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1. Topic: Stomatitis
Subject: AHN

2. Learning objectives
• At the end the learners will be able to;
• Define stomatitis.
• Describe causes of stomatitis.
• Enlist signs and symptoms of stomatitis.
• Discuss types of stomatitis.
• Discuss management of stomatitis.

3. Stomatitis
Definition : Stomatitis is an inflammation of the
mucous lining of the mouth , which may
involve the cheeks, gums ,tongue ,lips , and
roof or floor of the mouth. The word“
stomatitis “ literally means inflammation of
the mouth.

4. Description
Stomatitis is an inflammation of the lining of any of
the soft-tissue structures of the mouth.
It is usually a painful condition ,associated with
redness, swelling ,and occasional bleeding from
the affected area.
The inflammation may be caused by conditions in
the mouth itself , such as poor hygiene , from
burns from hot food or drinks,
or by conditions that affect the entire body , such
as medications , allergic reactions , or infections.

5. Stomatitis

6. Causes of stomatitis
• Chemotherapy
• Radiotherapy
• Loose-fitting dental prosthetics
• Trauma
• Poor dental hygiene
• Smoking
• Hematologic malignancies (stomatitis develops at 2to
3 times the rate of solid tumor)
• Infection (viral , fungal ,and bacterial)
• Dehydration
• Medications

7. Medications associated with
stomatitis
• Chemotherapy.
• Antihypertensive.
• Opioids .
• Antibiotics (indirect)
•Diuretics (increase risk of dehydration in
compromised state)
• Anticholinergic .
• Antihistamines and decongestants.
• Steroids.
• Antidepressants.

8. Signs and symptoms
• Pain or discomfort in the mouth.
• The presence of open sores or ulcers in the mouth.
• Fever ,sometimes as high as 101– 104°F .
• Irritability and restlessness .
• Blisters in the mouth .
• Swollen gums , which may be irritated and bleed.
• Drooling.
• Dysphagia.
• Foul-smelling breath.

9. Types of stomatitis
• Nutritional deficiency stomatitis
•Aphthous stomatitis
•Angular stomatitis
•Denture-related stomatitis
•Allergic contact stomatitis
•Migratory stomatitis
•Herpetic gingivostomatitis

10. Nutritional deficiency
• Malnutrition (improper dietary intake) or
malabsorption (poor absorption of nutrients
into the body) can lead to nutritional
deficiency states, several of which can lead to
stomatitis. For example, deficiencies of iron,
vitamin B2 (riboflavin), vitamin B3 (niacin),
vitamin B6 (pyridoxine), vitamin B9 (folic acid)
or vitamin B12 (cobalamine) may all manifest
as stomatitis.

11. Aphthous stomatitis
• Aphthous stomatitis (canker sores) is the
recurrent appearance of mouth ulcers in
otherwise healthy individuals. The cause is not
completely understood, but it is thought that the
condition represents a T cell mediated immune
response which is triggered by a variety of
factors. The individual ulcers (aphthae) recur
periodically and heal completely, although in the
more severe forms new ulcers may appear in
other parts of the mouth before the old ones
have finished healing.

13. Angular stomatitis
• Inflammation of the corners (angles) of the
lips is termed angular stomatitis or angular
cheilitis. In children a frequent cause is
repeated lip-licking, and in adults it may be a
sign of underlying iron deficiency anemia, or
vitamin B deficiencies (e.g., B2-riboflavin, B9-
folate, or B12-cobalamin, which in turn may be
evidence of poor diets or malnutrition such as
celiac disease).

14. Denture-related stomatitis
• this is a common condition present in denture
wearers. It appears as reddened but painless
mucosa beneath the denture. 90% of cases
are associated with Candida species, and it is
the most common form of oral candidiasis.
Treatment is by antifungal medication and
improved dental hygiene, such as not wearing
the denture during sleep.

15. Allergic contact stomatitis
• Allergic contact stomatitis (also termed
"allergic gingivostomatitis" or "allergic contact
gingivostomatitis") is a type IV (delayed)
hypersensitivity reaction that occurs in
susceptible atopic individuals when allergens
penetrate the skin or mucosa.

16. Migratory stomatitis
• Migratory stomatitis (or geographic stomatitis)
is an atypical presentation of a condition
which normally presents on the tongue,
termed geographic tongue. Geographic
tongue is so named because there are
atrophic, erythematous areas of depapillation
that migrate over time, giving a map-like
appearance.

17. Herpetic gingivostomatitis
• This is inflammation of the mouth caused by
herpes simplex virus.

18. Management
• Coating agents such as bismuth salicylate ,
sucralfate , or other antacids
• Water-soluble lubricants for mouth and lips
• Topical analgesics , such as benzamine
hydrochloride
• Topical anesthetics ,such as lidocaine viscous
(might impair gag reflex for a short period)
• Oral or parenteral analgesics, including opioids if
needed , for pain not controlled with above.

19. Conti…
• Antiseptic mouthwash
• Protective pastes
• Local anesthetic mouthwash or spray
• Oral analgesics (painkillers)
• Topical corticosteroids.

20. References
• Zaoutis,[editedby]Jeffrey M.Bergelson,Samir S.Shah,
Theoklis E. (2008). Pediatric infectious
diseases.Philadelphia: Mosby/Elsevier. ISBN
9780323076333.
• Jump up^ MichaelG. Stewart,SamuelSelesnick (editors)
(2010-10-04)."35". Differentialdiagnosis inotolaryngology
– head andneck surgery.NewYork: Thieme. ISBN
9781604062793
• Jump up Yamada T,Alpers DH,etal.(2009). Textbook of
gastroenterology (5thed.).Chichester,WestSussex:
Blackwell Pub. ISBN 978-1 -4051 -6911 -0.sites. Eur J
Cancer B Oral Oncol.1993;29B(1