Stomatitis causes,types, diagnosis and treatment | Mouth diseases

- The mouth contains many of commensal micro organisms. So, oral hygiene is essential. Negligence
of oral hygiene may lead to bacterial proliferation causing stomatitis.

- Stomatitis may also occur when resistance to the commensal population is lowered e.g. in the immune-compromised host.
- Stomatitis may also occur due to nutritional deficiency.

What is meant by stomatitis ?

It is inflammation of the mucous lining of any of the structures in the mouth, which may involve the gums,cheeks, tongue, lips, and roof or floor of the mouth .

1. Ulcerative stomatitis

Clinical Picture :

- It occurs in adults with malnutrition and poor dental hygiene.
- There are ulcers on the gum, palate, lips and the inner aspects of cheeks.
- Halitosis ( odor from the mouth ) .
Investigations :
- A stained smear shows spirochetes and fusiform bacilli.
Treatment :
- Metronidazole or penicillin .

2. Viral Stomatitis

-  Herpes simplex may cause herpes labial is in normal persons.
- It can lead to severe stomatitis in immune-compromised patients.
- Coxsackie virus causes herpangina with acute pharyngitis, ulcers of the soft palate and pharyngeal mucosa.

3. Candidiasis (Moniliasis) 

Etiology :
- The fungus candida albicans is a normal commensal in the mouth. It may proliferate to cause thrush in babies and in debilitated patients.

- Also thrush is common in patients receiving prolonged treatment with antibiotics and in patients who are immunosuppressed by corticosteroids or AIDs.

Clinical picture :
- White patches on the tongue and buccal mucosa.
- In severe infection the pharynx and esophagus can be affected causing dysphagia .
Treatment :
Treatment of the cause .
Lozenges or suspension of nystatin. .
Systemic antifungal in severe infection.
4. Stomatitis due to Nutritional deficiency

- This occurs due to deficiency of niacin, riboflavin, folic acid and vitamin B12.
- When the deficiency is acute and severe the tongue is red and painful because of atrophy of the papilla .
- Angular stomatitis often accompanies glossitis especially in severe riboflavin and iron deficiency.

What is Angular Chelitis (Angular stomatitis ) ?

 It is erythema or crusting of the labial angles. It is also caused by candida. It is associated with.intraoral candidasis. It is treated with topical with or without systemic. antifungal drugs, iron and vitamin supplements.

What does Chelitis mean ?

Painful vertical fissures mainly of lower lip caused by malnutrition. It may occur in crohn's disease or with·exposure to sunlight and wind .

5. Recurrent Aphthous Ulceration 

- It affects 20% of population .
- Unknown etiology.
- Emotional stress may precipitate the attack.
- May occur during the premenstrual phase.
- May occur in association with Crohn's disease, ulcerative colitis or Behcet's disease.
- Nutritional deficiencies with or without GI disorders are occasionally found.
- The ulcers are recurrent at intervals of days to a few months.
Clinical picture :
- Multiple shallow rounded ulcers, they are PAINFUL .

- Minor ophthous ulcers are < 10mm with grey white center with thin erythematous halo and heal with 14 days without scarring .
- Major aphthous ulcers > 10mm persist for weeks or months and heal with carring
Treatment :
- Hydrocortisone hemisuccinate lozenges .
- To ical anesthetics .
- Colchicine .

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