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Stomatitis


Stomatitis basically means inflammation of the mouth. But to be more specific, stomatitis is the inflammation of the mucous lining of the mouth which may include the gums, tongue, cheeks, lips and the floor or roof of the mouth. There are different types of stomatitis and classification is based on how the disease was acquired by a person. The two types of stomatitis are contact stomatitis and aphthous stomatitis. Contact stomatitis is an inflammation of the oral mucosa caused by coming in contact with allergens or irritants. It is classified by its pattern of distribution, etiologic factors, and clinical features. There some cases of contact stomatitis that are left undetected because of the lack of clinical signs. Anybody can have contact stomatitis regardless of race, age and sex. Although it has been observed that it is more common in the elders.

Aphthous stomatitis, also known as canker sore, is a kind of stomatitis with its etiology as unknown. Just like contact stomatitis, canker sore affects the oral mucosa. They can be described as shallow, discrete, and painful and are usually visible on the mucous membranes that are unattached. This type of stomatitis, just like contact stomatitis, is self limited and do not usually cause complications. The normal size of ulcers may last for 1 to 2 weeks but larger ulcers may last for months.

STOMATITIS SIGNS AND SYMPTOMS

Aphthous stomatitis is classified into 3 clinical forms. These 3 divisions are the major, minor and herpetiform. All of these however have the same characteristics of affecting inadequately kertanized surfaces of the oral mucosa. Examples of these are the ventral surface of the tongue, buccal mucosa, labial mucosa, maxillary sulci, mandibular sulci, soft palate, unattached gingival, tonsillar fauces, and the floor of the mouth.

The most common form of canker sores would be the minor classification. It accounts for 80% of all cases of canker sores. It is characterized as a discrete, shallow, recurrent and painful ulcer with its diameter that could be as big as 3 mm but is less than 1 cm. A number of 1 – 5 ulcers may come out together on the buccal mucosa, the floor of the mouth and the labial mucosa. These lesions can heal with 7 – 10 days without even leaving any kind of scar.

The major classification of canker sores, which was called before as periadenitis mucosa necrotica recurrens is not that common compared to minor canker sores. The ulcers can grow as big as 1 – 3 cm in diameter. In its severe form, major aphthae, as many as 10 may be simultaneously present. Unlike in the minor division, the ulcers can be deep and large and has the possibility to coalesce. The border is also irregular and is often raised. Most often than not, canker sores in the major classification affects the soft palate, the fauces, and the lips.

The classification Herpetiform has the least common frequencies of occurrence among the three. The aphthae in this division is the smallest among measuring only at 1 – 3 mm in diameter. Aphthae usually occurs in clusters or groups. It looks as if the whole thing is compose of tens or even hundred of minute ulcers. Commonly, they affect the oral cavity's soft mucosa.

STOMATITIS SYMPTOMS

The common symptoms of contact stomatitis are burning sensation, pain, paresthesia, numbness, bad taste, excessive salivation, and perioral itching.
stomatitis
Image: Stomatitis


The signs of contact stomatis are the manifestations of orofacial granulomatosis, burning mouth syndrome, contact urticaria, leukoplakialike lesions, erythematous lesions, erosions/ ulcerations and oral lichenoid reactions.

Orofacial granulomatosis can be due to contact to allergens such as gold, mercury, or certain kinds of food. Contact urticaria is characterized by the swelling of the buccal mucosa, tongue, lips and the severe itch on the gingival develops. Most often than not this is cause by an allergic reaction to latex. The leukoplakialike lesions are the results of being allergic to metals like nickel. This lesion can be asymptomatic and is usually located in the medial part of the cheek. Erythematous lesions on the other hand are caused by any of the ingredients of dental products such as toothpastes and mouthwashes. A person who has erythematous lesions may complain of a burning sensation. Erosions or ulcerations are caused by prolonged contact with substances like aspiring, vitamin c tablets. Oral lichenoid reactions are the result of exposure to palladium chloride, copper sulfate and gold.

STOMATITIS DIAGNOSIS

Aphthous stomatitis usually has the same signs and symptoms of contact stomatitis. The difference though is that the cause for the ulcerations and lesions are unknown. No irritants and allergens are known to cause aphthous stomatitis. There are, however, several factors that are suspected to be the culprit behind this disease. Some studies show that aphthous stomatitis is hereditary. There have been several cases which shows that this disease has been in the family according to the family history.

Another suspect cause of aphthous stomatitis is hematinic deficiency. Hematinic deficiency is the deficiency in vitamin B12, folic acid and iron. People who are suffering with hematinic deficiency most often than not also suffer from aphthous stomatitis.

STOMATITIS TREATMENT

The approach in the treatment of contact stomatitis and aphthous stomatitis will differ. In contact stomatitis the first course of action is to remove the source or the causative agent. Systemic steroids are given if the case calls for it. And the patient may be given ice cubes to suck on to provide relief and comfort. The medicine given to patients with contact stomatitis is corticosteroids.


In aphthous stomatitis, since the causative agent is unknown, a different approach is tackled. The treatment is more inclined to the prophylactic and palliative care. Some of the medicines given to provide comfort and relief to patients with aphthous stomatitis are topical agents such as creams, gels, paste, ointment, rinses, and sprays. Most of these topical agents are corticosteroids.

Systemic agents may also be given for those whose condition can't be controlled with the topical applications. Systemic agents mean medicines or drugs such as colchicine, cimetidine, azathiorprine, and thalidomide.

STOMATITIS PREVENTION

For contact stomatitis, the basic way to prevent it is by keeping away from the substances or things that can irritate your mouth. If allergic to gold, nickel or other metals, then stay away from metals. It is also good to be cautious when using dental care products. Some of its ingredients may cause allergic reactions to some people.

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