-IBIS-1.5.0-
tx
eyes/ears/nose/throat
aphthous stomatitis
diagnoses

definition and etiology

aphthous ulcers
:
definition:
Single or clustered acute painful ulcers with surrounding erythematous base located on the movable oral mucosa. Also called "canker sores".

etiology:
The ulcers appear idiopathically: they are thought to be a localized immune response. Although no clear cause is evident, there are several associations made in patients with recurring attacks: susceptibility to citrus fruits or gluten (or other individual food intolerances), vitamin/mineral deficiencies (esp. iron, B12 and folic acid), and adverse reactions to stress. Approximately 20% of the population experiences aphthous ulcers.

Smaller ulcers, 3-5 mm in diameter, heal without scarring; larger ulcers (7-15 mm), or a frequently recurring ulcer, may leave a scar. The ulcers are more common in women. Recurrent attacks are common, often with 2-3 ulcers per episode, but in some individuals, there may be 10-15 in a severely inflamed mouth. Attacks may recur in the same location. Lesions typically require 7-10 days to heal fully and the ulcer is usually painful for the entire time, although less so after 4-5 days.

stomatitis:
definition:
An inflammation of the oral mucosa that may be a primary disease or a symptom of a systemic illness.

etiology:
Causes of stomatitis are many and varied: irritants, trauma, infection, nutrient deficiency, dryness, and hypersensitivity reactions.
• micro-organisms: strep, G.C., candida albicans, treponema pallidum, herpes simplex, measles, etc.
• irritants: smoking, alcohol, spicy foods, toothpaste, mouthwash, etc.
• trauma: biting the cheek, burning from excessively hot food or drink, jagged teeth, poor dentures
• nutrients: iron, C or B vitamins

signs and symptoms

aphthous ulcers
:
The lesion begins as a shallow, oval yellowish erosion with a raised border that is surrounded by a hyperemic area. There is usually no vesicular stage before the ulcer appears. The ulcer becomes filled with a pseudomembrane of opaque yellowish substance comprising WBCs, oral bacteria and tissue fluids. In severe attacks there may be fever, anorexia, malaise and adenopathy.

stomatitis:
Clinical signs and symptoms vary as much as the causes for the stomatitis. Any new oral lesion can be considered a type of stomatitis. Direct smears and cultures of the lesion are recommended to isolate a potential microorganism.

course and prognosis

aphthous ulcers
:
Recurrent attacks are to be expected throughout the patient's life unless the true causative factor is found and treated.

stomatitis:
Depends solely on the cause: if the cause is corrected the stomatitis will resolve. However, positive diagnosis of cause may prove difficult, and require a full work-up to be determined.

differential diagnosis

aphthous ulcers
:
• herpes simplex
• Behcet's syndrome
• traumatic ulcers: e.g. from dentures
• herpangina
• hand, foot and mouth disease
• miscellaneous oral lesions

stomatitis:
• malignancy.
• Vincent's angina, acrodynia, pseudomembranous or membranous stomatitis, thrush, Kawasaki disease.
• lesions indicating systemic disease: scarlet fever, syphilis, Koplik's spots, erythema multiforme, pellagra, scurvy


footnotes