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stomatitis (includes oral ulceration)
Inflammation of the mucous membranes of the mouth, generally ulcerative or vesicular.
Etiology:
1) unknown: aphthous stomatitis
2) viral infection
a) Herpes simplex type I
- gingivostomatitis
- Herpes simplex labialis (cold sores)
b) Coxsackie A virus
- herpangina
- hand-foot-&-mouth disease
c) rubella
d) rubeola
e) varicella
f) Cytomegalovirus
3) bacterial infection
a) syphilis
b) tuberculosis
c) Mycoplasma pneumonia
d) anaerobic bacteria
4) systemic disorder
a) inflammatory bowel disease
b) connective tissue disease
c) Behcet's syndrome [2]
d) Kawasaki's disease
e) erythema multiforme
f) immunocompromised host - AIDS
5) trauma
a) biting
b) ill-fitting dentures
c) defective tooth fillings
6) irritants
a) aspirin
b) nicotine
7) chemotherapy
- methotrexate
8) carcinoma 96% oral ulcerations are squamous cell carcinoma
Clinical manifestations:
1) general
a) oral vesicles or ulcers
b) oral pain
c) systemic symptoms
d) lymphadenopathy
2) specific signs/symptoms for specific etiologies
Laboratory:
1) acute & convalescent serology for HSV-1
2) cytology showing giant cells with viral inclusion bodies
3) darkfield microscopy for syphilis
4) biopsy for suspected tuberculosis, fungi, carcinoma
5) diagnosis of aphthous stomatitis is clinical
Differential diagnosis:
1) allergic reaction
a) lesions tend to be diffuse
b) do not ulcerate
2) various etiologies of stomatitis
Management:
1) palliative treatment for aphthous stomatitis
2) antibacterial mouthwash
a) tetracycline
b) chlorhexidine gluconate oral rinse (Peridex)
3) acyclovir for Herpes
a) topical for Herpes labialis
b) systemic acyclovir for prodrome/gingivostomatitis
4) biopsy any ulcer that fails to heal
Specific
angular stomatitis
aphthous stomatitis; aphthous ulcer (canker sore)
gingivostomatitis
hand-foot-&-mouth disease
herpangina
Herpes simplex labialis (cold sore)
pyostomatitis vegetans
uvulitis
General
mucositis
mucosal ulcer
stomatognathic (mouth) disease
References
- Saunders Manual of Medical Practice, Rakel (ed), WB Saunders,
Philadelphia, 1996, pg 3017-18
- Unizony SH, Kim ND, Hoang MP.
Case Records of the Mass General Hospital. Case 7-2015:
A 25-year-old man with oral ulcers, rash, and odynophagia.
N Engl J Med. 2015 Feb 26;372(9):864-72
PMID: 25714165
http://www.nejm.org/doi/full/10.1056/NEJMcpc1413303