Stomatitis ￼ What is Stomatitis? Stomatitis is a sore or inflammation in the mouth. This can be in the cheeks, gums, inside of the lips, or on the tongue. There are two main forms of stomatitis: herpes stomatitis and aphthous stomatitis. Both forms usually occur more often in children and teens. Herpes stomatitis is an infection, usually in young children between the ages of six months and 5 years. It’s an infection of the Herpes Simplex 1 (HSV 1) virus, the same virus that causes cold sores on the outside of the lips in adults. It is related to HSV 2, the virus that causes genital herpes, but it is not the same virus. Aphthous stomatitis is also called canker sores. They are one or a cluster of small pits or ulcers in the cheeks, gums, the inside of the lips, or on the tongue. This is also much more common in young people, most often between 10 and 19 years old. What Causes Stomatitis? Herpes Stomatitis is caused by infection of the HSV1 virus in young children. Aphthous stomatitis is caused by a variety of problems with oral hygiene or damage to mucous membranes. Some potential causes include: dry tissues from breathing through the mouth due to clogged nasal passagessmall injuries due to dental work, accidental cheek bite, etc.sharp tooth surfaces, dental braces, or retainersceliac disease (allergy to gluten)food sensitivities to strawberries, citrus fruits, coffee, chocolate, eggs, cheese, or nutsallergic response to certain bacteria in the mouthinflammatory bowel diseasesautoimmune disease that attacks cells in the mouthHIV/AIDSweakened immune systemdeficiency in Vitamin B12, folic acid, iron, or zinccertain medicationsstress Symptoms of Stomatitis Herpetic stomatitis is usually indicated by multiple blisters that occur in the gums, palate, cheeks, tongue, or lip border. Eating, drinking, and swallowing may be difficult. Dehydration is a risk. Drooling, pain, and swollen gums can occur. The child can be very irritable. A fever is a major marker of the HSV1 infection, which can get as high as 104 degrees Fahrenheit. The fever occurs a few days before the blisters appear. When the blisters pop, ulcers can form in their place. Secondary infections of these ulcers can occur. The entire infection lasts between 7-10 days. Aphthous stomatitis or canker sores are round or oval ulcers with a red, inflamed border. The center is usually white or yellow. Most canker sores are small and oval, and heal within 1-2 weeks without scarring. Larger, irregular sores can occur with extensive injury and take six or more weeks to heal. These can leave scars in the mouth. Older adults may develop something called a “herpetiform” canker sore. The HSV1 virus does not cause these. Herpetiform canker sores are tiny, but occur in clusters of 10-100. They heal within two weeks. What are Treatments for Stomatitis? Herpes stomatitis can be treated with an antiviral drug acyclovir. This can shorten the length of the infection. Dehydration is a risk with young children, so getting them to drink enough liquid is important. A liquid diet made up of non-acidic foods and beverages is recommended. Acetaminophen for pain and fever is recommended. For severe pain, topical lidocaine may be used. Lidocaine numbs the mouth completely. It can cause problems swallowing, burns, or choking. It should be used with care. An HSV1 infection may become an eye infection called herpetic keratoconjunctivitis. This is a serious complication that could lead to blindness. Seek treatment immediately. Aphthous stomatitis is usually not severe and does not require treatment. If pain is significant or sores are larger, topical creams with benzocaine or another numbing agent may be applied. Mouth rinses of salt water or a mild mouthwash may help. Applying milk of magnesia a few times a day may be soothing. Diluting hydrogen peroxide with equal parts of water and dabbing a bit on each sore may relieve some inflammation. For severe outbreaks, an oral rinse of tetracycline can speed healing. However, it can permanently stain the developing teeth of young children. Steroid (dexamethasone) rinses may also be used to reduce inflammation. For large outbreaks of canker sores, medications that may be prescribed include cimetidine, colchicine or even oral steroid medications. These are rarely used and only for complex canker sores that repeatedly return. Occasionally, canker sores are chemically burned away with debacterol or silver nitrate. Sores that take a long time to heal or a fever that will not go away require medical care. Sores that return again and again might indicate a more serious condition or secondary infection. Patients should speak with a doctor in such cases.
Reccurtent stomatis VITAMINS deffin suppriposed condida iir Vit b complex nicotinamide Local mupcin 0nt T rabagen 1x3 7dys Amalonax oit bds Reviw aftr 7day If noy rspnd adf steroid local ont Stop smoking
Herpes simplex labialis
Recurrancy is due to smocking and bad oral hygine Too early,but if any lesion remain persistent for even short duration pl go for bx of that ulcerative lesion
Herpes simplex labialis. Cessation of smoking (may contribution indirectly in the healing and improve immune status), topical application of Acyclovir cream.
As oral hygiene looks poor So add povidine gargle Gingivitis component metrogyl 2oomg bds
CHRONIC EPETHUS ULCERS DIFFUSE GLOSSITIS SMOKINNG INDUCED
Stop Smoking. Zytee Lotion Locally. Inj Polybion IM 5 days.
Herpatic stomatitis ? Adv to maintain oral hygiene and to quit smoking Rx acyclovir and vitamin supplementation
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*Stomatitis* Description of stomatitis The term stomatitis means inflammation of the mouth. It usually refers to all the mucosal linings of the mouth including the cheeks, tongue, and gums. Stomatitis can be painful and result in sores. The two most common sores are canker sores and cold sores. Aphthous stomatitis is usually defined as canker sores that recur on a somewhat regular basis and is a fairly common condition. ￼ Types There are two main types of stomatitis: Canker sores These are also known as aphthous ulcers and are part of the most common cause of stomatitis. The sores are pale white or yellowish in color with a red outer ring. Canker sores can develop singly or in a cluster and usually occur on the inside of the lips or cheek, or on the tongue. Canker sores lead to acute, temporary pain. In minor cases, which are the most usual, the ulcers heal within 4-14 days. In more severe cases, which account for about 1 in 10 of all cases of stomatitis, the sores can last up to 6 weeks. Anyone can get canker sores, although women and people in their teens and 20s are more likely to experience them. They can run in families but are not contagious. Cold sores Cold sores are small, painful, fluid-filled sores that usually occur on or around the lips near the edge of the mouth. Caused by the herpes virus (HSV), the condition is also known as herpes stomatitis. A person may experience a tingling or burning sensation before the sore appears, as well as tenderness. Cold sores dry up and crust over with a yellow-colored scab. Cold sores tend to last for around 5-7 days and can keep coming back. They are also very contagious. Stomatitis can be broken down into different categories, depending on which area of the mouth is affected: Cheilitis – Inflammation of the lips and around the mouth Glossitis – Inflammation of the tongue Gingivitis – Inflammation of the gums Pharyngitis – Inflammation of the back of the mouth Pathophysiology of stomatitis The oral mucosa is relatively resistant to irritants and allergens due to the following anatomical and physiological factors: High vascularization that favors absorption and prevents prolonged contact with allergens The low density of Langerhans cells and T lymphocytes Dilution of irritants and allergens by saliva that also buffers alkaline compounds What causes the onset of stomatitis? An infection of the herpes simplex 1 (HSV-1) virus causes herpes stomatitis. It is more common in young children between the ages of 6 months and 5 years. People exposed to HSV-1 may develop cold sores later in life as a result of the virus. HSV-1 is related to HSV-2, the virus that causes genital herpes, but it isn’t the same virus. Aphthous stomatitis can be one or a cluster of small pits or ulcers in the cheeks, gums, the inside of the lips, or on the tongue. It’s more common in young people, most often between 10 and 19 years of age. Aphthous stomatitis is not caused by a virus and is not contagious. Instead, it’s caused by problems with oral hygiene or damage to mucous membranes. Some causes include: Dry tissues from breathing through the mouth due to clogged nasal passages Small injuries due to dental work, accidental cheek bite, or other injuries Sharp tooth surfaces, dental braces, dentures, or retainers Celiac disease Food sensitivities to strawberries, citrus fruits, coffee, chocolate, eggs, cheese, or nuts Allergic response to certain bacteria in the mouth Inflammatory bowel diseases Autoimmune diseases that attack cells in the mouth HIV/AIDS Weakened immune system Deficiency in vitamin B-12, folic acid, iron, or zinc Certain medications Stress Candida albicans infection Risk Factors Genetic factors Food hypersensitivities/allergens; common ones include nuts; shellfish; cinnamon; fruits; metals; dental materials; and ingredients in toothpaste, mouthwash, and gum. Local trauma: poor-fitting dentures, tooth brushing, local anesthetic injection, dental work Hormonal changes (menstrual cycle, pregnancy, and dysmenorrhea) Stress/anxiety Nutritional deficiencies (iron, folate, ferritin, vitamin B6, vitamin B12) Tobacco cessation Medications, for example, methotrexate, NSAIDs, phenobarbital Immunologic: HLA-B12 Immunologic gastrointestinal diseases: Crohn disease, celiac disease Systemic diseases: Behçet syndrome; cyclic neutropenia; HIV infection; periodic fever, aphthous stomatitis, pharyngitis, cervical adenitis (PFAPA); reactive arthritis; Sweet syndrome; mouth and genital ulcers with inflamed cartilage (MAGIC) syndrome Cancer therapies Clinical manifestations of stomatitis Stomatitis often results in pain, stinging, and soreness. Each person may experience different symptoms. These can include: Mouth ulcers with a white or yellow layer and red base, usually inside the lips, cheek, or on the tongue Red patches Blisters Swelling Oral dysaesthesia – a burning feeling in the mouth Lesions that heal in 4-14 days and often recur ￼ Complications of stomatitis Some complications of stomatitis include: Life-threatening complications Meningoencephalitis Other Common Complications Recurrent skin and mouth infections Dissemination of the infection Noma Complications Teeth loss How your doctors diagnose stomatitis? History A patient will complain of pain, burning sensation, intolerance to temperature extremes, and irritation with certain foods. During the review of clinical history, determine the onset, progression, number of ulcers/lesions, size of lesion, duration of each lesion, frequency, size, and whether it heals with a scar or not. This information helps diagnose localized versus systemic lesions. Physical Exam The physical exam should include a comprehensive oral examination. The extraoral exam includes inspection and palpation of cervical lymph nodes. Examine and palpate the lips, tongue, cheeks, and hard and soft palate as well as cervical, submandibular, and submental lymph nodes. Erythema and edema are the usual oral manifestations, often with ulcerations. Some will have constitutional symptoms: low-grade fever, malaise, lymphadenopathy, and headache. The pain will vary. Tests might include: Swabs, both bacterial and viral Tissue scrapings or swabs for fungal infections Biopsy, or the removal of cells or tissue for further study Blood tests Patch tests to identify allergy Treatment for common forms of stomatitis Mouth sores generally don’t last longer than two weeks, even without treatment. If a cause can be identified, your doctor may be able to treat it. If a cause cannot be identified, the focus of treatment shifts to symptom relief. The following strategies might help to ease the pain and inflammation of mouth sores: Avoid hot beverages and foods as well as salty, spicy, and citrus-based foods. Use pain relievers like Tylenol or ibuprofen. Gargle with cool water or suck on ice pops if you have a mouth burn. For canker sores, the aim of treatment is to relieve discomfort and guard against infection. Try the following: Drink more water. Rinse with saltwater. Practice proper dental care. Apply a topical anesthetic such as lidocaine or xylocaine to the ulcer (not recommended for children under 6). Use a topical corticosteroid preparation such as triamcinolone dental paste (Kenalog in Orabase 0.1%), which protects a sore inside the lip and on the gums. Blistex and Campho-Phenique may offer some relief of canker sores and cold sores, especially if applied when the sore first appears. For more severe sores, treatments may include: Lidex gel Aphthasol, an anti-inflammatory paste Peridex mouthwash ￼ If you seem to get canker sores often, you may have a folate or vitamin B12 deficiency. Talk to your doctor about being tested for these deficiencies. Anti-inflammatory drugs such as corticosteroids (including prednisone) are the most effective treatment for canker sores, as they will reduce swelling and pain. They are also effective for cold sores after the sore has been present for three to four days because at that point the virus has disappeared and only the inflammation remains. Not all people can take certain types of anti-inflammatory drugs. For example, if prednisone is given to people with diabetes, their blood sugars will go up. Talk to your doctor about any health conditions you have before starting a new medication. There is no cure for cold sores. Treatment includes: Taking a dose of valacyclovir (Valtrex) at the first sign of an attack Coating the lesions with a protective ointment such as an antiviral agent (for example, 5% acyclovir ointment) Applying ice to the lesion Taking L-lysine tablets may also help, as might antiviral mediations that a doctor prescribes. Some experts believe that these drugs shorten the time that the blisters are present. Not all sores are harmless. Schedule an appointment with your doctor if your mouth sores haven’t healed within two weeks. Prevention of Stomatitis About 90% of the population carries HSV. There’s little you can do to prevent your child from picking up the virus sometime during childhood. Your child should avoid all close contact with people who have cold sores. So if you get a cold sore, explain why you can’t kiss your child until the sore is gone. Your child should also avoid other children with herpetic stomatitis. If your child has herpetic stomatitis, avoid spreading the virus to other children. While your child has symptoms: Have your child wash his/her hands often. Keep toys clean and don’t share them with other children. Don’t allow children to share dishes, cups, or eating utensils. Don’t let your child kiss other children.Dr. Shailendra Kawtikwar6 Likes5 Answers
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A 65 yr old female non DM non HTN with no known addictions, came to me with h/o painful ulcerations over the tongue,soft palate and buccal mucosa since 1yr...on and off...she received multiple treatments...including multivitamins, short courses of steroids twice in this one year..subsided in between.But this time she is having it since 1 month,not subsiding with treatment and severe pain along with difficulty in swallowing. I diagnosed it as recurrent aphthous stomatitis and adv workup. HIV negative,RBS normal,UGI endoscopy-Normal.ANA sent report awaited. There are no other signs and symptoms suggestive of malignancy or autoimmune or behcets disease. I suspected HSV stomatitis and so started her on acyclovir, but did not send tzanck smear...also put her on triamcinolone 0.1% buccal paste, amlexanox and lignocaine ointment and also started pentoxyfylline 400 tid...she came after 3 days with no improvement and so i added defcort 6 mg bid. what is the next course of action,should i get a biopsy. Need expert opinion plsDr. Vamsi Mohan Kodamarty8 Likes55 Answers
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A female age 30 years suffering with SLE is having this type lesions in the mouth. What can be the reason and treatment for this.Dr. Arun Chugh2 Likes16 Answers
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25 yrs male with repeated episodes of apthous stomatitis and glossitis involving more the basal and tip of tongue since many( 2-3) yrs. Dental opinion-nil . CBC,MCV,B12level, normal.Subsides after few days.OpineDr. Neela Iyer3 Likes15 Answers
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57 year old male known case of HTN and DM. Complaints of soreness of mouth and tongue. Recurrent about 4 times per year. It was improved before on miconazole gel. No GI symptoms, not a smoker What do you think? It could be herps ?? Or aphthous ulcers? Underlying disease??Dr. Reema Sharma3 Likes19 Answers