Stomatitis

Stomatitis: Excerpt from In A Page: Pediatric Signs and Symptoms

Oral ulcers may represent a local infection, an immune reaction, or a general medical condition. The most common cause is idiopathic aphthous ulcers, followed by oral infections. Occasionally a general medical condition may be discovered in the evaluation of stomatitis, and HIV should be remembered as a potential etiology because stomatitis or rampant herpetic infections may be among the earliest clinical manifestations.

Differential Diagnosis

• 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

Workup and Diagnosis

• History
  –Onset, frequency, duration of symptoms
  –Established or suspected triggers
  –Concomitant symptom: Fever, lymphadenopathy, rash, diarrhea, weight loss
• Physical exam
  –Size of lesions
  –Distribution of lesions
  –Morphologic characteristics
  –Presence of other findings on physical exam: Fever, rash, abdominal tenderness
  • Labs
    –Tzanck smear (shows multinucleated giant cells) or a positive herpes simplex culture can confirm herpetic gingivostomatitis
    –Trench mouth may be confirmed by simple culture for fusiform bacteria or darkfield examination for spirochetes

  Treatment

  • Symptomatic care
    –Rinsing with a 1:1 solution of dipheniramine with antacid provides temporary relief
    –Acetaminophen may be used liberally
  • Occlusive topical solutions may aid in healing
  • Topical anesthetics such as benzocaine or viscous lidocaine should be used sparingly if at all in children
    –Damage to the mucous membranes may result
    –Accidental swallowing can lead to aspiration secondary to the impairment of the gag reflex
  • For severe or recurrent aphthous ulcers, systemic steroids or colchicine are sometimes used
    
  • Herpetic lesions are treated with oral acyclovir
  • Trench mouth is treated with penicillin

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

More About Stevens-Johnson Syndrome

• Back to disease: Stevens-Johnson Syndrome: Introduction
• Next Book Extract About Stevens-Johnson Syndrome: Erythema (Handbook of Signs & Symptoms (Third Edition))
• More Book Extracts: All Online Books for Stevens-Johnson Syndrome

More Medical Textbooks Online about Stevens-Johnson Syndrome

Review other book chapters online related to Stevens-Johnson Syndrome:

Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

 » Next page: Erythema (Handbook of Signs & Symptoms (Third Edition))

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Erythema (Handbook of Signs & Symptoms (Third Edition))
• Erythema Multiforme (A Pocket Manual of Differential Diagnosis)
• Erythema Nodosum (A Pocket Manual of Differential Diagnosis)
• Genital herpes (Professional Guide to Diseases (Eighth Edition))
• Herpes simplex (Professional Guide to Diseases (Eighth Edition))

Tools & Services:

• Bookmark this page
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

Common Health Mistakes

Symptom
Checker

Search Specialists by State and City