From the dentist to the gastroenterologist: aphthous stomatitis.

What does aphthous stomatitis look like?

Aphthae occur on the inside of the cheeks or lips, under the tongue, at the base of the gums, or on the soft palate.

https://img.medscapestatic.com/pi/meds/ckb/75/43075.jpg

They can be confused with manifestations of herpetic infection , but the latter usually appears at the red border of the lips, rarely in the oral cavity - usually on the gums or hard palate.

Aphthae first look like red bumps (papules), which then quickly turn into ulcers, surrounded by a red rim and covered with a gray-yellow coating (exudate). 1-2 days before the appearance of aphtha, there may be a local burning sensation of the mucous membrane.

Sometimes the child or family members notice what often triggers the appearance of aphthae. Journaling can help with this.

According to American data, about 20% of the population suffered from recurrent aphthous stomatitis at one time or another in their lives.

Most often children suffer and usually these are minor canker sores.

The peak incidence of aphthae is 1-19 years.

Features of treatment in children

The dentist will tell you how to treat aphthous stomatitis in a child. You can contact him at the direction of your pediatrician or on your own if you find characteristic ulcers in the oral cavity. The treatment regimen is the same as that used in the treatment of adult patients, but there are some differences: children under a certain age cannot rinse the mouth, so preference is given to drugs for application to mucosal ulcers. Otherwise, the treatment regimen is developed individually, taking into account the severity, symptoms of the disease, frequency of relapses, and the presence or absence of concomitant ailments in the child. Symptomatic therapy can be used to quickly alleviate the baby’s condition.

Specialists at STOMA clinics successfully treat aphthous stomatitis. By contacting us, you will receive qualified assistance, detailed recommendations on the treatment and prevention of relapse of the disease, and comprehensive assistance from dentists of all specializations, if necessary.

Types of aft.

Small aphthae is the most common type of aphthae (80-85%). Their size ranges from 1 to 10 mm. Ulcers can appear singly or several at a time (up to five).

Usually heal in 7-10 days.

Large aphthae (10-15%) - more than 10 mm in diameter, can even be up to 3 cm, deeper, take longer to heal (10-30 days).

They may leave scars behind. Very rare in children.

Herpetiform aphthae (5-10%) are small, from 1 to 3 mm, located in groups like herpetic vesicles. They heal quickly, within 10 days. They are not typical for children; they usually occur in the elderly.

The rest of the oral cavity looks normal - there is no inflammation of the gums, redness of the tonsils and pharynx, enlarged and painful cervical lymph nodes.

There is no fever or other general manifestations.

Aphthae in children is manifested primarily by refusal to eat and drink due to pain in the mouth.

The reasons for the recurrence of aphthae are not completely clear; the most popular theory is related to errors in the immune system.

Doctors most often do not find a specific cause of the failure; most likely it is a combination of several factors.

But doctors still have assumptions about some factors.

The main symptoms of stomatitis in adults

The main symptoms should be considered at different stages of the disease. It is worth noting that the disease progresses and becomes more pronounced over time. When affected by an infection, a person begins to feel weak, he regularly has headaches, there is an increase in temperature and brittleness in the joints. The patient may notice blood on the gums, feel burning and drying of the oral mucosa. Such symptoms torment a person for several hours, and sometimes for several days.

When examined by a doctor, the stage of stomatitis, symptoms and treatment are described. In this case, the optimal course for the stage of the disease is selected. The disease progresses and gradually all its manifestations intensify. The person’s general condition becomes weaker, headaches become more frequent and severe, which affects performance. Over time, the patient feels a sharp pain even with slight contact with the tongue. Brush your teeth

and it becomes more and more difficult to eat, as sharp convulsive bursts of pain occur. At the same time, the patient notices increased secretion of saliva, and also an unpleasant smell of rot from the oral cavity. If a wisdom tooth becomes infected, the ability to open the mouth decreases. This phenomenon in medicine is called trismus.

Some facts about the symptoms of the disease at different stages:

• the first manifestations of the disease are pain in areas of damaged teeth and damaged gums;
• Mild stomatitis is characterized by a limited spread process. At an early stage, only certain types of teeth are affected. The general condition of a person does not undergo significant changes, so performance does not suffer either;
• Severe stomatitis occurs with a body temperature of up to 40 degrees. At the same time, the person feels very bad. The mucous membrane of the oral cavity is especially severely affected. In some situations, the infection affects muscle mass and bones. If you do not seek help from a hospital in time, complications of the disease can lead to melting of the jaw bones. You can easily see the image of stomatitis in the photo, the treatment that was started;
• if the infection gets to the site of the palate or tonsil, then this disease belongs to the category of angina ailments;
• in the acute form of stomatitis, the disease can progress to the chronic stage.
• Males are most often susceptible to infection at a young age, namely from 17 to 30 years. The season of exacerbation of the disease is observed in the autumn.

What predisposes to recurrent oral aphthae?

Perhaps the microflora of the oral cavity, herpes group viruses, and maybe Helicobacter pylori, a microorganism that causes stomach and duodenal ulcers, play some role.

Also influence:

• injuries to the oral mucosa
• stress
• deficiency of vitamins B12, B1
• vitamin D deficiency
• zinc deficiency
• poor oral hygiene
• nitrates in drinking water
• Sodium lauryl sulfate is a very popular surfactant in the industry, which is often added to toothpastes for better cleaning and foaming effect.
• food allergies (eg, cow's milk protein) or food hypersensitivity (cinnamon, coffee, chocolate, cheese, figs, pineapple, citrus fruits, some spices)
• non-steroidal anti-inflammatory drugs

It is very important to understand: recurrent aphthae is an independent disease (most often this happens) or a manifestation of some systemic disease.

The latter option is rare, but the doctor should always keep in mind the possibility of this situation.

Ulcerative-necrotizing stomatitis

Necrotizing ulcerative stomatitis is an infectious disease. Its causative agents are Vincent's spirochete and spindle-shaped rod. It can affect only the gums, cover the entire mucous membrane of the mouth, and spread to the tonsils.

Degree of damage

The diagnosis is made depending on the degree of damage to the mucous membrane:

• Vincent's gingivitis or gingivostomatitis (only the gums are affected).
• Stomatitis (gums and other areas of the oral cavity are affected).
• Vincent's tonsillitis (the pathological process spreads to the oral mucosa and involves the palatine tonsils).

Causes

The main reason for the development of the disease is improper oral hygiene. The causative agents of the disease are present in the oral microflora of all healthy people. If hygiene rules are not followed, their number increases, resulting in the development of a pathological process.

The rapid development of ulcerative necrotic stomatitis can also be provoked by a general weakening of the body’s immunity and resistance. For this reason, the disease often accompanies colds.

Other reasons that can cause the development of stomatitis include:

• Hypothermia.
• Overwork.
• Severe stress.
• Exhaustion as a result of insufficient nutrition (for example, with strict diets).

The risk of developing stomatitis increases with the presence of injuries to the mucous membrane. The risk group includes patients whose mucous membranes are constantly injured, for example, by tooth fragments, poorly placed fillings, dentures, etc. Often stomatitis occurs during the eruption of wisdom teeth, since the gums are severely injured during the process.

Despite the abundance of reasons that can lead to the development of necrotizing ulcerative stomatitis, careless hygiene and poor dental care remain the most common provoking factors. The likelihood of developing the disease increases if:

• Plaques and tartar.
• Inflammatory processes in periodontal canals.
• Chips and cracks, etc.

Depending on the nature of the disease, acute, subacute and chronic stomatitis are distinguished. The disease can occur in varying degrees of severity.

Symptoms

At the initial stages of the disease, both specific (bleeding, burning, dry mouth) and general symptoms (weakness, fever, joint pain) occur. Often the patient considers them to be signs of other pathologies and does not associate them with the inflammatory process in the mouth. The duration of this stage differs depending on the severity of the disease. The disease can progress quickly and the condition worsens in just a few hours. In a chronic course, the first stage can last several days.

As the pathological process develops, the general condition worsens, and the following symptoms appear:

• Sharp pain in the mouth.
• Difficulty moving the tongue.
• Increased salivation.
• The appearance of putrid odor from the mouth.

Gradually, lesions develop on the gums. Subsequently, they spread to other areas of the mucosa. The gums swell and turn red. Severe pain and bleeding occurs. It becomes almost impossible to eat. As the disease progresses, the gums become covered with gray necrotic tissue.

General health depends on the severity of the disease. In a mild form, the patient’s general condition remains normal, the ability to work remains, and the person can lead a normal life. A severe course is always accompanied by a strong increase in temperature. The ulcers are deep and can reach tendons and bones. In this form, stomatitis can lead to another serious disease - osteomyelitis.

If you have a problem similar to that described in this article, be sure to contact our specialists. Don't diagnose yourself!

Why you should call us now:

• We will answer all your questions in 3 minutes
• Free consultation

• The average work experience of doctors is 12 years
• Convenient location of clinics

Single contact phone number: +7

Make an appointment

Treatment

If signs of stomatitis appear, you should immediately consult a doctor. During diagnosis, the doctor examines necrotic ulcers, determines the depth and extent of the lesion. After this, treatment is prescribed.

During treatment, it is important to ensure thorough sanitation of the oral cavity. The disease must be treated comprehensively:

• Rinse with antiseptic solutions.
• Taking antihistamines.
• Taking general strengthening medications and vitamin C.
• Ointments and applications for the treatment of necrotic ulcers.
• Removal of necrotic tissue and dental plaque.

Surgical intervention is indicated in cases where the development of stomatitis was provoked by the eruption of wisdom teeth. If treatment is started correctly and in a timely manner, the entire process takes 6 days. If the patient does not receive the necessary treatment in time, complications, gangrenous processes, and irreversible changes in the bones and periodontium begin to develop.

If you have a problem similar to that described in this article, be sure to contact our specialists. Don't diagnose yourself!

Why you should call us now:

• We will answer all your questions in 3 minutes
• Free consultation

• The average work experience of doctors is 12 years
• Convenient location of clinics

Single contact phone number: +7

Make an appointment

Sources:

1. Personal experience as a periodontist;
2. Diseases of the teeth and oral cavity; GEOTAR-Media - Moscow, 2012;
3. Diseases of the oral mucosa; Phoenix - Moscow, 2007;
4. Clinical manifestations of infectious diseases in the oral cavity in patients with HIV infection; Publishing house of the Russian Peoples' Friendship University - Moscow, 2013;
5. Therapeutic dentistry. Diseases of the oral mucosa. In 3 parts. Part 3; GEOTAR-Media - Moscow, 2013;
6. Therapeutic dentistry. Diseases of the lacrimal membranes of the oral cavity. In 3 parts. Part 3: GEOTAR-Media Moscow, 2013;
7. Banchenko G.V., Rabinovich I.M. Syphilis and its manifestations and oral cavity. Clinic, diagnosis, treatment; Medical Information Agency - Moscow, 2008;
8. Bark K., Burgorf V., Hede N. Diseases of the mucous membrane of the oral cavity and lips. Knika. Diagnosis and treatment. Atlas and guide; Medical literature Moscow, 2011;
9. Brad W. Neville - Oral and Maxillofacial Pathology (2016).

What systemic diseases can manifest as aphthae?

• Reiter's syndrome
• Behçet's disease
• AIDS
• cyclic neutropenia
• PFAPA syndrome

The gastroenterologist is especially interested in the connection between recurrent ulcers and specialized systemic diseases.

Celiac disease is found in 5% , and for a long time canker sores may be the only manifestation of a reaction to gluten.

Let me remind you that the estimated prevalence of celiac disease in the general population is about 1%.

Enamel defects and aphthous stomatitis in celiac and healthy subjects: Systematic review and meta-analysis of controlled studies

Other important conditions that manifest as canker sores are inflammatory bowel diseases: Crohn's disease and ulcerative colitis.

Extraintestinal Manifestations of Pediatric Inflammatory Bowel Disease: Prevalence, Presentation, and Anti-TNF Treatment

What is stomatitis?

Stomatitis, which means “mouth” in ancient Greek, is the most common name for a group of diseases of the oral mucosa. The disease should not be confused with glossitis (damage to the tongue), cheilitis (damage to the lips) and palatinitis (damage to the palate). Stomatitis is not contagious, but almost every person has directly or indirectly encountered one or another type of the disease. Once you have been ill, the chance of recurrence of the disease is very high.

Correctly diagnosing stomatitis is difficult. The doctor often assesses the situation only visually - in medicine there are no special tests for this disease. The difficulty of diagnosing stomatitis also lies in the fact that it can be a symptom of more serious diseases.

What can help in finding the cause of aphthae?

A conversation sometimes helps to find out whether relatives have important diseases with a family predisposition - celiac disease, Crohn's disease, lupus erythematosus.

During the examination, the doctor can evaluate the general manifestations of the disease (not typical with ordinary recurrent aphthous stomatitis) and check for the presence of ulcers outside the oral cavity.

The simplest laboratory examination is carried out - this is most often enough.

A general blood test may show anemia due to deficiency of iron, folic acid, and vitamin B12.

The level of neutrophils is also assessed - their decrease may be a sign of the rare systemic disease cyclic neutropenia

A high ESR may be a sign of Crohn's disease and ulcerative colitis.

Serum iron levels may be reduced in up to 20% of recurrent canker sores.

Symptoms and types of disease

Necrotizing ulcerative stomatitis has three types: acute, subacute, chronic. Depending on the severity, there are mild, moderate and severe forms.

Stomatitis occurs in three phases: initial, active and resolution stages. At the very beginning, the patient complains of slight malaise. Then the onset of gingivitis can be diagnosed: it is characterized by bleeding gums and the development of hyperemia. The mucous membrane of the mouth becomes covered with ulcers, covered with a yellowish and then gray-green coating on top. Tissues affected by necrosis adhere so tightly to the surface that they begin to bleed when trying to remove them.

In a mild form of the disease, the lesion is limited. Moderate severity is associated with loss of performance due to constant poor health - nausea, dizziness and high fever.

If there is no timely treatment, the disease spreads to the bone tissue and osteomyelitis occurs.

Treatment of aphthous stomatitis.

There is no radical and quick treatment.

The main task of the doctor is to fight the pain caused by aphthae. This is especially important for young children, who may refuse to eat or drink due to pain and become easily dehydrated.

For this purpose, local painkillers and drugs are used that form protective films on the aphthae.

The second goal is to speed up healing.

The most popular drugs for healing are anti-inflammatory corticosteroids for aphthae, in rare, especially severe situations - even orally for a short course (prednisolone tablets).

The third task is to avoid or at least reduce the frequency of recurrent aphthae.

For some people, regular intake of vitamins (especially B12), zinc, and iron helps.

Avoiding oral hygiene products containing lauryl sulfate may be helpful.

Together with your dental hygienist, you can consider ways to improve your oral hygiene.

A gluten-free diet will help with celiac disease.

Treatment methods for stomatitis

In order to successfully get rid of the disease, it is best to perform sanitation of the oral cavity. After eliminating the pain, doctors can begin to remove ulcers and unwanted deposits. In practice, a course of antibiotics is most often prescribed. So, an adult should drink about 4-5 tablets a day; for a child this norm is reduced to one. Also effective methods of treating the disease include:

• antiseptic substances
  - it is recommended to rinse your mouth with them at least 4 times a day;
• trichopolum
  - for optimal treatment, it is enough to take half a gram per day;
• antihistamine therapy
  - this method helps to suppress microbial sensitization;
• in the vitamin complex
  - to maintain the tone of the body, as well as strengthen it, it is recommended to consume vitamin C at least one and a half grams per day;
• keratoplastic ointment
  - it is used to lyse infectious plaque.

Conclusions:

Aphthae in the mouth recur at some point in life in almost 20% of all people, most often in the second decade of life.

It is difficult to establish a clear and unambiguous reason.

If recurrent aphthae occurs, the pediatrician, physician, or dentist should consider the possibility that rare aphthae are a manifestation of a serious systemic disease.

In such situations, the gastroenterologist must exclude celiac disease, Crohn's disease and ulcerative colitis.

4, total, today

Types of ulcerative stomatitis

Necrotizing ulcerative stomatitis can be acute or chronic. The acute phase usually lasts ten to fifteen days. Proper treatment during this period accelerates the healing process and prevents relapses. The pain goes away, the damaged areas are cleared of dead tissue, granulation and healing of the ulcers occurs. However, with self-medication at home or a complete lack of therapy in an already healed area, Vincent's stomatitis can resume and become chronic.

In this case, the disease progresses slowly, with mild symptoms, and virtually no pain. The main complaints are related to bleeding gums, increased salivation and putrid breath. Also, with chronic ulcerative-necrotic stomatitis, areas with congestive swelling, redness, ulceration and necrosis of the gums in the interdental spaces are visible on the mucous membrane. At an advanced stage, probing the gum edge reveals exposed gum bone. In addition, in adults, complications of necrotizing ulcerative stomatitis such as inflammation of the middle ear, chronic runny nose, inflammation of the genital tract, gastroenteritis, etc. are possible.