Stomatitis
Summary/Definition
Stomatitis is a generalized name for diseases that affect the mucous membrane of the oral cavity. Sores may appear on the inside of the cheeks, palate, throat, gums or lips. Stomatitis results from an inflammatory reaction of the oral mucosa due to various causes and is usually accompanied by pain. It can be classified according to symptoms, location, visual signs, and causes of rashes, but the applicability of such classification to each disease is limited, so stomatitis is usually classified by cause or symptomatology. According to clinical classification, stomatitis is subdivided into infectious and non-infectious stomatitis.
Infectious stomatitis is caused by bacteria, viruses, or fungi. Typical examples of such infections include herpes simplex, viral vesicular stomatitis (or hand, foot, and mouth disease), and oral candidiasis. Non-infectious stomatitis is caused by factors such as compromised immune system, trauma, age-related changes, menopause, and others. Examples of non-infectious stomatitis are aphthous (ulcerative) stomatitis, burning mouth syndrome and radiomucositis.
Symptoms
Among infectious stomatitis, herpes-induced stomatitis is the most common, and this type of stomatitis is prevalent among children and young adults. It should be noted that most adults are also infected with this virus. In most cases, the primary infection is asymptomatic or mild, and only about 10% of infected people develop symptoms such as general weakness or muscle aches after an incubation period lasting a week after infection. Then, after 1-3 days, a vesicular rash appears on the skin and mucous membranes. Initial symptoms of hand-foot-and-mouth disease include a slight rise in temperature, general malaise, cough, sore throat, loss of appetite, abdominal pain, headache, and enlarged cervical lymph nodes. Then a vesicular rash with blisters develops and ulcers (aphthae) form. Oral candidiasis is characterized by the appearance of bulging white plaques in the mouth that are easily removed. When these plaques are removed, bleeding may occur and there may be erythema or aphthous mucosa underneath. If oral candidiasis is not treated, the infection is highly likely to spread to the oropharyngeal mucosa and esophagus.
Among non-infectious stomatitis, aphthous stomatitis is the most common oral disease, accounting for about 20% of all diseases of the oral cavity. In the initial stage of the disease, known as the latency period, there are mostly no symptoms, but mild fever and sensory disturbances may be observed. In the stage before the formation of aphthae, spots or papules may appear on the oral mucosa, accompanied by pain, general weakness and loss of appetite. The ulcer formation phase may last from 1 to 16 days and is characterized by severe pain and difficulty swallowing. These symptoms usually disappear after ulcer healing and are usually not accompanied by systemic manifestations. Burning mouth syndrome is characterized by a constant burning sensation on the tongue, lips, palate or other parts of the mouth. This symptom persists for 4-6 months and is not accompanied by clinical abnormalities of the oral cavity or abnormalities detected on examination. Radiomucositis begins in the early inflammatory stage immediately after the onset of radiation therapy, and inflammatory mediators increase vascular permeability. Approximately 4-5 days after the start of treatment, the vasculature increases and there is destruction of elastic fibers in the vessel walls.
Diagnostics
Basic perception of stomatitis can be obtained by examining the macroscopic areas of the lesions. During the examination, the doctor establishes the onset of the disease, whether it occurred in the past, and may also prescribe a biopsy to detect malignant tumors. Blood tests are performed to find out if there are systemic diseases such as iron deficiency anaemia, pernicious anaemia, aplastic anaemia, leukemia, haemophilia or acquired immunodeficiency syndrome (AIDS).
Treatment and course of the disease
Treatment of stomatitis involves simultaneously treating the focus of infection, eliminating the causative agent of the disease and prescribing analgesics.
In the case of herpetic stomatitis, good oral hygiene, water balance, and conservative treatment including oral moisturization, antipyretics and analgesics in combination with medications including antibiotics and antivirals should be used. In the case of enteroviral vesicular stomatitis (or hand-foot-and-mouth disease), specific treatment is usually not required, but steroids should be avoided. In most cases, the condition goes away on its own within a week. If oral candidiasis is caused by long-term use of broad-spectrum antibiotics, the medication should be discontinued and more effective antibiotics and antimicrobial agents, such as nystatin suspension or throat rinses, should be used. If topical treatment fails, oral antimycotics such as ketoconazole, itraconazole, fluconazole, etc. can be taken.
As the causes of aphthous stomatitis cannot be determined, symptomatic treatments are mainly used to achieve rapid recovery and relief of symptoms. These include chemical therapy, electrocoagulation and drug therapy. In the case of secondary burning mouth syndrome, the first step is to diagnose the cause and then prescribe the appropriate treatment. However, if the cause is primary, it is difficult to clearly identify the cause of the syndrome and treatment is prescribed to relieve the symptoms. Local, systemic and cognitive-behavioral treatments are used to reduce pain. Topical therapies can help relieve symptoms, such as applying 1 mg of clonazepam to the oral mucosa three times a day for two weeks or gargling the throat with lidocaine. The ideal treatment for radiomucositis is to stop radiotherapy, but in most cases this is not possible, especially in cancer treatment where radiotherapy is essential. The patient should practice good oral hygiene before radiotherapy and continue to do so after radiotherapy-induced mucositis. Rinsing the mouth with saline or chlorhexidine can help maintain moisture levels, reduce pain and prevent inflammation.
Complications
In most cases, stomatitis does not cause any complications, but it may occur periodically and cause pain and discomfort in daily life. In rare cases of Behcet’s disease, there may be irreversible damage to the mucous membrane caused by large aphthae (ulcers).
