Stomatitis and other Oral Infections
A common infection, stomatitis may occur alone or as part of a systemic disease. This inflammation of the oral mucosa may also extend to the buccal mucosa, lips, and palate. The two main types are acute herpetic stomatitis and aphthous stomatitis.
Acute herpetic stomatitis is usually self-limiting; however, it may be severe.
Pediatric pointerAcute herpetic stomatitis is common in children between ages 1 and 3.
Aphthous stomatitis is common in young girls and female adolescents and usually heals spontaneously, without a scar, in 10 to 14 days. Other oral infections include gingivitis, periodontitis, and Vincent’s angina. (See Understanding oral infections.)
Causes
Acute herpetic stomatitis is caused by the herpes simplex virus. The cause of aphthous stomatitis is unknown, but autoimmune and psychosomatic causes are under investigation. Predisposing factors associated with aphthous stomatitis include stress, fatigue, anxiety, febrile states, trauma, and overexposure to the sun.
Complications
Stomatitis may be complicated by nutritional deficiencies if painful oral lesions cause dysphagia or make chewing difficult.
Assessment
The patient with acute herpetic stomatitis usually reports symptoms of sudden onset, including mouth pain, malaise, lethargy, anorexia, irritability, and a fever that may last 1 to 2 weeks. He may also complain of bleeding gums and extreme tenderness of the oral mucosa.
On inspection, the gums typically appear swollen, with papulovesicular ulcers evident in the mouth and throat. Eventually these ulcers become punched-out lesions with reddened areolae. The pain usually disappears 2 to 4 days before healing of ulcers is complete. Palpation commonly reveals submaxillary lymphadenitis.
Pediatric pointerIf the patient is achild, be sure to inspect his hands; thumbsucking can spread the viral infection to the hands.
In aphthous stomatitis, typical complaints are burning and tingling of the oral mucosa and painful ulcers. Mouth inspection reveals a slight swelling of the mucous membrane and single or multiple shallow ulcers with whitish centers and red borders, measuring about 2 to 5 mm in diameter. These ulcers appear and heal at one site but then reappear at another.
Diagnostic tests
Although diagnosis depends on physical examination, these tests may help to identify the type of infection.
Smear of ulcer exudate allows identification of the causative organism in Vincent’s angina.
Viral cultures may be performed on fluid and herpetic vesicles in acute herpetic stomatitis.
