammation of the mouth. Our oral cavity is lined with a soft tissue known as a mucous membrane. Often, it gets triggered due to mechanical or chemical causes, which results in stomatitis. Stomatitis can affect the mucous membrane lining the cheeks, tongue, palate, and gums. Oral ulceration might be present in some instances as well.

Causes

There are multiple different causes for stomatitis. They commonly occur due to a traumatic injury, infection, allergic reactions, and other skin diseases. Trauma-induced stomatitis is usually caused by ill-fitted dentures or other prosthetic dental appliances such as a nightguard. Braces can also be another cause. Patients with bruxism can accidentally bite their cheeks or tongue, leading to stomatitis. A mismanaged surgical treatment done inside the mouth can also affect the mucous lining. Burns from extremely hot food or drinks, chemical irritation, and dry mouth can contribute.

Infections that cause stomatitis can be viral, bacterial, and fungal. The most commonly caused stomatitis is by herpes simplex virus. It affects gums, lips, and cheeks; therefore, it is also known as herpetic gingivostomatitis. Allergic reactions to certain food substances or external factors might also cause stomatitis. Sexually Transmitted Diseases (STDs), chemotherapy, radiotherapy, immunocompromising diseases, and nutritional deficiencies are other important causes of stomatitis.

Types

Stomatitis generally appears in the form of sores in the mouth. The two most common types of sores are canker sores and cold sores.

Canker sores, also known as aphthous stomatitis, are frequently recurring stomatitis. If you experience ulcers in your mouth that repeatedly occur over time without any apparent infection or allergy, they are most likely canker sores. Their exact cause hasn’t been determined yet. Usually, these ulcers have a reddish base and a yellow center. They can range from painless ulcers to extremely painful lesions.

Cold sores, also known as herpes stomatitis, are caused by the herpes simplex virus (HSV). These are common among young children and usually occur on the lips or edges of the mouth. They appear as small-sized ulcers that can be tender and painful. You might experience a tingling sensation around your lips before they occur. Generally, they heal without any medication within two weeks.

Risk Factors and Epidemiology

Several risk factors are associated with the occurrence of stomatitis. It can be because of dentures, braces, or other dental appliances inside the mouth that are ill-fitting or pressurizing soft tissues. Alcoholics and smokers also have a higher tendency to develop stomatitis. Poor maintenance of oral hygiene is also another significant risk factor. People with known allergies to food substances need to take preventive measures in advance. Patients with immunocompromising diseases, cancer, or those undergoing chemotherapy and radiotherapy are at high risk. Other factors include H.pylori, genetic disorders, stress, or nutritional deficiency.

Aphthous stomatitis can occur at any age with no apparent cause. On the other hand, herpetic stomatitis occurs more frequently in children between 6 months to 5 years.

Signs and Symptoms

Patients with stomatitis usually present with multiple symptoms, including pain in the ulcerated regions, burning or tingling sensation, mucosal irritation, bleeding from gums, swelling, drooling, and dehydration due to less water intake. You may experience irritability and discomfort that might affect your daily routine. In cases of infection, patients might also present with fever, body ache, headache, and anorexia.

Diagnosis

The diagnosis of stomatitis is majorly dependent on the patient’s medical history. Your doctor will require a detailed history to identify the cause of stomatitis. A thorough clinical examination is also done. The size, texture, color, distribution pattern, and recurrence rate can help identify the type of stomatitis. Swab tests may be necessary to diagnose the causative agent in viral, bacterial, or fungal infections. Patients with allergic symptoms require a patch test if their allergies were already not identified. Some cases may require CBC and ESR for further examination.

Differential Diagnosis

Other diseases that might mimic the symptoms of stomatitis include leukoplakia, HSV infection, oral candidiasis, squamous cell carcinoma, burning mouth syndrome, Bechet’s syndrome, Crohn’s disease, oral melanoma, syphilis, HIV, chickenpox, and measles.

Treatment

Treatment of stomatitis depends on the cause and type of stomatitis. Herpetic stomatitis generally requires symptomatic treatment only. The ulcers dry over time and heal eventually within 10-14 days. In the case of aphthous stomatitis, topical analgesic or anesthetic agents are prescribed to reduce pain and discomfort. Depending on the cause, antibacterial or antiviral creams might be prescribed to reduce symptoms. Frequent hydration is suggested, and hot and spicy foods are to be avoided during the treatment of stomatitis.

Medications

For herpes stomatitis, the antiviral drug acyclovir is prescribed to diminish symptoms. Other types of stomatitis with painful ulcers require topical analgesics or topical anesthetics such as lignocaine. In patients with severe symptoms, i.e., fever, malaise, neck swelling, etc., broad-spectrum antibiotics such as penicillin are prescribed.

Prognosis

If the cause has been diagnosed correctly, effective treatment to treat the particular cause can result in a good prognosis. Herpetic stomatitis heals independently and completes its period with or without medication. Aphthous ulcers are manageable as well. The only complication with them is their recurrence over time. These can be managed with medicines and symptomatic care.

Prevention

Allergic persons should avoid or contact the allergen to prevent the risk of developing stomatitis. Smoking and alcohol should be limited as well. The primary preventive care is to maintain good oral hygiene by brushing twice a day, flossing, and using antiseptic mouthwashes. Staying well-hydrated is also beneficial since it prevents the mucous membrane from drying out. Patients with any dental appliance should clean their devices regularly and contact their dentist in case of loose dentures and broken brackets or wires. Beverages or food at scorching temperatures or with extreme spices should be limited as well to protect the mucous lining of your oral cavity.