Stomatitis

Uremic stomatitis– An inflammation or ulceration of the mouth that may be locally or systemically induced.

Causes and Incidence

Causes of stomatitis include viral or bacterial infection; drugs or toxic agents (barbiturates, antibiotics, chemotherapy, radiation, lead, mercury, acids, heavy metals); trauma from cheek biting, mouth breathing, or ill-fitting orthodontia; overuse of tobacco or alcohol; sensitivity to toothpastes, mouthwash, food dyes, or preservatives and spices; poor nutrition; and poor oral hygiene. Thrush, a common form of stomatitis, is seen in more than 80% of individuals with HIV or AIDS. Canker sores are also common and are seen frequently in adolescence or young adulthood. Herpetic stomatitis, the most common virally induced stomatitis, is seen in infants and small children. Mechanically induced stomatitis is often seen in older individuals with dentures that are difficult to fit because of continuing deterioration of gum and bone. Necrotizing ulceration is often seen in individuals using certain antibiotics and in people who have depressed immune systems.

Disease Process

The pathophysiology depends on the cause, but it involves a process that creates tissue inflammation in the oral mucosa or gums. These inflammatory changes lead to redness, ulceration, and fissures in the mouth.

Symptoms

Manifestations vary by type of stomatitis.

Allergic
Shiny erythema with slight edema, itching, drying, burning

Thrush
White, raised, milk curd patches; bleeding; dryness of the mouth; diminished taste; pain; fever; lymphadenopathy

Gingivitis
Redness, swelling, bleeding of gums; gum retraction from teeth

Herpetic
Ulcers 34 cm in diameter scattered over mucous membranes; swollen, inflamed gums; enlarged lymph nodes

Canker sores
Small, yellowish, hardened, painful sores with red, raised margins that often appear singly or in groups on the lips or in the corner of mouth

Necrotizing
Necrotic ulceration of mucous membranes with severe pain, increased salivation, and inability to eat; fetid breath; bleeding gums; difficulty talking and swallowing; pseudomembrane on ulcers
Complications: Tissue sloughing from necrosis may create craters and other altered tissue topography.

Diagnostic Tests

The diagnosis is made on the clinical history and a physical examination. Cultures or smears may aid in identification of the causative organism in cases arising from infection.

Treatments

Surgery
None.

Drugs
Topical anesthetics for pain; antiinfective drugs (topical, systemic) for bacterial or fungally induced stomatitis.

General
Meticulous oral hygiene; mild mouthwashes for comfort; treatment of underlying etiology (stopping drugs, avoiding toxins, refitting orthodontics, eliminating allergens); bland, soft, pureed, or liquid diet if eating is a problem; avoidance of alcohol and tobacco product.