Mouth nourishes a population of commensal microorganisms which is normally controlled by the reasonable standard of oral hygiene. If it is neglected bacterial population may proliferate and this causes stomatitis. Stomatitis may occur when resistance to commensal population is lowered by disease, particularly in immune-compromised host. Stomatitis can also be due to nutritional deficiencies or some other factors.
Ulcerative Stamatitis (vincent’s infection):- It occurs mainly in adults with malnutrition and poor dental hygiene. Ulcers with ragged necrotic margins occur particularly on gums. It may involve palate, lips or inner aspects of cheeks. Ulcers are covered by grey slough surrounded by erythematous margin. The stained smear shows several spirochaetes and fusiform bacilli. Those organisms are present in small number in normal commensal population of mouth and condition may be regarded as endogenous infection because of impairment of the host resistance. That condition is infectious, so that patient’s food vessels and the cutlery should be sterilized. This is treated with metronidazole (200mg 8hourly for 4 days) or penicillin.
Viral Infections: - Herpes Simplex type 1 may cause recurrent problems of the herpes Labialis in normal individuals. It may cause much more severe stomatitis in AIDS.
Candidosis:- Fungus ‘candida albicans’ is normal commensal in mouth. It may proliferate to cause thrush in babies, in aged and especially in debilitated patients. The thrush is common in those receiving prolonged treatment with oral antibiotics and in patients who are immuno suppressed by the corticosteroids or AIDS. White patches appear on tongue and buccal mucosa also may enlarge. There is a little surrounding inflammation. During severe infection the pharynx and the oesophagus may be affected causing dysphagia.
Stomatitis due to deficiency of nutritional factors: - It may arise directly from insufficient intake or indirectly as the result of impaired absorption of vitamins, particularly niacin, folic acid, riboflavin and vitamin B. When this deficiency is acute and severe the tongue is red, raw and also painful because of atrophy of papillae. Tongue appears to be moist and unduly clean when the deficiency is less severe and chronic. The angular stomatitis sometimes accompanies glossitis particularly in case of gross iron deficiency. During severe vitamin C deficiency gums become swollen and spongy.
Aphthous Ulceration: - It is a common recurrent condition of the unknown aetiology characterized by painful superficial ulcers in mouth. Lesion begins as indurated erythematous area in one day or so by ulceration. Ulcers are often multiple and also remain painful for about one week before healing commences. They can recur every few weeks. The emotional stress may also precipitate an attack. In many women ulcers tend to recur in the cyclical fashion during premenstrual phase. When most of the patients are healthy, severe chronic aphthous ulceration can be found in association with Crohn’s disease, ulcerative colitis, coeliac disease and Behcet’s syndrome.
Hydrocortisone hemisuccinate lozenges (2.5mg, 8 hourly) can be effective at early stage of the lesions. The pain may be reduced with tropical anesthetics. The secondary infection can be controlled with tetracycline mouth washer. Suspension of sucralfate can be tried for healing.
Other forms of stomatitis: - Allergic reaction to the chemicals in some toothpaste, destures, foodstuffs and many drugs, particularly antibiotics, may cause stomatitis. Blue-black punctuate line may be visible where gum margins adjoin teeth in lead poisoning. Skin diseases like lichen planus, pemphigus and erythema multiforme involve mouth often before being visible on the skin. The stomatitis may also be the manifestation of blood dyscrasias.
