Stomatitis is an inflammation of the mouth, often a symptom of systemic disease. Fetid breath odour and blood tinged saliva may accompany any ulcerative lesions of the oral mucosa.

Etiology! Stomatitis may be caused by infection, trauma, dryness, irritants and toxic agents, bypersensitivity, or autoimmune conditions. Infectious agents include streptococci, gonococci, fusospirochets, Candida albicans, Corynebacterium diptheriae, Treponoma pallidum, Mycobacterium tuberculosis, and the viruses of herpes simplex, cexsackie, measles, and infections mononucleosis.

Stomatitis may also result from avitaminosis, particularly lack of the Vitamins B or C (as in pellagra, spruve, pernicious anaemia or scurvy) or from iron deficiency anaemia with dysphasia (Plummer Version syndrome), agranulocytosis or leukuemia, Lichen planus, erythema multiform, SLE, Behcet's syndrome, and pemphiges vulgaris frequently present oral mucosa signs.

Mechanical trauma from cheek biting, mouth breathing, jagged teeth, orthodontic appliances, ill fitting dentures, or nursing bottles with hard or too-long nipples may produce characteristic lesions. Xerostomia resulting from drugs, the aging process, or radiation therapy predisposes the mouth to sensitivity and infection.

Generalised Stomatitis may follow excessive use of alcohol, tobacco, hot foods, or spices, or sensitisation to toothpaste, mouthwash, candy dyes, lipstick, and rarely, acrylic dentures, Phonation, iodides, bismuth, mercury, barbiturates, lead and many other drugs may produce Stomatitis. Chemical Stomatitis of occupational origin may be due to dyes heavy metals, acid fumes, or metal or mineral dust.

Symptoms and Signs :
Clinical signs varies according to the type of Stomatitis present. Allergic Stomatitis is characterised by an intense, shiny erythema with slight swelling, itching, dryness or burning, often present, may be due to sensitivity to foods or to lipsticks.

Vincent's infection (necrotizing, ulcerative gingivitis) causes ulceronecrotic lesions of the interdental papillia that may extend to the marginal ginginae or produce painful ulcers of the mucous membranes. Thrush (candidiasis) caused by Candida albicaus, is characterised by white, slightly raised patches resembling milk curds that when removed, expose a hyperemic area that may bleed slightly.

The infection usually begins on the tongue and buccal mucosa and may spread to the plate, gums, tonsils, pharynx, larynx, GI tract, respiratory system, and skin. Thrush is common in infants. Mouth is usually dry.

Pseudo membranous Stomatitis, an inflammatory reaction that produce a membrane like exudate, may be caused by chemical irritants, as well as bacteria. Fever, lymph adenopathy and malaise may occur or the infection may be localised.

Mucosal lesions accompanying systemic disease include the mucous patches of syphilis, the strawberry, then raspberry, tongue of scarlet fever, koplick spot of measdis; the ulcer of erythema multiforme; and the smooth, fiery red tongue and painful mouth of pellagun.

Establishing the etiology may be difficult. The history may disclose a systemic disease, a dietary deficiency, or contract with irritants or allergens. Physical examination is obligatory, since it may reveal lesions of other mucous membrance, as in erythema multitorme, candidiasis or syphilis; lesions of the skin, as in pellagra, pomphigus, lichen planus, or SLE, signs of pulmonary TB, sprue, anaemia, or another contributory disease; or a general decrease in exocrine secretion.

Direct smears and cultures from the lesions may disclose a pathogen. Darkfield examination of scrapings from the lesions and STS are indicated in an attempt to rule out syphilis. In thrush, a history of recent antibiotic therapy is common.

To identify C-albicaus, scrapings from suspect lesion should be cultured and examined microscopically. A solitary undiagnosed oral lesion of more than one well duration that does not respond to treatment must be considered malignant until biopsy proves otherwise.

Underlying systemic disorders should be treated specifically. Oral hygiene is always necessary. Candidiasis usually responds to nystatin oral suspension. Clotrimazole and lozenges are effective in persistent over growth.

When compliance is a problem, Ketoconazole, are 200mg tablet orally once a day is effective. Bacterial infection should be treated with antibiotics. Vitamins B-complex and C should be given for three or four weeks. Month wash and rinsing with appropriate solution is also advised.

Additional Resources:

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