Causes of Gingivostomatitis
Gingivostomatitis Causes: Book Excerpts
Gingivostomatitis as a symptom:
Conditions listing Gingivostomatitis
as a symptom may also be potential underlying causes of Gingivostomatitis.
Our database lists the following as having
Gingivostomatitis as a symptom of that condition:
Related information on causes of Gingivostomatitis:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Gingivostomatitis may be found in:
Causes of Gingivostomatitis: Online Medical Books
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Oral Lesions:
Differential Diagnosis
(In a Page: Signs and Symptoms)
-
Aphthous stomatitis
–Idiopathic
–Recurrent, shallow, painful, spontaneously
resolving oral ulcers -
Herpes stomatitis
–Due to a primary outbreak of HSV-1
–Severe gingivostomatitis with pain, redness,
and erosions around the gum line
–Recurrent oral HSV (“cold sores”) often occur at the lip border
–Stress, sun exposure, and many other factors contribute to flare-ups
-
Self-limited viral disease (e.g., herpangina,
hand-foot-mouth disease)
–Most often seen in children
–Prodrome of malaise and fever followed by
a 5–10 day outbreak of oropharyngeal erosions or vesicles is common
-
Chemotherapy drugs (especially 5-FU and methotrexate)
-
Squamous cell carcinoma should always be considered if a nonhealing ulcer or oral erosion is noted
-
Bullous diseases (e.g., pemphigoid,
pemphigus, lichen planus)
–Recurrent painful oral ulcers and erosions
–Evaluate for other skin rashes suggestive of
these disorders
-
Behçet syndrome
–Uncommon but well-known cause of oral ulcers
–Patients must exhibit other symptoms (e.g., uveitis, CNS problems, GI complaints, genital ulcers) before this diagnosis can be made
-
Allergic contact dermatitis to amalgams in dental work may result in buccal tenderness
-
Erythema multiforme (Stevens-Johnson syndrome)
–Characterized by oral ulcers, ocular involvement, and simultaneous targetoid, erythematous, or bullous skin lesions
–May be triggered by HSV infection, Mycoplasma infection, or drugs (e.g., phenytoin, sulfonamides)
-
Primary syphilis
–Painless chancre
-
Agranulocytosis or leukopenia
-
Histoplasmosis (especially in immunosuppressed patients)
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Stomatitis:
Differential Diagnosis
(In a Page: Signs and Symptoms)
- Aphthous stomatitis is the most common cause of recurrent oral lesions
–Presents as gray-yellow tender ulcer in anterior part of oral cavity
–Major, minor, and herpetiform subtypes
–Herpetiform ulcers: Multiple vesicles on tip
or sides of tongue
- Infectious stomatitis
–Herpes simplex virus may present as a primary infection (herpetic gingivostomatitis) with ulcers/vesicles in anterior oropharynx or as a secondary infection with “fever blisters” on lips
–Herpangina: Caused by coxsackievirus; results in 1–2 mm vesicles on soft palate that rupture to become white ulcers; seen primarily in children, may be associated with palmar and plantar lesions in hand-foot-and-mouth disease
–Syphilis (condyloma lata) results in painless oral chancres on lips, buccal mucosa, gingival
–Varicella or chicken pox
–Condylomata acuminata (warts) and molluscum contagiosum lesions resemble their characteristic genital lesions
–Primary HIV infection
–Candidiasis
- Stomatitis in immunocompromised patients
–Breakdown in epithelium results in superinfection by Candida, HSV, VZV, or CMV
–May occur secondary to chemotherapy - Stevens-Johnson syndrome
- Gangrenous stomatitis (acute necrotizing ulcerative gingivitis)
–Also known as “trench mouth”
–Primarily affects children with severe
malnourishment or debilitation
–Causative agent is most commonly a spirochete (e.g., Borrelia vincentii)
–Presents as painful, red vesicle on gingiva; progresses to necrotic ulcer, then cellulitis
-
Chronic granulomatous disease
-
Behçet syndrome (presents as recurrent oral and genital ulcers)
-
Lichen planus
-
Vitamin C deficiency
-
Cancers (e.g., mouth cancer, leukemia, mucositis following chemotherapy)
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Stomatitis:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
- Aphthous ulcers (idiopathic)
–May be due to alteration of T-cell immune function
–Triggers include dietary substances, stress, and illness
–Nutritional deficiencies (iron, B vitamins) may play a role
–May run in families, thus making it more difficult to distinguish from herpetic lesions that have been shared among family members
–May be small or large, may be singular or grouped
- Infectious stomatitis
–Coxsackievirus: Also known as hand-footand-mouth disease; all locations of lesions may not be present; usually seen in the summer and fall
–Herpetic gingivostomatitis: Common in toddlers; may last a week or longer; generally accompanied by fever, lymphadenopathy; painful lesions may cause reduction in oral intake and resultant dehydration
–Herpangina: Caused by an enterovirus rather than human herpesvirus; lesions are present primarily on the soft palate, anterior tonsillar pillars, and posterior pharynx
–Trench mouth: also known as Vincent angina; caused by fusiform bacteria or spirochetes; causes necrotizing gingivostomatitis with pseudomembrane formation; found in developing nations and malnourished patients
-
Hematologic disorders
–Associated with leukemia
–Associated with neutropenia secondary to
chemotherapy for malignancy
–Associated with cyclic neutropenia
-
Behçet disease
-
Stevens-Johnson syndrome
-
Inflammatory bowel disease: May be found in Crohn disease or ulcerative colitis
-
HIV
–Alterations in T-cell immunity can lead to aphthous ulcers
–HIV patients are more susceptible to herpetic infections
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Stomatitis and other oral infections:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Acute herpetic stomatitis results from the herpes simplex virus. It’s common in children ages 1 to 3. The cause of aphthous stomatitis is unknown, but predisposing factors include stress, fatigue, anxiety, febrile states, trauma, and solar overexposure. This type is common in girls and female adolescents.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Oral Lesions:
Differential Overview
(Field Guide to Bedside Diagnosis)
Ulceration
❑ Aphthous ulcers
❑ Angular cheilitis
❑ Herpes simplex
❑ Traumatic ulcers
❑ Impetigo
❑ Erythema multiforme
❑ Mucositis
❑ Lichen planus
❑ Squamous cell cancer
❑ Syphilis
❑ Coxsackievirus A
❑ Herpes zoster
❑ Primary HIV
❑ Crohn disease
❑ Behçet syndrome
❑ Acute leukemia
❑ Pemphigoid
Glossitis
❑ Vitamin B12 deficiency
❑ Folate deficiency
❑ Niacin deficiency
❑ Riboflavin deficiency
❑ Leukoplakia
❑ Candida
❑ Geographic tongue
❑ Black hairy tongue
❑ Scarlet fever
❑ Kwashiorkor
❑ Polyarteritis nodosa
Macroglossia
❑ Myxedema
❑ Angioedema
❑ Acromegaly
❑ Amyloidosis
Clinical Findings
Aphthous ulcers They occur on nonkeratinized mucosa as single lesions or clusters of small, shallow, painful, clearly defined ulcers with an erythematous halo and a white base. There are usually no systemic symptoms or lymphadenopathy. These ulcers stereotypically recur.
Angular cheilitis Tender fissuring at the corner of the mouth can be caused by Candida and either iron or vitamin B12 deficiency.
Herpes simplex An acute outbreak consists of labial vesicles that rupture and crust, and intraoral vesicles that quickly ulcerate. The lesions are usually quite painful and associated with fever, malaise, pharyngitis, and tender cervical lymphadenopathy. Recurrent lesions usually occur at the vermilion border and are preceded by localized burning dysesthesias.
Traumatic ulcers These ulcers occur at the bite margin or adjacent to dentures.
Impetigo Perioral painful shallow erosions spread rapidly. They are red and weeping, with honey-colored crusts.
Erythema multiforme The onset is rapid and progresses to systemic toxicity. Intraoral ruptured bullae surrounded by erythema become painful mucosal erosions with gray exudate. Hemorrhagic crusts appear on the lips. An extensive maculopapular rash develops on the extensor surfaces and is characterized by target and polycyclic lesions and persisting urticarial plaques. Target lesions on the hands and feet are pathognomonic.
Mucositis Initially there is a burning with diffuse mucosal redness and shininess that progresses to painful ulcers, then the tongue and buccal mucosa become denuded. There may also be a yellow pseudomembrane or hemorrhagic crust. This condition is found with Stevens-Johnson syndrome, agranulocytosis, and cancer chemotherapy.
Lichen planus Lacy mucosal striae break down into painful erosions. This is often associated with drugs such as chloroquine, furosemide, gold, lithium, methyldopa, phenothiazines, propranolol, quinidine, spironolactone, tetracycline, or thiazides.
Squamous cell cancer The ulcer is painless, malodorous, and indolent. It arises in an area of leukoplakia, bleeds easily, and has an elevated, indurated border. The presenting symptom is often pain, which may be referred to the ear, or dysphonia.
Syphilis A primary chancre is a painless ulcer with an indurated copper border and unilateral lymphadenopathy. Secondary lesions are linear “snail track” ulcers and gray mucous patches on the lips, tonsils, and palate. There is concurrent generalized rash and fever. A tertiary gumma is a firm, broad, ulcerated plaque that may produce palatal perforation.
Coxsackievirus A Herpangina presents with fever, sore throat, and grayish-white vesicles with a red halo, which quickly ulcerate. Hand, foot, and mouth disease (A16) has similar pharyngeal lesions accompanied by other lesions in the forenamed distribution.
Herpes zoster A vesicular eruption with ulceration stops at the midline. Vesicles will also be present on the lower midface. Burning pain is characteristic.
Primary HIV The most common presentation is a febrile mononucleosislike illness. Acute gingivitis and ulceration may be part of the spectrum.
Crohn disease Oral ulcers may occur when intestinal disease is active, with symptoms of diarrhea, mucus, and blood.
Behçet syndrome Multiple aphthous ulcers of the mouth occur with uveitis and genital ulcers.
Acute leukemia Gingival swelling and superficial ulceration occur; hyperplasia, hemorrhage, and necrosis ensue. Deep ulcers may occur elsewhere on the mucosa, and they often become secondarily infected.
Pemphigoid Painful grayish-white collapsed vesicles or bullae ulcerate when on the gingiva. Bullae may also involve the eyes, urethra, vagina, or rectum.
Vitamin B12 deficiency The tongue is beefy red, smooth, edematous, and painful. Pinpoint dots occur as a result of hyperemic capillaries and atrophied papillae. Peripheral neuropathy is commonly concurrent.
Folate deficiency It is similar in presentation to B12 deficiency but occurs more rapidly with nutritional depletion (e.g., alcoholics).
Niacin deficiency Pellagra produces a burning sensation with hot or spicy food, without a visible abnormality early in the course. Later there is an increase in papilla and redness of the tongue’s tip and sides, and then fiery redness and swelling with desquamation occur. It is associated with severe watery diarrhea, red skin eruptions, and confusion.
Riboflavin deficiency When advanced, the tongue looks magenta. Associated findings include a “shark skin” nose and conjunctival injection.
Leukoplakia Early lesions are thin, pearly, and crinkled, especially on the lateral border of the tongue. A white-gray thickened epithelium without papillae appears later. Oral hairy leukoplakia is a sentinel finding of HIV infection, and is caused by concurrent EBV infection.
Candida The tongue is bright red with cottage cheese-like material on the surface. Predisposing conditions include diabetes, dentures, recent antibiotics, or chemotherapy. In the absence of these factors, or severe or recalcitrant disease, HIV should be considered.
Geographic tongue The surface has a changing demarcated pattern. There may be oral discomfort or burning. This finding is present in serious illness with antibiotic use.
Black hairy tongue Elongated filiform papillae which may be discolored a yellow to brownish tone create the appearance. Associated conditions include antibiotic use, oral candidiasis, and poor oral hygeine.
Scarlet fever A “strawberry tongue” occurs in a patient with a confluent rash that has the texture of fine sandpaper.
Kwashiorkor Glossitis occurs early and is later accompanied by generalized edema and ascites.
Polyarteritis nodosa The patient presents with a diffusely inflamed, orange-red tongue that has a burning sensation.
Myxedema In addition to tongue enlargement, facial and pretibial skin is coarse, the voice is low and husky, and the relaxation phase of the deep tendon reflexes is delayed.
Angioedema Acute edema of tissues frequently includes the tongue. Similar findings may occur with food allergies (e.g., shellfish), drug reactions (penicillin), and serum sickness.
Acromegaly Tissues are generally thickened, and tongue enlargement is associated with jaw protrusion, malocclusion, and teeth that are widely spaced and tilt outward.
Amyloidosis Tongue enlargement occurs with enlargement of other viscera and with peripheral neuropathy.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Stomatitis and other oral infections:
Causes
(Handbook of Diseases)
Acute herpetic stomatitis results from herpes simplex virus. The cause of aphthous stomatitis is unclear.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
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