Recurrent stomatitis - relevance of the problem and ways of solution

Recurrent stomatitis is an inflammatory disease of the oral mucosa, has a chronic course with periods of remission and exacerbation. It is the most common disease of the oral mucosa.

This nosological unit can be independent, or it can be a complication of the underlying disease.

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Causes recurrent stomatitis

Recurrent stomatitis is a polyetiological disease. First of all, its occurrence is associated with insufficient oral hygiene. But the following causes of recurrent stomatitis are also distinguished:

1. Traumatization of the oral mucosa:
   1. mechanically (coarse food, poor quality denture, chipped tooth, biting the mucous membrane),
   2. chemically (sodium lauryl sulfate contained in many toothpastes and mouthwashes dries out the mucous membrane and thus makes it vulnerable; with accidental contact with various acids and alkalis),
   3. physical means (hot, sour food, accidental burn with steam, etc.).
2. Unhealthy diet with insufficient vitamins, micro- and macroelements in food.
3. Nervous tension, stress and sleep disorders. Many people note a relapse of stomatitis precisely during periods of stress.
4. Reduced immunity due to any disease.
5. Allergic reactions to food and medications.
6. Various infectious diseases:
   1. viral infections (ARI, flu, herpes, various forms of lichen, etc.),
   2. infections caused by Candida fungi,
   3. venereal diseases (syphilis, gonorrhea),
   4. infections of bacterial origin (tuberculosis, various pustular diseases).
7. Genetic predisposition. If parents have recurrent stomatitis, their children have a higher chance of developing it than others.
8. Hormonal factors. For example, some women experience recurrence of stomatitis during menstruation.
9. Disruption of the digestive system (dysbacteriosis, gastritis, colitis, etc.), endocrine pathology, etc.
10. Alcohol abuse and smoking.

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Symptoms recurrent stomatitis

There are general and local symptoms of recurrent stomatitis.

Common symptoms include weakness, increased temperature, sleep disturbance, irritability, and reluctance to eat. If a child has recurrent stomatitis, then tearfulness and capriciousness. Regional lymphadenitis (painful and enlarged lymph nodes) may be a complication.

Local symptoms of recurrent stomatitis:

• formation of reddened areas on the oral mucosa (in any place, of various shapes and in different quantities), the so-called catarrhal form of stomatitis. In the area of reddening, unpleasant sensations are noted in the form of burning, tingling, itching.
• As stomatitis progresses, erosions (aphthae) subsequently form at the site of redness in the case of aphthous progressive stomatitis, and in the case of herpetic stomatitis, vesicles (bubbles) first form, which open up, and then ulcers form in their place. In the case of yeast stomatitis, a milky-white coating forms on the hyperemic area, after which a bleeding spot is formed.
• the appearance of lesions (vesicles, erosions) of the oral mucosa is accompanied by severe pain, especially when eating or drinking.
• Increased salivation is typical, and an unpleasant odor from the mouth is possible.

Chronic recurrent aphthous stomatitis

Chronic recurrent aphthous stomatitis is a chronic disease with an unknown etiology (cause), in which painful ulcers (aphthae) form on the mucous membrane of the oral cavity. Chronic aphthous stomatitis is characterized by a long course, with phases of exacerbations and remissions.

Remissions can last from several weeks to several months, and sometimes even years. This disease is the most common among diseases of the oral mucosa (about 20% of the population is affected by it), it can occur at any age, but most often affects young people from 20 to 30 years old.

It is believed that recurrent aphthous stomatitis has an allergic origin. Namely, an allergy to:

• food products (most often citrus fruits, chocolate, nuts, etc.);
• helminthic infestations;
• toothpastes;
• household or industrial dust;
• medicinal preparations.

But predisposing factors alone are not always enough for the development of chronic aphthous stomatitis. Associated diseases also play an important role in its development:

• functional disorders of the digestive tract;
• microtraumas of the oral mucosa;
• respiratory viral infections;
• hypovitaminosis (deficiency of vitamins B and C, iron deficiency anemia);
• frequent inflammatory processes in the nasopharynx (rhinitis, otitis, tonsillitis);
• functional disorders of the nervous system;
• immune disorders.

It is worth noting the genetic predisposition to the development of recurrent stomatitis. For example, if both parents suffer from recurrent aphthous stomatitis, then their child has a 20% higher risk of developing this disease than others.

In the clinical picture of recurrent aphthous stomatitis, three stages are distinguished:

1. Prodrome period (precursor of the disease). Characterized by minor pain, tingling or burning sensation in the oral cavity. During examination of the oral mucosa, a reddened area and slight swelling are noted.
2. Eruption stage. Occurs a couple of hours after the initial stage. Characteristic defects appear in the place of reddening of the oral mucosa - aphthae (ulcers), they are very painful to the touch, have a round or oval shape and are covered with a fibrinous coating of a grayish-white color. Aphthae can appear on any part of the oral mucosa, but their favorite place is the inner surface of the lips, cheeks and the lateral surface of the tongue.
3. The period of the disease fading. It occurs, on average, seven days after the appearance of aphthae. Usually aphthae heal without leaving scars. If aphthae are not treated in a timely and adequate manner, or if personal hygiene is not observed, aphthae heal longer (by two to three weeks) and may leave scars (Sutton's aphthae).

The frequency of recurrent rashes depends on the severity of aphthous stomatitis.

• In case of a mild course, single aphthae appear once or twice a year.
• With moderate severity, aphthae appear every two to three months.
• In severe cases, they may appear weekly, with an increase in their number, depth of damage and duration of healing (Sutton's aphthae).

As for the general condition, there is general weakness, malaise, reluctance to eat due to severe pain, increased salivation, increased temperature, irritability, and sleep disturbances. Often, recurrent aphthous stomatitis is complicated by lymphadenitis.

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Recurrent herpetic stomatitis

Recurrent herpetic stomatitis occurs after a previous herpes infection. It has been scientifically proven that 70% - 90% of the population remain lifelong carriers of the herpes virus. The virus remains in the ganglia (nodes) of nerve cells as a latent infection and under certain conditions makes itself known as herpetic stomatitis.

Provoking factors of herpetic stomatitis.

1. Hypothermia.
2. Excessive insolation (overheating).
3. Heavy physical exertion.
4. Constant stress.
5. Microtraumas of the oral mucosa.
6. A previous illness with a high temperature.
7. Decreased immunity.
8. Previous surgeries.

The incubation period lasts from several days to several weeks.

• Redness of varying severity appears on a certain area of the mucous membrane.
• Unpleasant sensations are noted at the site of the lesion: itching, tingling, burning.
• After a couple of hours or even earlier, single or group bubbles (vesicles) appear in the area of reddened mucosa, which soon burst and form small erosions.
• There is no tissue swelling at the site of injury.
• Then epithelialization of erosions occurs, leaving no changes behind.
• In mild cases, recovery occurs within 4-5 days.
• The general condition during the period of exacerbation of herpetic stomatitis is characterized by pronounced weakness, aching joints, muscle pain, increased temperature, nervousness. Expressed general symptoms are noted in the early stages of the chronic process, over time - with each subsequent exacerbation, the general symptoms become easier.

Forms of recurrent herpetic stomatitis:

• Mild – exacerbations of the disease once a year or absent. Rashes are isolated, heal quickly, general well-being does not suffer.
• Moderately severe – exacerbations of stomatitis two to four times a year. The rash may already be grouped – several groups of blisters, the general condition may slightly worsen.
• Severe – more than five times a year. Due to frequent exacerbations, there are lesions on the oral mucosa at various stages of development. General symptoms are strongly expressed.

Recurrent herpetic stomatitis in children

Although the herpes virus affects all age groups, recurrent herpetic stomatitis most often occurs in children from one to six years old. According to statistics, about 90% of children by the age of three are already infected with the herpes virus.

In 50% of children after acute herpetic stomatitis, relapses occur. This indicates that adequate antiviral treatment is not started in a timely manner. Also, the occurrence of exacerbations of herpetic stomatitis in children depends on the characteristics of the formation of the immune system.

The symptoms of herpetic stomatitis in children are the same as in adults, only the general symptoms are more pronounced, especially before the age of 3.

If symptoms of herpetic stomatitis are detected in a child, it is necessary to immediately seek help from a doctor (pediatrician, dentist, ENT doctor) in order to begin treatment in time, prevent complications and relapse in the future.

Treatment of recurrent herpetic stomatitis is standard, as in adults, but with the use of drugs in age-appropriate dosages.

Diagnostics recurrent stomatitis

Usually, recurrent stomatitis is not difficult to diagnose. To make a diagnosis, an experienced and attentive doctor (dentist, ENT doctor, therapist, pediatrician) will need only complaints, clinical symptoms and anamnesis data (medical history). If necessary, additional research methods are prescribed:

• PCR – diagnostics for herpes virus, candidal fungi.
• smears from the pharynx and from the site of erosion (aphthae), their subsequent sowing with determination of sensitivity to antibiotics and antiseptics.

In cases of stomatitis that are difficult to treat, a more extensive examination and consultation with other specialists is prescribed in order to identify the underlying disease that caused the recurrent stomatitis.

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Treatment recurrent stomatitis

Treatment of recurrent stomatitis has the following goals.

1. Relieve pain.
2. Improve the healing of erosions (aphthae).
3. Prevent the occurrence of relapses or reduce their number.

Principles of treatment of recurrent aphthous stomatitis.

1. Elimination of predisposing factors that have an allergenic nature (if you are allergic to citrus fruits, then exclude them from your diet; if you are allergic to nuts, honey, chocolate, etc., then exclude them, etc.).
2. Treatment of concomitant diseases (it is necessary to promptly treat inflammatory diseases of the nasopharynx - otitis, rhinitis, tonsillitis; in case of hypovitaminosis, take the appropriate vitamins, etc.)
3. Diet. Eliminate coarse, spicy and sour foods from your diet to avoid additional irritation of the ulcers. Do not eat too cold or hot food, but only warm food. Include more plant foods (fruits, vegetables) and protein foods (lean meat, cottage cheese, fish, eggs) in your menu.
4. Thorough oral hygiene, preferably after eating rinse the mouth with an antiseptic solution (for example, chamomile decoction or rotokan, etc.).
5. Local therapy of the oral mucosa and aphthous (erosive) rashes consists of their antiseptic treatment. Sanitation can be carried out by a specialist (dentist, ENT doctor) or at home by the patient himself. It consists of periodic rinsing of the oral cavity:
   • antiseptic solutions (furacilin solution, rotokan, rekutan, etc.)
   • decoctions of medicinal herbs (chamomile, succession, sage, etc.).
6. During the period of exacerbation of aphthous stomatitis, when the aphthae are fresh, after sanitation, Metrogyl Denta gel (metronidazole + chlorhexidine) is often used, which has a local antibacterial, antiseptic, healing effect, and relieves inflammation well. After applying the gel, it is advisable to refrain from eating and drinking for 30 minutes.
7. During the period of exacerbation of herpetic stomatitis, after antiseptic treatment, local antiviral drugs are used (acyclovir, penciclovir, herpevir).
8. The specialist prescribes local painkillers:
   • 5% or 10% mixture of anesthesin in glycerin;
   • you can use 1% or 2% lidocaine solution;
   • A 3% solution of diclofenac based on hyaluronic acid and others are also used.

In severe cases of chronic aphthous stomatitis, when pain is severe, additional painkillers may be prescribed orally or intramuscularly (ketanov, movalis, dicloberl).

9. In the presence of necrotic plaque on aphthae, applications of proteolytic enzymes have a good effect; they gradually and painlessly eliminate it (lidase, trypsin, etc.).
10. When healing (epithelialization) of erosions begins, keratoplastic substances are used: sea buckthorn oil, rose hips, vinylin, propolis, solcoseryl. They accelerate and improve ulcer healing.
11. If a high temperature is observed, antipyretic drugs are prescribed (Nurofen, paracetamol, ibuprofen).
12. In case of recurrent herpetic stomatitis, antiviral therapy is prescribed from the very beginning of the disease (interferon, Anaferon, viburkol).
13. It is essential to use multivitamin complexes, since recurrent stomatitis is a consequence of hypovitaminosis (Multifort, Vitrum).
14. Since stomatitis has a chronic recurrent course, this indicates that the immune system is weakened and needs help. Therefore, immunomodulators of general action (echinacea, Anaferon) are necessarily prescribed. You can also use means to increase local immunity of the oral mucosa (Immudon).
15. Considering the possible allergic nature of recurrent stomatitis, antihistamines are often prescribed, which will additionally help relieve inflammation and swelling at the site of the rash (erius, fenkarol, fenistil).
16. Often recurrent aphthous stomatitis is complicated by regional lymphadenitis. In this case, lymphomyosot is used, which effectively relieves inflammation and pain in the lymph nodes.
17. Physiotherapeutic treatment is used mainly in severe cases of aphthae that take a long time to heal and often recur (photophoresis of drugs - oxoline, tetracycline ointments, etc., helium-neon laser).

Prevention

Prevention of recurrent stomatitis is very important and consists of the following:

• oral hygiene;
• it is necessary to avoid stressful situations, hypothermia, overheating, heavy physical exertion;
• preventing damage to the oral mucosa;
• timely identification and adequate treatment of diseases of the digestive system, nervous system, etc.;
• eat properly and nutritiously so that your diet contains enough vitamins and microelements;
• prevent the effects of allergens on the body (avoid contact with them);
• identification and removal of chronic foci of infection;
• lead a healthy lifestyle (avoid alcohol and smoking);
• improve your health (swimming, walking).

By following these simple steps you will forget about recurrent stomatitis and give yourself good health.

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