Stomatitis

Stomatitis: Intro & Etiology - Mouth's Mayhem Makers

Stomatitis: Inflammation of oral mucosa; painful, red, may ulcerate.

• Etiology - Diverse Causes:
  • Infectious:
    • Viral: HSV-1 (kids), Coxsackie (HFMD), VZV
    • Bacterial: ANUG (Vincent's angina)
    • Fungal: Candida albicans (thrush)
  • Traumatic: Physical (dentures), chemical, thermal injury
  • Aphthous Ulcers: Recurrent, painful; immune-mediated suspected
  • Allergic/Irritant: Foods, drugs, dental products
  • Systemic Links:
    • Autoimmune: Pemphigus, Behçet's
    • Nutritional: Fe, Vit B12, folate deficiency
    • GI: Crohn's, celiac disease
  • Drug-Induced: Chemotherapy, antibiotics, NSAIDs

⭐ Primary herpetic gingivostomatitis (HSV-1) is the most common cause of acute generalized stomatitis in children.

Aphthous & Herpetic Stomatitis - Ulcer Wars

📌 Mnemonic: Aphthous = Away from bone (non-keratinized); Herpetic = Hard/fixed sites (keratinized).

• Aphthous Stomatitis (RAS - Canker Sores)
  • Etiology: Immune-mediated; stress, trauma triggers.
  • Location: Non-keratinized mucosa (buccal, labial, ventral tongue).
  • Lesion: Painful, round/oval ulcer; yellowish-gray pseudomembrane, erythematous halo. No vesicles.
  • Recurrence: Frequent.
• Herpetic Stomatitis (HSV-1 - Cold Sores/Fever Blisters)
  • Etiology: Herpes Simplex Virus (HSV-1).
  • Location: Primarily keratinized mucosa (gingiva, hard palate), vermillion border.
  • Lesion: Multiple vesicles → rupture to form coalescing, painful ulcers.
  • Prodrome: Common (tingling, burning); fever, malaise in primary infection (Primary Herpetic Gingivostomatitis).
  • Diagnosis: Tzanck smear shows multinucleated giant cells.

⭐ Recurrent aphthous stomatitis (RAS) is the most common oral mucosal disease, characterized by painful, recurrent oral ulcers typically on non-keratinized mucosa.

Other Key Stomatitides - Diverse Oral Dilemmas

• Denture Stomatitis:
  • Inflammation of denture-bearing mucosa; often asymptomatic.
  • Presents as erythema, edema.
  • Key cause: Candida albicans, ill-fitting dentures.

  ⭐ Denture stomatitis, often asymptomatic, is most commonly associated with Candida albicans and typically presents as erythema and edema of the denture-bearing mucosa.

• Angular Cheilitis (Perleche):
  • Erythema, fissuring at mouth corners.
  • Causes: Candida, nutritional deficiencies (Fe, B2, B12, folate), ↓ vertical dimension of occlusion.
• Median Rhomboid Glossitis:
  • Well-demarcated erythematous, depapillated rhomboid area on tongue dorsum midline.
  • Associated with chronic Candida infection.
• Geographic Tongue (Benign Migratory Glossitis):
  • Migratory, depapillated erythematous patches with keratotic white borders.
  • Usually asymptomatic; unknown etiology.
• Hairy Tongue (Lingua Villosa):
  • Elongation of filiform papillae; discolored (black, brown, yellow).
  • Causes: poor oral hygiene, smoking, antibiotics, oxidizing mouthwashes.

Stomatitis: Dx & Management - Soothe & Solve Plan

• Diagnosis: Primarily clinical (history, lesion appearance).
  • Key Qs: Duration? Triggers? Systemic symptoms? Habits (tobacco/alcohol)?
  • Biopsy: If solitary ulcer >2-3 weeks, suspicious, or uncertain diagnosis.
• Management Principles ("Soothe & Solve"):
  • Identify & eliminate cause (irritants, infection, systemic).
  • Soothe: Topical analgesics/anesthetics (lignocaine), chlorhexidine mouthwash.
  • Solve: Specific Rx (antivirals, antifungals, antibiotics, steroids).
  • Support: Oral hygiene, soft bland diet, hydration.

⭐ Any solitary oral ulcer persisting for more than 2-3 weeks, especially in a patient with risk factors (smoking, alcohol), requires biopsy to exclude malignancy.

High‑Yield Points - ⚡ Biggest Takeaways

• Aphthous ulcers: recurrent, painful, typically on non-keratinized mucosa; strong association with Behçet's disease.
• Herpetic stomatitis (HSV-1): painful vesicles, often on keratinized mucosa (e.g., gingiva, hard palate); Tzanck smear reveals multinucleated giant cells.
• Oral candidiasis (Thrush): white, curd-like plaques that can be scraped off, revealing an erythematous base; common in immunocompromised patients, infants, and steroid users.
• Vincent's angina (ANUG): characterized by painful, bleeding gums, fetid breath, and "punched-out" interdental papillae; caused by spirochetes and fusiform bacteria.
• Hand, Foot, and Mouth Disease: caused by Coxsackie A virus; presents with oral vesicles and characteristic lesions on hands, feet, and buttocks.
• Oral Lichen Planus: may present with Wickham's striae (white, lacy pattern); can be erosive and painful; autoimmune basis suspected.