Causes of Glossitis
List of causes of Glossitis
Following is a list of causes or underlying conditions
(see also Misdiagnosis of underlying causes of Glossitis)
that could possibly cause Glossitis includes:
More causes:
see full list of causes for Glossitis
Causes of Glossitis (Diseases Database):
The follow list shows some of the possible medical causes of Glossitis
that are listed by the Diseases Database:
Source: Diseases Database
Glossitis Causes: Book Excerpts
Glossitis as a symptom:
Conditions listing Glossitis
as a symptom may also be potential underlying causes of Glossitis.
Our database lists the following as having
Glossitis as a symptom of that condition:
Related information on causes of Glossitis:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Glossitis may be found in:
Causes of Glossitis: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the causes of Glossitis.
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
Mouth lesions:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Acquired immunodeficiency syndrome (AIDS)
Oral lesions may be an early indication of the immunosuppression that’s characteristic of AIDS. Fungal infections can occur, with oral candidiasis being the most common. Bacterial or viral infections of the oral mucosa, tongue, gingivae, and periodontal tissue may also occur.
The primary oral neoplasm associated with AIDS is Kaposi’s sarcoma. The tumor is usually found on the hard palate and may appear initially as an asymptomatic, flat or raised lesion, ranging in color from red to blue to purple. As these tumors grow, they may ulcerate and become painful.
Actinomycosis (cervicofacial)
Actinomycosis is a chronic fungal infection that typically produces small, firm, flat, and usually painless swellings on the oral mucosa and under the skin of the jaw and neck. Swellings may indurate and abscess, producing fistulas and sinus tracts with a characteristic purulent yellow discharge.
Behçet’s syndrome
Behçet’s syndrome is a chronic, progressive syndrome that generally affects young males and produces small, painful ulcers on the lips, gums, buccal mucosa, and tongue. In severe cases, the ulcers also develop on the palate, pharynx, and esophagus. The ulcers typically have a reddened border and are covered with a gray or yellow exudate. Similar lesions appear on the scrotum and penis or labia majora; small pustules or papules on the trunk and limbs; and painful erythematous nodules on the shins. Ocular lesions may also develop.
Candidiasis
Candidiasis is a common fungal infection that characteristically produces soft, elevated plaques on the buccal mucosa, tongue, and sometimes the palate, gingivae, and floor of the mouth; the plaques may be wiped away. The lesions of acute atrophic candidiasis are red and painful. The lesions of chronic hyperplastic candidiasis are white and firm. Localized areas of redness, pruritus, and a foul odor may be present.
Discoid lupus erythematosus
Oral lesions are common, typically appearing on the tongue, buccal mucosa, and palate as erythematous areas with white spots and radiating white striae. Associated findings include skin lesions on the face, possibly extending to the neck, ears, and scalp; if the scalp is involved, alopecia may result. Hair follicles are enlarged and filled with scale.
Gender Cue:This chronic, recurrent disease is most common in women ages 30 to 40.
Erythema multiforme
Erythema multiforme is an acute inflammatory skin disease that produces a sudden onset of vesicles and bullae on the lips and buccal mucosa. Also, erythematous macules and papules form symmetrically on the hands, arms, feet, legs, face, and neck and, possibly, in the eyes and on the genitalia. Lymphadenopathy may also occur. With visceral involvement, other findings include a fever, malaise, a cough, throat and chest pain, vomiting, diarrhea, myalgia, arthralgia, fingernail loss, blindness, hematuria, and signs of renal failure.
Gingivitis (acute necrotizing ulcerative)
Gingivitis is a recurring periodontal condition that causes a sudden onset of gingival ulcers covered with a grayish white pseudomembrane. Other findings include tender or painful gingivae, intermittent gingival bleeding, halitosis, enlarged lymph nodes in the neck, and a fever.
Herpes simplex I
With primary infection, a brief period of prodromal tingling and itching, which is accompanied by a fever and pharyngitis, is followed by eruption of small and irritating vesicles on part of the oral mucosa, especially the tongue, gums, and cheeks. Vesicles form on an erythematous base and then rupture, leaving a painful ulcer, followed by a yellowish crust. Other findings include submaxillary lymphadenopathy, increased salivation, halitosis, anorexia, and keratoconjunctivitis.
Herpes zoster
Herpes zoster is a common viral infection that may produce painful vesicles on the buccal mucosa, tongue, uvula, pharynx, and larynx. Small red nodules typically erupt unilaterally around the thorax or vertically on the arms and legs, and rapidly become vesicles filled with clear fluid or pus; vesicles dry and form scabs about 10 days after eruption. A fever and general malaise accompany pruritus, paresthesia or hyperesthesia, and tenderness along the course of the involved sensory nerve.
Inflammatory fibrous hyperplasia
Inflammatory fibrous hyperplasia is a painless nodular swelling of the buccal mucosa that typically results from cheek trauma or irritation and is characterized by pink, smooth, pedunculated areas of soft tissue.
Leukoplakia, erythroplakia
Leukoplakia is a white lesion that can’t be removed simply by rubbing the mucosal surface — unlike candidiasis. It may occur in response to chronic irritation from dentures or from tobacco or pipe smoking, or it may represent dysplasia or early squamous cell carcinoma.
Erythroplakia is red and edematous and has a velvety surface. About 90% of all cases of erythroplakia are either dysplasia or cancer.
Pemphigoid (benign mucosal)
Pemphigoid is a rare autoimmune disease that’s characterized by thick-walled vesicles on the oral mucous membranes, the conjunctiva and, less commonly, the skin. Mouth lesions typically develop months or even years before other manifestations and may occur as desquamative patchy gingivitis or as a vesicobullous eruption. Secondary fibrous bands may lead to dysphagia, hoarseness, and blindness. Recurrent skin lesions include vesicobullous eruptions, usually on the inguinal area and extremities, and an erythematous, vesicobullous plaque on the scalp and face near the affected mucous membranes.
Pemphigus
Pemphigus is a chronic skin disease that’s characterized by thin-walled vesicles and bullae that appear in cycles on skin or mucous membranes that otherwise appear normal. On the oral mucosa, bullae rupture, leaving painful lesions and raw patches that bleed easily. Associated findings include bullae anywhere on the body, denudation of the skin, and pruritus.
Pyogenic granuloma
Typically the result of injury, trauma, or irritation, pyogenic granuloma — a soft, tender nodule, papule, or polypoid mass of excessive granulated tissue — usually appears on the gingivae, but can also erupt on the lips, tongue, or buccal mucosa. The lesions bleed easily because they contain many capillaries. The affected area may be smooth or have a warty surface; erythema develops in the surrounding mucosa. The lesions may ulcerate, producing a purulent exudate.
Squamous cell carcinoma
Squamous cell carcinoma is typically a painless ulcer with an elevated, indurated border. It may erupt in areas of leukoplakia and is most common on the lower lip, but it may also occur on the edge of the tongue or floor of the mouth. High risk factors include chronic smoking and alcohol intake.
Stomatitis (aphthous)
Stomatitis, a common disease, is characterized by painful ulcerations of the oral mucosa, usually on the dorsum of the tongue, gingivae, and hard palate.
With recurrent aphthous stomatitis minor, the ulcer begins as one or more erosions covered by a gray membrane and surrounded by a red halo. It’s commonly found on the buccal and lip mucosa and junction, tongue, soft palate, pharynx, gingivae, and all places not bound to the periosteum.
With recurrent aphthous stomatitis major, large, painful ulcers commonly occur on the lips, cheek, tongue, and soft palate; they may last up to 6 weeks and leave a scar.
Syphilis
Primarysyphilis typically produces a solitary painless, red ulcer (chancre) on the lip, tongue, palate, tonsil, or gingivae. The ulcer appears as a crater with undulated, raised edges and a shiny center; lip chancres may develop a crust. Similar lesions may appear on the fingers, breasts, or genitals, and regional lymph nodes may become enlarged and tender.
During the secondary stage, multiple painless ulcers covered by a grayish white plaque may erupt on the tongue, gingivae, or buccal mucosa. A macular, papular, pustular, or nodular rash appears, usually on the arms, trunk, palms, soles, face, and scalp; genital lesions usually subside. Other findings include generalized lymphadenopathy, a headache, malaise, anorexia, weight loss, nausea, vomiting, a sore throat, a low-grade fever, metrorrhagia, and postcoital bleeding.
At the tertiarystage, lesions (usually gummas — chronic, painless, superficial nodules or deep granulomatous lesions) develop on the skin and mucous membranes, especially the tongue and palate.
Systemic lupus erythematosus
Oral lesions are common and appear as erythematous areas associated with edema, petechiae, and superficial ulcers with a red halo and a tendency to bleed. Primary effects include nondeforming arthritis, a butterfly rash across the nose and cheeks, and photosensitivity.
Other causes
Drugs
Various chemotherapeutic agents can directly produce stomatitis. Also, allergic reactions to penicillin, sulfonamides, gold, quinine, streptomycin, phenytoin, aspirin, and barbiturates commonly cause lesions to develop and erupt. Inhaled steroids used for pulmonary disorders can also cause oral lesions.
Radiation therapy
Radiation therapy may cause oral lesions.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
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
Mouth lesions:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Acquired immunodeficiency syndrome (AIDS)
Oral lesions may be an early indication of the immunosuppression that’s characteristic of this disease. Fungal infections can occur, with oral candidiasis being the most common. Bacterial or viral infections of oral mucosa, tongue, gingivae, and periodontal tissue may also occur.
The primary oral neoplasm associated with AIDS is Kaposi’s sarcoma. The tumor is usually found on the hard palate and may appear initially as an asymptomatic, flat or raised lesion, ranging in color from red to blue to purple. As these tumors grow, they may ulcerate and become painful.
Actinomycosis (cervicofacial)
This chronic fungal infection typically produces small, firm, flat, usually painless swellings on the oral mucosa and under the skin of the jaw and neck. Swellings may indurate and abscess, producing fistulas and sinus tracts with a characteristic purulent yellow discharge.
Behçet’s syndrome
This chronic, progressive syndrome that generally affects young males produces small, painful ulcers on the lips, gums, buccal mucosa, and tongue. In severe cases, the ulcers also develop on the palate, pharynx, and esophagus. The ulcers typically have a reddened border and are covered with a gray or yellow exudate. Similar lesions appear on the scrotum and penis or labia majora; small pustules or papules on the trunk and limbs; and painful erythematous nodules on the shins. Ocular lesions may also develop.
Candidiasis
This common fungal infection characteristically produces soft, elevated plaques on the buccal mucosa, tongue, and sometimes the palate, gingivae, and floor of the mouth; the plaques may be wiped away. The lesions of acute atrophic candidiasis are red and painful. The lesions of chronic hyperplastic candidiasis are white and firm. Localized areas of redness, pruritus, and foul odor may be present.
Discoid lupus erythematosus
Oral lesions are common, typically appearing on the tongue, buccal mucosa, and palate as erythematous areas with white spots and radiating white striae. Associated findings include skin lesions on the face, possibly extending to the neck, ears, and scalp; if the scalp is involved, alopecia may result. Hair follicles are enlarged and filled with scale.
Gender Cue: This chronic, recurrent disease is most common in women ages 30 to 40.
Epulis (giant cell)
This rare tumor or growth occurs on the gingival or alveolar process, anterior to the molars. Dark red, pedunculated or sessile, and 0.5 to 1.5 cm in diameter, it commonly ulcerates to produce a concave defect in the underlying bone. Gingivae bleed easily with slight trauma.
Erythema multiforme
This acute inflammatory skin disease produces sudden onset of vesicles and bullae on the lips and buccal mucosa. Also, erythematous macules and papules form symmetrically on the hands, arms, feet, legs, face, and neck and, possibly, in the eyes and on the genitalia. Lymphadenopathy may also occur. With visceral involvement, other findings include fever, malaise, cough, throat and chest pain, vomiting, diarrhea, myalgias, arthralgias, fingernail loss, blindness, hematuria, and signs of renal failure.
Gingivitis (acute necrotizing ulcerative)
This recurring periodontal condition causes a sudden onset of gingival ulcers covered with a grayish white pseudomembrane. Other findings include tender or painful gingivae, intermittent gingival bleeding, halitosis, enlarged lymph nodes in the neck, and fever.
Gonorrhea
Painful lip ulcerations may occur, along with rough, reddened, bleeding gingivae (possibly necrotic and covered by a yellowish pseudomembrane), and a swollen, ulcerated tongue. Related effects vary. Most men develop dysuria, purulent urethral discharge, and a reddened, edematous urinary meatus. Most women remain asymptomatic, but others develop inflammation and a greenish yellow cervical discharge.
Herpes simplex 1
With primary infection, a brief period of prodromal tingling and itching, which is accompanied by fever and pharyngitis, is followed by eruption of small and irritating vesicles on any part of the oral mucosa, especially the tongue, gums, and cheeks. Vesicles form on an erythematous base and then rupture, leaving a painful ulcer, followed by a yellowish crust. Other findings include submaxillary lymphadenopathy, increased salivation, halitosis, anorexia, and keratoconjunctivitis.
Herpes zoster
This common viral infection may produce painful vesicles on the buccal mucosa, tongue, uvula, pharynx, and larynx. Small red nodules often erupt unilaterally around the thorax or vertically on the arms and legs, and rapidly become vesicles filled with clear fluid or pus; vesicles dry and form scabs about 10 days after eruption. Fever and general malaise accompany pruritus, paresthesia or hyperesthesia, and tenderness along the course of the involved sensory nerve.
Inflammatory fibrous hyperplasia
This painless nodular swelling of the buccal mucosa typically results from cheek trauma or irritation and is characterized by pink, smooth, pedunculated areas of soft tissue.
Leukoplakia, erythroplakia
Leukoplakia is a white lesion that cannot be removed simply by rubbing the mucosal surface—unlike candidiasis. It may occur in response to chronic irritation from dentures or tobacco or pipe smoking, or it may represent dysplasia or early squamous cell carcinoma.
Erythroplakia is red and edematous and has a velvety surface. About 90% of all cases of erythroplakia are either dysplasia or cancer.
Lichen planus
Oral lesions develop on the buccal mucosa or, less commonly, on the tongue as painless, white or gray, velvety, threadlike papules. These precede the eruption of violet papules with white lines or spots, usually on the genitalia, lower back, ankles, and anterior lower legs; pruritus; nails with longitudinal ridges; and alopecia.
Mucous duct obstruction
Obstruction produces a ranula—a painless, slow-growing mucocele on the floor of the mouth near the ducts of the submandibular and sublingual glands.
Pemphigoid (benign mucosal)
This rare autoimmune disease is characterized by thick-walled vesicles on the oral mucous membranes, the conjunctiva and, less often, the skin. Mouth lesions typically develop months or even years before other manifestations and may occur as desquamative patchy gingivitis or as a vesicobullous eruption. Secondary fibrous bands may lead to dysphagia, hoarseness, and blindness. Recurrent skin lesions include vesicobullous eruptions, usually on the inguinal area and extremities, and an erythematous, vesicobullous plaque on the scalp and face near the affected mucous membranes.
Pemphigus
This chronic skin disease is characterized by thin-walled vesicles and bullae that appear in cycles on skin or mucous membranes that otherwise appear normal. On the oral mucosa, bullae rupture, leaving painful lesions and raw patches that bleed easily. Associated findings include bullae anywhere on the body, denudation of the skin, and pruritus.
Pyogenic granuloma
Commonly the result of injury, trauma, or irritation, this soft, tender nodule, papule, or polypoid mass of excessive granulation tissue usually appears on the gingivae but can also erupt on the lips, tongue, or buccal mucosa. The lesions bleed easily because they contain many capillaries. The affected area may be smooth or have a warty surface; erythema develops in the surrounding mucosa. The lesions may ulcerate, producing a purulent exudate.
Squamous cell carcinoma
This is typically a painless ulcer with an elevated, indurated border. It may erupt in areas of leukoplakia and is most common on the lower lip, but it may also occur on the edge of the tongue or the floor of the mouth. High risk factors include chronic smoking and alcohol intake.
Stomatitis (aphthous)
This common disease is characterized by painful ulcerations of the oral mucosa, usually on the dorsum of the tongue, gingivae, and hard palate.
With recurrent aphthous stomatitis minor, the ulcer begins as one or more erosions covered by a gray membrane and surrounded by a red halo. It’s commonly found on the buccal and lip mucosa and junction, tongue, soft palate, pharynx, gingivae, and all places not bound to the periosteum.
With recurrent aphthous stomatitis major, large, painful ulcers commonly occur on the lips, cheek, tongue, and soft palate; they may last up to 6 weeks and leave a scar.
Syphilis
Primary syphilis typically produces a solitary painless, red ulcer (chancre) on the lip, tongue, palate, tonsil, or gingivae. The ulcer appears as a crater with undulated, raised edges and a shiny center; lip chancres may develop a crust. Similar lesions may appear on the fingers, breasts, or genitals, and regional lymph nodes may become enlarged and tender.
During the secondary stage, multiple painless ulcers covered by a grayish white plaque may erupt on the tongue, gingivae, or buccal mucosa. A macular, papular, pustular, or nodular rash appears, usually on the arms, trunk, palms, soles, face, and scalp; genital lesions usually subside. Other findings include generalized lymphadenopathy, headache, malaise, anorexia, weight loss, nausea, vomiting, sore throat, low fever, metrorrhagia, and postcoital bleeding.
At the tertiarystage, lesions (often chronic, painless, superficial nodules or deep granulomatous lesions, called gummas) develop on the skin and mucous membranes, especially the tongue and palate.
Systemic lupus erythematosus
Oral lesions are common and appear as erythematous areas associated with edema, petechiae, and superficial ulcers with a red halo and a tendency to bleed. Primary effects include nondeforming arthritis, butterfly rash across the nose and cheeks, and photosensitivity.
Trauma
The most common cause of oral lesions, trauma can produce ulcers anywhere in the mouth, especially on the tongue and buccal mucosa.
Tuberculosis (oral mucosal)
This rare disorder produces a painless ulcer (usually on the tongue) and, sometimes, caseation. Other findings include lymphadenopathy, fatigue, weakness, anorexia, weight loss, cough, low fever, and night sweats.
Other causes
Drugs
Various chemotherapeutic agents can directly produce stomatitis. Also, allergic reactions to penicillin, sulfonamides, gold, quinine, streptomycin, phenytoin, aspirin, and barbiturates commonly cause lesions to develop and erupt. Inhaled steroids used for pulmonary disorders can also cause oral lesions.
Orthodontics
The rubbing of orthodontic equipment or prosthesis on the buccal mucosa may cause eroded, tender areas.
Radiation therapy
Radiation therapy may cause oral lesions.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
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
Mouth lesions:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Acquired immunodeficiency syndrome
Oral lesions may be an early indication of the immunosuppression that’s characteristic of acquired immunodeficiency syndrome (AIDS). Fungal infections can occur, with oral candidiasis being the most common. Bacterial or viral infections of oral mucosa, tongue, gingivae, and periodontal tissue may also occur.
The primary oral neoplasm associated with AIDS is Kaposi’s sarcoma. The tumor is usually found on the hard palate. Initially producing no symptoms, it may appear as a flat or raised lesion, ranging in color from red to blue to purple. As these tumors grow, they may ulcerate and become painful.
Candidiasis
Candidiasis, a common fungal infection, characteristically produces soft, elevated plaques on the buccal mucosa, tongue, and sometimes the palate, gingivae, and floor of the mouth; the plaques may be wiped away. The lesions of acute atrophic candidiasis are red and painful. The lesions of chronic hyperplastic candidiasis are white and firm. Localized areas of redness, pruritus, and foul odor may be present.
Discoid lupus erythematosus
Oral lesions are common in discoid lupus erythematosus. They typically appear on the tongue, buccal mucosa, and palate as erythematous areas with white spots and radiating white striae. Associated findings include skin lesions on the face, possibly extending to the neck, ears, and scalp; if the scalp is involved, alopecia may result. Hair follicles are enlarged and filled with scale.
Erythema multiforme
Erythema multiforme, an acute inflammatory skin disease, produces sudden onset of vesicles and bullae on the lips and buccal mucosa. Also, erythematous macules and papules form symmetrically on the hands, arms, feet, legs, face, and neck and, possibly, in the eyes and on the genitalia. Lymphadenopathy may also occur. With visceral involvement, other findings include fever, malaise, cough, throat and chest pain, vomiting, diarrhea, myalgia, arthralgia, fingernail loss, blindness, hematuria, and signs of renal failure.
Gingivitis (acute necrotizing ulcerative)
Gingivitis, a recurring periodontal condition, causes a sudden onset of gingival ulcers covered with a grayish white pseudomembrane. Other findings include tender or painful gingivae, intermittent gingival bleeding, halitosis, enlarged lymph nodes in the neck, and fever.
Gonorrhea
With gonorrhea, painful lip ulcerations may occur, along with rough, reddened, bleeding gingivae (possibly necrotic and covered by a yellowish pseudomembrane), and a swollen, ulcerated tongue. Related effects vary. Most men develop dysuria, purulent urethral discharge, and a reddened, edematous urinary meatus. Most women remain asymptomatic, but others develop inflammation and a greenish yellow cervical discharge.
Herpes simplex 1
With primary herpes simplex infection, a brief period of prodromal tingling and itching, which is accompanied by fever and pharyngitis, is followed by eruption of small and irritating vesicles on any part of the oral mucosa, especially the tongue, gums, and cheeks. Vesicles form on an erythematous base and then rupture, leaving a painful ulcer, followed by a yellowish crust. Other findings include submaxillary lymphadenopathy, increased salivation, halitosis, anorexia, and keratoconjunctivitis.
Herpes zoster
Herpes zoster is a common viral infection that may produce painful vesicles on the buccal mucosa, tongue, uvula, pharynx, and larynx. Small, red nodules usually erupt unilaterally around the thorax or vertically on the arms and legs and rapidly become vesicles filled with clear fluid or pus; vesicles dry and form scabs about 10 days after eruption. Fever and general malaise accompany pruritus, paresthesia or hyperesthesia, and tenderness along the course of the involved sensory nerve.
Leukoplakia, erythroplakia
Leukoplakia is a white lesion that can’t be removed simply by rubbing the mucosal surface — unlike candidiasis. It may occur in response to chronic irritation from dentures or tobacco or pipe smoking, or it may represent dysplasia or early squamous cell carcinoma.
Erythroplakia is red and edematous and has a velvety surface. About 90% of erythroplakia cases are either dysplasia or cancer.
Lichen planus
With lichen planus, oral lesions develop on the buccal mucosa or, less commonly, on the tongue as painless, white or gray, velvety, threadlike papules. These precede the eruption of violet papules with white lines or spots, usually on the genitalia, lower back, ankles, and anterior lower legs; pruritus; nails with longitudinal ridges; and alopecia.
Squamous cell carcinoma
A squamous cell carcinoma is typically a painless ulcer with an elevated, indurated border. It may erupt in areas of leukoplakia and is most common on the lower lip, but it may also occur on the edge of the tongue or the floor of the mouth. High risk factors include chronic smoking and alcohol intake.
Stomatitis (aphthous)
Aphthous stomatitis is a common disease characterized by painful ulcerations of the oral mucosa, usually on the dorsum of the tongue, gingivae, and hard palate.
With recurrent aphthous stomatitis minor, the ulcer begins as one or more erosions covered by a gray membrane and surrounded by a red halo. It’s commonly found on the buccal and lip mucosa and junction, tongue, soft palate, pharynx, gingivae, and all places not bound to the periosteum.
With recurrent aphthous stomatitis major, large, painful ulcers commonly occur on the lips, cheek, tongue, and soft palate; they may last up to 6 weeks and leave a scar.
Syphilis
Primarysyphilis typically produces a solitary painless, red ulcer (chancre) on the lip, tongue, palate, tonsil, or gingivae. The ulcer appears as a crater with undulated, raised edges and a shiny center; lip chancres may develop a crust. Similar lesions may appear on the fingers, breasts, or genitals, and regional lymph nodes may become enlarged and tender.
During the secondary stage, multiple painless ulcers covered by a grayish white plaque may erupt on the tongue, gingivae, or buccal mucosa. A macular, papular, pustular, or nodular rash appears, usually on the arms, trunk, palms, soles, face, and scalp; genital lesions usually subside. Other findings include generalized lymphadenopathy, headache, malaise, anorexia, weight loss, nausea, vomiting, sore throat, low fever, metrorrhagia, and postcoital bleeding.
At the tertiarystage, lesions (usually gummas — chronic, painless, superficial nodules or deep granulomatous lesions) develop on the skin and mucous membranes, especially the tongue and palate.
Systemic lupus erythematosus
Oral lesions are common with systemic lupus erythematosus (SLE) and appear as erythematous areas associated with edema, petechiae, and superficial ulcers with a red halo and a tendency to bleed. Primary effects include nondeforming arthritis, butterfly rash across the nose and cheeks, and photosensitivity.
Other causes
Drugs
Various chemotherapeutic agents can directly produce stomatitis. Also, allergic reactions to penicillin, sulfonamides, gold, quinine, streptomycin, phenytoin, aspirin, and barbiturates commonly cause lesions to develop and erupt. Inhaled steroids used for pulmonary disorders can also cause oral lesions.
Treatments
Radiation therapy may cause oral lesions.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Mouth lesions:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Acquired immunodeficiency syndrome (AIDS).Oral lesions may be an early indication of the immunosuppression that's characteristic of AIDS. Fungal infections can occur, with oral candidiasis being the most common. Bacterial or viral infections of the oral mucosa, tongue, gingivae, and periodontal tissue may also occur.
The primary oral neoplasm associated with AIDS is Kaposi's sarcoma. The tumor is usually found on the hard palate and may appear initially as a flat or raised lesion that produces no symptoms and ranges from red to blue to purple. As these tumors grow, they may ulcerate and become painful.
Actinomycosis (cervicofacial).Actinomycosisis a chronic fungal infection that typically produces small, firm, flat, and usually painless swellings on the oral mucosa and under the skin of the jaw and neck. Swellings may indurate and abscess, producing fistulas and sinus tracts with a characteristic purulent yellow discharge.
Behçet's syndrome.Behçet's syndrome produces small, painful ulcers on the lips, gums, buccal mucosa, and tongue. In severe cases, the ulcers also develop on the palate, pharynx, and esophagus. The ulcers typically have a reddened border and are covered with a gray or yellow exudate. Similar lesions appear on the scrotum and penis or labia majora; small pustules or papules on the trunk and limbs; and painful erythematous nodules on the shins. Ocular lesions may also develop.
Candidiasis.Candidiasis characteristically produces soft, elevated plaques on the buccal mucosa, tongue, and sometimes the palate, gingivae, and floor of the mouth; the plaques may be wiped away. The lesions of acute atrophic candidiasis are red and painful. The lesions of chronic hyperplastic candidiasis are white and firm. Localized areas of redness, pruritus, and a foul odor may be present.
Discoid lupus erythematosus.Oral lesions are common with discoid lupus erythematosus, typically appearing on the tongue, buccal mucosa, and palate as erythematous areas with white spots and radiating white striae. Associated findings include skin lesions on the face, possibly extending to the neck, ears, and scalp; if the scalp is involved, alopecia may result. Hair follicles are enlarged and filled with scales.
Erythema multiforme.Erythema multiforme produces a sudden onset of vesicles and bullae on the lips and buccal mucosa. Also, erythematous macules and papules form symmetrically on the hands, arms, feet, legs, face, and neck and, possibly, in the eyes and on the genitalia. Lymphadenopathy may also occur. With visceral involvement, other findings include fever, malaise, cough, throat and chest pain, vomiting, diarrhea, myalgia, arthralgia, fingernail loss, blindness, hematuria, and signs of renal failure.
Gingivitis (acute necrotizing ulcerative).Gingivitiscauses a sudden onset of gingival ulcers covered with a grayish white pseudomembrane. Other findings include tender or painful gingivae, intermittent gingival bleeding, halitosis, enlarged lymph nodes in the neck, and fever.
Herpes simplex I.With primary herpes simplex I infection, a brief period of prodromal tingling and itching, which is accompanied by fever and pharyngitis, is followed by eruption of small and irritating vesicles on part of the oral mucosa, especially the tongue, gums, and cheeks. Vesicles form on an erythematous base and then rupture, leaving a painful ulcer, followed by a yellowish crust. Other findings include submaxillary lymphadenopathy, increased salivation, halitosis, anorexia, and keratoconjunctivitis.
Herpes zoster.Herpes zoster may produce painful vesicles on the buccal mucosa, tongue, uvula, pharynx, and larynx. Small red nodules typically erupt unilaterally around the thorax or vertically on the arms and legs, and rapidly become vesicles filled with clear fluid or pus; vesicles dry and form scabs about 10 days after eruption. Fever and general malaise accompany pruritus, paresthesia or hyperesthesia, and tenderness along the course of the involved sensory nerve.
Inflammatory fibrous hyperplasia.Inflammatory fibrous hyperplasia is a painless nodular swelling of the buccal mucosa characterized by pink, smooth, pedunculated areas of soft tissue.
Leukoplakia, erythroplakia.Leukoplakia is a white lesion that can't be removed simply by rubbing the mucosal surface—unlike candidiasis. It may occur in response to chronic irritation from dentures or from tobacco use or pipe smoking, or it may represent dysplasia or early squamous cell carcinoma.
Erythroplakia is red and edematous and has a velvety surface. About 90% of all cases of erythroplakia are either dysplasia or cancer.
Pemphigoid (benign mucosal).Pemphigoid is characterized by thick-walled vesicles on the oral mucous membranes, the conjunctiva and, less commonly, the skin. Mouth lesions typically develop months or even years before other manifestations and may occur as desquamative patchy gingivitis or as a vesicobullous eruption. Secondary fibrous bands may lead to dysphagia, hoarseness, and blindness. Recurrent skin lesions include vesicobullous eruptions, usually on the inguinal area and extremities, and an erythematous, vesicobullous plaque on the scalp and face near the affected mucous membranes.
Pemphigus.Pemphigus is characterized by thin-walled vesicles and bullae that appear in cycles on skin or mucous membranes that otherwise appear normal. On the oral mucosa, bullae rupture, leaving painful lesions and raw patches that bleed easily. Associated findings include bullae anywhere on the body, denudation of the skin, and pruritus.
Pyogenic granuloma.Pyogenic granuloma is a soft, tender nodule, papule, or polypoid mass of excessive granulated tissue that usually appears on the gingivae, but can also erupt on the lips, tongue, or buccal mucosa. The lesions bleed easily because they contain many capillaries. The affected area may be smooth or have a warty surface; erythema develops in the surrounding mucosa. The lesions may ulcerate, producing a purulent exudate.
Squamous cell carcinoma.Squamous cell carcinoma is typically a painless ulcer with an elevated, indurated border. It may erupt in areas of leukoplakia and is most common on the lower lip, but it may also occur on the edge of the tongue or floor of the mouth. High risk factors include chronic tobacco use and alcohol intake.
Stomatitis (aphthous).Stomatitis is characterized by painful ulcerations of the oral mucosa, usually on the dorsum of the tongue, gingivae, and hard palate.
With recurrent aphthous stomatitis minor, the ulcer begins as one or more erosions covered by a gray membrane and surrounded by a red halo. It's commonly found on the buccal and lip mucosa and junction, tongue, soft palate, pharynx, gingivae, and all places not bound to the periosteum.
With recurrent aphthous stomatitis major, large, painful ulcers commonly occur on the lips, cheek, tongue, and soft palate; they may last up to 6 weeks and leave ascar.
Syphilis.Primary syphilis typically produces a solitary painless, red ulcer (chancre) on the lip, tongue, palate, tonsil, or gingivae. The ulcer appears as a crater with undulated, raised edges and a shiny center; lip chancres may develop a crust. Similar lesions may appear on the fingers, breasts, or genitals, and regional lymph nodes may become enlarged and tender.
During the secondarystage, multiple painless ulcers covered by a grayish white plaque may erupt on the tongue, gingivae, or buccal mucosa. A macular, papular, pustular, or nodular rash appears, usually on the arms, trunk, palms, soles, face, and scalp; genital lesions usually subside. Other findings include generalized lymphadenopathy, headache, malaise, anorexia, weight loss, nausea, vomiting, a sore throat, low-grade fever, metrorrhagia, and postcoital bleeding.
At the tertiarystage, lesions (usually gummas—chronic, painless, superficial nodules or deep granulomatous lesions) develop on the skin and mucous membranes, especially the tongue and palate.
Systemic lupus erythematosus (SLE).Oral lesions are common with SLE and appear as erythematous areas associated with edema, petechiae, and superficial ulcers with a red halo and a tendency to bleed. Primary effects include nondeforming arthritis, a butterfly rash across the nose and cheeks, and photosensitivity.
Other causes
Drugs.Various chemotherapeutic agents can directly produce stomatitis. Also, allergic reactions to penicillin, sulfonamides, gold, quinine, streptomycin, phenytoin, aspirin, and barbiturates commonly cause lesions to develop and erupt. Inhaled steroids used for pulmonary disorders can also cause oral lesions.
Radiation therapy.Radiation therapy may cause oral lesions.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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