Stomatitis overview: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
No edit summary
Line 10: Line 10:


===Classification===
===Classification===
There is no known classification of stomatitis. Stomatitis can be classified on the basis of aetiology and on the basis of the pathogens involved. Some types of stomatitis may include:<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>
There is no known [[classification]] of stomatitis. Stomatitis can be classified on the basis of [[aetiology]] and on the basis of the [[pathogens]] involved. Some types of stomatitis may include:<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>
*[[Aphthous stomatitis]]
*[[Aphthous stomatitis]]
*[[Herpetic gingivostomatitis]]
*[[Herpetic gingivostomatitis]]
Line 34: Line 34:


===Pathophysiology===
===Pathophysiology===
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.<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>
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.<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>
*A definitive pathogenesis for [[aphthous stomatitis]] is not known 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>
*A definitive [[pathogenesis]] for [[aphthous stomatitis]] is not known 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 immunity|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>


===Causes===
===Causes===
Various pathogens including [[Herpes virus]], lack of [[oral hygiene]] and nutritional deficiencies can cause stomatitis along with many other causes. A detailed insight on the various causes of stomatitis has been described.
Various pathogens including [[Herpes virus]], lack of [[oral hygiene]] and [[nutritional deficiencies]] can cause stomatitis along with many other causes. A detailed insight on the various causes of stomatitis has been described.
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
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]]
  | author = [[R. Morgan]], [[J. Tsang]], [[N. Harrington]] & [[L. Fook]]
Line 59: Line 59:


===Differential Diagnosis===
===Differential Diagnosis===
Stomatitis should be differentiated from various subtypes of stomatitis and from many other disease that can involve the oral cavity such as [[agranulocystosis]], [[Behcet's disease]], [[immunodeficiency]] and tutors of the oral cavity like [[leukoplakia]] etc.<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>
Stomatitis should be differentiated from various subtypes of stomatitis and from many other disease that can involve the oral cavity such as [[Agranulocytosis|agranulocystosis]], [[Behcet's disease]], [[immunodeficiency]] and tutors of the oral cavity like [[leukoplakia]] etc.<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>


===Epidemiology and Demographics===
===Epidemiology and Demographics===
The epidemiology and demographics vary for various kinds of stomatitis.
The [[epidemiology and demographics]] vary for various kinds of stomatitis.
*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>
*[[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>
*[[Noma (disease)|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>
*Pyostomatitis vegetans usually occurs between the age of 20 to 50 years<ref>Hansen L.S., Silverman S., and Daniels T.E.: The differential diagnosis of pyostomatitis vegetans and its relation to bowel disease. Oral Surg Oral Med Oral Pathol 1983; 55: pp. 363-373</ref>
*Pyostomatitis vegetans usually occurs between the age of 20 to 50 years<ref>Hansen L.S., Silverman S., and Daniels T.E.: The differential diagnosis of pyostomatitis vegetans and its relation to bowel disease. Oral Surg Oral Med Oral Pathol 1983; 55: pp. 363-373</ref>


Line 103: Line 103:
*[[Alcohol]]
*[[Alcohol]]
*[[Trauma]]
*[[Trauma]]
*Psychological stress
*[[Psychological stress]]
*[[H. pylori]]
*[[H. pylori]]
*Sensitivity to food
*[[Sensitivity (human)|Sensitivity]] to food
*Nutritional abnormalities
*[[Nutritional deficiencies|Nutritional abnormalities]]
*Immunologic deficiencies e.g [[HIV]]
*[[Immune-mediated disease|Immunologic deficiencies]] e.g [[HIV]]
*Genetic factors
*[[Genetics|Genetic factors]]
*[[Chemotherapy]] or [[radiotherapy]]<ref>{{Cite journal
*[[Chemotherapy]] or [[radiotherapy]]<ref>{{Cite journal
  | author = [[Kenji Momo]]
  | author = [[Kenji Momo]]
Line 121: Line 121:
  | pmid = 26234349
  | pmid = 26234349
}}</ref>
}}</ref>
*Poor denture hygiene<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<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>


===Screening===
===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>
[[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, Complications, and Prognosis===
====Natural History====
====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>
*If left untreated [[herpetic stomatitis]] resolves after the [[vesicles]] erupt and the ulcers heal. The [[HSV]] travels along the nerves and moves to the [[Ganglion|ganglions]] where it stays in latent form. When the [[Immunocompromised host|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====
====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>
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>
*Meningoencephalitis
*[[Meningoencephalitis]]
*Recurrent skin and mouth infections
*Recurrent [[skin]] and mouth infections
*Dissemination of the infection
*Dissemination of the [[infection]]
*Teeth loss
*[[Teeth]] loss
====Prognosis====
====Prognosis====
The prognosis of stomatitis is good.
The [[prognosis]] of stomatitis is good.


==Diagnosis==
==Diagnosis==
===History and symptoms===
===History and symptoms===
A thorough history and understanding of the symptoms is necessary for a detailed understanding and diagnosis of stomatitis. The diagnosis of stomatitis is mostly clinical. The location and features of the ulcers are also important findings in this regard.
A thorough [[History & Symptoms|history and understanding of the symptoms]] is necessary for a detailed understanding and [[diagnosis]] of stomatitis. The diagnosis of stomatitis is mostly [[clinical]]. The location and features of the [[ulcers]] are also important findings in this regard.
Previous history of bad breath and refusal to eat or drink is common among patients presenting with an episode. <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>
Previous history of [[bad breath]] and refusal to eat or drink is common among patients presenting with an episode. <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>
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>
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]]
*[[Fever]]
Line 152: Line 152:


===Physical Examination===
===Physical Examination===
A thorough history and physical exam are a necessary for a detailed understanding and diagnosis of stomatitis. The diagnosis of stomatitis is mostly clinical. The location and features of the ulcers are also important findings in this regard. 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>
A thorough history and [[Physical examination|physical exam]] are a necessary for a detailed understanding and diagnosis of stomatitis. The diagnosis of stomatitis is mostly [[clinical]]. The location and features of the [[ulcers]] are also important findings in this regard. 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 pin-head [[vesicles]]
*Oral mucosal ulcers
*[[Oral ulcers|Oral mucosal ulcers]]
*Submandibular lymphadenitis
*[[Submandibular]] [[lymphadenitis]]
*Halitosis
*[[Halitosis]]


===Laboratory Findings===
===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.
[[History & Symptoms|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.
Viral culture, tzank smear for active lesions, serology, studies using immunofluorescent techniques and [[PCR]] are a few techniques normally used to diagnoses herpetic stomatitis.
[[Viral culture]], tzank smear for active lesions, [[serology]], studies using [[Immunofluorescence|immunofluorescent techniques]] and [[PCR]] are a few techniques normally used to diagnoses [[herpetic stomatitis]].


===X ray===
===X ray===
Xray is not required for the diagnosis of stomatitis.
[[X ray]] is not required for the diagnosis of stomatitis.


===CT===
===CT===
CT is not required for the diagnosis of stomatitis.
[[CT]] is not required for the diagnosis of stomatitis.


===MRI===
===MRI===
MRI is not required for the diagnosis of stomatitis.
[[MRI]] is not required for the diagnosis of stomatitis.


===Ultrasound===
===Ultrasound===
Ultrasound is not required for the diagnosis of stomatitis.
[[Ultrasound]] is not required for the diagnosis of stomatitis.


==Treatment==
==Treatment==

Revision as of 16:54, 19 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 overview On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Stomatitis overview

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Stomatitis overview

CDC on Stomatitis overview

Stomatitis overview in the news

Blogs on Stomatitis overview

Directions to Hospitals Treating Bursitis

Risk calculators and risk factors for Stomatitis overview

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

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. The inflammation can be caused by conditions in the mouth itself, 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.[1]

When it also involves an inflammation of the gingiva, it is called gingivostomatitis. Irritation and 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).

Classification

There is no known classification of stomatitis. Stomatitis can be classified on the basis of aetiology and on the basis of the pathogens involved. Some types of stomatitis may include:[2][3]

Pathophysiology

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.[9]

Causes

Various pathogens including Herpes virus, lack of oral hygiene and nutritional deficiencies can cause stomatitis along with many other causes. A detailed insight on the various causes of stomatitis has been described. The common causes of stomatitis include:[12][13][9]

Differential Diagnosis

Stomatitis should be differentiated from various subtypes of stomatitis and from many other disease that can involve the oral cavity such as agranulocystosis, Behcet's disease, immunodeficiency and tutors of the oral cavity like leukoplakia etc.[3][14]

Epidemiology and Demographics

The epidemiology and demographics vary for various kinds of stomatitis.

Risk Factors

Many factors contribute the development of stomatitis in an individual. The risk factors for stomatitis include alcohol, smoking, trauma, stress, nutritional deficiency, immunocompromised status etc.[16] The following risk factors are believed to influence the development of stomatitis:[17][18]

Screening

Screening for stomatitis is not recommended.[22]

Natural History, Complications, and Prognosis

Natural History

Complications

Some complications of stomatitis include[12][24]

Prognosis

The prognosis of stomatitis is good.

Diagnosis

History and symptoms

A thorough history and understanding of the symptoms is necessary for a detailed understanding and diagnosis of stomatitis. The diagnosis of stomatitis is mostly clinical. The location and features of the ulcers are also important findings in this regard. Previous history of bad breath and refusal to eat or drink is common among patients presenting with an episode. [12] Some general symptoms associated with herpetic stomatitis include[12]

Physical Examination

A thorough history and physical exam are a necessary for a detailed understanding and diagnosis of stomatitis. The diagnosis of stomatitis is mostly clinical. The location and features of the ulcers are also important findings in this regard. The exam findings may include[12]

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. Viral culture, tzank smear for active lesions, serology, studies using immunofluorescent techniques and PCR are a few techniques normally used to diagnoses herpetic stomatitis.

X ray

X ray is not required for the diagnosis of stomatitis.

CT

CT is not required for the diagnosis of stomatitis.

MRI

MRI is not required for the diagnosis of stomatitis.

Ultrasound

Ultrasound is not required for the diagnosis of stomatitis.

Treatment

Medical Therapy

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.The therapy for stomatitis is governed by following principles:[25]

Surgery

Surgery is not the treatment of choice in most types of stomatitis. It is not preferred unless there is a suspicion for an oral tumor or a biopsy is required for the diagnosis of the exact type of stomatitis. Surgical debridement may be done for Noma or Trench mouth. Surgery is sometimes done for cosmetic reasons e.g in the case of Noma i.e Gangrenous stomatitis.

Primary Prevention

Primary prevention of stomatiti includes adequate hydration, maintaining proper oral hygiene, maintaining denture hygiene, prevention of exposure to bovine papular stomatitis virus infected cow etc. Some primary preventive techniques for stomatitis include:

Secondary Prevention

Treatment of the underlying conditions like IBD or candidiasis which are a reason for causing stomatitis, are included in the secondary prevention of stomatitis. Some secondary preventive measures for stomatitis include:

  • Treatment of IBD prevents the development of pyostomatitis vegetans.[27]
  • Treatment of candidiasis

References

  1. ↑ "Smoking and Noncancerous Oral Disease" (PDF). The Reports of the Surgeon General. 1969. Retrieved 2006-06-23.
  2. ↑ 2.0 2.1 Murray LN, Amedee RG (2000). "Recurrent aphthous stomatitis". J La State Med Soc. 152 (1): 10–4. PMID 10668310.
  3. ↑ 3.0 3.1 3.2 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)​
  4. ↑ Zwetyenga N, See LA, Szwebel J, Beuste M, Aragou M, Oeuvrard C; et al. (2015). "[Noma]". Rev Stomatol Chir Maxillofac Chir Orale. 116 (4): 261–79. doi:10.1016/j.revsto.2015.06.009. PMID 26235765.
  5. ↑ 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.
  6. ↑ Anderson JG, Peralta S, Kol A, Kass PH, Murphy B (2017). "Clinical and Histopathologic Characterization of Canine Chronic Ulcerative Stomatitis". Vet Pathol: 300985816688754. doi:10.1177/0300985816688754. PMID 28113036.
  7. ↑ Katsoulas N, Chrysomali E, Piperi E, Levidou G, Sklavounou-Andrikopoulou A (2016). "Atypical methotrexate ulcerative stomatitis with features of lymphoproliferative like disorder: Report of a rare ciprofloxacin-induced case and review of the literature". J Clin Exp Dent. 8 (5): e629–e633. doi:10.4317/jced.52909. PMC 5149103. PMID 27957282.
  8. ↑ A. Tosti, B. M. Piraccini & A. M. Peluso (1997). "Contact and irritant stomatitis". Seminars in cutaneous medicine and surgery. 16 (4): 314–319. PMID 9421224. Unknown parameter |month= ignored (help)
  9. ↑ 9.0 9.1 Sonis ST (2004). "The pathobiology of mucositis". Nat Rev Cancer. 4 (4): 277–84. doi:10.1038/nrc1318. PMID 15057287.
  10. ↑ Ship JA (1996). "Recurrent aphthous stomatitis. An update". Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 81 (2): 141–7. PMID 8665304.
  11. ↑ 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.
  12. ↑ 12.0 12.1 12.2 12.3 12.4 12.5 12.6 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.
  13. ↑ 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)
  14. ↑ Scully C (1999). "A review of common mucocutaneous disorders affecting the mouth and lips". Ann Acad Med Singapore. 28 (5): 704–7. PMID 10597357.
  15. ↑ Hansen L.S., Silverman S., and Daniels T.E.: The differential diagnosis of pyostomatitis vegetans and its relation to bowel disease. Oral Surg Oral Med Oral Pathol 1983; 55: pp. 363-373
  16. ↑ 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)
  17. ↑ 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)
  18. ↑ Carolina-Cavalieri Gomes, Ricardo-Santiago Gomez, Livia-Guimaraes Zina & Fabricio-Rezende Amaral (2016). "Recurrent aphthous stomatitis and Helicobacter pylori". Medicina oral, patologia oral y cirugia bucal. 21 (2): e187–e191. PMID 26827061. Unknown parameter |month= ignored (help)
  19. ↑ Kenji Momo (2015). "[Indomethacin Spray Preparation for the Control of Pain Associated with Stomatitis Caused by Chemotherapy and Radiotherapy in Cancer Patients]". Yakugaku zasshi : Journal of the Pharmaceutical Society of Japan. 135 (8): 931–935. doi:10.1248/yakushi.15-00112-1. PMID 26234349.
  20. ↑ Arendorf TM, Walker DM (1987). "Denture stomatitis: a review". J Oral Rehabil. 14 (3): 217–27. PMID 3298586.
  21. ↑ 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.
  22. ↑ U.S. Preventive Services Task Force http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=stomatitis Accessed on August 31, 2016
  23. ↑ Amir J, Harel L, Smetana Z, Varsano I (1999). "The natural history of primary herpes simplex type 1 gingivostomatitis in children". Pediatr Dermatol. 16 (4): 259–63. PMID 10469407.
  24. ↑ 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.
  25. ↑ 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.
  26. ↑ Rodu B, Mattingly G (1992). "Oral mucosal ulcers: diagnosis and management". J Am Dent Assoc. 123 (10): 83–6. PMID 1401597.
  27. ↑ Hegarty AM, Barrett AW, Scully C (2004). "Pyostomatitis vegetans". Clin Exp Dermatol. 29 (1): 1–7. PMID 14723710.


Template:WS Template:WH

Retrieved from "https://www.wikidoc.org/index.php?title=Stomatitis_overview&oldid=1301483"