Stomatitis

An inflammation of the mucous lining of any structure related to the mouth like the tongue, gums, throat, cheeks, lips or the roof or floor of the mouth is called as "Stomatitis". There is redness, swelling, occasional bleeding and bad breath. It can affect the infant as well as the elderly.

Types

• Mycotic stomatitis : also called as an "oral thrush". This is an candida infection of the mouth and oral areas. In infants it may occur particularly after a course of antibiotics. Those with a weakened immune system are particularly susceptible
• Gingivostomatitis : inflammation of the gums. This is caused by the herpes simplex virus
• Stomatitis nicotina : caused by smoking cigars, cigarettes and pipes. Presence of red bumps on the roof of the mouth
• Herpetic stomatitis : viral infection of the mouth. Presence of ulcers and inflammation
• Chronic stomatitis
• Aphthous stomatitis : small ulcers appear in the mouth, inside the lips, on the cheeks or tongue

Symptoms

• Blood in saliva
• Oral bleeding
• Bad breath
• Oral membrane ulcers
• Mouth ulcers
• Sore mouth
• Mouth inflammation

Causes

• jagged teeth
• cheek biting
• poorly fitted oral appliances
• chronic mouth breathing
• drinking hot beverages
• the common cold sore, measles, gonorrhea, AIDS, leukemia, lack of vitamin C
• inflammatory bowel disease
• excess use of spices, alcohol, hot food or tobacco products
• sensitivity to mouthwashes, toothpastes and lipstick
• exposure to heavy metals like mercury, bismuth and lead
• fungal infections
• chemical irritation
• chronic stomatitis is caused by anemia, leukemia, neutropenia, vitamin C deficiency, agranulocytosis and auto-immune diseases

Diagnosis

• patient's history that comprises of a dietary deficiency, a systemic disease or contact with materials leading to an allergic reaction
• physical examination of oral lesions and other skin problems
• blood tests to infer any infection
• microscopic evaluation of the scrapings of the lining of the mouth
• cultures of the mouth to detect any infectious agent

Treatment

• local cleansing and good oral hygiene
• sharp-edged foods like tacos, peanuts and potato chips
• use of soft-bristled toothbrush and careful washing of teeth and gums
• amendment of ill-fitting dental appliances or sharp teeth by a dentist
• medication for infectious cause
• measures to overcome vitamin B12, iron or folate deficiency
• use of cotton-tipped applicator for aphthous ulcer
• low-power treatment with a carbon dioxide laser for recurrent aphthae
• use of tetracycline antibiotics or corticosteroids for aphthous stomatitis
• use of valacyclovir for stomatitis due to herpesviruses
• use of topical anesthetics like a 2% lidocaine gel or a protective paste (Orabase) or a coating agent like Kaopectate
• botanical medicine like calendula in tincture form and diluted for a mouth rinse is effective against stomatitis
• extract of leaves of Trichilia glabra (found in South America) kills viruses causing stomatitis

Topical treatments include corticosteroids, anesthetics, antibiotics, protective coatings, antihistamines and physical measures like cautery.

• 5 ml of 2% viscous lidocaine is mixed with 10 ml water and used as a rinse
• carboxymethylcellulose paste with or without 1% triamcinolone qid decreases irritation of local lesions
• 30 ml of sucralfate and aluminum-magnesium liquid antacides are used alone or mixed with 2% viscous lidocaine 5 ml, diphenhydramine, 12.5 mg kaolin for rinsing and expectoration
• tetracycline or nystatin suspension is useful
• fluocinonide gel is applied to the ulcer
• Amlexanox 5% past is applied qid

Chemical or physical cautery relieves pain. Silver nitrate sticks are less effective than low-power, defocused, pulsed-mode carbon dioxide laser treatments.

Prevention

• those having dentures should regularly visit the dentists
• those with systemic diseases or chronic medical problems should visit a health care provider
• avoid consuming hot foods and drinks
• avoid tobacco in any form
• apply moderation in alcohol consumption
• proper selection of mouthwashes and toothpastes