|Classification and external resources|
Stomatitis is inflammation in the mouth. The term refers to any inflammatory process affecting the mucous membranes of the mouth and lips, with or without oral ulceration. The inflammation can be caused by conditions in the mouth itself, such as poor oral hygiene, dietary protein deficiency, poorly fitted dentures, or from mouth burns and scars from food or drinks, toxic plants, or by conditions that affect the entire body, such as medications, allergic reactions, radiation therapy, or infections. When it also involves an inflammation of the gingiva (gums), it is called gingivostomatitis.
The term mucositis is often used synonymously with stomatitis, however the former refers to mucosal reactions to radiotherapy or chemotherapy, and may occur anywhere in the gastrointestinal tract and not just in the mouth.
- Herpetic gingivostomatitis—this is inflammation of the mouth caused by herpes simplex virus. Sometimes the term gingivostomatitis is used as a synonym for gingivostomatitis caused specifically by herpes simplex infection.
- Necrotizing ulcerative gingivostomatitis—this is sometimes used as a synonym of the Necrotizing periodontal disease more commonly termed necrotizing ulcerative gingivitis, or a more severe form (also termed necrotizing stomatitis). The term necrotizing gingivostomatitis is also sometimes used.
- Plasma cell gingivostomatitis—a synonym, or a severe form of plasma cell gingivitis.
- Atypical gingivostomatitis—another synonym of plasma cell gingivitis.
- Idiopathic gingivostomatitis—another synonym of plasma cell gingivitis.
- Allergic gingivostomatitis, or allergic contact gingivostomatitis.
Severe iron deficiency anemia can lead to stomatitis. Iron is necessary for the upregulation of transcriptional elements for cell replication and repair. Lack of iron can cause the genetic downregulation of these elements, leading to ineffective repair and regeneration of epithelial cells, especially in the mouth and lips. This condition is also prevalent in people who have a deficiency in vitamin B2 (Riboflavin), B3 (Niacin), B6 (Pyridoxine), B9 (folic acid) or B12 (cobalamine).
It may also be seen in ariboflavinosis (riboflavin deficiency) or neutropenia.
Aphthous stomatitis (canker sores) is the recurrent appearance of mouth ulcers in otherwise healthy individuals. The cause is not completely understood, but it is thought that the condition represents a T cell mediated immune response which is triggered by a variety of factors. The individual ulcers (aphthae) recur periodically and heal completely, although in the more severe forms new ulcers may appear in other parts of the mouth before the old ones have finished healing. Aphthous stomatitis is one of the most common diseases of the oral mucosa, and is thought to affect about 20% of the general population to some degree. The symptoms range from a minor nuisance to being disabling in their impact on eating, swallowing and talking, and the severe forms can cause people to lose weight. There is no cure for aphthous stomatitis, and therapies are aimed at alleviating the pain, reducing the inflammation and promoting healing of the ulcers, but there is little evidence of efficacy for any treatment that has been used.
Inflammation of the corners (angles) of the lips is termed angular stomatitis or angular cheilitis. In children a frequent cause is repeated lip-licking and in adults it may be a sign of underlying iron deficiency anemia, or vitamin B deficiencies (e.g. B2-riboflavin, B9-folate or B12-cobalamin, which in turn may be evidence of poor diets or malnutrition such as celiac disease).
Also, angular cheilitis can be caused by a patient's jaws at rest being 'overclosed' due to edentulousness or tooth wear, causing the jaws to come to rest closer together than if the complete/unaffected dentition were present. This causes skin folds around the angle of the mouth which are kept moist by saliva which in turn favours infection; mostly by Candida albicans or similar species. Treatment usually involves the administration of topical nystatin or similar antifungal agents. Another treatment can be to correct the jaw relationship with dental treatment (e.g. dentures or occlusal adjustment).
This is a common condition present in denture wearers. It appears as reddened but painless mucosa beneath the denture. 90% of cases are associated with Candidia species, and it is the most common form of oral candidiasis. Treatment is by antifungal medication and improved dental hygiene, such as not wearing the denture during sleep.
Migratory stomatitis (or geographic stomatitis) is an atypical presentation of a condition which normally presents on the tongue, termed geographic tongue. Geographic tongue is so named because there are atrophic, erythematous areas of depapillation that migrate over time, giving a map-like appearance. In migratory stomatitis, other mucosal sites in the mouth, such as the ventral surface (undersurface) of the tongue, buccal mucosa, labial mucosa, soft palate or floor of mouth may be afflicted with identical lesions, usually in addition to the tongue. Apart from not being restricted to the tongue, migratory stomatitis is an identical condition in every regard to geographic tongue. Another synonym for geographic tongue which uses the term stomatitis is "stomatitis areata migrans".
Chronic ulcerative stomatitis
Chronic ulcerative stomatitis is a recently discovered condition with specific immunopathologic features. It is characterized by erosions and ulcerations which relapse and remit. Lesions are located on the buccal mucosa (inside of the cheeks) or on the gingiva (gums). It is characterized by painful erosions and ulcerations which relapse and remit. Th condition resembles Oral lichen planus when biopsied. The diagnosis is made with Immunofluorescence techniques, which shows circulating and tissue-bound autoantibodies (particulate stratified squamous-epithelium-specific antinuclear antibody) to DeltaNp63alpha protein, a normal component of the epithelium. Treatment is with hydroxychloroquine.
Other forms of stomatitis
- Periodic fever, aphthous stomatitis, pharyngitis and adenitis (PFAPA) syndrome—occurs in children.
- Uremic stomatitis—a rare form of stomatitis that occurs with renal failure.
- Zaoutis, [edited by] Jeffrey M. Bergelson, Samir S. Shah, Theoklis E. (2008). Pediatric infectious diseases. Philadelphia: Mosby/Elsevier. ISBN 9780323076333.
- Michael G. Stewart, Samuel Selesnick (editors) (2010-10-04). "35". Differential diagnosis in otolaryngology -- head and neck surgery. New York: Thieme. ISBN 9781604062793.
- "Effects of Smoking on Pregnancy" (PDF). The Reports of the Surgeon General. 1969. Retrieved 2006-06-23.
- Zeppetella, Giovambattista (2012-06-14). Palliative care in clinical practice. London: Springer. p. 132. ISBN 9781447128434.
- Horning, GM (October 1996). "Necotizing gingivostomatitis: NUG to noma.". Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995) 17 (10): 951–4, 956, 957–8 passim; quiz 964. PMID 9533316.
- Neville BW, Damm DD, Allen CA, Bouquot JE. (2002). Oral & maxillofacial pathology (2nd ed.). Philadelphia: W.B. Saunders. pp. 141, 142. ISBN 0721690033.
- Janam, P; Nayar, BR; Mohan, R; Suchitra, A (January 2012). "Plasma cell gingivitis associated with cheilitis: A diagnostic dilemma!". Journal of Indian Society of Periodontology 16 (1): 115–9. doi:10.4103/0972-124X.94618. PMC 3357019. PMID 22628976.
- Kerr, DA; McClatchey, KD; Regezi, JA (September 1971). "Idiopathic gingivostomatitis. Cheilitis, glossitis, gingivitis syndrome; atypical gingivostomatitis, plasma-cell gingivitis, plasmacytosis of gingiva.". Oral surgery, oral medicine, and oral pathology 32 (3): 402–23. doi:10.1016/0030-4220(71)90201-5. PMID 5285187.
- Kanerva, L.; Alanko, K.; Estlander, T. (1 December 1999). "Allergic contact gingivostomatitis from a temporary crown made of methacrylates and epoxy diacrylates". Allergy 54 (12): 1316–1321. doi:10.1034/j.1398-9995.1999.00074.x. PMID 10688437.
- Neville BW, Damm DD, Allen CM, Bouquot JE. (2002). Oral & maxillofacial pathology (2nd ed.). Philadelphia: W.B. Saunders. pp. 253–284. ISBN 0721690033.
- Brocklehurst, P; Tickle, M; Glenny, AM; Lewis, MA; Pemberton, MN; Taylor, J; Walsh, T; Riley, P; Yates, JM (Sep 12, 2012). "Systemic interventions for recurrent aphthous stomatitis (mouth ulcers).". In Brocklehurst, Paul. The Cochrane database of systematic reviews 9: CD005411. doi:10.1002/14651858.CD005411.pub2. PMID 22972085.
- Treister NS, Bruch JM (2010). Clinical oral medicine and pathology. New York: Humana Press. pp. 20, 21. ISBN 978-1-60327-519-4.
- Solomon, LW (July 2008). "Chronic ulcerative stomatitis.". Oral diseases 14 (5): 383–9. doi:10.1111/j.1601-0825.2008.01446.x. PMID 18593454.
- Scully, Crispian (2008). Oral and maxillofacial medicine : the basis of diagnosis and treatment (2nd ed. ed.). Edinburgh: Churchill Livingstone. ISBN 9780443068188.
- Fourie, J; van Heerden, WF; McEachen, SC; van Zyl, A (April 2011). "Chronic ulcerative stomatitis: a distinct clinical entity?". SADJ : journal of the South African Dental Association = tydskrif van die Suid-Afrikaanse Tandheelkundige Vereniging 66 (3): 119–21. PMID 21874892.
- Laskaris, George (2006). Pocket atlas of oral diseases (2nd ed. ed.). Stuttgart: Thieme. p. 12. ISBN 9781588902498.