The Mouth

Examination of the mouth often shows some unhealthy condition of the lining mucous membrane, or of the teeth, gums, tonsils, or tongue. Any such disorder requires treatment to prevent the general health being affected.

In local conditions such as thrush, only local treatment is usually required.

General diseases may, however, produce signs in the mouth, as ulceration in syphilis, or bleeding of the gums in scurvy, and soreness of the tongue in pernicious anaemia. The main disease must receive the appropriate treatment, but local measures must not be neglected.

Some drugs, e.g. barbiturates, bromides, and sulphonamides, which cause skin rashes, also affect the mouth and give rise to swelling, redness, and tiny blisters in sensitive persons.

Mouth Care in General Diseases

The mouth requires careful attention in many different general disorders, especially in fevers, or cases of prolonged illness, in which the tongue becomes furred and sores develop round the lips.

Sponging of the tongue and tips with pieces of gauze soaked in lemon juice, or simple rinsing with warm (boiled) water is generally found to be a satisfactory method of cleansing these parts, and is especially necessary in feverish patients when the saliva is scanty and the mouth dry.

Mouth washes of dilute hydrogen peroxide, or of glycerin of thymol are also used, while the teeth should be cleansed twice a day.

Foul Breath

Foul breath, or foetor oris, is generally due to local conditions in the mouth, such as pyorrhoea, decayed teeth, Vincent's angina, or infected tonsils.

Indigestion, with a furred tongue, or infected sinuses, may also give rise to offensive breath. Smoking, and lung infections such as bronchiectasis cause a chronic unpleasant odour in the breath, but the most offensive smell is noticed in cases of cancer of the stomach.

Treatment. The underlying disease or disorder must be treated. Temporary relief may be obtained by the use of mouth-washes as advised in Mouth Care.

Trismus-Inability to Open the Mouth

This may be due to various causes includ-ing the following:

Stomatitis

Stomatitis or inflammation of the lining membrane of the mouth is common, especially in babies and children. It may be catarrhal from dyspepsia, or from general debility, especially in acute fevers; while in adults, rough teeth, smoking, worn dentures, or irritation from food may cause small ulcers. A sore mouth is fairly common in nursing mothers.

Thrush, an infection due to a fungus, generally affects weakly infants or debilitated persons, or in some cases insufficient care is taken in keeping teats and bottles clean.

Special attention should be paid to the sterilisation of teats and other utensils which should be well washed each time after use, boiled once a day, and protected from flies and dust.

Gentian violet 0.5 per cent may be used to paint the mouth, and the antibiotic nystatin may be given to prevent spread of the fungus to the bowel and lungs.

Catarrhal Stomatitis is seen in undernourished children, especially during teething, and in adults it may be caused by dyspepsia, highly seasoned foods, excessive smoking, specific fevers, or by pyorrhoea or carious teeth.

The gums and lips may be affected, or the whole inside of the mouth and the tongue may be inflamed, red and dry, with the tongue swollen. There is an unpleasant taste, especially on waking, and the breath is offensive. The teeth and gums must be cleaned carefully and regularly twice daily, and a mouth wash of glycerin of thymol or a weak Milton solution should be used after every meal. The bowels must be opened regularly.

Aphthous Stomatitis may occur in children or adults, often associated with some stress or digestive disturbance. It may be due to a herpes virus. Small red raised vesicles or blebs are seen in the mouth, which soon break and leave little grey ulcers with reddened edges.

The mouth is sore, and the patient is often unwilling to feed. The lesions should be coated with Orabase, a dental paste, after meals, or amethocaine tablets sucked.

Syphilitic Ulcers of the mouth sometimes develop in the late tertiary stage; a primary sore is less common; either type require prompt appropriate antisyphilitic treatment, which must be continued under medical supervision.

Vincent's Angina (also known as Vincent's infection, Vincent's Stomatitis, Ulcerative Stomatitis, and Trench Mouth) occurs in debilitated persons or in minor epidemics in crowded communities, causing ulceration in the mouth and pharynx, with the formation of yellowish membrane over the ulcers. The infection often affects the gums, causing inflammation and receding of the gum margins.

The glands of the neck are commonly swollen, and there is slight fever and general malaise. The breath is offensive and the tongue is coated. The condition is very infective and the patient should use separate eating utensils.

Mouth-washes of weak hydrogen peroxide should be used several times daily, and weak iodine may be painted round the affected areas. It is advisable to consult a doctor, who may prescribe penicillin which is usually given by injection.

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