Stomatitis pathophysiology: Difference between revisions

Jump to navigation Jump to search
Line 65: Line 65:


===Aphthous stomatitis===
===Aphthous stomatitis===
[[Image:Aphthous stomatitis.jpg|Aphthous stomatitis.<ref> title="By Farhan 9909 (Own work) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons" href="https://commons.wikimedia.org/wiki/File%3AAphthous_stomatitis_on_the_labial_mucosa.jpg"><img width="512" alt="Aphthous stomatitis on the labial mucosa" src="https://upload.wikimedia.org/wikipedia/commons/thumb/d/d3/Aphthous_stomatitis_on_the_labial_mucosa.jpg/512px-Aphthous_stomatitis_on_the_labial_mucosa.jpg"</ref>]]
[[Image:Aphthous stomatitis.jpg|Aphthous stomatitis<ref> title="By Farhan 9909 (Own work) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons" href="https://commons.wikimedia.org/wiki/File%3AAphthous_stomatitis_on_the_labial_mucosa.jpg"><img width="512" alt="Aphthous stomatitis on the labial mucosa" src="https://upload.wikimedia.org/wikipedia/commons/thumb/d/d3/Aphthous_stomatitis_on_the_labial_mucosa.jpg/512px-Aphthous_stomatitis_on_the_labial_mucosa.jpg"</ref>|500px]]


==Microscopic Pathology==
==Microscopic Pathology==

Revision as of 16:17, 8 March 2017

Stomatitis Microchapters

Home

Patient Information

Overview

Historical perspective

Classification

Pathophysiology

Causes

Differentiating Stomatitis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Stomatitis pathophysiology On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Stomatitis pathophysiology

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Stomatitis pathophysiology

CDC on Stomatitis pathophysiology

Stomatitis pathophysiology in the news

Blogs on Stomatitis pathophysiology

Directions to Hospitals Treating Bursitis

Risk calculators and risk factors for Stomatitis pathophysiology

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

Overview

Stomatitis is the inflammation of the mucosal surfaces in the mouth. Various factors can contribute to the pathogenesis of stomatitis depending on the type of stomatitis.[1]

Pathophysiology

Different mechanism are understood to cause different types of stomatitis:[1]

  • Aphthous stomatitis:
    • 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.[2][3][4]
  • 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.[5]
    • 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.[6]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.[7][8]
  • 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.[9]
  • Bovine papular stomatitis:
  • Pyostomatitis vegetans:
    • Pyostomatitis vegetans is characterised by numerous painless, yellow, superficial pinpoint pustules with oedema of the mucosa of the mouth. It is found in patients with ulcerative colitis. The vesicles can combine and involve the vermillion border of the upper as well as the lower lips. Snail track ulcerations are typical for pyostomatitis vegetans.[12][13]
    • The involvement of skin along with the oral mucosa is characterised by an entity called Pyodermatitis Pyostomatitis Vegetans.[14]
  • Trench mouth or Acute necrotising ulcerative gingivitis:
    • Trench mouth presents as ulceration and pain accompanied by gingival necrosis. It is characterised by the ulceration and destruction of the part of gum tissue present between the teeth.[15][16]
  • Hand Foot and Mouth disease:
  • Candidal Stomatitis:
    • Candidal stomatitis is also known as oral candidiasis. It can occur exclusively or as part of systemic candidiasis in immunocompromised individuals. It can be can present a hyper plastic or erythematous pictures due to the invasion by the virus. Glossitis has also been noticed.[18]

Genetics

Though the genetics of stomatitis have not been studied extensively. It is understood that genetic polymorphism is associated with the occurrence of stomatitis.[19]

Associated Conditions

The following conditions can be associated with stomatitis.[5][20][1]

Gross Pathology

The gross pathology of stomatitis of stomatitis can vary from redness and inflammation to presence of vesicles or pustules. Oral candidiasis for example may present a hyper plastic picture, erythematous picture or whitish pseudomembrane (thrush).

Herpetic Stomatitis

Herpetic stomatitis[21]

Aphthous stomatitis

Aphthous stomatitis[22]

Microscopic Pathology

The microscopic pathology helps to confirm the diagnosis and to differentiate different types of stomatitis.[23]

References

  1. 1.0 1.1 1.2 Sonis ST (2004). "The pathobiology of mucositis". Nat Rev Cancer. 4 (4): 277–84. doi:10.1038/nrc1318. PMID 15057287.
  2. Ship JA (1996). "Recurrent aphthous stomatitis. An update". Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 81 (2): 141–7. PMID 8665304.
  3. Dalghous AM, Freysdottir J, Fortune F (2006). "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". Scand J Rheumatol. 35 (6): 472–5. PMID 17343257.
  4. Murray LN, Amedee RG (2000). "Recurrent aphthous stomatitis". J La State Med Soc. 152 (1): 10–4. PMID 10668310.
  5. 5.0 5.1 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.
  6. Arendorf TM, Walker DM (1987). "Denture stomatitis: a review". J Oral Rehabil. 14 (3): 217–27. PMID 3298586.
  7. Abduljabbar T, Al-Askar M, Baig MK, AlSowygh ZH, Kellesarian SV, Vohra F (2017). "Efficacy of photodynamic therapy in the inactivation of oral fungal colonization among cigarette smokers and non-smokers with denture stomatitis". Photodiagnosis Photodyn Ther. doi:10.1016/j.pdpdt.2017.01.182. PMID 28130176.
  8. Marinoski J, Bokor-Bratić M, Čanković M (2014). "Is denture stomatitis always related with candida infection? A case control study". Med Glas (Zenica). 11 (2): 379–84. PMID 25082257.
  9. 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)
  10. Sharif S, Nakatani Y, Wise L, Corbett M, Real NC, Stuart GS; et al. (2016). "A Broad-Spectrum Chemokine-Binding Protein of Bovine Papular Stomatitis Virus Inhibits Neutrophil and Monocyte Infiltration in Inflammatory and Wound Models of Mouse Skin". PLoS One. 11 (12): e0168007. doi:10.1371/journal.pone.0168007. PMC 5148066. PMID 27936239.
  11. Mandell; Gouglas, Gordon; Bennett, John. Principles and Practice of Infectious Diseases. Harvard Medical School: WILEY MEDICAL. p. 988. ISBN 0-471-87643-7. Unknown parameter |firs1t= ignored (help)
  12. 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.
  13. Pellicer Z, Santiago JM, Rodriguez A, Alonso V, Antón R, Bosca MM (2012). "Management of cutaneous disorders related to inflammatory bowel disease". Ann Gastroenterol. 25 (1): 21–26. PMC 3959344. PMID 24713996.
  14. Matias Fde A, Rosa DJ, Carvalho MT, Castañon MC (2011). "Pyodermatitis-pyostomatitis vegetans: case report and review of medical literature". An Bras Dermatol. 86 (4 Suppl 1): S137–40. PMID 22068794.
  15. Hu J, Kent P, Lennon JM, Logan LK (2015). "Acute necrotising ulcerative gingivitis in an immunocompromised young adult". BMJ Case Rep. 2015. doi:10.1136/bcr-2015-211092. PMID 26376700.
  16. Mizrahi Y (2014). "[NUG--necrotizing ulcerative gingivitis: a review]". Refuat Hapeh Vehashinayim (1993). 31 (3): 41–7, 62. PMID 25219100.
  17. ROBINSON CR, RHODES AJ (1961). "Vesicular exanthem and stomatitis. Report of an epidemic due to Coxsacke virus Group A, Type 16". N Engl J Med. 265: 1104–5. doi:10.1056/NEJM196111302652207. PMID 14492892.
  18. Zhou PR, Hua H, Liu XS (2017). "Quantity of Candida Colonies in Saliva: 
A Diagnostic Evaluation for Oral Candidiasis". Chin J Dent Res. 20 (1): 27–32. doi:10.3290/j.cjdr.a37739. PMID 28232964.
  19. Gomes CC, Gomez RS, Zina LG, Amaral FR (2016). "Recurrent aphthous stomatitis and Helicobacter pylori". Med Oral Patol Oral Cir Bucal. 21 (2): e187–91. PMC 4788798. PMID 26827061.
  20. R. Morgan, J. Tsang, N. Harrington & L. Fook (2001). "Survey of hospital doctors' attitudes and knowledge of oral conditions in older patients". Postgraduate medical journal. 77 (908): 392–394. PMID 11375454. Unknown parameter |month= ignored (help)
  21. title="By Klaus D. Peter, Gummersbach, Germany (Own work) [CC BY 3.0 de (http://creativecommons.org/licenses/by/3.0/de/deed.en)], via Wikimedia Commons" href="https://commons.wikimedia.org/wiki/File%3AStomatitis_herpetica.jpg"><img width="512" alt="Stomatitis herpetica" src="https://upload.wikimedia.org/wikipedia/commons/thumb/8/84/Stomatitis_herpetica.jpg/512px-Stomatitis_herpetica.jpg"
  22. title="By Farhan 9909 (Own work) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons" href="https://commons.wikimedia.org/wiki/File%3AAphthous_stomatitis_on_the_labial_mucosa.jpg"><img width="512" alt="Aphthous stomatitis on the labial mucosa" src="https://upload.wikimedia.org/wikipedia/commons/thumb/d/d3/Aphthous_stomatitis_on_the_labial_mucosa.jpg/512px-Aphthous_stomatitis_on_the_labial_mucosa.jpg"
  23. title="By Klaus D. Peter, Gummersbach, Germany (Own work) [CC BY 3.0 de (http://creativecommons.org/licenses/by/3.0/de/deed.en)], via Wikimedia Commons" href="https://commons.wikimedia.org/wiki/File%3AStomatitis_herpetica.jpg"><img width="512" alt="Stomatitis herpetica" src="https://upload.wikimedia.org/wikipedia/commons/thumb/8/84/Stomatitis_herpetica.jpg/512px-Stomatitis_herpetica.jpg"


Template:WH Template:WS