Symptoms of stomatitis

Stomatitis is an inflammatory process in the oral mucosa (stoma in Greek means "mouth", itis - inflammatory process). Since the etiology, causes of inflammation can be different, the clinical picture, symptoms of stomatitis are also variable and depend on the form, localization of the disease, the degree of prevalence and many other factors. Factors that provoke stomatitis can be local or general - trauma, allergy, virus, fungal or bacterial infection, irritation of the oral cavity by food products, chemicals, vitamin deficiency and lack of trace elements (most often iron). Stomatitis develops in people of any age and gender, but more often it affects children and elderly patients.

In the international classification of diseases, ICD-10, the disease is described in block K12 – Diseases of the oral cavity, salivary glands and jaws.

Stomatitis and its symptoms are classified as follows:

1. By prevalence:

• Superficial inflammatory processes, superficial stomatitis.
• Aphthous (fibrinous).
• Catarrhal.
• Deep stomatitis.
• Ulcerative.
• Necrotic.

2. By reasons, etiology:

• Traumatic factors – physical, chemical.
• Infectious stomatitis – viruses, bacteria, fungi.
• Symptomatic stomatitis as a consequence of an underlying disease of internal organs and systems.

3. According to the course of the inflammatory process:

• Spicy.
• Subacute.
• Recurrent, chronic.

4. By localization of inflammation:

• Inflammation of the gums - gingivitis.
• Inflammation of the tongue – glossitis.
• Inflammation of the lips - cheilitis.
• Inflammation of the palate (upper and lower) - palatinitis.

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Is stomatitis contagious?

Depending on the form, etiology and type, stomatitis can indeed be contagious, i.e. infectious. There is still no consensus on how contagious stomatitis is, however, it is quite logical to assume that a viral, bacterial or fungal disease of the oral cavity can be transmitted from one person to another in the same way as other diseases. Whether stomatitis is contagious is determined by a dentist who identifies the true cause of the inflammation.

How can different types of stomatitis be transmitted:

1. Herpetic stomatitis. This type of disease can be transmitted through household items - dishes, toys, towels, toothbrushes, lipstick, etc. The herpes virus is transmitted from a sick person to a healthy one and can affect the oral cavity.
2. Candidal stomatitis. It is most often diagnosed in children under one year of age, but adults can also suffer from it. The fungus can be transmitted through untreated cutlery, an infected infant who is breastfed can infect the mother's breast (nipples), just as an infected mother can contribute to the infection of the child during childbirth - passing through the birth canal.
3. Enterovirus vesicular stomatitis. This type is highly contagious among young children and it is no coincidence that the disease is called "hand-foot-mouth disease". The virus is excreted from the feces, vesicles of an infected person and is transmitted in multiple ways - oral (food or water), contact, airborne.

It is believed that the contagiousness of stomatitis is not confirmed by scientifically proven facts, however, the question of whether stomatitis is contagious can be answered by practicing doctors, and unequivocally. As a rule, with stomatitis, they recommend that all objects used by the patient be treated as thoroughly as possible and that close contact (kissing) be limited in order to avoid infection. In short, like any other infection - bacterial, viral, mycotic, certain types of stomatitis are still contagious.

Signs of stomatitis

The most typical signs of stomatitis are hyperemia of the oral mucosa, swelling, burning sensation, itching, often ulceration and bleeding. Stomatitis can be localized in certain areas, but can also affect the entire oral cavity. The generalized form is accompanied by a severe condition - high temperature, weakness, difficulty eating.

Symptoms of stomatitis usually develop in three stages:

1. The first stage of the inflammatory process manifests itself in slight redness of areas of the oral cavity, and a feeling of dryness may appear.
2. A few days later, this area swells and a characteristic white coating appears, under which the developing erosion is hidden.
3. Ulcers under the plaque can be multiple or single, superficial or deep, merging with each other.

If the inflammation is not stopped, the process spreads throughout the mouth, often affecting the corners of the mouth (angular cheilitis). Ulcers covered with a white coating are visible on the cheeks, tongue, palate and even tonsils.

The specific clinical picture and symptoms of stomatitis are directly related to the type of disease, its form and causes and can be as follows:

• Redness of the oral mucosa.
• Formation of erosions of different sizes – from a millimeter to 10 mm.
• Feeling of dry mouth, frequent swallowing.
• Pain when swallowing food.
• Pain when talking.
• Redness and swelling of the tongue.
• Irritation of the tongue.
• Loss of taste.
• Intense salivation.
• Characteristic odor from the mouth.
• In the acute form – hyperthermia.
• Lack of appetite.
• Ulcers in the corners of the mouth.
• Coating on the tongue, cheeks, and palate.
• Bleeding.

Bad breath with stomatitis

As with many other diseases of the oral cavity, when bacteria and harmful microorganisms multiply there, bad breath with stomatitis is a common uncomfortable consequence. Hypersalivation, that is, increased salivation, is itself a source of unpleasant odor, but this symptom is especially typical in the ulcerative-necrotic form of the disease, when stomatitis does not occur in isolation, locally, but affects all the mucous membranes of the cavity up to the tonsils, spreading to the internal organs and skin. In addition to headache, hyperthermia, weakness and inability to eat and pain when talking, a characteristic smell of decay or, as it is commonly called, halitosis comes from the mouth of a sick person.

A similar symptom in the form of halitosis, an unpleasant odor is typical for almost all types of stomatitis, occurring in a chronic, recurrent form. The acute form of the disease rarely lasts more than 2 weeks and the bacteria simply do not have time to die and cause an unpleasant odor. Thus, the smell from the mouth with stomatitis can be a completely logical consequence of the course of catarrhal (chronic), aphthous, vesicular, ulcerative-necrotic, purulent type of disease. As soon as bacterial plaque and the actual cause of stomatitis are eliminated, the unpleasant odor disappears. In addition, measures aimed at treating gastrointestinal diseases, which are often the root cause of protracted stomatitis, help get rid of halitosis.

Blood in stomatitis

The mucous membrane is always populated by a certain number of microorganisms, this directly concerns the oral cavity, where the bacterial balance is most vulnerable. The balance between bacterial microflora and local immunity in the form of salivation is the most important protective function, and if it is disturbed, the mucous membrane becomes thinner, dry and ulcerated, opening the way to uncontrolled reproduction of bacteria. Blood in stomatitis can be released due to the appearance of ulcers, necrotic areas, and also because the mucous membrane is characterized by its intensive blood supply. Thus, local protection in the form of an intact mucous membrane is disturbed, the composition of saliva changes, where an increased level of lysozyme is noted.

Blood and bleeding in stomatitis are typical for herpetic, ulcerative-necrotic (Vincent's stomatitis), aphthous (severe recurrent form), and other types of the disease associated with infection and penetration of bacteria and viruses into the oral cavity. Blood is not typical in stomatitis caused by Candida, allergies, catarrhal, medicinal and symptomatic types of the disease, although their severe, advanced forms can also be accompanied by bleeding gums.

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Pain in stomatitis

Pain when swallowing, chewing food, talking, smiling, etc. is a typical clinical manifestation of many types of stomatitis in an advanced stage.

Even such a simple type as catarrhal inflammation of the oral mucosa can be accompanied by a pain symptom. Pain in stomatitis is caused by ulceration of large areas of the oral cavity, drying of the mucous membrane and tissue necrosis. In addition, pain can be caused by total swelling of the gums, palate, swelling and erosion of the tongue. The acute form of many types of stomatitis lasts quite a long time - up to two weeks and all this time the patient feels pain and burning during such everyday actions as eating, talking. Severe, recurrent forms of stomatitis are also characterized by pain, in addition, a person's body temperature rises and pain is felt not only in the oral cavity, but also in the submandibular lymph nodes, joints, muscles (aches). Pain is also characteristic of the herpetic type of stomatitis, while discomfort is felt constantly, the entire oral cavity itches, herpetic rashes can spread to the lips, which also hurt, their corners crack and become inflamed. The pain symptom subsides when the main inflammatory process is removed and the identified pathogen – virus, bacteria – is neutralized.

Temperature with stomatitis

Hyperthermia in stomatitis is a phenomenon typical for severe forms of the disease, when it is not diagnosed in a timely manner and is not treated at an early stage.

As a rule, the symptoms of acute forms of stomatitis subside within 2-3 days with proper therapy. If the inflammatory process is not stopped, it develops and becomes widespread, generalized, not only the oral mucosa suffers, the pathogens - viruses, bacteria, fungi - penetrate into the regional lymph nodes, often into the gastrointestinal tract (enteroviral stomatitis), provoking a reaction from the immune system.

The temperature during stomatitis can be quite high - up to 39-40 degrees, this is especially dangerous for newborn babies, who are most often diagnosed with candidal and herpetic types of stomatitis. Body temperature directly depends on the severity of the process, its prevalence, if stomatitis is mild, hyperthermia does not occur. Moderate forms are accompanied by subfebrile temperature, sometimes reaching 38 degrees. Stomatitis is most difficult for babies under 3 years old, older children cope with the symptoms easier, since they are able to rinse their mouths on their own, and, unlike newborns, understand the importance and take a direct part in the treatment.

The absence of elevated temperature during stomatitis indicates its mild or acute, transient form, when no additional infection joins the process - acute respiratory viral infection, adenovirus, and so on.

Cough with stomatitis

Cough with stomatitis is not a typical clinical manifestation of the disease and cannot be considered a specific symptom.

In dental and pediatric practice, there are cases where severe forms of generalized stomatitis may be accompanied by a runny nose, cough, and hyperthermia. However, this is more likely a manifestation of secondary symptoms of a concomitant or primary disease than a sign of stomatitis as an independent nosological entity. Even catarrhal stomatitis, despite the origin of the name from the Greek katarreo - inflammation, flow, is not characterized by coughing, rather it is characterized by inflammation of the entire mucous membrane, its hyperemia.

Cough with stomatitis is a signal of an accompanying infection, most often of viral etiology, since bacterial infections are more characterized by purulent discharge. Cough can accompany a severe form of herpetic stomatitis, but not as a specific symptom, but due to the fact that herpes weakens the immune system and makes the body vulnerable to various viral and bacterial diseases - influenza, acute respiratory viral infections, acute respiratory infections. Adenovirus, parainfluenza often coexists with stomatitis, especially in young children, manifesting itself as fever, cough and discharge from the nasopharynx.

In addition, cough is a typical symptom characteristic of stomatitis, which develops as a consequence of tuberculosis infection; such a disease is more often diagnosed in adult patients.

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Stomatitis on the gum

Stomatitis on the gums is gingivitis, this is what inflammatory processes localized on the gums are called. The cause of gum stomatitis can be various etiological factors, however, most often the inflammation is provoked by mechanical irritation of dentures, tartar, poorly placed filling or an incorrectly selected toothbrush. In addition, an elementary incorrect bite can become the main cause of gingivitis. Rarely, stomatitis on the gums can be caused by vitamin deficiency or periodontosis - a systemic disease of gum tissue.

Symptoms of gum inflammation:

• Swelling and hyperemia of the gums, lower or upper.
• Bleeding gums when eating or brushing teeth.
• A burning sensation and itching in the gum area with catarrhal gingivitis.
• Formation of ulcers along the edge of the gums in severe forms of stomatitis.
• Bad breath.

It should be noted that the rarest type of gum stomatitis is scurvy gingivitis, which develops as a result of persistent, permanent deficiency of vitamin C.

There is also a hypertrophic form of gingivitis, which is a consequence of chronic periodontosis, when the gums atrophy, become necrotic, and the teeth become loose without pain.

Stomatitis under the tongue

Symptoms that manifest as stomatitis under the tongue indicate that the herpetic form of inflammation of the oral cavity is developing. This type of stomatitis is characterized by ulceration of the area under the tongue, the bottom area. All other signs of stomatitis that concern the tongue are related to glossitis. Glossitis is characterized by inflammation of the superficial layer of the mucous membrane, less often deep ulcers can develop that affect the thickness of the tissue. The rarest symptom is a deep perforated ulcer of the tongue, accompanied by purulent discharge in the form of an abscess. Sublingual stomatitis can develop as a result of a protracted, infectious process, which is characterized as generalized, affecting the entire oral cavity. Most often, the sublingual area suffers from purulent-inflammatory stomatitis. A person has difficulty swallowing, talking, he develops hypersalivation (increased salivation). If timely treatment is not started, the spread of bacterial infection affects the mandibular space, the maxillo-lingual groove, the bone tissue of the jaw, up to the development of osteomyelitis.

Stomatitis in the mouth

Stomatitis is a general name that unites many types of inflammation of the oral cavity.

The collective description of the inflammatory process that many call stomatitis in the mouth is actually divided into certain isolated localized (local) inflammations:

• The inflammatory process in the gums is gingivitis.
• Inflammation of the palate - palatinitis.
• Inflammation of the mucous membrane of the tongue – glossitis.
• Inflammation of the border and tissues of the lips - cheilitis, including angular cheilitis (cheilitis).

Stomatitis in the mouth can also be generalized, that is, it affects literally the entire oral cavity, including the tonsils.

The causes of stomatitis are also multiple, the symptoms are directly related to the type of inflammation and its etiology. However, the general signs of stomatitis are:

• Redness of the oral cavity.
• Swollen gums.
• Plaques on the cheeks and tongue.
• The appearance of a rash in the form of papules, ulcers, aphthae, pustules (depending on the type of stomatitis).
• Bad breath.
• Bleeding.
• Pain when eating.

Diagnosis and treatment of stomatitis in the mouth is carried out differentially by symptoms and etiological causes. The prognosis is generally favorable, but relapses and transformation of inflammation into a chronic form are possible.

Stomatitis on the lip

Stomatitis on the lip, in the corners of the lips is cheilitis, most often caused by the herpes virus, as well as angular cheilitis or catarrhal cheilitis.

Causes of cheilitis:

• Candidal stomatitis.
• Rarely – catarrhal stomatitis, transforming into a chronic form.
• Herpetic stomatitis.
• Avitaminosis (B vitamins).
• Gonococcal stomatitis.
• Bacterial forms of stomatitis caused by staphylococcus, streptococcus.

Stomatitis on the lip most often manifests itself as angular inflammation, that is, angular cheilitis.

The corners of the lips first become inflamed, then covered with pustules containing pus. The pustules burst, forming cracks, which do not heal for a long time as a result of the lips moving when eating and talking. The skin of the corners of the lips becomes hyperemic, ulcers may form, periodically recurring and releasing pus. The epithelium of the lips desquamates (flakes), the lips itch and scratch. Stomatitis on the lip is a contagious inflammation, so the patient must first of all observe the rules of personal hygiene and use only personal cutlery, a toothbrush, a towel, etc.

Stomatitis on the tonsils

Stomatitis can spread to the tonsils only in the case of a severe form of the disease, such types of inflammation belong to a serious category - fusotrepanematosis of the oral cavity. The causative agents of such diseases are bacteria of the Treponema or Fusobacterium family. As a rule, the herpes virus, streptococci, staphylococci do not spread to the larynx due to stomatitis, although they can be present in it for another separate reason (an independent disease).

The following diseases are classified as fusotrepanematoses:

• Gingivostomatitis, Vincent's disease.
• Angina Plaut - Vincent.
• Ludwig's phlegmon, oral phlegmon.

Most often, stomatitis on the tonsils is Plaut-Vincent's angina or Botkin-Simanovsky's stomatitis. Its causative agents are two microorganisms - spirochetes and spindle-shaped bacilli, or more precisely saprophytes, which are present in the mouth of a healthy person without causing inflammation. The pathogenicity of microorganisms is associated with the following factors:

• Gradual decline in immune defense (often HIV).
• Violation of basic rules of personal hygiene.
• Alcoholism, drug addiction.
• General exhaustion of the body as a result of prolonged chronic inflammation.
• Starvation, poor nutrition.
• Hypothermia, frostbite.
• Intoxication.

Localized on the tonsils, such tonsillitis quickly spreads throughout the oral cavity, affecting the gums, tongue, cheeks, and palate. Most often, stomatitis on the tonsils is one-sided, accompanied by ulcers, infiltrates, and necrotic areas of the mucous membrane. The disease can recur if adequate comprehensive treatment is not used. In addition, complications can include adenophlegmon and severe intoxication of the body.

Symptoms of aphthous stomatitis

Aphthous stomatitis is divided according to the nature of the course into acute and recurrent, and the symptoms of the disease are correspondingly different.

The acute form of aphthous stomatitis has very specific causes:

• Colitis, enteritis, other diseases of the gastrointestinal tract.
• Allergy.
• Viral infection.
• Trophoneurotic disorders.

Symptoms of acute aphthous stomatitis are specific:

• A sharp increase in temperature to 39-40 degrees.
• Weakness, adynamia.
• On the second day, when aphthae appear, the condition becomes severe, there are all the signs of intoxication and inflammation.
• Enlargement of regional lymph nodes.
• Constant pain appears when eating and swallowing.
• Salivation increases.
• A sharp, specific smell from the mouth.

Acute aphthous stomatitis is characterized by its specific rashes on the mucous membrane - aphthae. These are single painful round formations that form from small bubbles that burst, turning into ulcers. The ulcers also look characteristic - covered with a thin fibrinous film, have a red rim along the edges. Aphthae are the main symptoms of aphthous stomatitis, they are localized on the lateral surfaces of the tongue, its tip, on the lips (the inner part of the mucous membrane), on the bottom of the oral cavity, inside the cheeks and on the palate. Aphthae can go away on their own within a week, but this does not mean their complete disappearance, aphthae can recur for many months without proper treatment. Frequent relapses are noted in the autumn and spring seasons, when aphthous stomatitis is diagnosed 2 times more often.

Recurrent chronic forms of aphthous stomatitis have the following symptoms and are classified as follows:

• Typical course of the disease, typical form, in which superficial ulcers-aphthae periodically form in the oral cavity. Symptoms of aphthous stomatitis in chronic typical form can be subdivided according to another differentiation:
  • A generalized form of aphthosis, in which aphthae spread to the oral mucosa, skin, genitals, conjunctiva of the eyes, causing extensive pyoderma and streptoderma.
  • Isolated recurrent aphthous stomatitis is the most frequently diagnosed type, in which ulcers affect the mucous membrane of the cheeks, lips, and sides of the tongue. Aphthae are not multiple, they are grouped in the form of 2-3 ulcers next to each other.
• An atypical form in which deep aphthae form, leaving scars (Sutton's aphthae, cicatricial aphthae).

There is a more dangerous type of aphthous stomatitis - Behcet's disease, when the entire mucous membrane of the mouth, including the tonsils, is covered with aphthae, moreover, aphthae spread to the conjunctiva of the eyes and even to the mucous tissue of the female genitals. This serious disease was described in the 30s of the last century by Dr. Behcet as a symptom complex, which included ulcerative stomatitis, ulcers of the genitals, uveitis (lesion of the conjunctiva of the eyes). Later, symptoms of thrombophlebitis, arthritis, erythema, cutaneous vasculitis, aneurysm of large aortas, ulcerative processes of the intestine joined this triad. The etiology of this systemic disease is still unclear, but the symptoms of aphthous stomatitis, which quickly spread throughout the body, are one of the characteristic signs of Behcet's disease.

Symptoms of Candidal Stomatitis

Symptoms of oral thrush, candidal stomatitis are quite specific and pronounced. Oral candidiasis is a common disease diagnosed in young children with reduced immune protection, aged up to 1-2 years.

Symptoms of candidal stomatitis in children depend on the location and form of the process:

• Signs of stomatitis throughout the oral cavity.
• Gingivitis.
• Glossitis.
• Angular cheilitis, cheilitis.

Forms - mild form of thrush with unmanifested symptoms, moderate-severe form, when signs of candidiasis can be such phenomena:

• White, cheesy in consistency, coating on the tongue and inside of the cheeks.
• Under the plaque areas there is an eroded surface of the mucous membrane.
• Pain when eating and swallowing.
• Decreased appetite, refusal to eat due to pain.
• Weight loss.
• Irritability, insomnia.

In severe, advanced cases, the symptoms of candidal stomatitis can spread to the gastrointestinal tract. If the fungus gets into the digestive organs, dyspepsia, bowel disorder, and dysbacteriosis develop.

Symptoms of oral thrush in adults:

• Burning, dry mouth.
• A characteristic white, cheesy coating, primarily on the tongue.
• Swelling and redness of the oral cavity.
• Bleeding when eating or brushing teeth.
• Loss of taste.
• Difficulty eating, painful chewing and swallowing.
• A characteristic metallic taste in the mouth.

Symptoms of herpetic stomatitis

Herpetic stomatitis is one of the most common types of infectious inflammation of the oral cavity, which is diagnosed in 75% of children. In adults, the herpes virus provokes the formation of vesicular rashes on the lips, less often in the oral cavity. The disease usually occurs in a mild form. Children suffer from herpetic stomatitis more severely, with an increase in body temperature, a feverish state.

Symptoms of herpetic stomatitis are as follows:

• Swelling of the oral mucosa.
• A sharp increase in body temperature to 38, sometimes up to 39 degrees.
• The lymph nodes become enlarged and are painful upon palpation.
• After 2-3 days of fever and reddening of the gums, many small vesicular eruptions form in the oral cavity, often so small that they are not noticeable against the background of the reddened membrane.
• The vesicles quickly merge with each other, forming larger erosions.
• Erosive areas are covered with a white-gray coating.
• The person often has a headache and develops nausea.
• With herpetic stomatitis, symptoms of catarrhal gingivitis (inflammation of the gums) often appear; the gums are swollen and bleeding.

Symptoms of viral stomatitis caused by herpes may appear depending on the form of the process:

1. Mild form – vesicles are located only in the mouth.
2. Moderate severity – the rash spreads to the lips.
3. Severe form of herpetic stomatitis - vesicles quickly spread to the lips, to areas of the body located far from the oral cavity - the nasolabial triangle, face. This form is most dangerous for newborns, who may have nosebleeds, blood appears in the saliva, symptoms of general intoxication of the body are noted, blood pressure and pulse drop. Patients with severe herpetic stomatitis are hospitalized.

Herpetic stomatitis, which takes on an advanced severe form, can transform into an ulcerative-necrotic, intoxicating form.

Symptoms of allergic stomatitis

Stomatitis of allergic etiology is divided into the following types according to the clinical picture:

• Catarrhal allergic stomatitis.
• Hemorrhagic stomatitis.
• Vesiculoerosive type.
• Ulcerative necrotic allergic stomatitis.
• Combined view.

Symptoms of allergic stomatitis can be localized, that is, appear only in a separate area of the oral cavity - the palate, gums, tongue, but the process can also be diffuse, widespread. In addition, the clinical picture depends on the type of immunological response, on morphological changes, which can be as follows:

• Serous allergic stomatitis.
• Hyperemic, exudative stomatitis.
• Erosive and ulcerative drug-induced inflammation of the oral cavity.

Clinical manifestations of allergic stomatitis, depending on the provoking factor, are as follows:

• Allergy to medications in the form of stomatitis is catarrhal, catarrhal-hemorrhagic stomatitis. The patient feels itching, burning in the gums, the oral cavity is dry, painful, especially when eating. The mucous membrane swells, puffs up, turns red. The papillae of the tongue atrophy and it looks like "varnished".
• Allergy to fillings, dentures. Patients complain of dry mouth, increased salivation (saliva is unusually viscous), burning in the gums, on the tongue. Denture bed - the mucous membrane is inflamed exactly within the boundaries of the denture, the gum tissue is loosened, hyperemic. Against the background of reddened gums, hypertrophic growths of the papilloma type are often noted. Characteristic symptoms of allergic stomatitis of this type are clear imprints of teeth on the inner zone of the cheeks, swelling of the tongue, palate, pharynx, difficulty swallowing food, erosive damage to the mucous membrane is possible.

A specific feature of the clinical picture of allergic stomatitis is the syndrome of withdrawal of the provoking factor; as soon as the triggering cause is eliminated, the symptoms subside.

Symptoms of viral stomatitis

Stomatitis is often provoked by viruses, among which the herpes virus has held the leading position for many years; less often, such inflammation is caused by the chickenpox virus, parainfluenza and flu, adenovirus, and enterovirus.

According to WHO statistics, herpetic lesions of the oral cavity are second only to influenza; the symptoms of viral stomatitis caused by herpes are as follows:

• Acute onset, sharp rise in body temperature from 37 to 40 degrees in a few hours.
• After two days, swelling forms on the reddened oral mucosa, hiding tiny rashes (vesicles). The blisters can be multiple and merge with each other, and they contain exudate. If the vesicles burst, erosive areas hidden by plaque and crust immediately form in their place.
• Hypersalivation is observed, with the saliva being very viscous, thick, and foamy.
• Vesicles spread to the border of the lips, corners of the lips, even to the mucous membrane of the nose and other organs if the disease is severe.
• The period of viral stomatitis rarely exceeds 3 weeks; after a week, the symptoms subside and recovery occurs, of course, with adequate treatment.

Symptoms of viral stomatitis may be a manifestation of vesicular stomatitis, which is clinically very similar to the signs of influenza. The vesicular type is a zoonotic infection that is rarely found in humans. Most often, signs of vesicular inflammation can be found in zoo workers, farm workers, and those who often and constantly come into contact with animals.

The person has a severe headache, fever develops, after 2-3 days vesicles form, usually in the oral cavity. The blisters are filled with a clear liquid, and when opened, they itch, transforming into ulcers.

Symptoms of Stomatitis on the Tongue

The inflammatory process in the mucous membrane and tissues of the tongue, glossitis, can be caused by an independent, separate disease, but most often this is how the symptoms of stomatitis on the tongue manifest themselves. The cause of the inflammation are pathogenic microorganisms, both bacteria and viruses. The most common among them are the herpes virus, staphylococcus, streptococcus, candida.

Symptoms of stomatitis on the tongue are as follows:

• Burning, itching in the upper part of the tongue, rarely in the sublingual region.
• Feeling of a foreign body in the mouth.
• Edema, swelling of the tongue.
• Increased salivation.
• Dulling of taste sensations, often loss of taste.
• A sensation of an unusual taste in the mouth.
• Painful sensations at the root of the tongue when swallowing.
• Swelling of the tongue causes difficulty in speaking (slurred, slow speech).

Symptoms of an advanced inflammatory process in the tongue area:

• Persistent swelling of the tongue.
• The structure of the tongue surface changes, the pattern of papillae changes.
• Plaques are possible, the nature of which depends on the type of stomatitis (white, cheesy, white, purulent, etc.).
• Redness and ulceration of the tongue.
• Advanced erosions can develop into a tongue abscess, which is manifested by pulsation, a strong increase in the abscess area, swelling of the entire tongue, hypersalivation, and an increase in temperature.

Symptoms of stomatitis in the throat

Some types of stomatitis can actually manifest clinically in places that are not typical for them – the skin of the face, larynx, nasopharynx.

Symptoms of stomatitis in the throat are most likely manifestations of aphthous recurrent inflammation of the oral cavity. It is with this course of the disease that aphthae can spread beyond the cheeks, palate, and gums. The generalized form of aphthous, ulcerative-necrotic inflammation of the oral mucosa is often accompanied by the appearance of characteristic ulcers not only in the oral cavity, but also on the mucous membrane of the palate, pharynx, larynx, but almost never on the tonsils. It should be noted that the symptoms and signs of stomatitis in the throat can be clinical manifestations of throat diseases themselves - tonsillitis, sore throat, and so on. In this case, stomatitis is a consequence of the primary pathology, and not the root cause.

In addition to aphthous, symptoms localized in the throat can be caused by almost any type of infectious stomatitis in a chronic, advanced form. Streptococci, staphylococci, diplococci, fungi and other pathogenic microorganisms easily penetrate deep into the oral cavity if the disease is not diagnosed and treated in a timely manner.

Types of stomatitis

Types of stomatitis are divided into three main classification areas:

Forms - acute and chronic, where the acute form of stomatitis is the primary symptoms of the disease, and the chronic form is stomatitis that is not treated at an early stage, characterized by a long course and relapses. Primary stomatitis includes catarrhal, fibrinous proliferative type of the disease. Secondary, chronic stomatitis is erosive, aphthous, ulcerative stomatitis.

Morphology:

• Simple form – catarrhal stomatitis.
• Aphthous stomatitis.
• Ulcerative stomatitis.
• Etiology:
• Traumatic stomatitis.
• Allergic stomatitis.
• Infectious stomatitis.
• Symptomatic stomatitis as a consequence of the underlying disease.
• Specific stomatitis as a consequence of a specific pathology, such as syphilis, tuberculosis.

In addition, types of stomatitis may differ in the nature and intensity of the inflammatory process, these are such varieties as:

• Catarrhal, simple stomatitis.
• Catarrhal-ulcerative.
• Catarrhal-desquamative stomatitis.
• Gangrenous.
• Vesicular stomatitis.
• Aphthous.
• Hyper and parakeratotic stomatitis.

Here is a description of the most common types of inflammatory processes in the oral cavity:

1. Catarrhal, simple stomatitis, which is characterized by inflammation of the mucous membrane without ulceration and formation of aphthae.
2. Ulcerative stomatitis, which often develops as a consequence of untreated primary catarrhal disease. In fact, the ulcerative type of stomatitis is the second stage of an undiagnosed catarrhal type. The ulcerative variety is characterized by a rather severe course of inflammation and is diagnosed mainly against the background of chronic gastrointestinal diseases, iron deficiency, anemia. Ulcers penetrate the entire depth of the mucous membrane, are accompanied by severe pain when eating, talking, body temperature may rise, lymph nodes may enlarge, and symptoms of general intoxication may be noted.
3. The aphthous variety of stomatitis is characterized by special formations in the oral cavity - aphthae. These are specific blisters that quickly rupture and transform into small ulcers. The ulcers have a characteristic appearance - they are covered with a thin fibrous film on top, and have a bright red rim along the edges. Aphthae are usually localized on the tongue, its tip, cheeks and hard palate. The tongue looks burnt, swollen, salivation increases. Aphthous stomatitis often recurs in the fall or spring season, aphthae heal with difficulty, slowly, often merging into one large ulcer.
4. Ulcer-necrotic type of stomatitis almost always covers the entire oral cavity and even internal organs, skin. Such stomatitis is characterized by a general severe condition, fever, intoxication, headaches, high temperature, hypersalivation and a characteristic putrid odor from the oral cavity.
5. Herpetic stomatitis, which, as a rule, is acute and is typical for small children and those with reduced immunity. Herpetic rashes are very similar to aphthae, but contain a characteristic serous fluid inside, develop faster, accompanied by intense symptoms - increased body temperature, enlarged submandibular lymph nodes. The herpetic type often transforms into ulcerative without proper treatment and oral care.
6. Candidal stomatitis (oral candidiasis, thrush). This is an inflammation caused by yeast-like microorganisms - fungi. Most often, newborn babies with a low immune status, elderly patients with persistent, chronic diseases suffer from oral thrush.
7. Traumatic stomatitis is typical for adults, especially those who use dentures. Types of stomatitis caused by trauma to the oral cavity usually develop as catarrhal inflammation and are treated quickly if diagnosed in time. More severe cases are associated with the addition of a microbial infection, when ulcers and infiltrates can develop in the oral cavity.
8. The vesicular type of stomatitis is very similar to the symptoms of influenza. A person begins to have a headache, bones ache, muscles ache, and a fever develops. Such signs accompany the formation of vesicles, which are visible 2-3 days after the first symptoms appear. Untreated vesicles transform into erosive ulcers.
9. Intoxication stomatitis, which is a consequence of poisoning with salts of heavy metals. Ulcers of this type are persistent, poorly treatable, a person cannot eat because of pain, feels a characteristic taste of metal. With intoxication, the clinical picture of poisoning very quickly appears - dyspepsia, weakness, a drop in blood pressure, and stomatitis is only one of the signals about the accumulation of toxins in the body.

Simple stomatitis

Simple stomatitis is considered to be a catarrhal superficial type of inflammatory process in the oral cavity or simple gingivitis - gingivitis simplex.

Simple stomatitis most often occurs acutely with the following symptoms:

• Redness of the oral mucosa.
• Swelling of the oral cavity and tongue.
• Erosive formations along the gum line, in areas where there is tartar or caries.
• Rounding and smoothing of the gingival papillae.
• There may be a feeling of loosening of the teeth in the alveoli.
• In the first few days, a whitish coating appears on the tongue, then it darkens.
• The mucous membrane becomes thinner and teeth marks are visible on it.
• Hypersalivation is observed – increased secretion of saliva.
• Bad breath appears.
• Eating may cause pain.

The acute form, which is characterized by simple stomatitis, lasts no more than 2 weeks. Further development of the disease can proceed in three variants:

• With timely diagnosis and treatment, the symptoms of stomatitis subside, the disease ends and does not recur.
• If catarrhal stomatitis is not treated, it becomes a persistent chronic form, and the disease can periodically recur.
• If the chronic form of simple stomatitis is accompanied by an additional infection of the oral cavity and nasopharynx, the disease transforms into a deep form.
• Recurrent catarrhal stomatitis is one of the typical signs of pathology of the digestive tract, as well as helminthic invasion.

Vesicular stomatitis

In terms of symptoms, vesicular stomatitis is very similar to acute respiratory viral infections, acute respiratory infections, and influenza. Stomatitis, which is not accidentally called Indiana fever or stomatitis vesiculosa contagiosa, since it is diagnosed mainly in the southern American states, as well as in Africa, less often in Europe and Asia. Vesicular stomatitis is an extremely infectious, contagious disease of cattle, horses, pigs. People rarely get sick with this type of stomatitis and only in the case of constant, close contact with sick animals. The disease has a viral etiology, the causative agent is a specific RNA virus from the Rhabdoviridae family. This virus tends to reproduce in the organisms of almost all vertebrates, easily replicates in animal cells.

In humans, the vesicular type of inflammation of the oral cavity is very rare, if such cases are diagnosed, then the treatment is carried out in accordance with the therapy of the influenza virus. The prognosis is favorable in 100%, recovery occurs in 5-7 days.

Catarrhal stomatitis

Catarrhal stomatitis is the simplest, safest and non-contagious form of inflammation of the oral cavity. The disease rarely lasts more than 2 weeks, has no consequences in the form of defects of the mucous membrane - ulcers, infiltrates, aphthae. The etiology of the catarrhal type of stomatitis lies in the failure to comply with the rules of personal hygiene, poor care of the oral cavity, teeth, in fact, such stomatitis is a disease of dirty hands and uncleaned teeth. Most often, catarrhal stomatitis is diagnosed in small children who pull everything into their mouths, but adults can also suffer from this disease due to persistent untreated caries, the presence of tartar. In addition, the catarrhal type of stomatitis can be a consequence of intolerance to the filling material in the treatment of teeth, dentures or allergies to certain types of medications.

The main symptoms are hyperemia of the oral mucosa, tongue, swelling, plaque on the tongue, burning sensation. There may be an unpleasant odor, bleeding gums, loosening of teeth. The acute stage can become chronic without proper treatment, in such cases the catarrhal type develops into aphthous and other types of stomatitis with more serious symptoms and consequences.

As a rule, treatment consists of following a diet that excludes irritating foods (spicy, sour, hot dishes, foods that have a hard consistency). Intensive oral sanitation is also carried out, rinses, B vitamins, vitamin C and A are prescribed. Treatment of carious teeth and removal of tartar are mandatory, and personal hygiene and oral care rules are considered the main preventive measures.

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Acute stomatitis

Acute stomatitis is diagnosed when such manifestations appear for the first time in the patient's medical history. Later, if after treatment stomatitis again manifests itself with one or another symptomatology, it is considered chronic, recurrent, which may be a sign of either inadequate therapy or a missed systemic pathological process in the internal organs.

Acute stomatitis, despite such a formidable name, is considered a fairly safe form, in which the disease progresses quickly and is treatable. Moreover, the acute form of stomatitis is the very initial stage of inflammation development, when it can be stopped and the formation of persistent recurrent types can be prevented. Acute stomatitis rarely lasts more than 14 days, is accompanied by a burning sensation in the mouth, hyperemia of the mucous membrane, tongue, usually without the formation of aphthous ulcers.

The acute form is most difficult for newborns, they refuse to eat, lose weight, their general condition worsens every day. Therefore, attentive parents should be alarmed when a white coating appears on the tongue, the inside of the baby's cheeks, pay attention to any atypical behavior - capriciousness, poor sleep, continuous crying.

The most dangerous is acute herpetic stomatitis, an extremely contagious disease that occurs with painful symptoms. The herpetic type of inflammation of the oral cavity has an incubation period of 2 to 4 days. Symptoms manifest rapidly and acutely:

• A sharp increase in body temperature to 39-40 degrees is possible.
• Pain in the mouth appears when eating or talking.
• The mucous membrane of the entire mouth is hyperemic, small vesicles are formed on it, which are often not visible.
• The vesicular stage lasts no more than a day; they quickly transform into ulcers.
• If treatment is not started, erosive ulcers spread to the palate, tongue and lips.
• A more severe form, which acute stomatitis of herpetic etiology can acquire, is accompanied by an increase in regional lymph nodes. This form of stomatitis in children is treated in hospital conditions.
• Despite the acute onset, this type of stomatitis goes away after 2-3 weeks with adequate therapy.

In clinical practice, any acute stomatitis is usually divided into three forms - mild, moderate and severe, and the disease also progresses in five stages:

1. Incubation.
2. Prodromal period.
3. Development.
4. Reduction of symptoms, fading of the process.
5. Recovery.

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Chronic stomatitis

Chronic stomatitis is a typical consequence of either self-medication or the complete absence of treatment measures during the manifestation of an acute form of inflammation of the oral cavity. Chronic stomatitis can bother a person for many months, and sometimes years, interspersed with short periods of remission. In addition to self-medication, uncontrolled use of medications or the absence of therapy as such, the causes of chronic recurrent stomatitis can be the following factors:

• Sluggish, latent pathological processes in the digestive tract – gastritis, colitis, dysbacteriosis.
• Reduced immune activity, immunodeficiency caused by either a sluggish disease of internal organs or systems, or a serious disease such as tuberculosis, sexually transmitted diseases, HIV. In addition, premature newborns can also have extremely low immune activity and suffer from chronic stomatitis for many months.
• Constant mechanical irritation of the oral cavity due to uncomfortable dentures and braces.
• Diseased teeth, such as chipped or protruding roots, constantly injuring the oral mucosa and opening the door to infection.
• Tartar, caries.
• Avitaminosis, anemia.
• Streptococcal, staphylococcal infection, systemic candidiasis.
• Bad habits such as smoking, nail biting, neurotic habits of holding pens, matches, and other objects in the mouth that can introduce bacterial or fungal infections into the mouth.
• Persistent failure to observe personal hygiene rules, including oral hygiene, the habit of using other people's toothbrushes, dishes, and cosmetics.

Chronic stomatitis, depending on the type, can manifest itself in periodic reddening of the oral mucosa or its ulceration. Subfebrile temperature is often noted, which is not associated with other specific diseases - colds, inflammation, etc. Constant formation of ulcers, aphthous erosions that do not respond to treatment, enlargement of lymph nodes, paroxysmal swelling of the tongue - this is far from a complete list of signs of chronic stomatitis.

Despite the variety of symptoms, they have one thing in common: systematic repetition and relapse.

Treatment of chronic stomatitis has a specific goal - eliminating the underlying cause; therapy is carried out using both local procedures and by prescribing drugs per os (orally).

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Ulcerative stomatitis

Ulcerative stomatitis is, as a rule, a consequence of untreated catarrhal form, but it can also be an independent disease associated with chronic pathologies of the gastrointestinal tract, infections or intoxication.

Ulcerative stomatitis is very different from the simple catarrhal type of inflammation, since with catarrh only the upper layer of the mucous membrane is damaged, and with the ulcerative form the entire tissue of the membrane is eroded. Ulcers penetrate so deeply that the superficial epithelium necrotizes, merges and forms fairly large erosions. Ulcers can even spread into the bone tissue of the jaw and provoke osteomyelitis.

Symptoms of ulcerative stomatitis:

• The onset is similar to the catarrhal form - hyperemia of the mucous membrane, swelling of the tongue, burning.
• A characteristic putrid smell appears from the mouth.
• Ulcers develop quickly and cause symptoms typical of general intoxication - weakness, increased body temperature (subfebrile temperature), headache.
• After 2-3 days, white-gray plaque forms on the cheeks and under the tongue, covering the eroded mucous membrane.
• The lymph nodes become enlarged from the first days of the disease.
• Eating, talking, smiling cause acute pain.

The earlier the treatment of ulcerative stomatitis is started, the lower the risk of penetration of the erosive process deep into the tissues. Local treatment is usually combined with etiotropic drugs prescribed orally. Pain is relieved with the help of powders, anesthetic ointments, and rinsing with antiseptic solutions, applications, and baths are also prescribed.

Timely treatment can reduce the period of erosion epithelialization to one week. After the painful symptoms subside, systemic oral sanitation is prescribed.

There is a more serious form of ulcerative stomatitis, this is ulcerative-necrotic inflammation. Vincent's stomatitis, named after the French doctor who at the beginning of the last century first described the syndrome of acute ulcerative process of the oral cavity in soldiers fighting at the front. The disease has many synonyms - "trench mouth", Vincent's angina, Vincent's gingivitis, Botkin-Simanovsky stomatitis and so on. The disease is provoked by a combination of spirochetes and fusiform bacilli, which is also present in healthy people. Under the influence of various factors, microbial symbiosis causes an acute erosive generalized process. The following factors can cause the development of Vincent's disease:

• Hypothermia.
• Starvation.
• Hypovitaminosis.
• Alcoholism.
• Intoxication with heavy metal salts.
• Calculus (tartar).
• Systematic irritation of the oral cavity by dentures and fragments of molars.
• Unsanitary conditions.
• Severe course of viral infection.
• Mononucleosis.
• Exudative erythema.
• Oncology.
• The consequence of cancer treatment is chemotherapy.

Vincent's stomatitis affects mainly young men; it begins as inflammation of the tonsils, then the tongue becomes inflamed and the process spreads to the entire oral cavity, reaching the deep layers of the mucous membrane, right down to the bone tissue of the jaw.

The symptoms of the disease are specific:

• Bleeding gums even without traumatic irritation - eating, brushing teeth.
• Pain in the gums, inability to chew food.
• Halitosis (bad breath).
• Ulceration of the gum edges, tissue necrosis.
• Bleeding ulcers in the mouth.
• Uncontrolled salivation.
• Compaction of the lymph nodes.
• General intoxication, nausea, weakness, dizziness.

Ulcerative stomatitis of this type is treated in a complex manner, first of all, anesthesia, pain relief are administered, then detoxification appointments and oral cavity sanitation are indicated. With timely intensive treatment, the prognosis is favorable, ulcers heal within a week. A chronic, advanced process requires longer therapy, in addition, it is often accompanied by periodontitis, which requires systematic monitoring of the oral cavity for a year.

Angular stomatitis

Angular stomatitis is what is commonly called angular cheilitis. The name comes from the Latin word angulus or angle, that is, inflammation in the corners of the mouth.

Also, in dental practice, the disease can be called infectious cheilitis.

Angular stomatitis is a typical process in young children, in whose body staphylococcal, streptococcal infection or candidiasis is detected.

In addition, the cause of angular stomatitis can be vitamin deficiency, iron deficiency anemia, chronic diseases of the throat, nasopharynx (tonsillitis, sinusitis).

Stages of the angular process:

• Hyperemic corners of the lips.
• Maceration of the skin and mucous membranes (softening).
• Formation of pustules (purulent blisters) in the corners of the lips.
• The pustules burst and form erosions.
• Movement of the lips and mouth when eating, talking, smiling causes cracking of the corners.
• The cracks bleed regularly and become covered with a crust.
• Failure to follow treatment guidelines may result in the pustules spreading over the entire face (impetigo).

Angular stomatitis is considered a contagious type of inflammation of the oral mucosa, when streptococci and staphylococci can be transmitted through household items, dishes, toothbrushes from a sick person to a healthy one.

Angular stomatitis can also be caused by candidiasis, in which case the lack of treatment can provoke the spread of the process throughout the entire oral mucosa inside. The disease can last for many months, periodically subside and recur again. It is precisely with the etiologic variability that the important role of accurate diagnostics is associated, which should include laboratory microscopy methods to identify a specific pathogen. In addition, angular cheilitis should be differentiated from cheilitis caused by syphilis or tuberculosis.

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Purulent stomatitis

Purulent stomatitis or pyostomatitis is a type of inflammation of the oral cavity caused by a microbial, bacterial infection. Most often, purulent stomatitis is caused by microtraumas of the oral mucosa. Traumas, in turn, can be provoked by gross mechanical damage (scratches, cuts), as well as thermal burns from eating excessively hot food, improper placement of molars, fragments of untreated teeth, and so on. The thing is that with each year the oral mucosa becomes more vulnerable, the saliva of an adult contains many times less antibacterial protection - lysozyme - than in childhood. When wounds form in the oral cavity, this means that the risk of infection and the development of bacterial stomatitis increases. In addition, purulent stomatitis can be a consequence of chronic inflammation of the nasopharynx - tonsillitis, otitis, sinusitis.

Symptoms of the purulent type of inflammation are non-specific, purulent pustules can form on the lips, that is, outside, but purulent ulcers can also be located inside - on the gums, on the cheeks and even on the tongue.

In addition, in dentistry and dermatology, a separate definition of purulent stomatitis is distinguished - vegetative pyostomatitis. This disease is described in the section of skin and venereal diseases as pyostomatitis vegetans - a purulent inflammatory process of the oral cavity. Symptoms - small vegetations with purulent contents, similar in appearance to an abscess. Pyostomatitis is characterized by multiple abscesses, which quickly transform into deep ulcers, eroded areas. Pustules open within 24 hours, ulcers also quickly epithelialize, leaving scars on the mucous membrane, later papillomatosis.

Gonococcal stomatitis

Gonococcal or gonorrheal stomatitis is currently very rare, since it mainly develops in utero and when the child passes through the infected birth canal of the mother. Every woman undergoes a comprehensive examination when registering for pregnancy, so gonorrhea is detected and treated before the baby can become infected.

Rare cases of gonococcal stomatitis infection are observed when a sick person comes into contact with a healthy person, usually oral. Nevertheless, gonococcal stomatitis occurs in dermatological practice and deserves a brief description.

In most diagnosed diseases, gonococcus affects not only the oral cavity, but also the entire nasopharynx. Diagnosis of gonococcal stomatitis can be difficult, since the initial stage of the disease is asymptomatic, moreover, gonorrhea is generally prone to episodes of false self-healing and remission. When the patient comes to the doctor's attention, the process has already spread throughout the pharynx, tonsils, and oral cavity.

This type of stomatitis is most often diagnosed in the following categories of the population:

• Newborns whose mothers do not register with obstetricians and gynecologists and lead an asocial lifestyle.
• Persons who engage in orogenital contacts (usually of non-traditional homosexual orientation).

The symptoms of gonococcal stomatitis are characterized by sluggishness, erasure, and may manifest themselves in the following non-specific signs:

• Subfebrile body temperature.
• Transient sore throat.
• Hyperemic oral mucosa.
• Small erosive areas in the mouth.
• The release of a viscous, purulent secretion along with saliva.
• The appearance of ulcers on the inside of the cheeks, gums, and tongue is a symptom of a severe form of the process.

Histological examination of the contents of eroded, ulcerated areas helps differentiate the type of stomatitis. Extragenital gonorrhea in the form of stomatitis is treated in the same way as the genital form - with antibiotics, in addition, aseptic lotions and applications are prescribed locally.

Herpetiform stomatitis

Herpetiform stomatitis is a very rare form of aphthous recurrent stomatitis, which is similar in appearance to the viral variant of inflammation of the oral cavity, herpes. With herpetiform stomatitis, as well as with herpes, multiple rashes are formed in the form of tiny ulcers that cover the entire mucous membrane. The aphthae are very small and this differs from the typical rather large aphthae (rashes) in the classical form of aphthous stomatitis. The ulcers are not clearly defined, have a grayish tint, the mucous membrane around them is not hyperemic. One of the specific signs of this rare type can be the localization of the aphthae - under the tongue, on the bottom of the oral cavity. Herpetiform stomatitis is prone to recurrence and periodic remissions. The ulcers heal quite quickly - within a week.

This form of the disease is more common in young women aged 28-30 years. The etiological causes have not been fully clarified.

Consequences and complications of stomatitis

The consequences and complications of stomatitis depend on the age of the sick person, the period of detection of inflammation, and the degree of neglect of stomatitis.

Stomatitis is in vain considered a safe disease; its complications can have a serious impact on health.

As a rule, catarrhal stomatitis proceeds most simply and quickly, but even it, without proper treatment, can transform into an ulcerative-necrotic process affecting not only the soft tissues of the gums, but also the bone tissue of the jaw (osteomyelitis). More severe complications can look like gangrenous inflammation, such pathologies are diagnosed with gonococcal stomatitis, stomatitis caused by tuberculosis, syphilis.

In addition, the consequences and complications of stomatitis in an advanced form are a potential threat of tooth loss, since the inflammation quickly becomes chronic, causing periodontal disease.

The main danger of any stomatitis is its transformation into a recurrent form, which is treated for a long time, is difficult and quite expensive due to the use of many drugs aimed at systemic effects on the body.

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Diagnosis of stomatitis

Diagnosis of stomatitis is generally not difficult, but all changes in the oral mucosa are non-specific, so differential methods are mandatory. Accurate diagnosis of stomatitis allows you to stop the process in the shortest possible time, stop the spread of symptoms and provide a therapeutic effect, providing for a stable remission without relapses. For this reason, the type and nature of stomatitis should be determined not only by a dentist, but also a dermatologist, a therapist, a pediatrician (in the case of diseases of children), and possibly a dermatovenerologist.

There are no specialized tests or samples for stomatitis; diagnostics usually take place in several stages: 1.

1. Collection of anamnesis, medical history.
2. Visual examination of the oral cavity:
   • Appearance of the mucous membrane.
   • The appearance of aphthae, ulcers, their shape, quantity, structure.
   • Definition of aureole, erosion boundaries, edge characteristics.
   • Presence of plaque on the ulcers.
   • Presence of plaque on the mucous membrane.
   • Characteristics, color, structure of plaque.
   • Localization of ulcers, plaque.
3. Identification of accompanying symptoms - body temperature, pain, nausea, and so on.

The main parameter that helps in diagnosing stomatitis is external, visual signs, that is, external examination is the most important in the diagnostic sense. Additional smears for bacterial culture, blood tests, etc. only confirm the primary assumption of doctors. In addition, stomatitis must be differentiated by types associated with different etiological factors, the success and duration of treatment depend on the definition of a specific type - infectious, traumatic, allergic, symptomatic.

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Tests for stomatitis

The main basis for diagnosis is clinical manifestations, symptoms and visual examination of the oral cavity.

Tests for stomatitis are carried out to clarify the diagnosis; for these purposes, the following measures are prescribed:

• OAC – complete blood count.
• Biochemical blood test.
• Blood sugar level.
• Blood for antibodies to treponema, gonococci if there is a suspicion of venereal etiology of stomatitis.
• Immunofermentogram to clarify immune activity.
• Bacteriological culture of saliva to determine the bacterial infection and the specific pathogen.
• Cytology, histology of smears from the inflamed mucous membrane.
• Virological examination of nasopharyngeal swabs and fluid contained in vesicles and bubbles.

The final conclusions depend on the combination and overall picture of the examination, collection of anamnesis, and analytical research data.

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