Stomatitis
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
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Hematologic disorders
–Associated with leukemia
–Associated with neutropenia secondary to
chemotherapy for malignancy
–Associated with cyclic neutropenia
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Behçet disease
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Stevens-Johnson syndrome
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Inflammatory bowel disease: May be found in Crohn disease or ulcerative colitis
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HIV
–Alterations in T-cell immunity can lead to aphthous ulcers
–HIV patients are more susceptible to herpetic infections
Workup and Diagnosis
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History
–Onset, frequency, duration of symptoms
–Established or suspected triggers
–Concomitant symptom: Fever, lymphadenopathy, rash,
diarrhea, weight loss
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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
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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
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For severe or recurrent aphthous ulcers, systemic steroids or colchicine are sometimes used
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-
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Herpetic lesions are treated with oral acyclovir
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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.
Other Book Chapters Related to Red tongue
Read excerpts from these other book chapters related to Red tongue:
Medical Books Excerpts
- Mouth lesions
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Stomatitis
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
More About Causes of Red tongue
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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
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» Next page: SMOOTH TONGUE AND OTHER CHANGES (Differential Diagnosis in Primary Care)
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