Stomatitis
Stomatitis refers to inflammation of the oral mucous membranes. It represents a heterogeneous group of underlying conditions, many of which are infectious in etiology. A careful history and physical examination are often sufficient to effectively narrow the differential diagnosis. In uncertain cases, a biopsy of the lesions and/or referral to an otolaryngologist, dermatologist, or oral surgeon is appropriate.
Differential Diagnosis
- Aphthous stomatitis is the most common cause of recurrent oral lesions
–Presents as gray-yellow tender ulcer in anterior part of oral cavity
–Major, minor, and herpetiform subtypes
–Herpetiform ulcers: Multiple vesicles on tip
or sides of tongue
- Infectious stomatitis
–Herpes simplex virus may present as a primary infection (herpetic gingivostomatitis) with ulcers/vesicles in anterior oropharynx or as a secondary infection with “fever blisters” on lips
–Herpangina: Caused by coxsackievirus; results in 1–2 mm vesicles on soft palate that rupture to become white ulcers; seen primarily in children, may be associated with palmar and plantar lesions in hand-foot-and-mouth disease
–Syphilis (condyloma lata) results in painless oral chancres on lips, buccal mucosa, gingival
–Varicella or chicken pox
–Condylomata acuminata (warts) and molluscum contagiosum lesions resemble their characteristic genital lesions
–Primary HIV infection
–Candidiasis
- Stomatitis in immunocompromised patients
–Breakdown in epithelium results in superinfection by Candida, HSV, VZV, or CMV
–May occur secondary to chemotherapy - Stevens-Johnson syndrome
- Gangrenous stomatitis (acute necrotizing ulcerative gingivitis)
–Also known as “trench mouth”
–Primarily affects children with severe
malnourishment or debilitation
–Causative agent is most commonly a spirochete (e.g., Borrelia vincentii)
–Presents as painful, red vesicle on gingiva; progresses to necrotic ulcer, then cellulitis
-
Chronic granulomatous disease
-
Behçet syndrome (presents as recurrent oral and genital ulcers)
-
Lichen planus
-
Vitamin C deficiency
-
Cancers (e.g., mouth cancer, leukemia, mucositis following chemotherapy)
Workup and Diagnosis
Diagnosis usually evident by history and clinical observation
–Focus on onset, duration, pain, associated symptoms (e.g., hand or foot lesions, dermatologic complaints, fever, past medical history, and exposure/sexual history)
–Physical examination should focus on the eyes, ears, nose, throat, neck, and skin, with a cursory systemic evaluation
-
For infectious causes, specific microbe identification by culture, antigen detection assays, and histologic studies is necessary, especially in immunocompromised patients
-
Laboratory evaluation may include CBC, RPR, viral titers, ESR, HIV and others
-
Chronic granulomatous disease: Lab studies may show anemia of chronic disease, leukocytosis, and elevated ESR
–Diagnosis by NBT slide test: In absence of oxidase activity, neutrophils from CGD patients do not stain with NBT dye
-
A biopsy may be necessary for definitive diagnosis; if an infectious etiology is being considered, send one part of the specimen for biopsy in formalin and a second piece in nonbacteriostatic saline for cultures
-
Consider a referral to a dermatologist, otolaryngologist, or oral surgeon in uncertain cases
Treatment
Aphthous stomatitis: Symptomatic treatment only; lesions
spontaneously resolve within 2 weeks
–Strict oral hygiene (e.g., antiseptic mouthwash)
–Topical anesthetics may relieve pain
–Judicious use of topical and oral steroids in severe
disease
–Oral thalidomide reportedly helpful in severe disease (e.g., AIDS patients) Infectious stomatitis: Target specific organism with
appropriate antimicrobial treatment
–Topical antiseptic/anesthetic
–Coating agents (e.g., milk of magnesia, aluminum
hydroxide) may be helpful
-
Gangrenous stomatitis
–High-dose IV penicillin
–Correct underlying malnutrition or debility
–Surgery may be necessary
-
Chronic granulomatous disease: Early recognition and aggressive management of infections
Book Source Details
- Book Title: In a Page: Signs and Symptoms
- Author(s): Scott Kahan, Ellen G. Smith
- Year of Publication: 2004
- Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.
Other Book Chapters Related to White tongue
Read excerpts from these other book chapters related to White tongue:
Medical Books Excerpts
- Mouth lesions
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Stomatitis
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
Copyright Details: In a Page: Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
More About Causes of White tongue
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More About This Book:
Title: In a Page: Signs and Symptoms
Authors: Scott Kahan, Ellen G. Smith
Publisher: Lippincott Williams & Wilkins
Copyright: 2004
ISBN: 1-4051-0368-X
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» Next page: Stomatitis (In A Page: Pediatric Signs and Symptoms)
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