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{{Stomatitis}}
{{Stomatitis}}
{{CMG}}; {{AE}}{{USAMA}}
{{CMG}}; {{AE}}{{USAMA}}, {{SaraM}}


==Overview==
{{SK}} [[Aphthous stomatitis]]; [[Herpetic stomatitis]]
Stomatitis is an [[inflammation]] of the [[mucous lining]] of any of the structures in the [[mouth]], which may involve the [[cheeks]], [[gums]], [[tongue]], [[lips]], [[throat]], and roof or floor of the mouth. Most physicians do not regularly examine the mouth of patients and so stomatitis or triggering conditions can remain undiagnosed unless they become symptomatic.<ref>{{Cite journal
| author = [[R. Morgan]], [[J. Tsang]], [[N. Harrington]] & [[L. Fook]]
| title = Survey of hospital doctors' attitudes and knowledge of oral conditions in older patients
| journal = [[Postgraduate medical journal]]
| volume = 77
| issue = 908
| pages = 392–394
| year = 2001
| month = June
| pmid = 11375454
}}</ref> The inflammation of the structures in the mouth can be caused by a condition limited just to the mouth, such as poor [[oral hygiene]], poorly fitted [[dentures]], or from mouth burns from hot food or drinks, or by conditions that affect the entire body, such as [[medications]], [[allergic reactions]], or [[infections]]. A form of stomatitis known as stomatitis nicotina can be caused by smoking cigars, cigarettes, and pipes, and is characterized by small red bumps on the roof of the mouth.<ref>{{cite web|year=1969|title=Smoking and Noncancerous Oral Disease|format=PDF|work=The Reports of the Surgeon General|url=http://profiles.nlm.nih.gov/NN/B/B/L/N/_/nnbbln.pdf|accessdate=2006-06-23}}</ref>


When it also involves an inflammation of the [[gingiva]], it is called gingivostomatitis.
==[[Stomatitis overview|Overview]]==
Irritation and [[fissure|fissuring]] in the corners of the lips is termed angular stomatits 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]] deficiencis (e.g. B2-[[riboflavin]], B9-[[folate]] or [[B12]]-cobalamins), which in turn may be evidence of poor diets or malnutrition (e.g. [[celiac disease]]).


==Historical Perspective==
==[[Stomatitis historical perspective|Historical Perspective]]==
*Between 460-370 B.C., in relation to disorders of the mouth the term aphthae was first used by [[Hippocrates]].<ref name=Stomatitis-update> Ship, Jonathan A. "Recurrent aphthous stomatitis: an update." Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 81.2 (1996): 141-147.</ref>
*In 1898, the first clinical description of the aphthous stomatitis was reported by Von Mikulicz and Kumme as a Mikuliez aphthea
*In 1911, stomatitis aphthae recurrens cicatricicans was first described by Sutton.
*In 1961, stomatitis aphthae recurrens herpetiformis was first described by Cooke.<ref name="pmid6929240">{{cite journal| author=Kramer IR, Pindborg JJ, Bezroukov V, Infirri JS| title=Guide to epidemiology and diagnosis of oral mucosal diseases and conditions. World Health Organization. | journal=Community Dent Oral Epidemiol | year= 1980 | volume= 8 | issue= 1 | pages= 1-26 | pmid=6929240 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6929240  }} </ref>


==Classification==
==[[Stomatitis classification|Classification]]==
According to the etiology, stomatitis may be classified into:<ref name="pmid10668310">{{cite journal| author=Murray LN, Amedee RG| title=Recurrent aphthous stomatitis. | journal=J La State Med Soc | year= 2000 | volume= 152 | issue= 1 | pages= 10-4 | pmid=10668310 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10668310  }} </ref><ref name="Gangrenous stomatitis">{{cite book |last1=Mandell |firs1t=Gerald |last2=Gouglas |first2=Gordon |last3=Bennett |first3=John |date= |title=Principles and Practice of Infectious Diseases |location= Harvard Medical School |publisher=WILEY MEDICAL |page=383 |isbn=0-471-87643-7}}​</ref>


'''Infectious Stomatitis'''
==[[Stomatitis pathophysiology|Pathophysiology]]==
*[[Aphthous stomatitis]]
 
**Major aphthous stomatitis
==[[Stomatitis causes|Causes]]==
***This type can last unto a few months and involves tonsils and the soft palate as well. It can subset for long intervals and then re appear.
 
**Minor aphthous stomatitis
==[[Stomatitis differential diagnosis|Differentiating Stomatitis from other Diseases]]==
***This is the characteristic form of aphthous stomatitis and is characterised by yellow-grey, painful minute ulcers in the anterior ora cavity in the buccal and oral mucosa with raised margins. They can last from a few days upto 2 weeks
 
**Herpetiform stomatitis
==[[Stomatitis epidemiology and demographics|Epidemiology and Demographics]]==
***These are multiple in number and effect the tongue at the lateral part and the tip. Ulcers are grey and very painful and are often accompanied by inability to eat. Intra nuclear inclusions can be found in the ulcers
*[[Herpetic gingivostomatitis]]
*[[Necrotizing ulcerative stomatitis]] or [[gangrenous stomatitis|stomatitis gangrenosa]](NOMA)<ref name="pmid26235765">{{cite journal| author=Zwetyenga N, See LA, Szwebel J, Beuste M, Aragou M, Oeuvrard C et al.| title=[Noma]. | journal=Rev Stomatol Chir Maxillofac Chir Orale | year= 2015 | volume= 116 | issue= 4 | pages= 261-79 | pmid=26235765 | doi=10.1016/j.revsto.2015.06.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26235765  }} </ref>
*Vesicular stomatitis
*Vincent's stomatitis (Trench Mouth)
*[[Hand-foot-and-mouth disease|Enteroviral vesicular stomatitis with exanthem]]
*Candida stomatitis
'''Other forms'''
*[[angular cheilitis|Angular stomatitis]]
*Denture stomatitis
*Ulcerative or Chronic ulcerative stomatitis<ref name="pmid28113036">{{cite journal| author=Anderson JG, Peralta S, Kol A, Kass PH, Murphy B| title=Clinical and Histopathologic Characterization of Canine Chronic Ulcerative Stomatitis. | journal=Vet Pathol | year= 2017 | volume=  | issue=  | pages= 300985816688754 | pmid=28113036 | doi=10.1177/0300985816688754 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28113036  }} </ref><ref name="pmid27957282">{{cite journal| author=Katsoulas N, Chrysomali E, Piperi E, Levidou G, Sklavounou-Andrikopoulou A| title=Atypical methotrexate ulcerative stomatitis with features of lymphoproliferative like disorder: Report of a rare ciprofloxacin-induced case and review of the literature. | journal=J Clin Exp Dent | year= 2016 | volume= 8 | issue= 5 | pages= e629-e633 | pmid=27957282 | doi=10.4317/jced.52909 | pmc=5149103 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27957282  }} </ref>
*Contact stomatitis<ref>{{Cite journal
| author = [[A. Tosti]], [[B. M. Piraccini]] & [[A. M. Peluso]]
| title = Contact and irritant stomatitis
| journal = [[Seminars in cutaneous medicine and surgery]]
| volume = 16
| issue = 4
| pages = 314–319
| year = 1997
| month = December
| pmid = 9421224
}}</ref>
*Migratory stomatitis or geographic stomatitis
*Stomatitis nicotina
*Pyostomatitis vegetans<ref name="pmid28153136">{{cite journal| author=Magliocca KR, Fitzpatrick SG| title=Autoimmune Disease Manifestations in the Oral Cavity. | journal=Surg Pathol Clin | year= 2017 | volume= 10 | issue= 1 | pages= 57-88 | pmid=28153136 | doi=10.1016/j.path.2016.11.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28153136  }} </ref><ref name="pmid24713996">{{cite journal| author=Pellicer Z, Santiago JM, Rodriguez A, Alonso V, Antón R, Bosca MM| title=Management of cutaneous disorders related to inflammatory bowel disease. | journal=Ann Gastroenterol | year= 2012 | volume= 25 | issue= 1 | pages= 21-26 | pmid=24713996 | doi= | pmc=3959344 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24713996  }} </ref>
*Bovine papular stomatitis<ref name="pmid27751948">{{cite journal| author=Kurosaki Y, Okada S, Nakamae S, Yasuda J| title=A loop-mediated isothermal amplification assay for rapid and sensitive detection of bovine papular stomatitis virus. | journal=J Virol Methods | year= 2016 | volume= 238 | issue=  | pages= 42-47 | pmid=27751948 | doi=10.1016/j.jviromet.2016.07.031 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27751948  }} </ref>
*Chemotherapy induced stomatitis


==Pathophysiology==
==[[Stomatitis risk factors|Risk Factors]]==
Different mechanism are understood to cause different types of stomatitis:<ref name="pmid15057287">{{cite journal| author=Sonis ST| title=The pathobiology of mucositis. | journal=Nat Rev Cancer | year= 2004 | volume= 4 | issue= 4 | pages= 277-84 | pmid=15057287 | doi=10.1038/nrc1318 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15057287  }} </ref>


*Aphthous stomatitis:
==[[Stomatitis screening|Screening]]==
**It is the most common cause of oral ulcers. A definitive pathogenesis does not exist for aphthous stomatitis but the proposed mechanism involves immune system abnormalities and the presence of autoimmune antibodies. It is thought to be caused by some types of cytokine and T cell accumulation manifesting as a defective cell mediated arm of the immunity.Recurrence is very common in aphthous ulcers.<ref name="pmid8665304">{{cite journal| author=Ship JA| title=Recurrent aphthous stomatitis. An update. | journal=Oral Surg Oral Med Oral Pathol Oral Radiol Endod | year= 1996 | volume= 81 | issue= 2 | pages= 141-7 | pmid=8665304 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8665304  }} </ref><ref name="pmid17343257">{{cite journal| author=Dalghous AM, Freysdottir J, Fortune F| title=Expression of cytokines, chemokines, and chemokine receptors in oral ulcers of patients with Behcet's disease (BD) and recurrent aphthous stomatitis is Th1-associated, although Th2-association is also observed in patients with BD. | journal=Scand J Rheumatol | year= 2006 | volume= 35 | issue= 6 | pages= 472-5 | pmid=17343257 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17343257  }} </ref><ref name="pmid10668310">{{cite journal| author=Murray LN, Amedee RG| title=Recurrent aphthous stomatitis. | journal=J La State Med Soc | year= 2000 | volume= 152 | issue= 1 | pages= 10-4 | pmid=10668310 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10668310  }} </ref>
*Herpetic stomatitis:
**This type is causes by [[HSV1]] virus. It is caused by the destructive effect cause by the virus on the tissues in the form of break down of the infected cells. The infection may start as vesicles that are typically pin-head like and ultimately rupture, resulting ulceration. As a characteristic to the virus these ulcers are painful, irregular in appearance and often have a yellow-grey covering layer.
**After the lesions resolve, the virus travels though the nerves to the nerve cells and goes into a latent stage. It can then reactivate when the person becomes immunocompromised and cause symptoms.<ref name="pmid16451405">{{cite journal| author=Kolokotronis A, Doumas S| title=Herpes simplex virus infection, with particular reference to the progression and complications of primary herpetic gingivostomatitis. | journal=Clin Microbiol Infect | year= 2006 | volume= 12 | issue= 3 | pages= 202-11 | pmid=16451405 | doi=10.1111/j.1469-0691.2005.01336.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16451405  }} </ref>
**Encephalitis associated with herpetic stomatitis is due to the interaction of [[HSV1]] with Toll-like receptor 2 or  [[TLR2]]
*Chemotherapy associated stomatitis:
**The Chemotherapy causes RNA and DNA damage by the reactive oxygen species leading to an excessive production of inflammatory cytokines. These cytosines cause inflammation thus causing breaks in the epithelium.
*Denture stomatitis:
**Denture stomatitis effects upto 67% of denture wearers. It moct commonly affects the palatal mucosa.<ref name="pmid3298586">{{cite journal| author=Arendorf TM, Walker DM| title=Denture stomatitis: a review. | journal=J Oral Rehabil | year= 1987 | volume= 14 | issue= 3 | pages= 217-27 | pmid=3298586 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3298586  }} </ref>The material used in fillings and dentures are porus because of the chemicals used and to give it a better grip. Pathogens like candida alibicans can colonize such suitable sites leading to an inflammatory response and thus denture stomatitis. The irritaitive effect of the foreign denture material can also contribute to the pathogenesis.<ref name="pmid28130176">{{cite journal| author=Abduljabbar T, Al-Askar M, Baig MK, AlSowygh ZH, Kellesarian SV, Vohra F| title=Efficacy of photodynamic therapy in the inactivation of oral fungal colonization among cigarette smokers and non-smokers with denture stomatitis. | journal=Photodiagnosis Photodyn Ther | year= 2017 | volume=  | issue=  | pages=  | pmid=28130176 | doi=10.1016/j.pdpdt.2017.01.182 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28130176  }} </ref><ref name="pmid25082257">{{cite journal| author=Marinoski J, Bokor-Bratić M, Čanković M| title=Is denture stomatitis always related with candida infection? A case control study. | journal=Med Glas (Zenica) | year= 2014 | volume= 11 | issue= 2 | pages= 379-84 | pmid=25082257 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25082257  }} </ref>
*Noma or Gangrenous stomatitis:
**Gangrenous stomatitis is also known as Noma or 'cancrum Doris'. Noma or gangrenous stomatitisIt is focal and destructive infection caused by [[Borrelia]] vincentii, [[Fusobacterium]] and [[Bacteroides]]. It is an acute infection of the tissues in the orofacial region. Immunocompromised individuals are predisposed to develop this condition. Noma or gangrenous stomatitis is more common in children. The infection can begin as a spot or vesicle on the gingival surface of the mandibular molars and premolars. This spot or vesicle is red initially and painful and develops into an ulcer. The lesion has cone shaped expansion with bone, teeth and tissue underneath being exposed after the soft tissue sloughs off.<ref name="Gangrenous stomatitis">{{cite book |last1=Mandell |firs1t=Gerald |last2=Gouglas |first2=Gordon |last3=Bennett |first3=John |date= |title=Principles and Practice of Infectious Diseases |location= Harvard Medical School |publisher=WILEY MEDICAL |page=383 |isbn=0-471-87643-7}}​</ref>
*[[Bovine papular stomatitis]]:
**[[Bovine papular stomatitis]] is a [[zoonotic]] disease. It is caused by [[bovine papular stomatitis virus]], starting as a single lesion and becoming a nodular mass ultimately. The virus has chemokine binding proteins that prevent the [[neutrophils]] and [[monocytes]] from migrating to the site of the pathology.<ref name="pmid27936239">{{cite journal| author=Sharif S, Nakatani Y, Wise L, Corbett M, Real NC, Stuart GS et al.| title=A Broad-Spectrum Chemokine-Binding Protein of Bovine Papular Stomatitis Virus Inhibits Neutrophil and Monocyte Infiltration in Inflammatory and Wound Models of Mouse Skin. | journal=PLoS One | year= 2016 | volume= 11 | issue= 12 | pages= e0168007 | pmid=27936239 | doi=10.1371/journal.pone.0168007 | pmc=5148066 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27936239  }} </ref><ref name="bovine papular stomatitis">{{cite book |last1=Mandell |firs1t=Gerald |last2=Gouglas |first2=Gordon |last3=Bennett |first3=John |date= |title=Principles and Practice of Infectious Diseases |location= Harvard Medical School |publisher=WILEY MEDICAL |page=988 |isbn=0-471-87643-7}}​</ref>
*Pyostomatitis vegetans:
**Pyostomatitis vegetans is characterised by numerous painless, yellow, superficial pinpoint pustules with oedema of the mucosa of the mouth.<ref name="pmid28153136">{{cite journal| author=Magliocca KR, Fitzpatrick SG| title=Autoimmune Disease Manifestations in the Oral Cavity. | journal=Surg Pathol Clin | year= 2017 | volume= 10 | issue= 1 | pages= 57-88 | pmid=28153136 | doi=10.1016/j.path.2016.11.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28153136  }} </ref>


==Causes==
==[[Stomatitis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
===Life Threatening Causes===
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.


*[[Ebola]]
==Diagnosis==


===Common Causes===
[[Stomatitis history and symptoms|History and Symptoms]] | [[Stomatitis physical examination|Physical Examination]] | [[Stomatitis laboratory findings|Laboratory Findings]]
The common causes of stomatitis include:<ref name="pmid16451405">{{cite journal| author=Kolokotronis A, Doumas S| title=Herpes simplex virus infection, with particular reference to the progression and complications of primary herpetic gingivostomatitis. | journal=Clin Microbiol Infect | year= 2006 | volume= 12 | issue= 3 | pages= 202-11 | pmid=16451405 | doi=10.1111/j.1469-0691.2005.01336.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16451405  }} </ref><ref>{{Cite journal
| author = [[R. Morgan]], [[J. Tsang]], [[N. Harrington]] & [[L. Fook]]
| title = Survey of hospital doctors' attitudes and knowledge of oral conditions in older patients
| journal = [[Postgraduate medical journal]]
| volume = 77
| issue = 908
| pages = 392–394
| year = 2001
| month = June
| pmid = 11375454
}}</ref><ref name="pmid15057287">{{cite journal| author=Sonis ST| title=The pathobiology of mucositis. | journal=Nat Rev Cancer | year= 2004 | volume= 4 | issue= 4 | pages= 277-84 | pmid=15057287 | doi=10.1038/nrc1318 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15057287  }} </ref>
*[[Aphthous stomatitis]]
*[[Dentures]]
*[[Folate deficiency]]
*[[Herpes]]
*[[Oropharyngeal candidiasis]]
*[[Vitamin B12 deficiency]]
*[[Chemotherapy]]
===Gangrenous stomatitis===
Following are a few causes of gangrenous stomatitis<ref name="Gangrenous stomatitis">{{cite book |last1=Mandell |firs1t=Gerald |last2=Gouglas |first2=Gordon |last3=Bennett |first3=John |date= |title=Principles and Practice of Infectious Diseases |location= Harvard Medical School |publisher=WILEY MEDICAL |page=383 |isbn=0-471-87643-7}}​</ref>
*[[Borrelia]]
*[[Fusobacterium]]
*[[Bacteroides]]


===Bovine papular stomatitis===
==Treatment==
*[[Bovine papular stomatitis virus]]<ref name="bovine pustular stomatitis">{{cite book |last1=Mandell |firs1t=Gerald |last2=Gouglas |first2=Gordon |last3=Bennett |first3=John |date= |title=Principles and Practice of Infectious Diseases |location= Harvard Medical School |publisher=WILEY MEDICAL |page=988 |isbn=0-471-87643-7}}​</ref>


===Causes by Organ System===
[[Stomatitis medical therapy|Medical Therapy]] | [[Stomatitis surgery|Surgery]] | [[Stomatitis primary prevention|Primary Prevention]] | [[Stomatitis secondary prevention|Secondary Prevention]]
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |[[Kawasaki disease]]
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"|[[Bismuthia]], [[gold]], [[mercury poisoning]], [[nickel]], [[thallium]]
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| [[Angular cheilitis]], [[angular cheilitis|angular stomatitis]], [[aphthous stomatitis]], [[aphthous ulcer]], [[burning mouth syndrome]], [[dentures]], [[desquamative gingivitis]], [[dry mouth]], [[herpetic gingivostomatitis]], [[hypertrophic gums]], [[nicotine stomatitis]], [[oral lesions]], oral submucous fibrosis, [[oral lesions|oral ulceration]], [[trench mouth]], [[gingivitis|ulcerative gingivitis]], [[Vincent's angina]]
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| [[Behcet's disease]], [[bismuthia]], [[erythema multiforme]], [[gluten-sensitive enteropathy associated conditions]], [[lip balm]], [[pemphigoid]], [[Stevens-Johnson syndrome]], [[vesicular stomatitis with exanthem]], [[warts]]
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"|[[Acmella oleracea]], [[afatinib]], [[aflibercept]], [[alemtuzumab]], [[aminopterin]], [[chloroquine|aralen phosphate]], [[auranofin]], [[benzydamine]], [[bleomycin]], [[boceprevir]], [[busulfan]], [[cabozantinib]], [[capecitabine]], [[carboplatin]], [[cerubidine]], [[chemotherapy]], [[chloramphenicol]], [[chloroquine phosphate]], [[clofibrate]], [[cosmegen]], [[cyclophosphamide]], [[cytosine arabinoside]], [[dacarbazine]], [[dactinomycin]], [[daptomycin]], [[daunorubicin]], [[docetaxel]], [[epirubicin]],[[eribulin]], [[etoposide]], [[everolimus]], [[floxuridine]], [[fluorouracil]], [[gemcitabine]], [[gemtuzumab ozogamicin]], [[gentamicin]], [[ginkgo biloba]], [[hexetidine]], [[ixabepilone]], [[ketorolac tromethamine]], [[lenvatinib]], [[levoleucovorin]], [[lincomycin hydrochloride]], [[lomustine]], [[loratadine]], [[melphalan]], [[methotrexate]], [[metronidazole]], [[mitomycin]], [[mitoxantrone]], [[nabumetone]], [[nicotine polacrilex]], [[oxaliplatin]], [[oxaprozin]], [[oxcarbazepine]], [[palbociclib]], [[panitumumab]], [[paraplatin]], [[penicillin G potassium]], [[pentostatin]], peplomycin, [[pertuzumab]], [[phenylbutazone]], [[pixantrone]], [[pralatrexate]], [[pramipexole]], [[procainamide]], [[sargramostim]], [[sirolimus]], [[sodium aurothiomalate]], [[sorafenib]], [[sulfasalazine]], [[sulindac]], [[sunitinib]], [[temsirolimus]], [[thioguanine]], [[tiagabine]], [[tolmetin]], [[trametinib]], [[ziv-aflibercept]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| [[angular cheilitis|Angular stomatitis]], [[aphthous stomatitis]], [[aphthous ulcer]], [[glandular fever]], [[oropharyngeal cancer]], [[periodic fever, aphthous stomatitis, pharyngitis and adenitis]], [[trench mouth]], [[palatine uvula|uvulitis]], [[Vincent's angina]]
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"|[[Glucagonoma]]
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Celiac disease]], [[Crohn's disease]], [[dysphagia]], [[inflammatory bowel disease]], [[odynophagia]], [[oropharyngeal candidiasis]], [[ulcerative colitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"|[[Chronic granulomatous disease]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| [[Agranulocytosis]], [[anemia]], [[cyclic neutropenia]], [[iron deficiency anemia]], [[leukemia]], [[neutropenia]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"|[[Irradiation]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Aphthous stomatitis]], [[aphthous ulcer]], [[arbovirus]], [[baculovirus]], [[bovine papular stomatitis]], [[candidiasis]], [[coxsackie virus]], [[diphtheritic stomatitis]], [[ebola]], [[esophageal candidiasis]], [[feline calicivirus]], [[feline immunodeficiency virus]], [[gangrenous stomatitis]], [[glandular fever]], [[hand-foot-and-mouth disease]], [[herpangina]], [[herpes simplex virus]], [[herpes zoster]], [[herpes]], [[herpetic gingivostomatitis]], [[HIV]], infectious stomatitis, [[lassa fever]], [[lichen planus]], [[Marburg virus]], [[noma (disease)]], [[oncolytic virus]], [[oropharyngeal candidiasis]], [[parapoxvirus]], [[periodic fever, aphthous stomatitis, pharyngitis and adenitis]], [[syphilis]], [[trench mouth]], [[tuberculosis]], [[typhlitis]], [[vesicular stomatitis virus]], [[vesicular stomatitis with exanthem]], [[vesiculovirus]], [[Vincent's angina]], [[warts]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"|[[Odynophagia]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"|[[Parkinson's disease]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| [[Angular cheilitis]], [[ariboflavinosis]], [[folate deficiency]], [[kwashiorkor]], [[lingzhi]], [[nutritional deficiency]], [[pyrophosphate]], [[vitamin B12 deficiency]], [[riboflavin|vitamin B2 deficiency]], [[vitamin B6 deficiency]], [[vitamin C deficiency]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"|[[Warts]]
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| [[Cancer]], [[glucagonoma]], [[leukemia]], [[oropharyngeal cancer]]
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"|[[Emotional stress]]
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| [[Allergies]], [[autoimmune diseases]], [[Behcet's disease]], [[chronic granulomatous disease]], [[combined immunodeficiencies]], [[drug hypersensitivity]], [[gluten-sensitive enteropathy associated conditions]], [[pemphigoid]], [[periodic fever syndrome]], [[systemic lupus erythematosus]], [[TNF receptor associated periodic syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"|[[Trauma]]
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"|[[Mucosa hemorrhage]]
|-
|}


===Causes in Alphabetical Order<ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN140510368X</ref>===
==Related Chapters==
{{columns-list|3|
*[[Acmella oleracea]]
*[[Afatinib]]
*[[Aflibercept]]
*[[Agranulocytosis]]
*[[Alemtuzumab]]
*[[Allergies]]
*[[Aminopterin]]
*[[Anemia]]
*[[Angular cheilitis]]
*[[angular cheilitis|Angular stomatitis]]
*[[Aphthous stomatitis]]
*[[Aphthous stomatitis]]
*[[Aphthous ulcer]]
*[[Herpetic stomatitis]]
*[[chloroquine|Aralen phosphate]]
*[[Chicken pox]]
*[[Arbovirus]]
*[[Trench mouth]]
*[[Ariboflavinosis]]
*[[Auranofin]]
*[[Autoimmune diseases]]
*[[Baculovirus]]
*[[Behcet's disease]]
*[[Benzydamine]]
*[[Bismuthia]]
*[[Bleomycin]]
*[[Bovine papular stomatitis]]
*[[Bovine papular stomatitis]]
*[[Burning mouth syndrome]]
*[[Busulfan]]
*[[Cabozantinib]]
*[[Cancer]]
*[[Candidiasis]]
*[[Capecitabine]]
*[[Carboplatin]]
*[[Celiac disease]]
*[[Cerubidine]]
*[[Chemotherapy]]
*[[Chloramphenicol]]
*[[Chloroquine phosphate]]
*[[Chronic granulomatous disease]]
*[[Clofibrate]]
*[[Combined immunodeficiencies]]
*[[Cosmegen]]
*[[Coxsackie virus]]
*[[Crohn's disease]]
*[[Cyclic neutropenia]]
*[[Cyclophosphamide]]
*[[Cytosine arabinoside]]
*[[Dacarbazine]]
*[[Dactinomycin]]
*[[Daptomycin]]
*[[Daunorubicin]]
*[[Dentures]]
*[[Desquamative gingivitis]]
*[[Diphtheritic stomatitis]]
*[[Docetaxel]]
*[[Doxorubicin]]
*[[Drug hypersensitivity]]
*[[Dry mouth]]
*[[Dysphagia]]
*[[Ebola]]
*[[Emotional stress]]
*[[Epirubicin]]
*[[Eribulin]]
*[[Erythema multiforme]]
*[[Esophageal candidiasis]]
*[[Etoposide]]
*[[Everolimus]]
*[[Feline calicivirus]]
*[[Feline immunodeficiency virus]]
*[[Floxuridine]]
*[[Fluorouracil]]
*[[Folate deficiency]]
*[[Gangrenous stomatitis]]
*[[Gemcitabine]]
*[[Gemtuzumab ozogamicin]]
*[[Gentamicin]]
*[[Ginkgo biloba ]]
*[[Glandular fever]]
*[[Glucagonoma]]
*[[Gluten-sensitive enteropathy associated conditions]]
*[[Gold]]
*[[Hand-foot-and-mouth disease]]
*[[Hand-foot-and-mouth disease]]
*[[Herpangina]]
*[[Herpes]]
*[[Herpes simplex virus]]
*[[Herpes zoster]]
*[[Herpetic gingivostomatitis]]
*[[Hexetidine]]
*[[HIV]]
*[[Hypertrophic gums]]
*[[Infectious stomatitis]]
*[[Inflammatory bowel disease]]
*[[Iron deficiency anemia]]
*[[Irradiation]]
*[[Ixabepilone]]
*[[Kawasaki disease]]
*[[Ketorolac tromethamine]]
*[[Kwashiorkor]]
*[[Lassa fever]]
*[[Lenvatinib]]
*[[Leukemia]]
*[[Levoleucovorin]]
*[[Lichen planus]]
*[[Lincomycin hydrochloride]]
*[[Lingzhi]]
*[[Lip balm]]
*[[Lomustine]]
*[[Loratadine]]
*[[Marburg virus]]
*[[Melphalan]]
*[[Mercury poisoning]]
*[[Methotrexate]]
*[[Metronidazole]]
*[[Mitomycin]]
*[[Mitoxantrone]]
*[[Mucosa hemorrhage]]
*[[Nabumetone]]
*[[Neutropenia]]
*[[Nickel]]
*[[Nicotine polacrilex]]
*[[Nicotine stomatitis]]
*[[Noma (disease)]]
*[[Nutritional deficiency]]
*[[Odynophagia]]
*[[Oncolytic virus]]
*[[Oral lesions]]
*[[Oral submucous fibrosis]]
*[[oral lesions|Oral ulceration]]
*[[Oropharyngeal cancer]]
*[[Oropharyngeal candidiasis]]
*[[Oxaliplatin]]
*[[Oxaprozin]]
*[[Oxcarbazepine]]
*[[Palbociclib]]
*[[Panitumumab]]
*[[Paraplatin]]
*[[Parapoxvirus]]
*[[Parkinson's disease]]
*[[Pemphigoid]]
*[[Penicillin G potassium]]
*[[Pentostatin]]
*[[Peplomycin]]
*[[Periodic fever syndrome]]
*[[Periodic fever, aphthous stomatitis, pharyngitis and adenitis]]
*[[Pertuzumab]]
*[[Phenylbutazone]]
*[[Pixantrone]]
*[[Pralatrexate]]
*[[Pramipexole]]
*[[Procainamide]]
*[[Pyrophosphate]]
*[[Sargramostim]]
*[[Sirolimus]]
*[[Sodium aurothiomalate]]
*[[Sorafenib]]
*[[Stevens-Johnson syndrome]]
*[[Sucralfate]]
*[[Sulfasalazine]]
*[[Sulindac]]
*[[Sunitinib]]
*[[Syphilis]]
*[[Systemic lupus erythematosus]]
*[[Temsirolimus]]
*[[Thallium]]
*[[Thioguanine]]
*[[Tiagabine]]
*[[TNF receptor associated periodic syndrome]]
*[[Tolmetin]]
*[[Trametinib]]
*[[Trauma]]
*[[Trench mouth]]
*[[Tuberculosis]]
*[[Typhlitis]]
*[[Ulcerative colitis]]
*[[gingivitis|Ulcerative gingivitis]]
*[[palatine uvula|Uvulitis]]
*[[Vesicular stomatitis virus]]
*[[Vesicular stomatitis with exanthem]]
*[[Vesiculovirus]]
*[[Vincent's angina]]
*[[Vitamin B12 deficiency]]
*[[riboflavin|Vitamin B2 deficiency]]
*[[Vitamin B6 deficiency]]
*[[Vitamin C deficiency]]
*[[Warts]]
*[[Ziv-aflibercept]]
}}
== Differentiating Stomatitis from other Diseases ==
Stomatitis should be differentiated from other disease as well as from possible underlying conditions causing stomatitis including:<ref name="Gangrenous stomatitis">{{cite book |last1=Mandell |firs1t=Gerald |last2=Gouglas |first2=Gordon |last3=Bennett |first3=John |date= |title=Principles and Practice of Infectious Diseases |location= Harvard Medical School |publisher=WILEY MEDICAL |page=383 |isbn=0-471-87643-7}}​</ref><ref name="pmid10597357">{{cite journal| author=Scully C| title=A review of common mucocutaneous disorders affecting the mouth and lips. | journal=Ann Acad Med Singapore | year= 1999 | volume= 28 | issue= 5 | pages= 704-7 | pmid=10597357 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10597357  }} </ref>
*Tumors of the tongue
**Squamous cell carcinoma
***It can prevent as a non healing ulcer or as a mass and is mostly caused by smoking or alcohol utilization.<ref>{{Cite journal
| author = [[R. Morgan]], [[J. Tsang]], [[N. Harrington]] & [[L. Fook]]
| title = Survey of hospital doctors' attitudes and knowledge of oral conditions in older patients
| journal = [[Postgraduate medical journal]]
| volume = 77
| issue = 908
| pages = 392–394
| year = 2001
| month = June
| pmid = 11375454
}}</ref>
**Leukoplakia
***It is benign but can progress to carcinoma after almost 10 years. It is common in atypical users of tobacco, other than smoking.<ref>{{Cite journal
| author = [[D. Grady]], [[J. Greene]], [[T. E. Daniels]], [[V. L. Ernster]], [[P. B. Robertson]], [[W. Hauck]], [[D. Greenspan]], [[J. Greenspan]] & [[S. Jr Silverman]]
| title = Oral mucosal lesions found in smokeless tobacco users
| journal = [[Journal of the American Dental Association (1939)]]
| volume = 121
| issue = 1
| pages = 117–123
| year = 1990
| month = July
| pmid = 2370378
}}</ref>
***Oral proliferative verrucous leukoplakia is an aggressive sub type that has multiple lesions and has higher conversion to warts or carcinoma.<ref>{{Cite journal
| author = [[Ann M. Gillenwater]], [[Nadarajah Vigneswaran]], [[Hanadi Fatani]], [[Pierre Saintigny]] & [[Adel K. El-Naggar]]
| title = Proliferative verrucous leukoplakia (PVL): a review of an elusive pathologic entity!
| journal = [[Advances in anatomic pathology]]
| volume = 20
| issue = 6
| pages = 416–423
| year = 2013
| month = November
| doi = 10.1097/PAP.0b013e3182a92df1
| pmid = 24113312
}}</ref>
**Melanoma
***It has the typical abcde characteristics including asymmetry, irregular borders, color change, increase in diameter and evolution and is usually diagnosed in its later stages.<ref>{{Cite journal
| author = [[P. DeMatos]], [[D. S. Tyler]] & [[H. F. Seigler]]
| title = Malignant melanoma of the mucous membranes: a review of 119 cases
| journal = [[Annals of surgical oncology]]
| volume = 5
| issue = 8
| pages = 733–742
| year = 1998
| month = December
| pmid = 9869521
}}</ref>
**Fordyce spots
***These are benign neoplasms with sebaceous features
**Torrus Paltinus
***It is a nodular mass on the hard palate, covered with normal mucosa<ref>{{Cite journal
| author = [[Barry Ladizinski]] & [[Kachiu C. Lee]]
| title = A nodular protuberance on the hard palate
| journal = [[JAMA]]
| volume = 311
| issue = 15
| pages = 1558–1559
| year = 2014
| month = April
| doi = 10.1001/jama.2014.271
| pmid = 24737369
}}</ref>
*Autoimmune diseases
*[[Agranulocytosis]]
*Behcet's syndrome<ref name="pmid17343257">{{cite journal| author=Dalghous AM, Freysdottir J, Fortune F| title=Expression of cytokines, chemokines, and chemokine receptors in oral ulcers of patients with Behcet's disease (BD) and recurrent aphthous stomatitis is Th1-associated, although Th2-association is also observed in patients with BD. | journal=Scand J Rheumatol | year= 2006 | volume= 35 | issue= 6 | pages= 472-5 | pmid=17343257 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17343257  }} </ref>
*Nicorandil induced ulcers
***It is a drug use in angina pectoris
*Burning mouth syndrome
**It is characterized by constant sensation of burning in the mouth in post menopausal women.
**There is no particular cause for it and no specific treatment is done.
*[[Syphilis]]
*[[Coxsackie virus]] accompanies involvement of the hands and the mouth
*[[HIV]]
*[[VZV]] or [[Chicken pox]]
== Epidemiology and Demographics ==
===Age===
*Herpetic gingivostomatitis occurs mostly in children between 6 months to 5 years. It can also occur in other age groups.<ref name="pmid16451405">{{cite journal| author=Kolokotronis A, Doumas S| title=Herpes simplex virus infection, with particular reference to the progression and complications of primary herpetic gingivostomatitis. | journal=Clin Microbiol Infect | year= 2006 | volume= 12 | issue= 3 | pages= 202-11 | pmid=16451405 | doi=10.1111/j.1469-0691.2005.01336.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16451405  }} </ref>
*Noma or gangrenous stomatitis is more common in children<ref name="Gangrenous stomatitis">{{cite book |last1=Mandell |firs1t=Gerald |last2=Gouglas |first2=Gordon |last3=Bennett |first3=John |date= |title=Principles and Practice of Infectious Diseases |location= Harvard Medical School |publisher=WILEY MEDICAL |page=383 |isbn=0-471-87643-7}}​</ref>
===Gender===
*Denture stomatitis is more common in females <ref name="pmid3298586">{{cite journal| author=Arendorf TM, Walker DM| title=Denture stomatitis: a review. | journal=J Oral Rehabil | year= 1987 | volume= 14 | issue= 3 | pages= 217-27 | pmid=3298586 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3298586  }} </ref>
===Season===
*Herpetic gingivostomatitis has no seasonal preference.<ref name="pmid16210107">{{cite journal| author=Kimberlin DW| title=Herpes simplex virus infections in neonates and early childhood. | journal=Semin Pediatr Infect Dis | year= 2005 | volume= 16 | issue= 4 | pages= 271-81 | pmid=16210107 | doi=10.1053/j.spid.2005.06.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16210107  }} </ref>
==Risk Factors==
The following risk factors are believed to influence the development of stomatitis:<ref>{{Cite journal
| author = [[R. Morgan]], [[J. Tsang]], [[N. Harrington]] & [[L. Fook]]
| title = Survey of hospital doctors' attitudes and knowledge of oral conditions in older patients
| journal = [[Postgraduate medical journal]]
| volume = 77
| issue = 908
| pages = 392–394
| year = 2001
| month = June
| pmid = 11375454
}}</ref><ref>{{Cite journal
| author = [[Carolina-Cavalieri Gomes]], [[Ricardo-Santiago Gomez]], [[Livia-Guimaraes Zina]] & [[Fabricio-Rezende Amaral]]
| title = Recurrent aphthous stomatitis and Helicobacter pylori
| journal = [[Medicina oral, patologia oral y cirugia bucal]]
| volume = 21
| issue = 2
| pages = e187–e191
| year = 2016
| month = March
| pmid = 26827061
}}</ref>
*[[Smoking]]
*[[Alcohol]]
*[[Trauma]]
*[[H. pylori]]
*Sensitivity to food
*Nutritional abnormalities
*Immunologic deficiencies e.g [[HIV]]
*Genetic factors
*[[Chemotherapy]] or [[radiotherapy]]<ref>{{Cite journal
| author = [[Kenji Momo]]
| title = &#91;Indomethacin Spray Preparation for the Control of Pain Associated with Stomatitis Caused by Chemotherapy and Radiotherapy in Cancer Patients&#93;
| journal = [[Yakugaku zasshi : Journal of the Pharmaceutical Society of Japan]]
| volume = 135
| issue = 8
| pages = 931–935
| year = 2015
| month =
| doi = 10.1248/yakushi.15-00112-1
| pmid = 26234349
}}</ref>
===Risk factors for denture stomatitis===
Some risk factors for denture stomatitis include<ref name="pmid3298586">{{cite journal| author=Arendorf TM, Walker DM| title=Denture stomatitis: a review. | journal=J Oral Rehabil | year= 1987 | volume= 14 | issue= 3 | pages= 217-27 | pmid=3298586 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3298586  }} </ref><ref name="pmid25082257">{{cite journal| author=Marinoski J, Bokor-Bratić M, Čanković M| title=Is denture stomatitis always related with candida infection? A case control study. | journal=Med Glas (Zenica) | year= 2014 | volume= 11 | issue= 2 | pages= 379-84 | pmid=25082257 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25082257  }} </ref>
*Poor denture hygiene
*Overnight wearing of dentures
*pH of oral mucosal surfaces < 6.5
*Dietry deficiencies
*Hematological diseases
===Bovine papular stomatitis===
*Expoure to infected cow
== Screening ==
Screening for stomatitis is not recommended.<ref name=stomatitis-Screening>U.S. Preventive Services Task Force http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=stomatitis Accessed on August 31, 2016</ref>
==Natural History, Complications and Prognosis==
===Natural History===
*If left untreated herpetic stomatitis resolves after the vesicles erupt and the ulcers heal. The [[HSV]] travels length nerves and moves to the ganglions where it stays in latent form. When the host becomes immunocompromised after taking medications or due to some other illness, the virus assesses the opportunity and through the same nerves becomes active once again manifesting symptoms such as oral [[vesicles]].<ref name="pmid16451405">{{cite journal| author=Kolokotronis A, Doumas S| title=Herpes simplex virus infection, with particular reference to the progression and complications of primary herpetic gingivostomatitis. | journal=Clin Microbiol Infect | year= 2006 | volume= 12 | issue= 3 | pages= 202-11 | pmid=16451405 | doi=10.1111/j.1469-0691.2005.01336.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16451405  }} </ref>
**The viral shedding can continue for 2-12 days after primary infection.<ref name="pmid10469407">{{cite journal| author=Amir J, Harel L, Smetana Z, Varsano I| title=The natural history of primary herpes simplex type 1 gingivostomatitis in children. | journal=Pediatr Dermatol | year= 1999 | volume= 16 | issue= 4 | pages= 259-63 | pmid=10469407 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10469407  }} </ref>
===Complications===
Some complications of stomatitis include<ref name="pmid16451405">{{cite journal| author=Kolokotronis A, Doumas S| title=Herpes simplex virus infection, with particular reference to the progression and complications of primary herpetic gingivostomatitis. | journal=Clin Microbiol Infect | year= 2006 | volume= 12 | issue= 3 | pages= 202-11 | pmid=16451405 | doi=10.1111/j.1469-0691.2005.01336.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16451405  }} </ref><ref>Kurt-Jones, Evelyn A., et al. "Herpes simplex virus 1 interaction with Toll-like receptor 2 contributes to lethal encephalitis." Proceedings of the National Academy of Sciences of the United States of America 101.5 (2004): 1315-1320.</ref>
====Life threatening complications====
*Meningoencephalitis
====Other Common Complications====
*Recurrent skin and mouth infections
*Dissemination of the infection
====Noma Complications====
*Teeth loss
==History and Symptoms==
The diagnosis of stomatitis is mostly clinical. The location and features of the ulcers are also important findings in this regard. A detailed history followed by a physical exam is very helpful.<ref name="pmid11577924">{{cite journal| author=Amir J| title=Clinical aspects and antiviral therapy in primary herpetic gingivostomatitis. | journal=Paediatr Drugs | year= 2001 | volume= 3 | issue= 8 | pages= 593-7 | pmid=11577924 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11577924  }} </ref><ref name="pmid10469407">{{cite journal| author=Amir J, Harel L, Smetana Z, Varsano I| title=The natural history of primary herpes simplex type 1 gingivostomatitis in children. | journal=Pediatr Dermatol | year= 1999 | volume= 16 | issue= 4 | pages= 259-63 | pmid=10469407 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10469407  }} </ref>
===History===
Previous history of stomatitis is common among patients presenting with an episode. Some findings in the history are<ref name="pmid16451405">{{cite journal| author=Kolokotronis A, Doumas S| title=Herpes simplex virus infection, with particular reference to the progression and complications of primary herpetic gingivostomatitis. | journal=Clin Microbiol Infect | year= 2006 | volume= 12 | issue= 3 | pages= 202-11 | pmid=16451405 | doi=10.1111/j.1469-0691.2005.01336.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16451405  }} </ref>
*Bad breath
*Refusal to drink or eat
===General symptoms===
Some general symptoms associated with herpetic stomatitis include<ref name="pmid16451405">{{cite journal| author=Kolokotronis A, Doumas S| title=Herpes simplex virus infection, with particular reference to the progression and complications of primary herpetic gingivostomatitis. | journal=Clin Microbiol Infect | year= 2006 | volume= 12 | issue= 3 | pages= 202-11 | pmid=16451405 | doi=10.1111/j.1469-0691.2005.01336.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16451405  }} </ref>
*[[Fever]]
*[[Anorexia]]
*[[Irritability]]
*[[Drooling]]
*Maliase
*[[Headache]]
===HEENT===
*Painful swallowing
*Neck pain
==Physical Examination==
A comprehensive physical exam has great significance in the diagnosis of stomatitis. The exam findings may include<ref name="pmid16451405">{{cite journal| author=Kolokotronis A, Doumas S| title=Herpes simplex virus infection, with particular reference to the progression and complications of primary herpetic gingivostomatitis. | journal=Clin Microbiol Infect | year= 2006 | volume= 12 | issue= 3 | pages= 202-11 | pmid=16451405 | doi=10.1111/j.1469-0691.2005.01336.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16451405  }} </ref>
*Oral pin-head vesicles
*Oral mucosal ulcers
*Submandibular lymphadenitis
*Halitosis
==Laboratory Findings==
History and physical examination are the mainstay of diagnosing stomatitis. If required laboratory findings can play an important role in diagnosing and differentiating the particular type of stomatitis.
===Herpetic Stomatitis===
*Viral culture
*Tzank smear for active lesions
**It can not differentiate between the various types of viruses that can cause stomatitis i.e [[HSV1]], [[HSV2]] or [[VZV]]
*Serology
*Studies using immunofluorescent techniques
*[[PCR]]
====Noma or Gangrenous stomatitis====
The diagnosis of Noma or gangrenous stomatitis is made by:<ref name="Gangrenous stomatitis">{{cite book |last1=Mandell |firs1t=Gerald |last2=Gouglas |first2=Gordon |last3=Bennett |first3=John |date= |title=Principles and Practice of Infectious Diseases |location= Harvard Medical School |publisher=WILEY MEDICAL |page=383 |isbn=0-471-87643-7}}​</ref>
*Culture of organisms
*Biopsy showing deep tissue involvement
==Medical Therapy==
The therapy for stomatitis is governed by following principles:<ref name="pmid7036816">{{cite journal| author=Wade JC, Newton B, McLaren C, Flournoy N, Keeney RE, Meyers JD| title=Intravenous acyclovir to treat mucocutaneous herpes simplex virus infection after marrow transplantation: a double-blind trial. | journal=Ann Intern Med | year= 1982 | volume= 96 | issue= 3 | pages= 265-9 | pmid=7036816 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7036816  }} </ref>
*Oral or IV hydration
*Pain control
*Application of a barrier cream or jelly
*[[Zilactin]], a combination of [[lidocaine]] and [[hydroxypropyl cellulose]] can be used to prevent the ulcers from further trauma and irritation.<ref name="pmid1401597">{{cite journal| author=Rodu B, Mattingly G| title=Oral mucosal ulcers: diagnosis and management. | journal=J Am Dent Assoc | year= 1992 | volume= 123 | issue= 10 | pages= 83-6 | pmid=1401597 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1401597  }} </ref>
===Denture stomatitis===
*In most cases correction of denture fitness, avoidance of plaque development and avoidance of continuous wearing of dentures helps correct the defect. Antiseptic and antifungal agents are not required in most cases.<ref name="pmid3298586">{{cite journal| author=Arendorf TM, Walker DM| title=Denture stomatitis: a review. | journal=J Oral Rehabil | year= 1987 | volume= 14 | issue= 3 | pages= 217-27 | pmid=3298586 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3298586  }} </ref>
===Herpetic stomatitis===
*IV [[acyclovir]] is used in case of immunocompromised individuals with [[HSV-1]] stomatitis<ref name="pmid17632484">{{cite journal| author=Thomas E| title=A complication of primary herpetic gingivostomatitis. | journal=Br Dent J | year= 2007 | volume= 203 | issue= 1 | pages= 33-4 | pmid=17632484 | doi=10.1038/bdj.2007.585 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17632484  }} </ref><ref name="pmid7048914">{{cite journal| author=Meyers JD, Wade JC, Mitchell CD, Saral R, Lietman PS, Durack DT et al.| title=Multicenter collaborative trial of intravenous acyclovir for treatment of mucocutaneous herpes simplex virus infection in the immunocompromised host. | journal=Am J Med | year= 1982 | volume= 73 | issue= 1A | pages= 229-35 | pmid=7048914 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7048914  }} </ref><ref name="pmid6113352">{{cite journal| author=Mitchell CD, Bean B, Gentry SR, Groth KE, Boen JR, Balfour HH| title=Acyclovir therapy for mucocutaneous herpes simplex infections in immunocompromised patients. | journal=Lancet | year= 1981 | volume= 1 | issue= 8235 | pages= 1389-92 | pmid=6113352 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6113352  }} </ref>
===Noma or Gangrenous stomatitis===
*High dose IV [[penicillin]]<ref name="Gangrenous stomatitis">{{cite book |last1=Mandell |firs1t=Gerald |last2=Gouglas |first2=Gordon |last3=Bennett |first3=John |date= |title=Principles and Practice of Infectious Diseases |location= Harvard Medical School |publisher=WILEY MEDICAL |page=383 |isbn=0-471-87643-7}}​</ref>
===Criteria for Hospitalization===
The patient who develops the following conditions must be institutionalized<ref name="pmid16451405">{{cite journal| author=Kolokotronis A, Doumas S| title=Herpes simplex virus infection, with particular reference to the progression and complications of primary herpetic gingivostomatitis. | journal=Clin Microbiol Infect | year= 2006 | volume= 12 | issue= 3 | pages= 202-11 | pmid=16451405 | doi=10.1111/j.1469-0691.2005.01336.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16451405  }} </ref>
*Encephalitis
*Epiglotittis
*Pneumonitis
*Immunocompromised status
*Poor oral intake
==Surgical Therapy==
===Noma or Gangrenous stomatitis===
Surgery may be require in Noma in the following conditions<ref name="Gangrenous stomatitis">{{cite book |last1=Mandell |firs1t=Gerald |last2=Gouglas |first2=Gordon |last3=Bennett |first3=John |date= |title=Principles and Practice of Infectious Diseases |location= Harvard Medical School |publisher=WILEY MEDICAL |page=383 |isbn=0-471-87643-7}}​</ref>
*Removal of the teeth that are loose
*Surgery for cosmetic reasons
==Primary Prevention==
*Adequate hydration
*Oral hygiene
*Denture hygiene
*Prevention of exposure to bovine papular stomatitis virus infected cow


==Secondary Prevention==
==References==


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[[Category:Infectious Disease]]
[[Category:Primary Care]]
[[Category:Primary Care]]
[[Category:Emergency mdicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Otolaryngology]]
[[Category:Dermatology]]
[[Category:Gastroenterology]]

Latest revision as of 00:18, 30 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2], Sara Mehrsefat, M.D. [3]

Synonyms and keywords: Aphthous stomatitis; Herpetic stomatitis

Overview

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