Stomatitis - the formation of foci of inflammation and ulcers in the mouth, accompanied by a sense of burning and pain. This is a common problem that occurs in both adults and children. Often pregnant women suffer from it. Without adequate treatment, stomatitis leads to a decrease in immunity, general intoxication, and fever. Therefore, it is important to recognize and cure it in time.
Types of disease
Stomatitis is translated from the Greek as "mouth", the name of the disease was due to the location. In the general classification of diseases, it is assigned the code ICD10 - K12. A distinctive feature is the formation of bright inflamed spots on the mucous membrane, most often on the lips, cheeks, gums. Sometimes these symptoms appear on the genitals, hands and feet. The nature and causes of this phenomenon are not yet fully understood. However, it is precisely known that stomatitis is of several forms and various factors influence its appearance. The consequence of this disease is pain during eating and talking, bad breath, and sometimes a rise in temperature.
Stomatitis occurs at any age, from infants to the elderly. Depending on the pathogen, the disease proceeds in different ways and is localized in different places.
Allergic stomatitis develops when the body responds to the action of allergens. It may be a drug, microbial or food allergy.
Also, the symptoms of this disease manifest themselves in local infectious or systemic autoimmune diseases. It manifests itself in different ways, depending on what factor caused the outbreak. Symptoms occur if the allergen has entered the body or just in contact with the oral mucosa. Often this form of stomatitis is observed in people with removable dentures, crowns, fillings. At the same time, against the background of an allergic reaction, any area of the mouth is affected: the inside and outside of the lips, cheeks, tongue, and gums. In rare cases, inflammation occurs on the tonsils, lateral ridges, soft palate, back of the throat.
Manifestations of the disease:
- dry mouth;
- effect of "lacquer tongue";
- the formation of single or multiple ulcers;
- swelling of the mucous membrane;
The type of allergic stomatitis and the stage of the disease is determined by the set of symptoms. In the framework of the allergic form, there are catarrhal stomatitis, ulcerative, medication, catarrhal-hemorrhagic. All of them are studied separately, although they have the same reason - the body’s response to the allergen. This form is more common in adults, in children - quite rare. At the time of diagnosis, it is important to distinguish the allergic form from others, since the treatment tactics are different. This type is eliminated by the appointment of antihistamine antiseptic preparations for the oral cavity. Perhaps the use of the GCS.
This type of disease is accompanied by inflammation of the mucous membranes and the formation of erosion, which are called "aphthae". The mucous membrane reddens, sometimes itches and swells, on the background of such hyperemia, aphthae are formed - yellowish formations covered with fibrous tissue. The submandibular lymph nodes also increase and the temperature rises, the patient experiences pain when swallowing and talking. The cause of the phenomenon is still under study, studies show the relationship between outbreaks of the disease and the work of the immune system. Presumably the immune system does not recognize some of the elements in the composition of saliva and attacks them. Also, the trigger is an allergy to products, mechanical damage, a strong psychological shock. Despite the similarity of pathogenesis with other forms, aphthous stomatitis differs in symptoms.
Erosion is formed against the background of an inflamed reddened mucous membrane, most often localized on the lateral surface of the tongue, inside the folds and near them, on the upper and lower lip, in the region of the ducts of the salivary glands. Aphthae form over several days, then heal from 2 to 4 weeks. With proper treatment, the symptoms disappear within a week. Without proper therapy, the situation is sometimes aggravated by the emergence of new ulcers, the unification into extensive zones, and severe swelling of the oral cavity. In women, during menstruation, new outbreaks occur, but during pregnancy this form of stomatitis more often regresses. Most often, this form is observed in young people, the tendency to it is inherited.
Herpetic form resembles aphthous stomatitis with external manifestations. However, they differ in the course of the disease and its cause. Herpes - caused by reproduction of the herpes simplex virus. If this virus is present in the body, the confluence of unpleasant circumstances causes an outbreak of stomatitis. So, redness and erosion in the mouth area appear with reduced immunity, against the background of ARVI or flu, blood diseases, from hypothermia, treatment with antibiotics.
- redness of individual sections of the oral cavity;
- a clump of erosions covered with a light soft crust;
- lack of appetite;
- pain and itching in the area of erosion.
In contrast to the aphthous, with the herpetic form, erosion forms quickly and passes on its own in 5-7 days. Rashes are localized more often on the outer and inner side of the lips, on the palate, and on the mucous membrane of the cheeks. Also in rare cases, the symptoms are caused by type 2 virus, the virus of genital herpes. At the same time, the same reddening, itching and erosion are observed on the penis in men and boys, on the large and small lips of women and girls. In women with genital herpes, the virus often affects the cervix. These types of stomatitis must be treated by a doctor.
With reduced immunity and no treatment, stomatitis becomes recurrent in nature. New aphthae appear even before the previous ones pass, separate foci of inflammation unite and form a single ulcer. The herpetic form is observed with the same frequency in adults and children, often manifested in infants. In a child, the manifestations of the disease consist in constant temperature surges, the appearance of many small rashes. With severe disease, the temperature rises to 40 degrees, a rash appears on the face, nasal mucosa, eyelids, skin of the hands. With this form, infants must be hospitalized. Herpetic stomatitis is contagious, it is transmitted from a sick person to a healthy person through contact and by airborne droplets.
The catarrhal form proceeds without the formation of ulcers and aft, unlike other types of disease. At the same time, the mucous membrane of the oral cavity becomes inflamed and swollen, it is covered with redness, there is a feeling of burning and pain. This form is one of the most common, equally common in women and men, in children. The main reasons for this phenomenon are the presence of the following circumstances:
- reduced immunity;
- poor oral hygiene;
- damage to the mucous membrane.
This situation develops if the patient has caries, systemic diseases, poor-quality or old fillings, and removable prostheses. Also, the use of too stiff a toothbrush, toothpaste or rinse with sodium sulfate can trigger a flash. Inflammation appears more often on the cheeks and the inner side of the lips, while it seems that the lips and cheeks are swollen, although there are no external changes. Lymph nodes are not inflamed, the temperature rises only when running forms. A lesion with white blotch appears only at the site of mucosal injury.
Catarrhal stomatitis is diagnosed in children and adults, proceeds equally in the first and in the second case. If the rules of hygiene are observed, the symptoms disappear within a week, the child lasts up to 2 weeks. If the patient is not treated, and the mucous membrane is permanently damaged, for example from braces, this can lead to the development of an ulcer-necrotic form.
Separate ulcers are formed when the mucous membrane is injured, such erosion is covered with a light patina, it hurts. Traumatic stomatitis is not transmitted, but it appears very often in healthy people. He has one reason - damage to the mucous membrane, it may be a burn of too hot food or drinks, a wound from a bite, accidental damage by foreign objects. Often this form of the disease is observed with improperly installed braces, prostheses and fillings, after the removal of a wisdom tooth. A broken tooth can permanently traumatize the cheek or tongue, which also leads to the formation of a wound.
A healthy and strong body quickly copes with this problem, the wound heals within 2-3 days without a trace. However, against the background of weak immunity or chronic diseases, such a trauma turns into erosion, which does not heal for a long time and hurts. The situation is aggravated by improper dental care. Traumatic stomatitis is treated by eliminating the cause of damage and antiseptic preparations for the oral cavity. Since it is very simple to wound soft tissue, this form of the disease is more common in young children with teething. Also from the age of one when the child "tastes" everything that tastes in his hands.
Vesicular stomatitis is a type of enterovirus infection caused by the action of a virus. From penetration into the body of the infected appears a characteristic rash on the mucous membrane and rash on the hands and feet. Also, the rash sometimes covers the genitals and buttocks. Infection occurs through the fecal-oral or airborne routes. The source of infection is a sick person or carrier.
The risk group includes children under 10 years. After the pathogen enters the body, weakness begins, a slight fever, a headache. During the week, flat rashes appear in the mouth and on other parts of the body, which after a few days transform into vesicles - vesicles. Rash in children almost never itches, in adults itching is accompanied, sometimes very severe. Specific treatment is not required, patients are necessarily isolated, eliminate the symptoms with painkillers, antihistamines and personal hygiene. In most cases, those who have been ill form a stable immunity to enteroviral vesicular stomatitis. However, it does not protect against other types of stomatitis.
It is considered the most severe form of the disease, as it leads to a strong focal destruction of the mucous membrane. Manifested in the form of single ulcers or their clusters, covered with light bloom. The disease at the first stage is similar to the catarrhal type: the mucous swells, reddens, hurts. After that, under the tongue, on the tip of the tongue, on the cheeks and gums appear rounded sores, which are very painful. In some cases, these foci of inflammation combine to form a large, painful ulcer.
The patient can not chew on food, feels pain while talking and swallowing.
Ulcerative stomatitis occurs as an independent disease, but may be a consequence of the launched other forms of stomatitis. Also, the risk of ulcers is increased in patients with:
- gastrointestinal problems;
- blood disorders;
- diseases of the cardiovascular system.
In some cases, the cause of the disease is a combination of bacteria: Vincent's spirochete and fusiform stick. When the infectious nature of the disease develop severe symptoms, inflammation is rapidly increasing, a large number of deep erosions with scarlet edges are formed, the shell of the ulcers bleeds. The patient has a putrid odor from the mouth, the saliva becomes viscous, in the neglected forms of the wound are covered with a bloom of gray-green color.
The chronic form leads to the loss of teeth and periodic relapses, general intoxication, so it is important to cure the disease in time. Mild forms of the disease are treated with antiseptics and hygiene, and severe ones require serious complex therapy. Self-medication only worsens the situation and increases the risk of becoming chronic. Ulcer-necrotic type of stomatitis is most common in young men and the elderly.
The angular form of the disease is characterized by the formation of cracks, wounds and vesicles in the corners of the mouth. Unlike other species, this one does not infect the inner part of the mouth, but is localized on its outer part. During the formation of wounds and erosion, a person experiences pain when talking, yawning, eating. The disease is caused by the action of fungi and streptococci. Among the factors that contribute to the development of the disease:
- lack of vitamins, mainly C and B;
- low immunity;
- diseases of the stomach and intestines;
- bad habits;
- hormonal drugs.
The outbreak of the disease occurs more often in the spring, when the body is experiencing a shortage of useful substances. In the framework of this form distinguish candidal type and streptococcal. The first is caused by the action of yeast-like fungi that cause candidiasis and thrush. With this kind of disease in the corners of the mouth cracks appear, redness with a cheesy white bloom. Streptococcal is characterized by the fact that small bubbles with liquid are formed at the same places. This form is more common in young children, rarely in adolescents. Also, newborns are infected with candida when passing through the birth canal in natural childbirth. In adults, the streptococcal type is more common.
In addition to the considered types of the disease, its less common forms are distinguished. For example, gangrenous stomatitis belongs to the category of gangrene and is accompanied by a strong disintegration of soft tissues near the jaw area. An atrophic type is derived into a separate classification, which is caused by the usual lack of vitamins, accompanied by the appearance of papillomas.
What causes stomatitis
Stomatitis is divided into forms, each of which provokes a separate cause. They do not have a single trigger, but scientists are aware of the conditions in which the risk of manifestation of the disease is increased. This is a combination of circumstances, as low immunity, poor hygiene and the presence of the pathogen. The causative agent can be many microorganisms, they are divided into:
- viral: herpes simplex virus, coxsackie virus, enterovirus 71, etc .;
- microbial: candida, streptococcus.
The defeat of the oral mucosa can be an independent disease and secondary, as a manifestation of other pathogenic changes in the body. For example, the appearance of ulcers may indicate that something is wrong in the body: impaired blood circulation, poor digestion, lack of vitamins, diabetes, and so on. Thus, the body sends a signal of impaired health. Therefore, when referring to a doctor, the specialist prescribes a series of examinations to establish the nature of the disease: the patient’s primary stomatitis or secondary stomatitis. Weakened by chronic illnesses, the body often suffers from outbreaks of stomatitis.
Therefore, systematic pathologies also serve as a reason for it.
Reduced immunity is among the "favorable" factors for the development of erosion, so people with unhealthy diet and bad habits increase the risk of infection. For the same reason, inflammation of the mucous membranes often occurs after hormonal preparations, antibiotics, and chemotherapy. Considering the ways of transmission, the direct cause of infection with stomatitis is contact with the patient, if the latter is caused by viruses, fungi or bacteria. An important role is played by personal hygiene, for example, the traumatic type happens to almost everyone, but it only turns into a real problem for those who have poor health of their teeth.
Clinical picture of the disease
The set of symptoms and the appearance of erosions, if any, are one of the main factors by which the doctor distinguishes one form of illness from another. It is important to choose the right treatment tactics. For example, antihistamines are needed to eliminate allergic forms, and antibiotics are not always needed. At the same time, the ulcer type is very similar in appearance to the allergic, but it necessarily requires the prescription of antibiotics. Therefore, it is important to distinguish the stages and symptoms of the disease.
All types of disease have a common feature - inflammation of the mucous membrane and the appearance of erosive sites. These areas are usually with smooth edges, oval or round. When purulent formations of erosion are uneven, deep, covered with yellow or gray bloom. If the disease is caused by the action of microbes, viruses or fungi, a few days before the onset of obvious signs, the person experiences:
- malaise and weakness;
- elevated temperature, from low deviations to fever;
- nausea and lack of appetite, with infection with vesicular type often vomiting;
- dry mouth.
Each type of disease includes its own characteristics of inflammation. So, with allergic forms, erosions appear with a moderate sensation of pain, covered with white bloom. In this case, before the onset of visible symptoms, the person does not feel unwell. Ulcer-necrotic type, characterized by a strong pain, deep and extensive erosion, surrounded by an inflamed mucosa. There is also a herpetiform type, in which a large number of small vesicles appear under the tongue. Also, the appearance of sores on the genitals, buttocks, arms and legs can also talk about stomatitis. Differentiate this rash from others can only specialist: dermatologist, venereologist.
Infection in infants and children up to 2 years of age is accompanied by diarrhea, irregular temperature, and refusal to eat. Older children become lethargic and drowsy, in adolescents the symptoms are the same as in adults.
Visual signs in toddlers and adults, too, are no different.
Stage of the disease
If the disease is caused by the action of pathogenic microorganisms, the first symptoms may resemble a cold: fever, weakness, lack of appetite. In this case, it is considered the first stage. The incubation period lasts from 3 to 7 days, at this time there are no visual changes. Thereafter:
- There comes a common stage in all types of disease - redness of the mucous membrane, it becomes shiny and dry.
- After 1-2 days on the tongue and the sky appears white scurf without the formation of erosion.
- Then, wounds and sores appear in separate areas.
Independently such symptoms pass quickly enough, within 1-2 weeks. The situation worsens when hygiene is not observed and mucous membrane is damaged. As a rule, after healing the wound, there are no traces left. An exception is the ulcerative-necrotic form, in which deep erosion gradually hems and leaves a mark, in severe situations the patient may lose a tooth from the destruction of the gums.
Diagnosis of stomatitis
In the diagnosis of the most important role played by the clinical picture. The doctor first of all studies the history of the disease, there may possibly be a cause of stomatitis in the form of a chronic affliction. Then the specialist necessarily examines the patient, assesses the number, size and shape of the rash. Also important is the type of rash, they can be purulent, be empty or filled with a clear liquid. To accurately understand the nature of the rash, tests are assigned:
- scraping from the surface of ulcers;
- saliva collection;
- general and biochemical blood test.
However, specific tests to detect stomatitis have not yet been found. Doctors conclude based on the appearance of the rash, the patient's complaints, the frequency of relapses. In most cases, the appearance of sores in the mouth is associated with systematic pathologies or a lack of vitamins.
What is dangerous stomatitis
Most people who have had stomatitis do not even know the name and the cause of the disease. This is due to the fact that the disease passes quickly and does not lead to serious consequences. In the first stages, there is discomfort from pain, itching and unpleasant smell in the mouth. However, after healing, these symptoms disappear. Therefore, in most cases, the prognosis is favorable. Danger threatens in the presence of severely reduced immunity or chronic diseases. In this case, simple stomatitis can turn into more severe forms, such as aphthous or ulcerative, which are harder and longer treated.
Complications are in the absence of treatment and neglected forms. On the soft tissues in the mouth, deep erosion with pus is formed, when the blood is infected, the body is intoxicated. This is fraught with strong fever, disruption of vital systems. After healing of extensive and deep aft on the soft tissues, a scar remains, as a result, a part of the tooth may become bare, periodontitis is formed, the tooth falls out. However, severe negative consequences are extremely rare, as a rule, in people with a dysfunctional lifestyle or with severe health disorders: AIDS, hepatitis, very low blood clotting, hemophilia, and so on.
How to treat
Today, there are many ways to eliminate the unpleasant symptoms of stomatitis, but there is no single medicine yet. The treatment is aimed at getting rid of the signs and associated symptoms. All methods of therapy are divided into home treatment and medical care. The doctor after examination determines the form of the disease, on the basis of this is prescribed:
- Drugs for the treatment of ulcers. These are pastes and ointments for applying ulcers on the surface; such agents have an antibacterial and anesthetic effect. The patient self-inflicts them on the affected area, from which the wounds cease to hurt, heal faster and do not progress. In the case of viral nature, antiviral ointments are prescribed: oxolinic, bonaftonic, interferon.
- Tablets are prescribed for the bacterial and fungal nature of the disease. Also reduce the frequency of formation of sores can receive drugs from the underlying disease, if stomatitis is its consequence. In this case, pills and injections are assigned to eliminate or alleviate chronic pathologies. Often, treatment requires taking antihistamines if there is a suspicion of an allergic reaction.
- Vitamins are prescribed after testing. Restorative effect is observed from taking multivitamins with components of group B and C.
Also, the doctor himself may prescribe treatment at home. A good effect is provided by decoctions of sage, chamomile, and St. John's wort. Reviews allocate a decoction of oak bark, which is used as a means for rinsing the mouth. If flashes occur very often, self-medication is dangerous. The treatment tactics are especially carefully chosen if a woman is sick in early pregnancy, an infant or a nursing mother. With such a disease, patients are not hospitalized, the doctor makes recommendations and a list of medicines at home. The duration of therapy depends on the type of disease, it takes 2 weeks for milder forms, and 1-3 months in severe cases.
How to warn
Prevention is also important for those who have already had such outbreaks, and for those who have never encountered them. Ailment can occur at any age, so prevention methods are better for everyone to know. Prevention rules include careful hygiene, this applies not only to the care of the oral cavity, but also clean hands, bed and clothes. In case of accidental damage to the soft tissues of the mouth, it is imperative to rinse the mouth with an antiseptic agent. When choosing a toothpaste and rinse for teeth, it is better to give preference to formulations without sodium lauryl sulfate. This substance is added to foment caring agents; however, it dries the mucous membrane and reduces its ability to resist harmful microorganisms.
Toothbrush is better to choose with medium hardness. Too soft not enough to clean the teeth, because of what appears plaque and increases the risk of injury and infection. Too hard brushes injure the gums themselves. A little harder to prevent such a problem in young children. Infants develop a candida or herpetic appearance more often, it is rather difficult to protect the baby from them, as his immune system is weak and any damage to the tissues or the introduction of pathogens will lead to illness. Parents are advised to thoroughly wash the child, to monitor the cleanliness of his clothes and linen, and to observe his own hygiene.
For children of one year old and older, traumatic stomatitis is a frequent occurrence. It is enough for parents to watch that the baby takes in the mouth. Given the complexity of this condition, parents should check the condition of the child’s mouth. Also for the prevention and treatment of diet matters.
Nutrition for painful mouth ulcers plays an important role. In drawing up the diet, they are guided by the correct preparation and processing of products, their caloric and nutritional value. The inflamed mucosa sharply reacts to too hot and cold food, and when exacerbated inflammation the patient cannot eat at all. The principle of nutrition is made individually, based on the stage and type of the disease. But there are general rules for drafting a stomatitis menu.
- spices and seasonings;
- sour and spicy food;
- too hot and cold;
- raw foods, especially vegetables and fruits;
- alcohol and nicotine;
- cocoa and coffee;
- dry bakery products.
Additional exceptions may be associated with comorbidities, for example, in patients with diabetes mellitus, fast carbohydrates are also excluded. Food should be high-calorie, contain many nutrients to enhance immunity. Be sure all products are carefully crushed, so as not to injure the mucous. Meat and fish dishes are passed through a meat grinder twice, other products should also be in the form of mashed potatoes, souffles, soups.
For painful and deep ulcers, only liquid food is recommended, which the patient can take through a tube. At the time of exacerbation of the inflammatory process, the appetite often disappears, but it is important for the patient to support the body to combat the ailment. Also for quick recovery useful non-acidic fresh juices:
- cucumber with greens;
After each meal, be sure to rinse your mouth with a product that is prescribed by the doctor or a decoction of herbs. During the treatment period, liquid or pureed porridges are useful: semolina, oatmeal, rice. To maintain digestion and immunity, it is recommended to eat dairy products: cottage cheese, plain yogurt, kefir, ryazhenka.
After recovery, it is important to maintain the principle of healthy and fortified food, which will serve as an additional prevention.
Can I get a vaccine for stomatitis
Stomatitis is a sure sign that immunity is weak. Vaccinations are carried out only against the background of a strong, healthy body. Many doctors, even pediatricians, do not consider stomatitis as a contraindication for inoculation. However, for protection and insurance for vaccination, it is worth going a week after recovery, especially if it concerns a child.
Can I go to the kindergarten with stomatitis
First of all, you need to establish exactly that the child has stomatitis. This can only be done by a dentist. If the diagnosis is confirmed, the child should stay at home and undergo treatment. In kindergarten, such a disease, especially of an infectious nature, is quickly transmitted through objects (dishes, toys).
A sick child can infect healthy people; also with weakened immunity, the same child can easily catch any other disease from other children. Therefore, during stomatitis in the kindergarten a child can not be led.
Do you get sick leave for stomatitis?
A patient with stomatitis is given if a person cannot perform his duties or threatens the health of other people, for example, flight attendants, educators, catering workers, and so on. It also depends on the extent of the disease.
If a patient has a mild form and he can do his job without risks to others, he is not given sick leave. In severe forms of the patient even determined to the hospital, for example, with ulcerative-necrotic type.
Specialty: infectious diseases specialist, gastroenterologist, pulmonologist.
Total experience: 35 years.
Education: 1975-1982, 1MMI, San gig, high qualification, infectious diseases doctor.
Science degree: doctor of the highest category, PhD.
- Infectious diseases.
- Parasitic diseases.
- Emergency conditions.