🔅 STOMATITIS

– Stomatitis is a general term for inflammation and soreness of the oral mucosa, which is the thin layer of tissue that covers the inside of the mouth. Stomatitis can affect any part of the mouth, such as the cheeks, lips, gums, tongue, or palate. Stomatitis can cause pain, difficulty eating, talking, and sleeping, and increased risk of infection. Stomatitis can have various causes, types, symptoms, and treatments, depending on the underlying condition.

Some of the common types and causes of stomatitis are:

1). Canker sores: These are also known as aphthous ulcers or aphthous stomatitis. They are small, round, white or yellow sores with a red border that appear on the mucosa, usually on the inner lips, cheeks, or tongue. They can be single or multiple, and they can be painful or burning. The exact cause of canker sores is unknown, but they may be triggered by trauma, stress, hormonal changes, food allergies, vitamin deficiencies, or immune disorders. Canker sores are not contagious and usually heal within 1-2 weeks without treatment.

2). Cold sores: These are also known as herpes labialis or herpes stomatitis. They are blisters filled with clear fluid that appear on or around the lips, sometimes spreading to the nose or chin. They are caused by the herpes simplex virus type 1 (HSV-1), which infects the nerve cells and remains dormant until reactivated by stress, illness, sun exposure, or hormonal changes. Cold sores are contagious and can spread to other parts of the body or to other people through direct contact or sharing utensils. Cold sores usually heal within 7-10 days, but they can recur periodically.

3). Mouth irritation: This is also known as traumatic/contact stomatitis. It is caused by physical, chemical, or thermal injury to the mucosa, such as biting, scratching, burning, or exposure to irritants. It can also be caused by allergic reactions to certain foods, medications, or dental materials. Mouth irritation can cause redness, swelling, blisters, ulcers, or peeling of the mucosa. It usually resolves once the source of irritation is removed or avoided.

4). Infections: These are caused by bacteria, viruses, fungi, or parasites that invade the mucosa and cause inflammation, ulcers, or lesions.

– Some examples of infectious stomatitis are:

• Bacterial stomatitis: This can be caused by streptococci, staphylococci, or other bacteria that normally live in the mouth or enter through wounds or dental procedures. It can cause gingivitis (inflammation of the gums), periodontitis (inflammation of the tissues that support the teeth), or necrotizing ulcerative gingivitis (a severe infection that causes ulceration and tissue death of the gums). Bacterial stomatitis can be treated with antibiotics and good oral hygiene.

• Viral stomatitis: This can be caused by various viruses that infect the mucosa and cause vesicles, ulcers, or lesions. Some examples of viral stomatitis are:

i). Herpangina: This is caused by coxsackievirus or echovirus, which are members of the enterovirus family. It mainly affects children and causes fever, sore throat, and small blisters or ulcers on the soft palate, tonsils, or uvula. It usually resolves within a week without treatment.

ii). Hand, foot, and mouth disease: This is also caused by coxsackievirus or echovirus, and it mainly affects children. It causes fever, sore throat, and blisters or ulcers on the hands, feet, and mouth. It usually resolves within a week without treatment.

iii). Primary herpetic gingivostomatitis: This is caused by HSV-1, and it mainly affects children and young adults. It causes fever, swollen lymph nodes, and multiple blisters or ulcers on the gums, tongue, lips, or cheeks. It usually resolves within 2 weeks, but the virus remains latent in the nerve cells and can reactivate as cold sores.

• Fungal stomatitis: This can be caused by Candida albicans, a yeast that normally lives in the mouth but can overgrow and cause infection under certain conditions, such as weakened immunity, diabetes, antibiotic use, or denture wearing. It causes oral thrush, which is characterized by white patches or plaques on the tongue, palate, or cheeks that can be scraped off. It can also cause angular cheilitis, which is cracking and redness at the corners of the mouth. Fungal stomatitis can be treated with antifungal medications and good oral hygiene.

• Parasitic stomatitis: This can be caused by protozoa, such as Entamoeba histolytica or Leishmania, that can infect the mucosa and cause ulcers or lesions. These parasites are usually transmitted by contaminated water, food, or insects. Parasitic stomatitis can be treated with antiparasitic medications and supportive care.

• Autoimmune diseases: These are conditions where the immune system mistakenly attacks the body's own tissues, causing inflammation and damage. Some examples of autoimmune diseases that can affect the mucosa are:

• Pemphigus: This is a rare disease that causes blisters and erosions on the skin and mucous membranes. It is caused by autoantibodies that target desmogleins, which are proteins that hold the epithelial cells together. Pemphigus can be life-threatening if left untreated, as it can lead to infection, dehydration, and malnutrition. Pemphigus can be treated with immunosuppressive drugs and supportive care.

• Behçet's disease: This is a rare disease that causes inflammation of various parts of the body, such as the eyes, skin, joints, blood vessels, and nervous system. It is caused by an unknown trigger that activates the immune system and causes vasculitis, which is inflammation of the blood vessels. Behçet's disease can cause recurrent oral ulcers, genital ulcers, uveitis (inflammation of the eye), and skin lesions. Behçet's disease can be treated with anti-inflammatory drugs, immunosuppressive drugs, and supportive care.

• Lupus: This is a chronic disease that causes inflammation of various organs and tissues, such as the skin, joints, kidneys, heart, lungs, and brain. It is caused by autoantibodies that target various antigens, such as DNA, histones, or phospholipids. Lupus can cause oral ulcers, skin rashes, arthritis, nephritis (inflammation of the kidneys), pericarditis (inflammation of the heart lining), and neurologic disorders. Lupus can be treated with anti-inflammatory drugs, immunosuppressive drugs, and supportive care.

– Some of the common symptoms and complications of stomatitis are:

• Pain, burning, or tingling sensation in the mouth.

• Difficulty eating, drinking, talking, or swallowing.

• Altered taste or bad breath.

• Dry mouth or excessive salivation.

• Fever, malaise, or lymphadenopathy (swollen lymph nodes).

• Dehydration, weight loss, or nutritional deficiencies.

• Infection, sepsis, or systemic inflammatory response syndrome (SIRS).

• Anemia, bleeding, or thrombocytopenia (low platelet count).

• Secondary oral lesions, such as hairy tongue, geographic tongue, or fissured tongue.

DIAGNOSIS OF STOMATITIS

– The diagnosis of stomatitis is based on the history, physical examination, and laboratory tests of the patient. Some of the tests that can be used to determine the type, cause, and severity of stomatitis are:

• Oral swab or biopsy: This is a sample of the oral mucosa that is taken for microscopic examination, culture, or molecular testing. It can help identify the presence of bacteria, viruses, fungi, parasites, or abnormal cells that can cause stomatitis.

• Blood tests: These are tests that measure the levels of hemoglobin, hematocrit, white blood cells, platelets, electrolytes, glucose, liver enzymes, kidney function, and inflammatory markers in the blood. They can help assess the extent of blood loss, infection, inflammation, or organ damage caused by stomatitis.

• Serology tests: These are tests that detect the presence of antibodies or antigens in the blood that are associated with certain infections or autoimmune diseases that can cause stomatitis. Some examples are HSV-1, HIV, HCV, EBV, CMV, syphilis, Candida, Entamoeba, Leishmania, pemphigus, or lupus.

• Imaging tests: These are tests that use X-rays, ultrasound, CT, or MRI to visualize the structures of the head and neck, such as the teeth, jaws, sinuses, or salivary glands. They can help identify any abnormalities or complications that can cause or result from stomatitis, such as dental caries, abscesses, tumors, or sialadenitis (inflammation of the salivary glands).

TREATMENT OF STOMATITIS

– The treatment of stomatitis depends on the type, cause, and severity of the condition. Some of the treatment options include:

• Medications: These are drugs that can reduce inflammation, infection, acid production, or bleeding in the oral mucosa. Some examples are antibiotics, anti-inflammatory drugs, proton pump inhibitors, H2 blockers, antacids, sucralfate, or octreotide.

• Fluids and blood transfusions: These are interventions that can restore the fluid and blood volume that is lost due to stomatitis. Fluids and blood transfusions can prevent dehydration, shock, and anemia.

• Surgery: This is an option that can be used to remove or repair the source of stomatitis, such as ulcers, tumors, polyps, or perforations. Surgery can also be used to create a bypass or shunt to reduce portal hypertension and prevent variceal bleeding.

• Lifestyle changes: These are modifications that can help prevent or reduce the recurrence of stomatitis. Some examples are avoiding alcohol, smoking, spicy foods, or NSAIDs, managing stress, and following a balanced diet.

• Supportive care: This includes measures that can relieve the pain and discomfort of stomatitis, such as rinsing the mouth with salt water or baking soda solution, applying ice or cold compresses, using topical anesthetics or analgesics, or sucking on sugar-free candies or lozenges.

– The choice of treatment depends on the individual case and the doctor's recommendation. Some cases of stomatitis may resolve on their own without treatment, while others may require more aggressive intervention. The goal of treatment is to heal the oral mucosa, prevent complications, and improve the quality of life of the patient.

What is the prognosis of stomatitis? What are the home/natural remedies for stomatitis?

– The prognosis of stomatitis depends on the type, cause, and severity of the condition. In general, most cases of stomatitis heal within 1-2 weeks without complications, but some cases may recur or become chronic. Some factors that can affect the prognosis are:

• The underlying cause of stomatitis, such as infection, trauma, allergy, or autoimmune disease.

• The location and number of ulcers or lesions in the mouth.

• The presence of comorbid conditions, such as diabetes, HIV, or cancer.

– The response to treatment and prevention measures:

Some natural remedies that may help with stomatitis are:

• Rinsing the mouth with salt water, baking soda solution, or apple cider vinegar to reduce inflammation and infection.

• Applying ice, cold compresses, or aloe vera gel to soothe the pain and swelling.

• Using topical anesthetics, analgesics, or anti-inflammatory agents, such as lidocaine, benzocaine, or ibuprofen, to relieve the discomfort.

• Taking vitamin supplements, such as vitamin B12, folate, or iron, to correct any nutritional deficiencies that may contribute to stomatitis.

• Avoiding alcohol, tobacco, spicy, acidic, or hard foods that may irritate the mouth or trigger stomatitis.

• Practicing good oral hygiene, such as brushing, flossing, and using mouthwash, to prevent plaque buildup and infection.

• Seeking medical help if the stomatitis is severe, persistent, or recurrent, or if there are signs of complications, such as fever, dehydration, or bleeding.

How can I prevent stomatitis from recurring?

– To prevent stomatitis from recurring, you should follow these steps:

• Practice good oral hygiene:- Brush and floss regularly. Replace your toothbrush often until your infection clears up. Don't share toothbrushes. Disinfect dentures. Ask your dentist for the best way to disinfect your dentures to avoid reinfection.

• Avoid triggers:- Identify and avoid the factors that may trigger or worsen your stomatitis, such as stress, hormonal changes, food allergies, vitamin deficiencies, or certain medications. You can also try to avoid biting, scratching, or burning your mouth.

• Use natural remedies:- Some natural remedies may help soothe and heal your stomatitis, such as rinsing your mouth with salt water, baking soda solution, or apple cider vinegar, applying ice, cold compresses, or aloe vera gel, or taking vitamin supplements.

• Seek medical help:- If your stomatitis is severe, persistent, or recurrent, or if you have signs of complications, such as fever, dehydration, or bleeding, you should seek medical help. Your doctor may prescribe medications, such as antibiotics, antivirals, antifungals, or steroids, to treat the underlying cause of your stomatitis. You may also need endoscopy or surgery to remove or repair the source of bleeding or infection.

– These are some of the ways you can prevent or reduce the recurrence of stomatitis. However, you should always consult your doctor before trying any home remedies, as they may not be suitable for your condition or may interact with your medications. You should also follow your doctor's advice for treatment and prevention of stomatitis.

Can I use honey for stomatitis?

– Honey is a natural remedy that may help with stomatitis, which is inflammation and soreness of the oral mucosa. Honey has anti-inflammatory, antibacterial, and wound-healing properties that can reduce the pain, swelling, and infection of the mouth ulcers. However, the effectiveness and safety of honey for stomatitis may depend on the type, cause, and severity of the condition, as well as the quality and composition of the honey used. Therefore, you should always consult your doctor before trying any home remedies, as they may not be suitable for your condition or may interact with your medications. You should also follow your doctor's advice for treatment and prevention of stomatitis.