Definition
Stomatitis is an acute or chronic inflammatory process that affects the oral cavity of individuals of any age group.
This inflammation can be localized in a precise point of the oral mucosa or affect it in a widespread and generalized way. Stomatitis can lead to different symptoms, all located in the oral cavity: swelling, redness, oral ulcers (mouth ulcers), and, in some cases, blood loss. These signs are associated with a feeling of pain, which occurs while eating, talking or brushing one's teeth.
Stomatitis occurs on the tissue that covers the oral cavity: it can be located inside the cheeks, on the palate, tongue, gums and / or lips. Sometimes stomatitis is associated with small painful ulcers, called mouth sores.
The lesions that characterize stomatitis, if extremely painful, can make food intake problematic, leading to dehydration and malnutrition.
In the event that the stomatitis is repeated with a certain regularity, it is appropriate to reflect on the possible triggering factors, which generally consist in food intolerances or in allergies, in nutritional deficiencies (for example iron deficiency, folic acid, vitamin B3) or in high stress conditions.
Forms of stomatitis
The most frequent forms of stomatitis are:
- Aphthous stomatitis
- Catarral stomatitis
- Ulcerative stomatitis
- Antibiotic stomatitis
- Herpetic stomatitis
- Stomatitis of toxic origin
- Nicotine stomatitis
- Vincent stomatitis
Symptoms
Stomatitis is generally very painful inflammation and can present with local pain and burning; such sensations usually increase during the act of chewing.
The main symptoms that characterize stomatitis are:
- Redness of the oral mucosa;
- Onset of pustules;
- Onset of canker sores.
To the general symptoms can be added further secondary signs: halitosis, gum bleeding, increase in salivary secretion and, in some cases, fever and enlarged lymph nodes.
Stomatitis should not be confused with labial ulcers caused by herpes simplex.
The vesicles that appear due to infection of the herpetic virus are located outside the oral cavity (around the lips, chin or inside the nostrils) and are contagious.
Ulcers associated with stomatitis, on the other hand, cannot be transmitted.
Causes
At the level of the oral mucosa there are, for various reasons, numerous saprophytic and pathogenic bacteria, which could predispose to inflammation; however the normal flow of saliva is generally effective in protecting the mucosa against mechanical, physical and chemical insults.
Sometimes, with the onset of stomatitis it is possible to highlight a decrease in the defenses naturally present in the oral cavity; this deficit, in fact, favors the establishment and proliferation of bacteria, viruses or fungi that can exert their pathogenic action. This condition would be favored by nutritional deficiencies or disorders of the endocrine system.
Stomatitis can be caused not only by local infections, but also by contact with irritating substances (chemical or physical) or an allergic reaction.
In addition to these diseases localized at the level of the epithelium of the oral cavity, it is necessary to remember the secondary stomatitis and some systemic diseases that predispose to the onset of disorders characteristic of stomatitis.
In some cases, stomatitis can be defined as an idiopathic disease (ie without known external causes).
The factors that predispose to the onset of stomatitis can be of various nature:
- Poor oral hygiene
- Altered saliva composition
- Infectious diseases
- Metabolic alterations
The most common causes of stomatitis include: | |
Cause | Examples |
Bacterial infections | Oral actinomycosis Acute necrotizing ulcerative gingivitis Gonorrhea Syphilis Tuberculosis |
Fungal infections | Candida infections Cryptococcosis (mycosis caused by Cryptococcus neoformans ) Coccidiomycosis (systemic mycosis caused by the fungus Coccidioides immitis ) Mucurmicosi Blastomycosis (systemic mycosis due to Blastomyces dermatitidis ) |
Viral infections | Herpes simplex (primary infection, especially in children) Herpes simplex (secondary infection, cold sores on the lips or palate) Varicella zoster virus (primary infection of the herpetic type 3 virus, which causes chickenpox) Herpes zoster (due to the reactivation of the latent Varicella-zoster virus, commonly called "shingles") Other infections: coxsackievirus, cytomegalovirus, Epstein-Barr virus, HIV, condylomata acuminata, influenza, rubella |
Systemic diseases | Diabetes Celiac disease Immunodeficiency Behçet syndrome Inflammatory bowel disease Nutritional deficiencies Iron deficiency Vitamin B3 deficiency (pellagra) Vitamin C deficiency (scurvy) Leukemia Platelet disorders Cyclic neutropenia Kawasaki disease Stevens-Johnson syndrome Thrombocytopenic thrombotic purpura Pemphigus vulgaris Erythema multiforme |
drugs | Antibiotics (prolonged treatments with penicillin, tetracycline, chloramphenicol ..) anticonvulsants Barbiturates Chemotherapy drugs Non-steroidal anti-inflammatory drugs (NSAIDs) |
Irritating agents of the oral mucosa, irritations of a physical nature and allergic reactions | Acid or irritant foods (example: spicy or spicy foods) Taking too hot foods and / or drinks (they cause burns in the oral cavity) Inadequate dental devices and / or prostheses with sharp edges (which can cause persistent trauma) Occupational exposure to dyes, acid vapors, heavy metals (example: mercury, bismuth, lead) Excessive alcohol consumption Tobacco (nicotinic stomatitis particularly affects pipe smokers) Dentures that fit poorly Traumas (example: bites inside the mouth or tongue; too vigorous washing of the teeth) Type IV hypersensitivity (for reactions to toothpaste, mouthwash, candy, dyes or lipstick ingredients) |
More | Oral cancer Xerostomia (also known as dry mouth) Burning mouth syndrome (burning mouth syndrome or stomatopirosis) Lichen planus (mucocutaneous disease of immune origin) Recurrent aphthous stomatitis Radiotherapy Chemotherapy Stress and anxiety conditions |
Risk factors
As highlighted, the factors that predict the onset of stomatitis are different and multiple. The main risks can be:
- Poor oral hygiene
- Food shortages
- Presence of chronic systemic diseases
- Immunodeficiency
- traumas
- Inadequate prostheses
- Chemotherapy and radiotherapy therapies
A further risk factor for stomatitis is due to the presence of a specific genetic polymorphism that determines high concentrations of IL-1 (interleukin type 1, involved in the inflammatory process) and of TNF-α (tumor necrosis factor α, also it involved in the promotion of systemic inflammation). This genetic polymorphism is related to an increased risk in the onset of recurrent aphthous stomatitis.
Continue: Stomatitis: Diagnosis, Cure and Treatment, Prevention "
