Treatment and Examination Methods for Stomatitis

Treatment of Stomatitis

1. General treatment concepts

Treatment for stomatitis may vary depending on the type of stomatitis. In general, medications used for stomatitis include analgesics, antihistamines, topical steroids, immunosuppressants, antifungal agents, antiviral agents, antibiotics, fluoride preparations, oral cleansers, treatments for nutritional deficiencies, and saliva substitutes. Some of these medications are selected and used appropriately depending on the type of stomatitis.

Analgesics are used to control the pain that accompanies stomatitis, and antihistamines reduce oral irritation symptoms by suppressing hypersensitivity to histamine. Topical steroids or immunosuppressants are useful for treating symptoms related to severe inflammation or ulcerative lesions, and they may be taken orally or applied to the affected area as ointments.

When the causative bacteria, viruses, or fungi of stomatitis have been identified, antibiotics, antiviral agents, or antifungal agents can be selected and used accordingly. Oral cleansers are used to restore and maintain oral hygiene, and fluoride preparations are used preventively in patients who are at high risk of dental problems.

Stomatitis caused by poor systemic nutritional status is treated by replenishing the deficient nutrients along with treatment of the stomatitis to promote rapid recovery. Sufficient fluid intake and saliva substitutes are used to prevent worsening of the condition due to decreased salivary secretion.

2. Treatment by condition

1. Recurrent aphthous stomatitis

Because the cause is unknown, treatment mainly consists of symptomatic therapy to promote healing and relieve symptoms, and includes a range of approaches from chemical or electrical cauterization to drug therapy.

2. Behçet syndrome

Treatment of oral mucosal lesions in Behçet syndrome is the same as treatment for aphthous stomatitis, and steroids, immunosuppressants, anticoagulants, and antiviral agents are used to treat other symptoms.

3. Traumatic ulcer

In the acute stage of a traumatic ulcer, hemostasis and disinfection are performed, and suturing may be done if there is a tear.

4. Decubitus ulcer

A decubitus ulcer heals easily when the cause is removed and secondary inflammation is eliminated. However, if healing is delayed, the ulcer wall gradually becomes fibrotic, so when granulation tissue formation is extensive, a laser may be used to remove the granulation tissue in the central part of the ulcer.

5. Pemphigus

Treatment of pemphigus involves systemic administration of high-dose steroids for a certain period of time, with dose reduction according to symptoms. In severe cases, immunosuppressants may be used or plasmapheresis may be performed.

6. Pemphigoid

Treatment of pemphigoid includes oral hygiene, symptomatic therapy for symptom relief, and, in mild cases, topical steroids. When lesions progress rapidly, systemic immunosuppressive therapy such as systemic steroids and immunosuppressants is used.

7. Herpetic gingivostomatitis

Treatment of herpetic gingivostomatitis includes maintaining good oral hygiene, adequate fluid intake, oral rinsing, antipyretics, analgesics, and other conservative treatments, together with antibiotic treatment to prevent secondary infection. Topical or systemic antiviral agents may also be used.

8. Herpes labialis

For herpes labialis, symptomatic treatment and prevention of secondary infection are important, and ointments or administration of combination products such as antibiotics and steroids, as well as topical and systemic antiviral agents, may be used.

9. Herpes zoster

If immune function is not compromised, herpes zoster does not require special treatment, but medication may be administered for pain relief and prevention of secondary infection.

10. Herpetic pharyngotonsillitis

Herpetic pharyngotonsillitis is treated with conservative therapy and symptomatic treatment to improve general condition.

11. Hand, foot, and mouth disease

Hand, foot, and mouth disease does not require special treatment, but it is advisable to avoid steroid ointments. The course is favorable, and it usually heals spontaneously in about a week.

12. Erythema multiforme

Mild erythema multiforme heals spontaneously. The most important part of treatment is finding and removing the cause, stopping unnecessary medications, providing adequate fluids, and managing nutrition. Steroid therapy is effective for improving symptoms.

13. Oral candidiasis

For oral candidiasis, if antibiotics are being used, the medication should be discontinued, and antifungal agents such as nystatin suspension are effective; in severe cases, systemic treatment is performed.

14. Fissured tongue

Fissured tongue does not require special treatment, and there is no appropriate specific therapy. However, irritating foods should be avoided, and the deep grooves should be kept clean and free from infection.

15. Hairy tongue

Hairy tongue does not require special treatment, but it recovers quickly if the cause is removed. Keep the tongue clean by brushing it, and dissolve the keratinized layer with an alcohol solution containing salicylic acid.

16. Geographic tongue

Geographic tongue does not require special treatment, but if pain is present, a topical mucosal anesthetic may be used.

17. Radiation mucositis

Radiation mucositis is managed by keeping the mouth clean and maintaining hydration. If pain is severe, topical anesthetic solutions, analgesics, and similar agents may be used, and steroids may also be used temporarily during the acute stage.

Tests for Diagnosing Stomatitis

1. Medical history review

Ask about the patient’s main symptoms, the duration of onset, associated symptoms, and whether the lesions have changed over time after onset. Also review past medical history, the presence of systemic diseases, trauma, allergies, and skin diseases. Obtain information about smoking, alcohol consumption, viral infections, sexual activity, and consumption of unusual foods. Information on whether the symptoms are recurrent, whether other symptoms are present, and whether the pattern changes over time can also help with diagnosis.

2. Oral examination

After the patient is seated comfortably on the examination chair, carefully observe various areas inside the mouth. Systematically inspect the lips, gums, teeth, buccal mucosa, floor of the mouth, tongue, retromolar triangle, palate (including the hard palate), and the oropharynx including the tonsils. After palpation, observe the condition of the lips, gums, and teeth. It is also necessary to carefully examine all oral mucosa, including the floor of the mouth, buccal mucosa, gums, and hard palate.

3. Biopsy

To confirm the lesion, make a differential diagnosis, and check for malignant change, some mucosal lesions are biopsied. In general, incisional biopsy is most commonly performed, taking samples from multiple possible sites around the lesion, including both the lesion and some surrounding normal mucosa, as well as the center of the lesion. When the lesion is small and the possibility of invasive cancer is low, excisional biopsy is performed by removing the lesion together with some surrounding normal tissue. Another method that may be used is to scrape the lesion with a brush and place the collected cells in fixative, then observe the exfoliated cell clusters using histologic and molecular biological methods.

4. Smear test and culture test

For some fungal, viral, or skin-related mucosal diseases of the mouth, there are also methods in which the lesion area is scraped with a cotton swab and observed through specially processed smear specimens, as well as methods to culture the causative strain.

So far, we have explained the treatment and examination methods for stomatitis.

In the next installment, we will look at carpal tunnel syndrome.

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