What is stomatitis and how to prevent it

Reasons for the development of stomatitis

The causes of damage to the oral mucosa may be:

• Infection (viruses, bacteria, fungal microflora)
• Allergy
• Weakening of the immune system
• Unbalanced diet
• Some diseases (ENT diseases, diabetes mellitus, anemia, gastrointestinal diseases)
• Microtraumas, burns and other damage to the oral mucosa
• Failure to comply with personal hygiene rules
• Taking medications
• Hormonal imbalances
• Smoking (“nicotine stomatitis”)
• Genetic predisposition

Symptoms of stomatitis

Despite the multiplicity of causes, the symptoms of stomatitis are usually similar:

• Pain and discomfort in the mouth that worsens while eating or talking
• Redness of areas of the mucous membrane, their swelling
• The appearance of painful red ulcers with a whitish center on the mucous membrane
• Increased salivation
• Bad breath
• Bleeding gums
• During the acute phase, there may be an increase in body temperature and enlargement of regional lymph nodes

The importance of nutrition during stomatitis

Proper nutrition for stomatitis not only helps speed up recovery, but can also prevent relapse of the disease.

In addition, if the oral mucosa is damaged, almost any food and drink causes severe pain.

This can cause fear of eating and even refusal to eat, which is completely unacceptable. Therefore, it is necessary to eat with stomatitis according to certain rules.

The duration of such a gentle diet is determined by the doctor based on the form and severity of the disease.

Stomatitis

Stomatitis

During antitumor treatment, various side effects from the oral cavity and pharynx may occur.
This occurs due to the direct damaging effect on normal tissues located in this area during the treatment. This most often occurs during systemic drug treatment, such as chemotherapy or targeted therapy. Damaged tissue can become an “entry gate” for infection, most often bacterial or fungal, which can intensify local manifestations of stomatitis, causing pain and inflammation. It is likely that other undesirable effects will develop in this area. For example, chemotherapy and radiation therapy to the head and neck area can damage the salivary glands and the normal mucous membrane of the oral cavity, resulting in dry mouth and difficulty chewing and swallowing food. Examples of side effects that occur in the oral cavity are the following adverse events (medical terms are indicated in parentheses):

• changes in the sense of taste (dysgeusia) and smell (perception of smells) - familiar smells and tastes that you previously liked may suddenly seem unfamiliar or even unpleasant against the background of antitumor treatment. In more severe cases, there may be a complete loss of the perception of taste and smell, which can have a negative impact on the quality of life;
• dry mouth (xerostomia), which is a consequence of the above-mentioned damage to the cells of the salivary glands. Disruption of their normal functioning can cause a subjectively unpleasant feeling of dryness in the oral cavity and, since the production of saliva plays an important role in the process of swallowing food, complicate the eating process. For example, you may have difficulty swallowing solid or dry foods;
• increased sensitivity of teeth and gums to heat and/or cold, as well as progression of the caries process - the growth of cavities in the teeth, which disrupt their normal structure and can lead to pain when chewing and the development of typical complications of caries (pulpitis, gingivitis, etc. );
• the appearance of ulcers in the mouth, a feeling of pain and swelling in these areas. The development of such a process is referred to as “stomatitis” or “oral mucositis,” which is a common complication of many types of antitumor treatment. The incidence of such complications depends on the treatment provided (for more details on prostomatitis and its treatment, see below).

In the most severe cases, the development of the above problems can lead to the development of complications such as lack of nutrition (malnutrition), severe weight loss, and dehydration (dehydration). In addition to unpleasant sensations, infectious complications arising from stomatitis greatly complicate the process of antitumor treatment; they may require delays or cause the need to reduce the doses of drugs used, which could potentially reduce the effectiveness of therapy. In some cases, severe stomatitis makes it impossible to continue treatment.

If you notice the appearance of ulcers in the mouth, including painless ones, as well as an episode of a rise in temperature to 38.0 0C or higher, if these complications disturb your sleep, interfere with normal nutrition and fluid intake - immediately inform your doctor!

Before starting treatment

As with many diseases, the development of oral complications is easier to prevent than to cure. If complications have already developed, the sooner the necessary measures are taken, the less likely it is that they will increase and become severe. There are various methods aimed at preventing and treating oral complications.

Visit the dentist and make sure that you do not have any foci of chronic infection in the oral cavity, such as carious teeth, chronic periodontitis, as well as untreated teeth, for example, “fragments” that need removal or prosthetics, etc. Tell your dentist that you are undergoing cancer treatment; he or she may be able to give you valuable advice on oral hygiene.

On the other hand, it is very important to understand that dental treatment should not delay antitumor therapy, as this may reduce its effectiveness. Discuss with your attending physician the required scope of dental interventions in your individual case.

Stomatitis and pain when swallowing

As mentioned above, stomatitis is a characteristic complication of many types of antitumor treatment, which is characterized by the appearance of single or multiple ulcers in the oral cavity, on the gums and/or on the tongue, the back wall of the pharynx, etc. They can be painless or cause significant discomfort, up to acute pain requiring strong analgesics, making it impossible to eat by mouth. Their appearance and size can vary from pinpoint changes to large ulcers that bleed or are covered with a whitish coating.

Stomatitis is not observed in all patients; its severity can vary greatly and depend on the treatment provided. As a rule, the development of stomatitis occurs 7-10 days after the start of antitumor treatment, but its earlier appearance is also possible. In most cases, subject to the following rules, it does not cause significant discomfort to the patient and, in the absence of infectious complications, goes away on its own and heals without a trace within 2-4 weeks.

Tips for preventing the development of stomatitis

• Check your oral health by brushing your teeth and rinsing your mouth daily. At least once a day, inspect your mouth for the formation of ulcers or spots covered with a whitish coating. If any unusual changes occur, tell your doctor.
• Rinsing your mouth daily with warm water and a baking soda solution may be helpful;
• Take gentle but thorough care of your teeth, gums and tongue. Brush your teeth after every meal and before bed;
• Use only a soft toothbrush, as this will minimize trauma to the gums and oral mucosa during brushing;
• Try not to use toothpicks unnecessarily, as they can injure your gums; it is preferable to use dental floss;
• Avoid eating foods that may irritate the oral mucosa. These foods include spicy, salty foods, a variety of pickles, sauerkraut, sour fruits, especially pineapples, citrus fruits, pomegranates, vegetables (for example, radishes), as well as alcoholic drinks and hot (highly heated) dishes.
• Avoid smoking and chewing tobacco products. Quitting smoking before starting treatment can significantly reduce the risk of developing oral complications.

Treatment of stomatitis

When stomatitis develops, try to eat foods and dishes that do not cause you discomfort when chewing and swallowing, for example, those that have a soft consistency and are quite moist. Sauces can be added to “dry” dishes to make them more moist. Using a blender, you can make milkshakes and shakes, as well as grind food to a comfortable consistency.

Frequent mouth rinsing is one of the most important and effective methods of preventing and treating stomatitis. For rinsing, you can use almost any solution that does not irritate the oral mucosa. Do not use acidic solutions, such as those containing vinegar or lemon juice. Most often, a saline solution (0.9%, i.e. 9 g of table salt per 1 liter of clean drinking water), a baking soda solution of similar concentration is used for rinsing the mouth; for additional pain relief, local anesthetics (lidocaine, novocaine) can be added to them ), diphenhydramine (diphenhydramine), etc. It is advisable to alternate such solutions with local antiseptics, for example, chlorhexidine.

Ask your doctor in advance for recipes for mouth rinses in case you develop mouth ulcers, including painful ones that interfere with eating.

In case of severe pain and ineffectiveness of local painkillers, painkillers that have a systemic effect are used, for example, the same ones used for headaches or toothaches. It is better to use the drugs that you are used to. In severe cases, opioid analgesics are used.

The use of anti-inflammatory drugs that suppress the activity of cyclooxygenase-1, for example, aspirin, ibuprofen, diclofenac, ketoroloc and ketoprofen is contraindicated in the presence of severe thrombocytopenia.

Appearance of dry mouth

Drink more often, try to consume as much fluid as possible, this provides additional hydration to the oral cavity, in addition, dry mouth contributes to the progression of caries and infections in the oral cavity. Always keep a container of liquid with you to ensure easy access to drinking water. Sucking on ice slices (“chips”), using chewing gum and sugar-free candies, and moisturizing lip balms may be helpful.

For changes and disturbances in taste sensitivity

Although this complication does not pose a threat to the patient’s health, it can cause significant discomfort and significantly reduce the quality of life during antitumor therapy. There may be changes in the perception of sweet, sour and bitter tastes, as well as the appearance of an unpleasant “chemical” or “metallic” taste in the mouth. It can be helpful to try eating different foods to find the ones you like best in a new situation. The following tips can also help cope with this unpleasant situation:

• If food seems bland (tasteless) to you, try adding various sauces and spices to it. Improvise! Choose the flavor you like;
• Often, familiar red meat, such as pork or beef, can begin to cause disgust and taste unusual. In this case, try replacing them in your diet with other high-protein foods, such as poultry (chicken, turkey), cottage cheese, eggs, fish and/or other foods;
• Using sweeteners can help if food tastes too salty, bitter, or sour;
• If you notice a metallic taste in your food, try to avoid using metal or metal-coated utensils and utensils, especially knives. It is useful to use ceramic knives.

Dental complications arising during antitumor treatment

If existing chronic oral diseases have not been treated before starting therapy, this may lead to their exacerbation during treatment. If they occur, contact your attending physician and ask him about possible contraindications to dental treatment. It is also necessary to perform a general (clinical) blood test, since a decrease in the number of neutrophils can lead to an increased risk of infection during dental surgery, and a decrease in the number of platelets increases the risk of bleeding. The need for dental interventions must be assessed taking into account the clinical picture of the underlying disease, the condition of the oral cavity and blood test results.

It must be taken into account that with the use of certain antitumor drugs, such as vinca alkaloids (vincristine, vinblastine), thalidomide, lenalidomide, symptoms characterized by acute toothache, similar to acute pulpitis and other dental diseases, may occur. This occurs due to their direct irritant effect on sensitive nerve fibers. In these cases, a thorough examination is necessary to determine the cause of the toothache.

The occurrence of acute toothache and loosening of teeth is possible due to the use of drugs aimed at maintaining the normal state of bone tissue, such as bisphosphonates (zoledronic acid, ibandronic acid, alendronic acid) or denosumab (Exgiva, Prolia) can be a symptom of a dangerous complication - osteonecrosis of the jaw . Immediately report these symptoms to your doctor if they occur and especially if they get worse!

How to eat with stomatitis

The task of nutrition for stomatitis is to provide the body with all the necessary nutrients, as well as to protect the mucous membrane from irritation as much as possible.

Frequent split meals (5-6 times a day) are recommended. Food must be crushed as much as possible, preferably to a puree state. The temperature of the dishes is 35-40 degrees.

After eating, the mouth must be rinsed with an antiseptic solution prescribed by a doctor or simply with boiled water.

For stomatitis, it is important to drink enough liquid at a comfortable temperature (close to body temperature).

Any degree of dehydration of the body should not be allowed, as this makes the mucous membranes even more vulnerable to inflammation.

Vitamins are the key to healthy gums

If a patient has problems with gums too often, specialists prescribe a course of vitamins that replenish the supply of microelements in the body. The following groups are especially useful:

• Vitamin C. Accelerates the healing process, prevents the development of complications. Found in large quantities in citrus fruits and some berries.
• Vitamin A. Carrots are especially rich in this element. Since it is not recommended to eat it during inflammation, you can boil or stew the vegetable and bring it to a soft state.
• Group B vitamins. With a deficiency of these microelements, the gums become loose, pockets form and more serious pathological processes occur. B vitamins are found in large quantities in almost every nut.

The health of the soft tissues of the oral cavity depends not only on nutrition, but also on lifestyle. We strongly advise you to quit smoking and fully implement all hygiene procedures regarding the oral cavity. When you brush your teeth, don't forget about your gums. Massage them with a brush to normalize blood circulation in them.

Menu for stomatitis

Chopped products should be made from meat: meatballs, meatballs, soufflé, pate. It is good to boil the cereals, giving preference to slimy porridges (oatmeal, rice).

It is better to use cottage cheese in the form of casseroles, and make puree from vegetables.

If you have stomatitis, you should not eat sour vegetables and fruits:

• Citrus
• Green apples
• Tomatoes
• Currant
• Sorrel
• Spinach

The menu should contain a minimum of sweets, and chocolate, sweets, and sweet carbonated drinks are completely excluded.

Simple carbohydrates (sugars) are an ideal environment for the development of bacteria in the oral cavity, so their consumption can worsen the condition and significantly interfere with treatment.

You cannot use coffee, alcohol, or add spices to food. Everything sour, spicy, salty, pickled and smoked is excluded from the diet.

All this irritates the mucous membrane and provokes the appearance of new ulcerations.

For the same reason, you should not eat hard, rough foods: stale bread, fresh hard vegetables and fruits, crackers, waffles and more.

List of recommended products and dishes

• Cream soups and broths
• Minced lean meat (chicken, turkey, beef, rabbit)
• Liver (as pate or soufflé)
• Fish, incl. 1-2 times a week fatty varieties
• Milk and fermented milk drinks
• Cottage cheese, soft cheese
• Unrefined vegetable oils (linseed, olive, corn)
• Various cereals in the form of liquid viscous porridges
• Non-acidic stewed or boiled vegetables, purees from them (cabbage, broccoli, pumpkin, potatoes, zucchini, carrots)
• Non-acidic soft fruits and berries (banana, baked apple, watermelon, melon)
• Compotes, fruit drinks, natural juices from non-acidic vegetables and fruits, jelly

Nutrition rules

Many patients complain to doctors that they cannot eat with stomatitis. Such a refusal to eat due to painful sensations is fraught with consequences for the entire body. No matter what type of disease you have, be it viral, bacterial, allergic or aphthous stomatitis, nutrition is key to a speedy recovery. But what can you do to prevent a simple lunch from causing pain? Here are a few simple recommendations that, if followed, will help you eat normally without experiencing discomfort:

• All products must be ground to a puree before use. Grate vegetables and fruits on a fine grater or boil and rub through a strainer;
• it is easier to consume meat, fish and poultry in the form of thermally processed minced meat or soufflé;
• give preference to cream soup or puree soup instead of the usual broth with pieces of meat and vegetables;
• The patient's diet should be rich in vitamins B and C, as they help strengthen the immune system. And vitamins A and E help speed up the healing of cracks, wounds and erosions;
• food should be lukewarm, since both hot and cold food cause additional irritation of the mucous membrane;
• Immediately after a meal, be sure to thoroughly rinse your mouth with clean warm water to remove any remaining food.

Diso Nutrimun for stomatitis

Nutrimun protein mixture for stomatitis will be an excellent additional source of complete, easily digestible protein.

Nutrimun is easily mixed into dishes of any consistency, enriching them with protein of the highest biological value.

With Nutrimun, the body will receive the right amount of protein even in small amounts of food or drinks.

This is especially true for stomatitis, when frequent and split meals are indicated, and appetite is reduced due to pain in the mouth.

What is Nutrimun

SBKS Diso Nutrimun are concentrated milk proteins, easy to digest and complete in amino acid composition.

The mixture has virtually no taste or smell, so your favorite dishes will not change their usual characteristics.

With the addition of Nutrimun, the dish is enriched with healthy, easily digestible protein, necessary for the body to function and successfully fight diseases.

How does he help?

Diso Nutrimun is 5 grams of protein per scoop, it was developed by scientists and recommended by doctors for constant use.

You can add it to any dish: soups, broths, purees, soufflés, porridges, etc. You can stir Nutrimun in drinks: tea, compote, jelly.

Nutrimun is a specialized food product that increases and improves the protein part of the diet.

It contains all the amino acids necessary for the body in the correct ratio to each other for better absorption and greater benefits.

The protein of the Diso Nutrimun mixture is not only complete and balanced in amino acid composition, it is easily broken down in the digestive tract and is easily absorbed by the body.

Sample menu for the day

A sample menu is presented to help you understand what to feed your baby.

Food should be varied, dishes should not be repeated for at least seven days. Its task is not only to nourish the child in a gentle manner during the period of exacerbation of stomatitis, it should help strengthen the immune system and the body’s defenses.