Stomatitis and Its Types

Stomatitis is a general term for inflammatory diseases accompanied by pain occurring in the oral cavity. However, diseases that occur in the oral mucosa are diverse, and because their lesions often look similar, differential diagnosis can be difficult, so careful history-taking and observation are needed. There are various classification methods for stomatitis according to symptoms, site of occurrence, cause, and physical examination findings, but it is difficult to apply them uniformly to each disease. Therefore, most cases are classified by combining several of these methods, and generally stomatitis is divided into ulcerative stomatitis, vesicular stomatitis, and erosive stomatitis.

Cause

The causes of stomatitis are very diverse. In general, there are infectious causes such as bacterial infection, tuberculosis infection, syphilis infection, fungal infection, and viral infection. In addition, nutritional disorders including vitamin deficiencies (such as B12 and C) and iron-deficiency anemia, physical fatigue, stress, systemic disease, high fever, immune disorders caused by colds and gastrointestinal disorders, as well as poor oral hygiene, cavities, and trauma can also be causes. It may also occur in special cases, such as in occupations that handle metals like mercury, lead, zinc, and arsenic, or after radiation therapy.

Types of Stomatitis

1. Ulcerative stomatitis

1. Recurrent aphthous stomatitis

An aphthous ulcer refers to a small, shallow ulcer that is round or oval in shape. The cause has not yet been identified, but viral or bacterial infection is considered the main cause, and fatigue, mental stress, abnormalities in immune function, genetic factors, menstruation, allergies, endocrine disorders, and nutritional disorders are also known to be important causes.

2. Behçet syndrome

Behçet syndrome is a chronic, recurrent, idiopathic, systemic disease, and its cause is still not clear. It commonly occurs in people in their 20s and 30s. Triggering factors include stress, emotional disturbance, early summer and autumn seasonally, menstruation in women, irritating foods, and overwork. The main symptoms include aphthous ulcers in the oral mucosa, iritis, uveitis, and genital ulcers.

3. Traumatic ulcer

Traumatic ulcers often occur when the mucosa is bitten by teeth while chewing food or due to external injury. The center of the ulcer is depressed, but the edges are slightly raised in an irregular shape or have a folded mucosal appearance. Pressure causes pain, and the lesion has a red border around it.

4. Pressure ulcer

A pressure ulcer is a disease caused by mechanical stimulation such as pressure or friction, and occurs when oral mucosal tissue is pressed by an ill-fitting denture or prosthesis. Most occur as a single lesion, and because blood supply to the tissue is not smooth due to pressure, necrosis and detachment of the epithelial cell layer occur, forming a painful ulcer. It can also occur when there is a habit of biting the mucosa of the lips or cheeks, or the tongue.

2. Vesicular stomatitis

1. Pemphigus

Pemphigus is a rare autoimmune disease that forms blisters on the skin and mucous membranes. It occurs at similar rates in men and women and is most common between the ages of 50 and 60. In the most common form, pemphigus vulgaris, blisters develop in the mouth and painful ulcers occur in most patients.

2. Pemphigoid

Pemphigoid shows clinical findings similar to pemphigus but tends to have relatively mild symptoms and a favorable prognosis, and it usually occurs frequently in people over 50. Diagnosis is made through immunofluorescence testing using a tissue biopsy.

3. Herpetic gingivostomatitis

Herpetic gingivostomatitis is a stomatitis characterized by acute contagious formation of small vesicles caused by the herpes simplex virus. It is extremely common, with more than 60% of the population infected, and clinically it is divided into primary infection and secondary or recurrent infection. It occurs frequently in children and adolescents, and fever, malaise, and cervical lymph node swelling appear suddenly.

4. Herpes labialis

Herpes labialis appears when the disease recurs or when, in latent infection, the herpes simplex virus remains dormant in the host's nervous tissue (the trigeminal ganglion) and then appears mainly around the mouth due to triggering factors such as ultraviolet light, stress, fatigue, fever, cold exposure, upper respiratory infection, gastrointestinal disorders, menstruation, pregnancy, and immunosuppression.

5. Herpes zoster

Herpes zoster refers to the formation of vesicles in the distribution of peripheral nerves when varicella-zoster virus is reactivated in a person with latent infection whose immune function has declined (malignant tumors, trauma, medications, radiation therapy, high-dose steroid treatment). Herpes zoster in the oral cavity forms vesicles and ulcers on the buccal mucosa, palate, and pharynx, resembling aphthous ulcers.

6. Herpetic angina

Herpetic angina is caused by a viral infection. Unlike recurrent herpes that appears periodically, it is an epidemic disease that occurs in summer and autumn and is common in infants and young children. After an incubation period of 2 to 4 days, it is accompanied by high fever, pharyngeal pain, and systemic symptoms such as headache, diarrhea, and vomiting.

7. Hand, foot, and mouth disease

Hand, foot, and mouth disease is a contagious dermatologic and mucosal disease caused by a viral infection, in which vesicles form on specific areas of the skin (hands, feet, buttocks) and in the mouth, including the palate, tongue, cheeks, and mucosa. It occurs mainly in children.

3. Erosive stomatitis

1. Erythema multiforme

Erythema multiforme is an acute, recurrent disease in which inflammation causes capillary dilation, papules, and nodules on the mucosa or skin, and as it progresses they merge with each other, becoming varied in shape and size, with findings such as vesicles, erosions, and bleeding on the surface. Clinically, it is divided into mild erythema multiforme limited to the skin and mucosa, and Stevens-Johnson syndrome, which shows an acute course with fever and toxic symptoms and epidermal necrosis on the skin and mucosa.

2. Oral candidiasis

Oral candidiasis is a disease caused by weakly pathogenic fungi that naturally exist in the oral cavity when the balance of normal oral bacteria is disrupted in patients with diseases such as malignant tumors, blood disorders, immunodeficiency, tuberculosis, and diabetes, or in patients with weak physical strength or resistance such as girls, the elderly, and pregnant women.

4. Others

1. Fissured tongue

Fissured tongue is a common oral condition seen in about 10% of healthy people, and the surface of the tongue has many crack-like grooves. It is caused by underdevelopment of the tongue, is not present in children, and appears as people get older.

2. Hairy tongue

Hairy tongue is a condition in which the surface of the tongue looks as if it has hair. It ranges from light yellow to dark brown, but it often appears black, so it is also called black hairy tongue.

3. Geographic tongue (benign migratory glossitis)

Geographic tongue is a condition in which soft, irregularly shaped mucosal lesions with slightly raised, well-defined white borders appear on the tongue.

4. Radiation mucositis

Radiation mucositis occurs when normal oral mucosa is damaged by ionizing radiation, and it is related to the dose and rate of radiation exposure, the type, the irradiation area, and the state of oral hygiene. About two weeks after radiation exposure, erythema and erosions usually appear on the lips, buccal mucosa, palate, and throat.

So far, we have looked at the types of stomatitis.

In the next part, we will look at the treatment and examination methods for stomatitis.

Source: Korea Disease Control and Prevention Agency National Health Information Portal