Stomatitis

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Stomatitis

Definition

Stomatitis is an inflammation of the mucous membranes of the mouth. It may involve the cheeks, gums, tongue, lips, and roof or floor of the mouth. The inflammation may be caused by conditions within the mouth itself, such as poor oral hygiene and poorly fitted dentures, or from mouth burns caused by hot foods or drinks. It also may be caused by factors affecting the entire body, such as medications, allergic reactions, or infections.

Description

Stomatitis is an inflammation of the lining of any of the soft-tissue structures of the mouth. It is usually a painful condition, associated with redness, swelling, and occasionally bleeding from the affected area. Stomatitis affects all age groups, from infants to the elderly.

Causes And Symptoms

A number of factors can cause stomatitis. Poorly fitted oral appliances, cheek biting, or jagged teeth can persistently irritate the oral structures. Chronic mouth breathing may cause dryness of the mouth tissues, which in turn can lead to irritation. Drinking beverages that are too hot can burn the mouth, causing irritation and pain. Some diseases, such as infections (bacterial, viral, and fungal), gonorrhea, measles, leukemia, pellagra, oral erythema multiforme, and AIDS may present with oral symptoms. Chemotherapy and radiation therapy can cause stomatitis by destroying the healthy cells of the oral cavity. Other causes include deficiencies in the B vitamins or vitamin C, and iron deficiency anemia. Stomatitis may also follow overuse of alcohol, tobacco, and spicy foods, as well as exposure to certain toothpastes and mouthwashes. Exposure to heavy metals, such as mercury, lead, or bismuth may also cause stomatitis.

Aphthous stomatitis, also known as "canker sores," is a specific type of stomatitis that presents with shallow, painful ulcers that are usually located on the lips, cheeks, gums, or roof or floor of the mouth. These ulcers can range from pinpoint size up to 1 inch (2.5 cm) or more in diameter. Though the specific causes of canker sores are unknown, nutritional deficiencies are suspected.

The symptoms of stomatitis may include:

reddened mucous membranes in the mouth
painful areas in the mouth
increased sensitivity to spicy foods
presence of ulcers in the oral cavity
dry or swollen tongue
difficulty swallowing

Diagnosis

The patient will often present with complaints of painful lesions in the oral cavity. The physician or nurse performs a thorough assessment of the mouth, noting any signs of stomatitis. Regular oral examinations are especially important for the patient undergoing cancer treatment. A patient's history may disclose a dietary deficiency, a systemic disease, or contact with materials causing an allergic reaction. Blood tests may be done to determine if any infection is present. Cultures of the mouth may be sent to the laboratory for microscopic evaluation, again to deter-mine if an infectious agent is causing the stomatitis.

Treatment

The treatment of stomatitis is based on the problem causing it. Local cleansing and good oral hygiene are essential. Sharp-edged foods such as peanuts, tacos, and potato chips should be avoided. A soft-bristled toothbrush should be used, and the teeth and gums should be brushed very carefully. A dentist can correct local factors, including ill-fitting dental appliances. Infectious causes can usually be treated with antibiotics or other medications. Systemic causes, such as AIDS, leukemia, and anemia are treated by the appropriate medical specialist. Minor mouth burns from hot beverages or hot foods will usually resolve on their own in a week or so. Chronic problems with aphthous stomatitis are treated by first correcting any nutritional deficiencies. If those measures are ineffective, medication can be prescribed that is applied to each aphthous ulcer with a cotton-tipped applicator. This therapy is only successful with a limited number of patients. Mouth pain can be alleviated through the use of prescribed topical or oral analgesics.

Other treatments include measures to maintain oral hygiene and increase comfort as the stomatitis heals. These measures include:

Avoiding spicy or acidic foods, or very hot foods.
Avoiding tobacco products and alcohol.
Rinsing the oral cavity after meals and before bedtime with a mild saltwater or baking soda and water solution to help keep the mouth clean and free of debris.

Some limited studies have suggested that a few alternative therapies may be effective in preventing and treating stomatitis. These include the use of glutomine, an amino acid; vitamin E supplementation; and chamomile mouthwashes. The patient with stomatitis should be instructed to consult their health care professional prior to using any alternative treatments.

Prognosis

The prognosis for the resolution of stomatitis is based on the cause of the problem. Many local factors can be modified, treated, or avoided. Infectious causes of stomatitis can normally be managed with medications. Uncomplicated cases of stomatitis caused by cancer treatment will usually resolve within two to four weeks.

Health care team roles

The physician and nurse are responsible for thoroughly assessing the oral cavity for signs and symptoms of stomatitis. An awareness of the causes and associated conditions is important when treating the patient. The nurse should instruct the patient on the appropriate treatment and preventative measures, and about any medications used to treat the stomatitis.

Prevention

Stomatitis caused by local irritants can be prevented by good oral hygiene, regular dental checkups, and good dietary habits. Problems with stomatitis caused by systemic diseases can be minimized by practicing good oral hygiene measures, and by closely following the medical therapy prescribed. Cancer patients undergoing treatment can decrease the severity of stomatitis by maintaining good nutritional intake, good oral hygiene, and by having frequent assessments of the oral cavity by their health care professional.