04.05.2018
The oral cavity connects the body with the environment and can therefore be subject to a variety of negative influences. Such influences include the influence of too hot or too rough food, the influence of pathogenic microorganisms. In such cases, the first protective barrier is the mucous membrane, which lines the entire oral cavity and has, in addition to protective ones, many other functions. The mucous membrane is well supplied with blood, and its cells divide quickly and frequently. Therefore, wounds on the mucous membrane heal faster than on other parts of the body. However, for a number of reasons, the mucous membrane can be subject to inflammatory processes called stomatitis. Stomatitis is considered separately from such inflammatory processes in the oral cavity as gingivitis (inflammation of the gums; they have their own characteristics) and periodontitis (inflammation of the periodontium). The causes of stomatitis are very diverse.
Infectious causes
Stomatitis can be caused by infection with viruses or bacteria. In these cases, stomatitis is usually considered as an independent disease.
This is especially true for infection with herpes simplex viruses, which leads to very painful inflammation of the mucous membrane. There are two types of herpetic stomatitis - acute herpetic stomatitis (with primary infection) and recurrent herpetic stomatitis (which can pass through the acute stage or manifest itself as a general infection of the body in the presence of provoking factors). Herpetic stomatitis can lead to an aphthous form, in which erosions, aphthae, and even painful ulcers appear on the mucous membrane.
A specific type of stomatitis is chronic recurrent aphthous stomatitis, which begins almost immediately with the formation of aphthae, and the nature of which is not yet clear. But viral and bacterial infections and vitamin imbalances are also suggested as initiating factors.
The specific infection that causes stomatitis includes a fungal infection (fungi of the genus Candida) and the disease itself is called candidiasis (thrush). Thrush is characterized by the formation of whitish dots on the mucous membrane, and as the fungal infection multiplies, a whitish coating. Candidiasis develops, as a rule, as a result of violations of hygiene rules, physiological disorders in the body, and the use of certain medications. It is often observed in children and its danger cannot be underestimated. This infection, which initially appears on the oral mucosa, can be spread to all organs and systems of the body, and in this case already poses a significant threat to health.
Purely bacterial causes of stomatitis are less common. As a rule, bacterial infections affecting the oral mucosa accompany viral types of stomatitis (for example, streptostaphylococcal lesions).
Organization of treatment
With the development of an inflammatory process in the oral cavity, treatment has two directions - general and local.
General treatment
General treatment of the oral mucosa is carried out in case of severe disease. Patients are prescribed drugs for oral administration in the following groups:
- antibiotics – Amoxiclav, Ciprofloxacin, Metronidazole;
- antiviral drugs - Zovirax, Acyclovir;
- vitamins – vitamin complexes or monovitamins in injections;
- means for normalizing blood microcirculation - Trental, Pentoxifylline;
- immunostimulants – Levamisole.
General therapy aimed at restoring the throat mucosa necessarily involves correction of the primary disease. In accordance with the diagnosis, antihistamines, chemotherapy drugs, etc. may be indicated. General treatment to restore the condition of the mucous membrane is prescribed on an individual basis.
Local treatment
The inflammatory process in the mouth requires treatment of the lesions. The ulcers are washed with a soda solution; infusion solutions of sodium bicarbonate can also be used, which can be bought in pharmacies in 200 ml glass containers. It is forbidden to use cotton wool to treat ulcerations, as its fluff may remain in the wound, causing increased inflammation.
After treatment with solutions, the ulcers are washed with antiseptics - Miramistin, Chlorhexidine, and a slightly diluted solution of potassium permanganate. Antiseptics help reduce the intensity of inflammation and quickly achieve the onset of regeneration.
After antiseptics, the ulcers are treated with healing preparations that soften and moisturize the lesions. This is Solcoseryl, sea buckthorn oil. In case of severe pain, anesthetics - Kamistad or Lidocaine - can be used for recovery. For viral stomatitis, the use of Acyclovir is indicated.
Other causes of stomatitis
In addition to infections, there is a whole range of other causes that can cause inflammation of the oral mucosa: • allergic reactions of a local and general nature (for example, to certain foods, medications, filling materials, oral care products) • the presence of soft and hard dental plaque, multiple caries • incorrectly installed dentures or orthodontic devices (braces) • irritation and trauma to the mucous membrane (mechanical injuries, burns) • deficiency conditions in the body (vitamins A, B and C, iron, folic acid); • intoxication with nicotine, alcohol, metal compounds.
Stomatitis can be manifestations and side effects of common infectious diseases (measles, diphtheria) or internal and general diseases and pathologies (blood and skin diseases, hormonal fluctuations, metabolic disorders).
Inflammation of the oral mucosa occurs especially often when the body's immune system is weakened and due to insufficient oral hygiene. The danger of stomatitis may also be associated with increased and constant dryness of the mouth, in which the protective functions of the mucous membrane are sharply weakened. The salivary glands produce on average up to 1.5 liters of fluid per day, and its deficiency leads to an imbalance in the acidity of the environment, an imbalance of inorganic components and, ultimately, has a depressing effect on the immune defense of the mucous membrane.
Relieving Oral Pain During Cancer Treatment
What to avoid
If you experience oral pain during cancer treatment, you should avoid:
- tobacco;
- alcohol;
- mouth rinses containing alcohol (such as Scope® and Listerine®);
- salty foods and dishes containing hot spices (such as pepper, chili powder, horseradish, curry powder and Tabasco® sauce);
- citrus fruits and juices from them (orange, lemon, lime, grapefruit and pineapple);
- tomatoes and tomato sauce;
- hard, dry or rough foods (such as toast, crackers, raw vegetables, potato chips and pretzels);
- very hot or cold food and drinks.
Eliminating symptoms
Medication Information
If you have several small areas of tenderness, your doctor will prescribe a pain reliever (medication that causes numbness), such as a 2% viscous solution of lidocaine. You can apply it to painful areas using a cotton swab (Q-tip®). If necessary, apply it every hour.
If you experience pain throughout most of your mouth and throat, your doctor may prescribe a full-mouth medicine (such as GelClair® or 2% viscous lidocaine). Rinse your mouth and throat thoroughly with 1 tablespoon of the medicine every 3 to 4 hours up to 8 times a day, and then spit it out. Do not swallow the medicine. Do not eat anything for 60 minutes after using the medicine.
If your mouth pain persists, tell your doctor or nurse. They may prescribe a different medicine to treat mucositis.
Swallowing problems
Below are some tips to help you make swallowing easier. These will help you eat enough protein and calories during treatment:
- If you have a dry mouth, rinse it immediately before eating to moisturize and also stimulate the taste buds.
- Consume warm or chilled foods and foods. Do not eat too hot or too cold foods.
- Choose soft, moist, mild-tasting foods, bite into small pieces and chew thoroughly.
- Use gravies and sauces.
- Moisten foods with yogurt, milk, soy milk or water.
- Soak dry foods in liquids.
- Grind food with a blender or puree it.
- Avoid foods that irritate the throat, such as alcoholic beverages, bitter or sour fruits and juices, spicy foods, pickles, and tobacco.
- Drink enough water in small sips throughout the day to ensure your body is properly hydrated. Remember that sugary drinks (juices, iced teas and sodas) can cause tooth decay. You can consume them with meals, but limit their consumption between meals.
Dry mouth
To relieve dry mouth, drink small sips of water throughout the day. You can also use:
- a bottle with a spray bottle for irrigating the oral cavity with water;
- oral moisturizers (eg, Biotene® Oral Balance, Salivart® Oral Moisturizer, Mouth Kote® Dry Mouth Spray);
- Biotene® chewing gum;
- humidifier in the room where you are.
Eating problems
Oral pain may make it difficult for you to eat. If so, use the guidelines below to ensure you're getting all the nutrients you need.
- Tell your doctor or nurse if you are not eating well. They may refer you to see a nutritionist.
- Take nutritional supplements such as Carnation® Instant Breakfast and Ensure®.
- Add protein powder to broths, soups, cereals and drinks.
- Eat small, frequent meals throughout the day rather than large, infrequent meals. Try to eat small amounts of food every 2-3 hours.
to come back to the beginning
Main symptoms of stomatitis
Symptoms of stomatitis depend on its type and form, are very diverse and specific. General symptoms include redness, swelling of the mucous membrane, burning and pain in the mouth (including when eating hot, sour or spicy foods), an increase (or, conversely, a decrease) in salivation, bad breath, as well as the manifestation, in depending on the severity of the disease, specific lesions - erosions, af, ulcers.
Organization of diagnostics
If a person goes to the hospital with complaints of discomfort and pain in the oral cavity, the doctor first conducts a survey to diagnose associated lesions. Then tests are prescribed:
- allergy test;
- bacterial culture from the site of inflammation to identify the type of infection - viral, fungal or bacterial.
A general blood test and blood serum test are required. If necessary, a referral for diagnostics from specialists of a different profile is issued.
Only after a full examination, identification of the etiology and type of the disease is it prescribed how to treat inflammation in the mouth. Independent actions will only aggravate the condition and provoke complications.
- Inflammation of the oral mucosa: causes and treatment
Treatment
The primary diagnosis of the disease based on clinical manifestations is carried out by a dentist, who also carries out local symptomatic treatment based on the primary diagnosis. But in complex and unobvious cases, laboratory diagnostics are carried out, and doctors of other specialties (allergists, dermatologists, immunologists) are brought in for treatment.
Local symptomatic treatment usually involves the use of rinses with solutions of painkillers and antiseptic drugs (including herbal origin), the use of drugs for tissue regeneration (after the acute phase subsides), if necessary, the elimination of irritating and provoking factors (removal of dental plaque, hard deposits, treatment dental caries).
Local drug treatment is carried out only after an accurate diagnosis has been established (the cause of stomatitis) and usually includes treatment with antiviral, antibacterial, antifungal drugs in the form of ointments and applications.
General treatment is carried out, as a rule, in a hospital and is aimed at eliminating the internal causes of stomatitis (treatment of internal pathologies), taking therapeutic drugs according to special regimens, and physiotherapy.
Prevention
In general, it is quite difficult to avoid this disease in the presence of predisposing causes; you can only take some general measures to possibly prevent the disease or complication in the form of stomatitis.
Since the herpetic virus, especially in acute primary forms, is extremely contagious, a certain isolation of the patient is required to prevent the spread of infection by airborne droplets and contact. The difficulty here is that there is a rather long incubation period, up to 26 days, and the first signs of stomatitis may escape attention.
Other preventive measures are of a general nature and consist of proper and complete oral hygiene, regular professional cleanings in a dental clinic (removal of soft and hard plaque), timely treatment of mucosal injuries, and measures to generally strengthen the immune system.
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