Stomatitis

Source: Wikipedia, the free encyclopedia.
Stomatitis
An infant with stomatitis due to kwashiorkor and an accompanying Vitamin B deficiency.
SpecialtyDermatology

Stomatitis is

oral ulceration.[2]

In its widest meaning, stomatitis can have a multitude of different causes and appearances. Common causes include infections, nutritional deficiencies, allergic reactions, radiotherapy, and many others.

When inflammation of the gums and the mouth generally presents itself, sometimes the term gingivostomatitis is used, though this is also sometimes used as a synonym for herpetic gingivostomatitis.

The term is derived from the Greek stoma (στόμα), meaning "mouth", and the suffix -itis (-ῖτις), meaning "inflammation".

Causes

Nutritional deficiency

vitamin B9 (folic acid) or vitamin B12 (cobalamine) may all manifest as stomatitis. Iron is necessary for the upregulation of transcriptional elements for cell replication and repair. Lack of iron can cause genetic downregulation of these elements, leading to ineffective repair and regeneration of epithelial cells, especially in the mouth and lips. Many disorders which cause malabsorption can cause deficiencies, which in turn causes stomatitis. Examples include tropical sprue.[3]
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Aphthous stomatitis

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.[4] 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,[5] 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.

Angular stomatitis

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

celiac disease
).

Also, angular cheilitis can be caused by a patient's jaws at rest being 'overclosed' due to

dentures or occlusal
adjustment).

Denture-related stomatitis

This is a common condition present in

antifungal medication
and improved dental hygiene, such as not wearing the denture during sleep.

Allergic contact stomatitis

Allergic contact stomatitis (also termed "allergic gingivostomatitis" or "allergic contact gingivostomatitis")

mucosa.[7]

Allergens, which may be different for different individuals, combine with

T lymphocytes, sensitizing them to that antigen and causing them to produce many specific clones. The second time that specific antigen is encountered, an inflammatory reaction is triggered at the site of exposure.[7] Allergic contact stomatitis is less common than allergic contact dermatitis because the mouth is coated in saliva, which washes away antigens and acts as a barrier.[7] The oral mucosa is also more vascular (has a better blood supply) than skin, meaning that any antigens are more quickly removed from the area by the circulation.[7] Finally, there is substantially less keratin in oral mucosa, meaning that there is less likelihood that haptens will form.[7]

Allergic contact stomatitis appears as non-specific inflammation, so it may be mistaken for chronic physical irritation.[7] There may be burning or soreness of the mouth and ulceration.[7] Chronic exposure to the allergen may result in a lichenoid lesion.[7] Plasma cell gingivitis may also occur, which may be accompanied by glossitis and cheilitis.[7]

Patch test

Allergens that may cause allergic contact stomatitis in some individuals include

allergic contact cheilitis
can occur, together with allergic contact stomatitis.

The diagnosis is confirmed by patch test, and management is by avoidance of exposure to the allergen.[7]

Migratory stomatitis

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

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.[14] 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".

Herpetic gingivostomatitis

Herpetic stomatitis (herpetic gingivostomatitis)

This is inflammation of the mouth caused by herpes simplex virus.

Irradiation and chemotherapy

Stomatitis may also be caused by chemotherapy, or radiation therapy of the oropharyngeal area.

radiotherapy or chemotherapy, and may occur anywhere in the gastrointestinal tract and not just in the mouth.[16]

Necrotizing ulcerative gingivostomatitis

The term necrotizing ulcerative gingivostomatitis 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.[17]

Stomatitis nicotina

Also called smoker's palatal keratosis,

premalignant condition, and the appearance reverses if the smoking is stopped.[18]
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Chronic ulcerative stomatitis

Chronic ulcerative stomatitis is a condition with specific immunopathologic features, which was first described in 1990.

gingiva (gums).[20][21] The condition resembles oral lichen planus
when biopsied.

The diagnosis is made by microscopic examination of biopsy tissue: direct

basal layer of stratified epithelium.[19] Treatment with hydroxychloroquine can be effective.[19]

Plasma cell gingivostomatitis

Terms such as plasma cell gingivostomatitis,[22] atypical gingivostomatitis and idiopathic gingivostomatitis[23][24] are sometimes a synonym for plasma cell gingivitis, or specifically to refer to a severe form of plasma cell gingivitis.

Other forms of stomatitis

References

External links