Aphthous stomatitis

Aphthous stomatitis is a form of stomatitis that manifests itself as ulcerative lesions in the oral cavity and is accompanied by discomfort.

An ulcerative lesion of the mucous membrane is a small wound that causes pain when eating or talking. Such defects are called aphthae. They can be located singly or in small clusters. Their shape varies from round to oval, with clear contours and a narrow red border with a grayish central coating.

Depending on the age of the person, the state of his immune defense, the provoking factor, which is considered the trigger for the development of the reaction, as well as the form of manifestation of stomatitis, treatment should be selected individually, taking into account all the features of the course of the disease.

ICD-10 code

Stomatitis consists of a large number of diseases that are characterized by the development of an inflammatory reaction on the oral mucosa. As a result of developing inflammation, dystrophic changes are observed, in particular ulcerative defects on the mucosa, the cause of which may be bacteria or viruses. Quite often, there are cases when stomatitis accompanies other concomitant diseases, such as hypovitaminosis, traumatic injuries, allergic reactions or various infectious diseases.

Aphthous stomatitis ICD 10 refers to a large group of stomatitis, which differ in the degree of impact on the mucous membrane. According to the International Classification, stomatitis and similar lesions are classified as diseases of the oral cavity, salivary gland and jaw. Each nosology has its own special code. For example, stomatitis is coded as K12.

Depending on the type of inflammatory reaction and the depth of the lesion, it is customary to distinguish superficial, catarrhal, aphthous, deep, ulcerative and necrotic stomatitis. The course of the disease can be acute, subacute and recurrent.

Aphthous stomatitis ICD 10 has a separate code - K12.0. The last digit indicates the type of damage to the mucous membrane. Thus, under the code K12.1 are other forms of stomatitis - ulcerative, vesicular, etc., and under K12.2 are meant phlegmons and abscesses of the oral cavity.

Causes of aphthous stomatitis

Stomatitis is also divided depending on the causative factor. Thus, traumatic stomatitis can develop as a result of prolonged exposure to some damaging physical or chemical agent on the oral mucosa. Infectious stomatitis develops after exposure to viruses, bacteria or fungi. In addition, this group separately distinguishes specific stomatitis, which develops in the presence of progressive tuberculosis, syphilitic or other specific infection in the body. Symptomatic stomatitis appears against the background of existing diseases of the internal organs.

The causes of aphthous stomatitis can be of various nature, however, the most common include herpes, influenza virus, some forms of staphylococcus, adenoviruses, measles virus, diphtheria bacillus and many other viruses. In addition, the body is constantly exposed to the influence of various factors, which, when combined with the cause, can provoke the development of the disease.

The factors include a low level of immune protection of the body, hypovitaminosis (C, B, lack of trace elements - iron, copper, zinc), diseases of the digestive system, aggravated allergic history, genetic heredity. Also, the causes of aphthous stomatitis can be manifested by various diseases of the oral cavity (caries, gum inflammation), burns of the mucous membrane and traumatic damage to the integrity of the mucous membrane after biting or a tooth fragment. Stomatitis most often develops in children, and in older age up to 40 years, a chronic form of aphthous stomatitis is observed.

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The causative agent of aphthous stomatitis

For the disease to develop, the pathogen must enter the body. Protective factors include the skin and mucous membranes. However, if there is even a slight breach in the integrity of one of the barriers, the infection gets inside and the incubation period begins. During this time, the pathogen waits for the right moment when the immune defense decreases or a provoking factor acts to begin reproducing.

To develop this disease, the pathogen of aphthous stomatitis penetrates through the damaged mucous membrane of the oral cavity, the defect of which can form as a result of careless brushing of teeth or during chewing. Against the background of weakened immunity, the infection begins to multiply rapidly.

The pathogen can not only enter the oral cavity from outside. Normal microflora of the oral cavity is represented by bacteroids, fusobacteria and streptococci. As a result of a decrease in the protective functions of the body or under the influence of a provoking factor, even the inhabitants of the microflora can cause the disease. Under normal conditions, they peacefully exist in the oral cavity.

The causative agent of aphthous stomatitis can be of both viral and bacterial origin. Thus, chickenpox, measles and herpes belong to viral agents. In addition, a bacterial infection can not only lead to aphthous stomatitis, but also provide a favorable background for the development of complications. Such pathogens include streptococcal, tuberculosis and scarlet fever infections. As for the fungal nature, chronic candidal stomatitis and thrush deserve special attention. Pathogens can enter the body both through the alimentary route, with food, and through the air, through the upper respiratory tract.

Symptoms of aphthous stomatitis

Symptoms of aphthous stomatitis may vary depending on the stage of the disease. The initial period is characterized by such manifestations as with a common acute respiratory viral infection. There is an increase in temperature to 38 degrees, decreased appetite, general weakness and malaise. An increase in the cervical and occipital groups of lymph nodes is also noted. This period ends with redness appearing at the site of the ulcer.

Further, as the disease progresses, aphthae are formed, which can be separate small ulcers or a cluster of them with a diameter of up to 5 mm. Defects can be located on the mucous membrane of all surfaces and parts of the oral cavity. The edges of the ulcer are separated from healthy tissues by a reddish rim with a gray fibrinous coating in the center. In addition, the remaining symptoms of aphthous stomatitis retain their intensity (temperature and general malaise). Then, discomfort is added during eating or talking, laughing or moving the tongue. Burning and pain are also noted throughout the disease.

Aphthous stomatitis on the tongue

The damage to the oral mucosa can manifest itself in various places, namely where the mucous membrane itself is. The tongue is no exception. If there is an ulcerative defect on the lateral or anterior surface of the tongue, severe pain is noted even with the slightest movement of the tongue. Especially if the ulcer is located on the transitional fold.

Aphthous stomatitis on the tongue is characterized by excessive salivation, which has a reflex nature. In addition, ulcerative defects on the tongue prevent the taste diagnostics of food. Thus, the process of eating is not only painful, but the taste of food is not felt.

Aphthae on the tongue are areas of damaged mucous membrane integrity that have a clear border with healthy tissue. The plaque has a grayish tint, and the edges are red. The ulcer size can reach 5 mm, and the shape is oval or round.

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Aphthous stomatitis in children

There are many more reasons for the development of stomatitis in children than in adults. This occurs because in childhood, various objects get into the mouth that can injure the mucous membrane of the oral cavity. In addition, children are more susceptible to infectious diseases due to an imperfect immune system.

Aphthous stomatitis in children can be observed mainly at the age of 1 to 5 years. Quite often, stomatitis is mistaken for ARVI due to a sharp rise in temperature to 39 degrees. In addition, it is worth paying attention to a decrease in appetite, increased salivation and bad breath. This is observed due to the presence of ulcerative defects in the oral cavity, the size of which can reach 6 mm in diameter. The baby may refuse to eat at all, since aphthae are accompanied by painful sensations.

Attentive mothers can independently examine the child's oral cavity to visualize the defect. It is especially worth paying attention if the baby has increased irritability, has become restless, whiny, has a high temperature for several days. Also, aphthous stomatitis in children can begin with the appearance of ulcerative defects in the corners of the mouth, and then move to the oral mucosa. In severe cases of the disease, a deterioration in the general condition can be accompanied by nausea, vomiting, apathy and panic attacks.

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Acute aphthous stomatitis

This infectious disease is considered an epidemic condition that mainly affects children in kindergarten. This occurs due to the spread of the virus by airborne droplets. Most often, acute aphthous stomatitis is caused by streptococci, staphylococci, and when a secondary infection is added, diplococci are also observed in smears from the plaque of aphthae.

The disease is registered mainly at the age of 1 to 3 years, during the period of teething. At this age, stomatitis manifests itself with symptoms of flu and inflammation of the upper respiratory tract. In addition, it can accompany measles, scarlet fever, diphtheria and whooping cough. When small aphthae merge, significant damage to the mucous membrane can form.

Acute aphthous stomatitis has its own characteristics. There is a sharp rise in temperature, which lasts for several days, aphthae cause severe pain with the slightest movement of the oral cavity. Regional lymph nodes increase in size and are painful when palpated. In addition, there is a characteristic bad breath, headache, dysfunction of the digestive tract in the form of constipation or diarrhea.

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Chronic aphthous stomatitis

Morphological manifestations of the chronic form of the disease are practically no different from ulcerative defects in acute stomatitis. However, the differences lie in the course of the disease and its duration. Thus, some acute aphthae can heal 5 days after their appearance, without leaving a scar. If stomatitis is not treated and the provoking factor continues to act, then the process of ulcer epithelialization will continue for about a month. Chronic aphthous stomatitis is characterized by the presence of long-term non-healing ulcers, which can develop again after partial scarring. Thus, the mucous membrane of the oral cavity is almost constantly in a damaged state.

This form of the disease is the suppression of the body's immune defense due to the presence of concomitant pathology, for example, AIDS. The body is unable to cope even with the common flu virus or cold, which is why all diseases that are in the chronic stage are exacerbated.

Chronic aphthous stomatitis may have an allergic origin, when the mucous membrane is especially sensitive to all irritants. In this regard, ulcerative defects do not have time to heal, as new ones appear. People with bronchial asthma, urticaria or migraine are subject to this condition. Numerous studies have revealed a high level of eosinophils in the blood, which determines the allergic nature of stomatitis.

By following a diet and maintaining a healthy diet, you can regulate the functioning of the gastrointestinal tract. After all, in some cases, it is toxic substances that remain in the intestines for a long time due to constipation that are the provoking factor in the development of stomatitis. Chronic aphthous stomatitis is most often observed in people with diseases of the large intestine, such as colitis, helminthic invasion or chronic appendicitis.

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Recurrent aphthous stomatitis

Recurrent aphthous stomatitis manifests itself in periodic rashes on the oral mucosa. The rash cycle can be a year or months throughout life. This form of the disease is observed mainly in adults, but it also occurs in children.

The symptoms differ from the acute form, namely, with the appearance of ulcerative defects, the general condition of the person does not change. There are options when two adjacent ulcers can merge into one or the aphtha can increase in size on its own. The most common places of localization include the mucous membrane of the tongue, lips, cheeks, soft and hard palate.

The clinical manifestations of the chronic form do not differ from the acute form. An ulcerous defect with a reddish rim and gray deposits in the central area is noted. The inflammatory process develops exclusively in the epithelial layer, without affecting the mucous and submucous tissue. The ulcers are very painful, and the regional lymph nodes are enlarged.

Recurrent aphthous stomatitis may have various causes. Thus, the influence of an infectious agent remains unproven, since it was not possible to detect it on the ulcer plaque. There are suggestions that the disease may develop due to the presence of a disorder of chloride metabolism in the body, changes in the transmission of nerve impulses, and also as a manifestation of the exudative process. The most acceptable cause is the allergic nature of the disease, especially in people who are prone to it.

Aphthous herpetic stomatitis

Aphthous stomatitis of herpetic origin belongs to the group of infectious diseases and is manifested by a violation of the integrity of the mucous membrane of the oral cavity. The cause of occurrence is the herpes virus, which, having caused the disease once, remains in the body in an inactive form. The source of infection can be a sick person or a carrier of the virus in the inactive phase.

Aphthous herpetic stomatitis, especially in moderate and severe forms of the disease, can manifest itself not only in local lesions, but also in general ones. There are cases of infection of children in infancy or from a mother who does not have antibodies to the herpes virus. When the disease develops at this age, a generalized form is observed with lesions of the eyes and skin.

The infection can be transmitted by contact or airborne droplets. The incubation period lasts on average up to 4 days, and then the clinical picture of the disease increases sharply. It begins with a rise in temperature to 40 degrees, and after 1-2 days there is pain when talking and laughing. The mucous membrane is swollen and hyperemic. There are small blisters on it, located singly or in groups. Their number can reach 30 pieces.

Aphthous herpetic stomatitis is rarely registered at the stage of rashes, as they quickly turn into an ulcerative form. Defects have a picture typical of stomatitis. When a secondary infection is added, deep ulcers are formed. The typical localization site is the palate, tongue and lips.

Enlargement of regional lymph nodes precedes the formation of ulcers and persists for another 1-2 weeks after epithelialization of defects.

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Diagnosis of aphthous stomatitis

To diagnose stomatitis, the doctor must first study the medical record. Perhaps the child has already had stomatitis, or is currently suffering from some other infectious disease. Next, a visual examination of the skin should be performed for rashes and proceed to an examination of the oral cavity. Diagnosis of aphthous stomatitis is based on the search for ulcerative defects on the oral mucosa.

The tissue surrounding the aphtha has a healthy appearance, and the defect itself is characterized by all the typical signs of aphthous stomatitis. Differential diagnostics should be carried out with foot-and-mouth disease, syphilitic papule, thrush and herpetic eruptions.

Diagnosis of aphthous stomatitis does not cause any particular difficulties, knowing its main manifestations - this is severe pain in ulcerative defects and an inflammatory rim around each aphtha.

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Differential diagnosis

Aphthous stomatitis should be differentiated from herpetic stomatitis, pemphigus, bullous pemphigoid, lichen planus, fixed toxicoderma, etc.

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Medicines for the treatment of aphthous stomatitis

The means that quickly and effectively fight stomatitis have not yet been developed. Nowadays, there are a huge number of drugs that can improve the well-being during the disease, as well as relieve some symptoms.

Medicines for the treatment of aphthous stomatitis should contain an anesthetic component, because ulcers are quite painful. For example, based on lidocaine, trimecaine or Kalanchoe juice. In addition, they can reduce the sensitivity of aphthae.

The products that clean the ulcer to avoid secondary infection should contain hydrogen peroxide or carbamide peroxide. Also, antibacterial drugs for oral administration or rinsing are used for this purpose. The effectiveness of chlorhexidine in accelerating the epithelialization of aphthae has been proven.

If a viral cause of the disease development has been identified, then the drugs for the treatment of aphthous stomatitis should be antiviral. Otherwise, if there is a provoking factor in the body, the disease will not be able to regress quickly. A separate group consists of drugs that stimulate the healing of ulcerative defects, for example, sea buckthorn oil, ointment with propolis, vinylin and carotolin.

Do not forget about strengthening the immune system with vitamin complexes. Also, in severe forms, antibacterial drugs should be included in the treatment. In order to reduce sensitization of the body, you should pay attention to antihistamines - Tavegil, Telfast. To reduce inflammation and pain, the appointment of corticosteroids is justified. It is advisable to add electrophoresis, phonophoresis and laser therapy to the treatment complex.

Local treatment of aphthous stomatitis consists of rinsing with a tetracycline solution (the contents of 1 capsule, 250 mg, are dissolved in water and kept in the mouth for 151 min.), corticosteroids (0.1% triamcinolone ointment, 0.05% betamethasone ointment). Local anesthetics are indicated for pain. A good effect is achieved by injecting corticosteroids into the lesion (3-10 mg/ml triamcinolone).

Treatment of aphthous stomatitis in adults

The therapeutic course must be accompanied by adherence to a certain diet, which includes the exclusion of coarse, traumatic food, as well as the consumption of hypoallergenic products.

Treatment of aphthous stomatitis in adults consists of a set of techniques aimed at reducing symptoms and healing aphthae. For this, boric acid and chamomile are needed to treat the ulcer. Rinse with the solution several times a day.

A non-concentrated solution of potassium permanganate, hydrogen peroxide diluted with water 1:1, and furacilin tablets dissolved in water are also recommended for rinsing.

Local treatment involves the use of sea buckthorn, peach oil or Kalanchoe juice. For desensitizing purposes, sodium thiosulfate is used as intravenous injections or taken orally. Strengthening the immune system is mandatory, as well as taking sedatives and antihistamines.

Treatment of aphthous stomatitis in adults can take from a week to a month, so to reduce pain, you should use anesthesin, hexoral tablets or lidochlor. These drugs will help get rid of discomfort in the oral cavity.

Treatment of aphthous stomatitis in children

Treatment of aphthous stomatitis in children should include medications aimed at eliminating the cause of the disease. At the first stage, it is necessary to exclude from the diet foods that can cause allergies, as well as spicy dishes with coarse food. However, sometimes stomatitis can be a reaction to taking some medications, so you should consult a doctor about replacing it.

The complex must include antiallergic drugs. Among them, it is worth highlighting Cetrin, Suprastin, Telfast, Diazolin. The list can be continued indefinitely, since there are a huge number of them in our time.

Local treatment of ulcerative defects should be carried out with various preparations, depending on the stage of their development. At the initial stages, it is rational to use preparations based on antiseptics, for example, Miramistin, for irrigation of ulcers. Anti-inflammatory gels are used to treat defects and relieve their pain (Holisas). These products are used up to 4 times a day.

Once the acute inflammatory phase has passed and the pain has decreased, it is necessary to add agents that can accelerate the epithelialization of aphthae - Actovegin gel. In addition to healing, it can relieve pain in the ulcerous lesion.

Physiotherapy procedures occupy a special place in treatment. They are aimed at irradiating aphthae for their accelerated healing.

Treatment of aphous stomatitis in children includes local immunomodulators. For this purpose, toothpaste with enzymes (lysozyme, lactoferrin and glucose oxidase) is used. They help strengthen the immune defense in the oral cavity and increase the resistance of the mucous membrane to bacteria and viruses. In addition, the drug "Imudon" has shown good results in the fight against stomatitis.

An integral part of the treatment is oral sanitation, since one of the causes of aphthous stomatitis is considered to be staphylococcus. This pathogenic bacterium is present in plaque of carious teeth and stones. In this regard, carious lesions and plaque should be removed from the oral cavity, and the child should be taught to maintain hygiene.

Prevention of aphthous stomatitis

Aphthous stomatitis is a group of oral diseases that manifests itself as aphthae and general symptoms. In order to prevent the development of stomatitis, it is necessary to avoid the causative factor. Thus, one should not expose oneself to traumatization of the oral mucosa. In addition, one should monitor one's diet. If there are allergenic products, one should exclude them. It is also necessary to monitor the body's immune defense, periodically taking vitamin complexes.

Prevention of aphthous stomatitis includes timely treatment of the existing disease, which is a provoking factor in the development of stomatitis. When the first symptoms of ulcerative defects appear, you must immediately begin treatment and follow the rules of oral hygiene.

Provided that the diagnosis is correct, pathogenetic treatment is started quickly, and all recommendations and diet are followed, stable and long-term remission can be achieved. However, complete recovery from chronic aphthous stomatitis is recorded quite rarely.