| Stomatitis | |
|---|---|
 | |
| An infant with stomatitis due tokwashiorkor and an accompanying Vitamin B deficiency. | |
| Specialty | Dermatology |
Stomatitis isinflammation of the mouth and lips.[1] It refers to any inflammatory process affecting themucous membranes of the mouth and lips, with or withoutoral 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 termgingivostomatitis is used, though this is also sometimes used as a synonym forherpetic gingivostomatitis.
The term is derived from Greek στόμα (stoma) 'mouth' and -ῖτις (-itis) 'inflammation'.
Malnutrition (improper dietary intake) ormalabsorption (poor absorption of nutrients into the body) can lead tonutritional deficiency states, several of which can lead to stomatitis. For example, deficiencies ofiron,vitamin B2 (riboflavin),[3]: 490 vitamin B3 (niacin),vitamin B6 (pyridoxine),vitamin B9 (folic acid) orvitamin 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 includetropical sprue.[3]: 49
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 aT 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 theoral 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.
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 underlyingiron deficiency anemia, orvitamin B deficiencies (e.g., B2-riboflavin, B9-folate, orB12-cobalamin, which in turn may be evidence of poor diets or malnutrition such asceliac disease).
Also, angular cheilitis can be caused by a patient's jaws at rest being 'overclosed' due toedentulousness ortooth wear, causing the jaws to come to rest closer together than if the complete/unaffecteddentition were present. This causes skin folds around the angle of the mouth which are kept moist by saliva, which in turn favours infection; mostly byCandida albicans or similar species. Treatment usually involves the administration of topicalnystatin or similarantifungal agents. Another treatment can be to correct the jaw relationship with dental treatment (e.g.,dentures orocclusal adjustment).
This is a common condition present indenture wearers. It appears as reddened but painless mucosa beneath the denture. 90% of cases are associated withCandida species, and it is the most common form oforal candidiasis. Treatment is byantifungal medication and improved dental hygiene, such as not wearing the denture during sleep.
Allergic contact stomatitis (also termed "allergic gingivostomatitis" or "allergic contact gingivostomatitis")[6] is atype IV (delayed) hypersensitivity reaction that occurs in susceptibleatopic individuals whenallergens penetrate the skin ormucosa.[7]
Allergens, which may be different for different individuals, combine withepithelial-derivedproteins, forminghaptens which bind withLangerhans cells in the mucosa, which in turn present the antigen on their surface toT lymphocytes, sensitizing them to that antigen and causing them to produce many specificclones. 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 thanallergic 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 lesskeratin inoral 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 alichenoid lesion.[7]Plasma cell gingivitis may also occur, which may be accompanied byglossitis andcheilitis.[7]
Allergens that may cause allergic contact stomatitis in some individuals includecinnamaldehyde,Balsam of Peru,peppermint,mercury,gold,pyrophosphates,zinc citrate, freeacrylic monomer,nickel,fluoride, andsodium lauryl sulfate.[7][8][9][10][11][12][13] These allergens may originate from many sources, including various foods and drink, chewing gum, toothpaste, mouthwash, dental floss, dental fillings, dentures, orthodontic bands or wires, and many other sources.[7] If the substance containing the allergen comes into contact with the lips,allergic contact cheilitis can occur, together with allergic contact stomatitis.
The diagnosis is confirmed bypatch test, and management is by avoidance of exposure to the allergen.[7]
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 areatrophic,erythematous areas ofdepapillation 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".
This is inflammation of the mouth caused byherpes simplex virus.
Stomatitis may also be caused by chemotherapy, or radiation therapy of the oropharyngeal area.[15] The termmucositis is sometimes used synonymously with stomatitis, however the former usually refers to mucosal reactions toradiotherapy orchemotherapy, and may occur anywhere in the gastrointestinal tract and not just in the mouth.[16]
The termnecrotizing ulcerative gingivostomatitis is sometimes used as a synonym of the necrotizing periodontal disease more commonly termednecrotizing ulcerative gingivitis, or a more severe form (also termed necrotizing stomatitis). The termnecrotizing gingivostomatitis is also sometimes used.[17]
Also called smoker's palatal keratosis,[18]: 176 this condition may occur in smokers, especially pipe smokers. The palate appears dry and cracked, and white fromkeratosis. The minorsalivary glands appear as small, red and swollen bumps. It is not apremalignant condition, and the appearance reverses if the smoking is stopped.[18]: 176
Chronic ulcerative stomatitis is a condition with specific immunopathologic features, which was first described in 1990.[19] It is characterized byerosions andulcerations which relapse and remit. Lesions are located on the buccal mucosa (inside of the cheeks) or on thegingiva (gums).[20][21] The condition resemblesoral lichen planus when biopsied.
The diagnosis is made by microscopic examination of biopsy tissue: directimmunofluorescence can reveal the presence ofantinuclear antibodies specifically directed against theΔNp63α form of the p63 protein, which is normally expressed within thebasal layer ofstratified epithelium.[19] Treatment withhydroxychloroquine can be effective.[19]
Terms such asplasma cell gingivostomatitis,[22]atypical gingivostomatitis andidiopathic gingivostomatitis[23][24] are sometimes a synonym for plasma cell gingivitis, or specifically to refer to a severe form of plasma cell gingivitis.
Stomatitas vaikui: kaip atpažinti ir gydyti burnos gleivinės uždegimą