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


==Overview==
==Overview==
Preventive measures and medical therapy are the main stay of the therapy of stomatitis. Th medical therapy varies for various causes and types of stomatitis.
[[Preventive care|Preventive measures]] and avoidance of the inciting cause is enough for the treatment of most non-infectious causes of stomatitis. Pain medications may also be required to manage the pain caused by stomatitis. [[Antibiotic therapy|Antibiotic medical therapy]] is the mainstay of treatment for [[infectious]] stomatitis. The medical therapy varies among different causes and types of stomatitis.


==Medical Therapy==
==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>
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
*[[Hydration|Oral or IV hydration]]
*Pain control
*[[Pain]] control
*Application of a barrier cream or jelly
*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>
*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 but pain medications are usually required.<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>


===Pyostomatitis vegetans===
===Criteria for Hospitalization===
*Treatment of underlying [[IBD]] is very effective in eradicating pyostomatitis vegetates lesions.<ref name="pmid28153136">Magliocca KR, Fitzpatrick SG (2017) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=28153136 Autoimmune Disease Manifestations in the Oral Cavity.] ''Surg Pathol Clin'' 10 (1):57-88. [http://dx.doi.org/10.1016/j.path.2016.11.001 DOI:10.1016/j.path.2016.11.001] PMID: [https://pubmed.gov/28153136 28153136]</ref>
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>
*In the absence of [[IBD]], [[topical corticosteroids]] are useful.<ref name="pmid14723710">{{cite journal| author=Hegarty AM, Barrett AW, Scully C| title=Pyostomatitis vegetans. | journal=Clin Exp Dermatol | year= 2004 | volume= 29 | issue= 1 | pages= 1-7 | pmid=14723710 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14723710 }} </ref>
*[[Encephalitis]]
===Trench mouth or acute necrotizing ulcerative gingivitis===
*[[Epiglottitis]]
*Nicotininc acid<ref>King, J. D. "Nutritional and other Factors in" Trench Mouth," with Special Reference to the Nicotinic Acid Component of the Vitamin B2 Complex." Brit. dent. J. 74.6 (1943): 141-7.</ref>
*[[Pneumonitis]]
*[[Immunocompromised]] status
*Poor oral intake
===Infectious Types===
 
====Trench mouth or acute necrotizing ulcerative gingivitis====
*[[Nicotinic acid]]<ref>King, J. D. "Nutritional and other Factors in" Trench Mouth," with Special Reference to the Nicotinic Acid Component of the Vitamin B2 Complex." Brit. dent. J. 74.6 (1943): 141-7.</ref>
*Local therapy
*Local therapy
*For systemic involvement<ref name="pmid23763733">{{cite journal| author=Atout RN, Todescan S| title=Managing patients with necrotizing ulcerative gingivitis. | journal=J Can Dent Assoc | year= 2013 | volume= 79 | issue=  | pages= d46 | pmid=23763733 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23763733  }} </ref>
*For [[systemic]] involvement<ref name="pmid23763733">{{cite journal| author=Atout RN, Todescan S| title=Managing patients with necrotizing ulcerative gingivitis. | journal=J Can Dent Assoc | year= 2013 | volume= 79 | issue=  | pages= d46 | pmid=23763733 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23763733  }} </ref>
**Preferred regimen (1): Amoxicillin, 250 mg TDS for 7 days
**Preferred regimen (1): [[Amoxicillin]], 250 mg TDS for 7 days {{withorwithout}} [[Metronidazole]], 250 mg TDS for 7 days
**Preferred regimen (2): Metronidazole, 250 mg TDS for 7 days
*If [[debridement]] is delayed:<ref name="123urlAcute Necrotizing Ulcerative Gingivitis (ANUG) - Dental Disorders - Merck Manuals Professional Edition">{{cite web |url=http://www.merckmanuals.com/professional/dental-disorders/periodontal-disorders/acute-necrotizing-ulcerative-gingivitis-anug |title=Acute Necrotizing Ulcerative Gingivitis (ANUG) - Dental Disorders - Merck Manuals Professional Edition |format= |work= |accessdate=October 25, 2016}}</ref>
**[[Amoxicillin]] 500 mg every 8 hours for 3 days
**[[Erythromycin]] 250 mg every 6 hours for 3 days
**[[Tetracycline]] 250 mg every 6 hours for 3 days
*For a detailed review of the medical therapy for [[Trench mouth]], click '''[[Trench mouth medical therapy|here]]'''


===Candidal stomatitis===
====Candidal stomatitis====
*Preferred regimen for disease limited to oral cavity:[[Nystatin]]  
*Preferred regimen for disease limited to oral cavity: [[Nystatin]]  
*Preferred regimen for systemic [[candidiasis]] : [[Fluconazole]] 100mg PO for 7 to 14 days  or [[clotrimazole]] 10 mg torches 5 times daily for 14 days
*Preferred regimen for systemic [[candidiasis]] : [[Fluconazole]] 100mg PO for 7 to 14 days  or [[clotrimazole]] 10 mg torches 5 times daily for 14 days
*Alternate regimen for systemic [[candidiasis]] : [[Clotrimazole]] 10 mg torches 5 times daily for 14 days
*Alternate regimen for systemic [[candidiasis]] : [[Clotrimazole]] 10 mg torches 5 times daily for 14 days
*For detailed review of the therapy for [[candidiasis]], click '''[[Candidiasis medical therapy|here]]'''
====Herpetic stomatitis====
*[[HSV]] shedding is increased in [[HIV]]-infected persons. Whereas [[AIDS antiretroviral drugs|antiretroviral therapy]] reduces the severity and frequency of symptomatic [[genital herpes]], frequent subclinical [[Viral shedding|shedding]] still occurs.<ref name="Posavad-2004">{{Cite journal  | last1 = Posavad | first1 = CM. | last2 = Wald | first2 = A. | last3 = Kuntz | first3 = S. | last4 = Huang | first4 = ML. | last5 = Selke | first5 = S. | last6 = Krantz | first6 = E. | last7 = Corey | first7 = L. | title = Frequent reactivation of herpes simplex virus among HIV-1-infected patients treated with highly active antiretroviral therapy. | journal = J Infect Dis | volume = 190 | issue = 4 | pages = 693-6 | month = Aug | year = 2004 | doi = 10.1086/422755 | PMID = 15272395 }}</ref>
*Preferred regimen in case of [[Immunocompromised|immunocompromised individuals]] with [[HSV-1]] stomatitis (1): IV [[acyclovir]] <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>
*For a detailed review of treatment of [[Herpes simplex]] infection click '''[[Herpes simplex treatment|here]]'''


===Herpetic stomatitis===
====[[Noma]] or [[Gangrenous]] stomatitis====
*Preferred regimen: 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>


*Preferred regimen in case of immunocompromised individuals with [[HSV-1]] stomatitis (1): IV [[acyclovir]] <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>
===Non-infectious Types===
====Denture stomatitis====
*In most cases, correction of [[denture]] fitness, avoidance of [[Plaque|plaque development]], and avoidance of continuous wearing of dentures helps correct the defect. [[Antiseptic]] and [[antifungal]] agents are not required in most cases, but [[pain medications]] are usually required.<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>


===Noma or Gangrenous stomatitis===
====Pyostomatitis vegetans====
*Preferred regimen: 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>
*Treatment of underlying [[IBD]] is very effective in eradicating pyostomatitis vegetates [[lesions]].<ref name="pmid28153136">Magliocca KR, Fitzpatrick SG (2017) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=28153136 Autoimmune Disease Manifestations in the Oral Cavity.] ''Surg Pathol Clin'' 10 (1):57-88. [http://dx.doi.org/10.1016/j.path.2016.11.001 DOI:10.1016/j.path.2016.11.001] PMID: [https://pubmed.gov/28153136 28153136]</ref>
*Preferred regimen in the absence of [[IBD]]: [[Topical steroid|Topical corticosteroids]]<ref name="pmid14723710">{{cite journal| author=Hegarty AM, Barrett AW, Scully C| title=Pyostomatitis vegetans. | journal=Clin Exp Dermatol | year= 2004 | volume= 29 | issue= 1 | pages= 1-7 | pmid=14723710 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14723710  }} </ref>
*For the details about the medical therapy of [[IBD]], click '''[[Irritable bowel syndrome medical therapy|here]]'''


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


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[[Category:Dermatology]]
[[Category:Dermatology]]
[[Category:Primary care]]
[[Category:Emergency mdicine]]
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[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
 
[[Category:Otolaryngology]]
 
[[Category:Gastroenterology]]
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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: Sara Mehrsefat, M.D. [2], Usama Talib, BSc, MD [3]

Overview

Preventive measures and avoidance of the inciting cause is enough for the treatment of most non-infectious causes of stomatitis. Pain medications may also be required to manage the pain caused by stomatitis. Antibiotic medical therapy is the mainstay of treatment for infectious stomatitis. The medical therapy varies among different causes and types of stomatitis.

Medical Therapy

The therapy for stomatitis is governed by following principles:[1]

Criteria for Hospitalization

The patient who develops the following conditions must be institutionalized[3]

Infectious Types

Trench mouth or acute necrotizing ulcerative gingivitis

Candidal stomatitis

Herpetic stomatitis

Noma or Gangrenous stomatitis

Non-infectious Types

Denture stomatitis

Pyostomatitis vegetans

References

  1. ↑ Wade JC, Newton B, McLaren C, Flournoy N, Keeney RE, Meyers JD (1982). "Intravenous acyclovir to treat mucocutaneous herpes simplex virus infection after marrow transplantation: a double-blind trial". Ann Intern Med. 96 (3): 265–9. PMID 7036816.
  2. ↑ Rodu B, Mattingly G (1992). "Oral mucosal ulcers: diagnosis and management". J Am Dent Assoc. 123 (10): 83–6. PMID 1401597.
  3. ↑ Kolokotronis A, Doumas S (2006). "Herpes simplex virus infection, with particular reference to the progression and complications of primary herpetic gingivostomatitis". Clin Microbiol Infect. 12 (3): 202–11. doi:10.1111/j.1469-0691.2005.01336.x. PMID 16451405.
  4. ↑ King, J. D. "Nutritional and other Factors in" Trench Mouth," with Special Reference to the Nicotinic Acid Component of the Vitamin B2 Complex." Brit. dent. J. 74.6 (1943): 141-7.
  5. ↑ Atout RN, Todescan S (2013). "Managing patients with necrotizing ulcerative gingivitis". J Can Dent Assoc. 79: d46. PMID 23763733.
  6. ↑ "Acute Necrotizing Ulcerative Gingivitis (ANUG) - Dental Disorders - Merck Manuals Professional Edition". Retrieved October 25, 2016.
  7. ↑ Posavad, CM.; Wald, A.; Kuntz, S.; Huang, ML.; Selke, S.; Krantz, E.; Corey, L. (2004). "Frequent reactivation of herpes simplex virus among HIV-1-infected patients treated with highly active antiretroviral therapy". J Infect Dis. 190 (4): 693–6. doi:10.1086/422755. PMID 15272395. Unknown parameter |month= ignored (help)
  8. ↑ Thomas E (2007). "A complication of primary herpetic gingivostomatitis". Br Dent J. 203 (1): 33–4. doi:10.1038/bdj.2007.585. PMID 17632484.
  9. ↑ Meyers JD, Wade JC, Mitchell CD, Saral R, Lietman PS, Durack DT; et al. (1982). "Multicenter collaborative trial of intravenous acyclovir for treatment of mucocutaneous herpes simplex virus infection in the immunocompromised host". Am J Med. 73 (1A): 229–35. PMID 7048914.
  10. ↑ Mitchell CD, Bean B, Gentry SR, Groth KE, Boen JR, Balfour HH (1981). "Acyclovir therapy for mucocutaneous herpes simplex infections in immunocompromised patients". Lancet. 1 (8235): 1389–92. PMID 6113352.
  11. ↑ Mandell; Gouglas, Gordon; Bennett, John. Principles and Practice of Infectious Diseases. Harvard Medical School: WILEY MEDICAL. p. 383. ISBN 0-471-87643-7. Unknown parameter |firs1t= ignored (help)​
  12. ↑ Arendorf TM, Walker DM (1987). "Denture stomatitis: a review". J Oral Rehabil. 14 (3): 217–27. PMID 3298586.
  13. ↑ Magliocca KR, Fitzpatrick SG (2017) Autoimmune Disease Manifestations in the Oral Cavity. Surg Pathol Clin 10 (1):57-88. DOI:10.1016/j.path.2016.11.001 PMID: 28153136
  14. ↑ Hegarty AM, Barrett AW, Scully C (2004). "Pyostomatitis vegetans". Clin Exp Dermatol. 29 (1): 1–7. PMID 14723710.

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