Symptoms of stomatitis

Stomatitis is an inflammatory process in the mucous membrane of the mouth (stoma in Greek "mouth", itis - inflammatory process). Because the etiology, the causes of inflammation can be different, the clinical picture, the symptoms of stomatitis are also variable and depend on the form, from the localization of the disease, the prevalence and many other factors. The factors that provoke stomatitis can be local or common - trauma, allergy, virus, fungal or bacterial infection, irritation of the oral cavity with food, chemicals, beriberi and micronutrient deficiencies (most often iron). Stomatitis develops in people of any age and sex, but more often they suffer children, patients of advanced age.

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

The stomatitis and its symptoms are classified thus: 

1. By prevalence:

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

2. For reasons of etiology: 

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

3. On the course of the inflammatory process: 

• Acute.
• Subacute.
• Recurrent, chronic.

4. By localization of inflammation: 

• Inflammation of the gums - gingivitis.
• Inflammation of the tongue is glossitis.
• Lip inflammation - cheilitis.
• Inflammation of the palate (upper and lower) - palatinitis.

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Is it contagious?

Depending on the form, etiology and type of stomatitis can indeed be contagious, that is contagious. There is still no consensus as to how contagious the 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 just like other diseases. It is contagious whether stomatitis is determined by a dentist who reveals the true cause of inflammation.

How can stomatitis of various kinds be transmitted: 

1. Herpetic stomatitis. This kind of disease can be infected through household items - dishes, toys, towels, a toothbrush, lipstick and so on. The herpes virus is transmitted from a sick person to a healthy one and can affect the oral cavity.
2. Candidiasis stomatitis. Most often, it is diagnosed in children under one year, but adults may suffer from it. Fungus can be transmitted through untreated cutlery, an infected infant breastfed can infect the mother's breast (nipples), as well as an infected mother can contribute to infecting the child during childbirth - passing through the birth canal.
3. Enterovirus vesicular stomatitis. This species is distinguished by a high degree of contagiosity among young children and it is no accident that the disease is called "hand-foot-mouth". The virus is released from feces, vesicles of the infected person and is transmitted by multiple routes - oral (food or water), contact, airborne.

It is believed that the contagiosity of stomatitis is not supported by scientifically substantiated facts, but the question is whether stomatitis is contagious, practitioners may respond, and, unequivocally. As a rule, with stomatitis, they recommend the maximum careful handling of all items that the patient uses and limit close contact (kisses) to avoid infection. In a word, like any other infection - bacterial, viral, mycosis, certain types of stomatitis are still contagious.

Signs of stomatitis

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

Symptoms of stomatitis, as a rule, develops within the framework of three stages: 

1. The first stage of the inflammatory process is manifested in a slight reddening of the areas of the oral cavity, a feeling of dryness may appear.
2. A few days later, this zone swells, a characteristic white coating appears, under which evolving erosion disappears.
3. Sores under the plaque can be multiple or single, superficial or deep, merging with each other.

If the inflammation is not stopped, then the process spreads throughout the mouth, often affecting the corners (seizures). The sores covered with a white coating are visible on the cheeks, tongue, palate and even tonsils.

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

• Reddening of the mucous membrane of the mouth.
• Formation of erosions of different sizes - from millimeter to 10 mm.
• 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 acute form - hyperthermia.
• Lack of appetite.
• Sores in the corners of the mouth.
• Plaque on the tongue, cheeks, sky.
• Bleeding.

Odor from the mouth with stomatitis

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

A similar symptom in the form of halitosis, an unpleasant smell is typical for almost all types of stomatitis, which occurs 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 smell. 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 disease. Once the bacterial raids and the actual cause of stomatitis are eliminated, an unpleasant odor disappears. In addition, from the halitosis help to get rid of activities aimed at the treatment of gastrointestinal diseases, which are often the root cause of protracted stomatitis.

Blood with stomatitis

The mucous membrane is always populated with a certain number of microorganisms, this directly affects 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 mucosa thinens, becomes dry and ulcerated, opening the way for uncontrolled reproduction of bacteria. Blood in stomatitis can be allocated due to the appearance of ulcers, necrotic areas, and also because the mucosa is characterized by its intensive blood supply. Thus, local protection in the form of a complete mucous membrane is broken, the composition of saliva changes, where an elevated level of lysozyme is noted.

Blood and bleeding during stomatitis are characteristic for herpetic, ulcerative necrotic (Vincent's stomatitis), aphthous (severe relapsing form), and other types of diseases associated with infection and penetration of bacteria and viruses into the oral cavity. Untypical blood for stomatitis caused by Candida, an allergy, for catarrhal, medicamentous and symptomatic type of disease, although their heavy, neglected forms can also be accompanied by bleeding gums.

[2], [3]

Pain with stomatitis

Pain symptom when swallowing, chewing food, talking, smiling and so on - this is a typical clinical manifestation of many types of stomatitis in a neglected stage.

Even such a simple form as catarrhal inflammation of the oral mucosa may be accompanied by a pain symptom. Pain caused by stomatitis is caused by ulceration of large areas of the oral cavity, by draining the mucous membrane and necrotic tissue. In addition, pain can cause total swelling of the gums, palate, swelling and erosion of the tongue. The acute form of many types of stomatitis lasts for a long time - up to two weeks and all this time the patient feels pain and burning with such ordinary actions as eating, talking. Severe, relapsing forms of stomatitis are also characterized by pain, in addition, the person's body temperature rises and pain is felt not only in the oral cavity, but also in the submaxillary lymph nodes, joints, muscles (aches). The pain is also characteristic of the herpetic form of stomatitis, while the discomfort is felt constantly, itches all mouth cavity, herpetic eruptions 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 detected causative agent - the virus, bacteria - is neutralized.

Temperature with stomatitis

Hyperthermia with stomatitis is a phenomenon characteristic of severe forms of the disease, when it is not diagnosed in a timely manner and is not treated at the initial stage.

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

The temperature with stomatitis can be quite high - up to 39-40 degrees, especially it is dangerous for newborn babies, in whom candidal and herpetic types of stomatitis are most often diagnosed. Body temperature directly depends on the degree of severity of the process, its prevalence, if stomatitis occurs in mild form, hyperthermia does not arise. Moderately severe forms are accompanied by subfebrile temperature, sometimes reaching 38 degrees. The most difficult to tolerate stomatitis is toddlers up to 3 years old, older children cope with the symptomatology more easily, since they are able to rinse their mouths themselves, and unlike newborns understand the importance and take a direct part in the treatment.

The absence of fever during stomatitis speaks about its easy or acute, transitory form, when additional infection does not join the process - ARVI, adenovirus and so on.

Cough with stomatitis

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

In dental, pediatric practice, cases are noted where severe forms of generalized stomatitis can be accompanied by a runny nose, cough, hyperthermia. However, it is more a manifestation of the side symptomatology of the concomitant or primary disease, rather than the sign of stomatitis as an independent nosological unit. Even catarrhal stomatitis, despite the origin of the name from the Greek katarreo - inflammation, runoff, is not characterized by a cough, rather with it typically inflammation of the entire mucosa, its hyperemia.

Cough with stomatitis is a signal about an infection, more often of a viral etiology, since bacterial infections are more characteristic of purulent discharge. Cough can be accompanied by a severe form of herpetic stomatitis, but not as a specific sign, but because herpes weakens the immune system and makes the body vulnerable to various viral and bacterial diseases - influenza, SARS, acute respiratory infections. Adenovirus, parainfluenza often coexists with stomatitis, especially in young children, manifested by fever, coughing and discharge from the nasopharynx.

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

[4], [5]

Stomatitis on the gum

A stomatitis on a gum is a gingivitis, so the inflammatory processes localizing on gums or gingivas are called. The cause of gum stomatitis can be a variety of etiological factors, however, the most common causes of inflammation are mechanical irritation with prostheses, tartar, an inadequately placed seal or an improperly selected toothbrush. In addition, an elementary incorrect bite can become the main cause of gingivitis. Rarely, gum stomatitis can be caused by avitaminosis or periodontitis, a systemic disease of the gingival tissue.

Symptoms of the inflammation of the gums: 

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

It should be noted that the most rare 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 periodontitis, when the gum is atrophied, necrotic, teeth are loosened without painful sensations.

Stomatitis under the tongue

Symptoms that manifest as stomatitis under the tongue indicate that the herpetic form of inflammation of the oral cavity develops. It is this kind of stomatitis that is characterized by the ulceration of the zone under the tongue, the bottom region. All other signs of stomatitis, which relate to language, refer to glossitis. Glossitis is characterized by inflammation of the superficial layer of the mucous membrane, and less often deep ulcers can affect the thickness of the tissues. The most rare symptom is a deep perforative ulcer of the tongue, accompanied by purulent secretions in the form of an abscess. The stomatitis sublingualis can develop as a result of a protracted, infectious process, which is characterized as a generalized, exciting whole oral cavity. Most often the sublingual region suffers from purulent-inflammatory stomatitis. It is difficult for a person to swallow, talk, develop hypersalivation (increased salivation). If timely treatment is not initiated, the spread of bacterial infection captures the mandibular space, maxillary gullet, bone tissues of the jaw, until the development of osteomyelitis.

The stomatitis in a mouth

Stomatitis is a common, uniting many kinds of inflammation of the mouth, the name.

A collective description of the inflammatory process, which 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 is palatinous.
• Inflammation of the mucous membrane of the tongue is glossitis.
• Inflammation of the border and tissues of the lips - cheilitis, including angular (seizures).

Also, stomatitis in the mouth can be generalized, that is, one that affects the entire oral cavity, including the tonsils.

The causes of stomatitis are also multiple, the symptomatology is directly related to the type of inflammation and its etiology. Nevertheless, common signs of stomatitis are: 

• Redness of the mouth.
• Swelling of the gums.
• Rashes on the cheeks, tongue.
• The appearance of a rash in the form of papules, ulcers, aphthus, pustules (depending on the type of stomatitis).
• Smell from the mouth.
• Bleeding.
• Pain when eating.

Diagnosis and treatment of stomatitis in the mouth is carried out differentially for symptomatic and etiological reasons. The prognosis is mostly favorable, but relapses and the transformation of inflammation into a chronic form are possible.

Lips stomatitis

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

Reasons for cheilitis: 

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

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

The corners of the lips first become inflamed, then they are covered with pustules containing pus. Pustules burst, forming cracks, which as a result of the movement of the lips when absorbing food, talking, do not heal for a long time. The skin of the corners of the lips is hyperemic, ulcers can periodically form, periodically recurring and emitting pus. The epithelium of the lips is desquamated (husks), the lips itch, itch. Stomatitis on the lip is a contagious inflammation, so the patient first of all needs to follow the rules of personal hygiene and use only personal cutlery, a toothbrush, a towel and so on.

Stomatitis on tonsils

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

Fuzotrepanematoses include such diseases: 

• Gingivostomatitis, Vincent's disease.
• Angina Plaut - Vincent.
• Phlegmon Ludwig, phlegmon of the mouth.

Most often, stomatitis on the amygdala is the placenta Plaut-Vincent or the stomatitis of Botkin-Simanovsky. Its causative agents are two microorganisms - spirochaetes and spindle-shaped bacilli, more accurately saprophytes, which are present in a healthy person in the mouth, without causing inflammation. Pathogenicity of microorganisms is associated with such factors: 

• Gradual reduction of 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.
• Fasting, poor nutrition.
• Subcooling, frostbite.
• Intoxication.

Localized on tonsils, such a sore throat quickly spreads throughout the oral cavity, affecting the gums, tongue, cheeks, palate. Most often, stomatitis on the tonsils is one-sided, accompanied by ulcers, infiltrates, necrotic areas of the mucosa. The disease can recur unless complex, adequate treatment is used. In addition, complications can be adenophlegons and strong intoxication of the body.

Symptoms of aphthous stomatitis

Aphthous stomatitis is subdivided according to the nature of the course into acute and relapsing, and the symptoms of the disease are also different.

The acute form of aphthous stomatitis has quite definite reasons: 

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

Symptoms of aphthous stomatitis in acute form are specific:

• A sharp rise in temperature to 39-40 degrees.
• Weakness, adynamia.
• On the second day, when aphthae appear, the condition becomes severe, there are all signs of intoxication, inflammation.
• Enlargement of lymphatic regional nodes.
• There is a constant pain when eating, swallowing.
• Salivation increases.
• A sharp, specific smell from the mouth.

Aphthous acute stomatitis is characterized by its specific rashes on the mucous membrane - aphthae. These are single painful formations of circular shape that are formed from small bubbles, which bursting, turn into ulcers. Ulcers also look characteristic - they are covered with a thin fibrinous film, the edges have a red rim. Afts are the main symptoms of aphthous stomatitis, they are localized on the lateral surfaces of the tongue, its tip, on the lips (inside the mucous membrane), on the bottom of the mouth, inside the cheeks and in the sky. Afts can pass 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 season, when aphthous stomatitis is diagnosed 2 times more often.

Recurrent chronic forms of aphthous stomatitis have the following symptoms and are classified in this way: 

• A typical course of the disease, a typical form, in which periodically in the oral cavity surface ulcers are formed-aphthae. Symptoms of aphthous stomatitis in a chronic typical form can be subdivided according to yet another differentiation: 
  • The generalized form of aphthosis, in which aphthae spread to the oral mucosa, on the skin, on the genitals, conjunctiva of the eyes, provoking extensive pyoderma, streptoderma.
  • Isolated recurrent aphthous stomatitis is the most frequently diagnosed type, in which ulcers affect the mucous cheeks, lips, and sides of the tongue. Afts are not plural, they are grouped in the form of 2-3 ulcers nearby.
• Atypical form, which forms deep aphthae, leaving scars (Sutton aphthae, scarring 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 the aphids spread to the conjunctiva of the eyes and even to the mucous tissue of the female genital organs. This serious disease was described in the 30s of the last century by Dr. Behcet as a symptom complex, which included ulcerative stomatitis, genital ulcers, uveitis (defeat of the conjunctiva of the eyes). Later, the symptoms of thrombophlebitis, arthritis, erythema, cutaneous vasculitis, aneurysms of large aortas, ulcerative processes of the intestine joined this triad. The etiology of this systemic disease is still not clear, but the symptoms of aphthous stomatitis, which spread rapidly throughout the body, are one of the characteristic signs of Behçet's disease.

Symptoms of candidal stomatitis

Symptoms of thrush of the oral cavity, candidal stomatitis are quite specific and manifested. Candidiasis of the mouth is a common disease diagnosed in young children with reduced immune defense, at the age of 1-2 years.

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

• Signs of stomatitis of the entire oral cavity.
• Gingivitis.
• Glossitis.
• Zaeda, cheilitis.

Forms - an easy form of thrush with unmanifest symptoms, medium-heavy form, when signs of candidiasis can be such phenomena: 

• White, curdled in consistency, plaque on the tongue, the inner cavity of the cheeks.
• Under the patches of plaque, there is an erosive surface of the mucosa.
• Pain when eating, swallowing.
• Decreased appetite, refusal of food due to pain.
• Weight loss.
• Irritability, insomnia.

In severe, neglected form, the symptoms of candidal stomatitis can spread to the gastrointestinal tract. If the fungus enters the digestive system, dyspepsia develops, upset of the stool, dysbacteriosis.

Symptoms of an oral mastitis in adults: 

• Burning, dry mouth.
• Characteristic white, cheesy plaque primarily in the language.
• Swelling and redness of the mouth.
• Bleeding when eating, brushing teeth.
• Loss of taste.
• Difficulty with eating, painful chewing, swallowing.
• A characteristic taste of metal in the mouth.

Symptoms of herpetic stomatitis

Herpetic stomatitis is one of the most common types of infectious inflammation of the mouth, which in 75% is diagnosed in children. In adults, the herpes virus provokes the formation of vesicular eruptions on the lips, less often in the oral cavity. The disease proceeds, as a rule, in a mild form. Children suffer from herpetic stomatitis heavier, with fever, fever.

Symptoms of herpetic stomatitis are as follows: 

• Swelling of the oral mucosa.
• A sharp increase in body temperature to 38, sometimes to 39 degrees.
• Lymph nodes are enlarged, they are painful when palpated.
• 2-3 days after the temperature rises and the reddening of the gums in the mouth, many small vesicular eruptions are formed, often so small that they are not seen against the background of the reddened shell.
• Vesicles quickly merge with each other, forming larger erosion.
• The erosion areas are covered with a white-gray coating.
• A person often has a headache, nausea develops.
• When herpetic stomatitis often manifests the symptoms of catarrhal gingivitis (inflammation of the gums), the gums are swollen, bleed.

Symptoms of viral stomatitis caused by herpes can be manifested depending on the form of the flow of the process: 

1. Light form - the vesicles are located only in the mouth.
2. The average severity - the rash spreads to the lips.
3. Severe form of herpetic stomatitis - vesicles quickly spread lips, on areas of the body far from the mouth - nasolabial triangle, face. The most dangerous form for newborns, which can open nasal bleeding, saliva appears blood, symptoms of general intoxication of the body are noted, blood pressure and pulse are falling. Patients with herpetic stomatitis, which is very severe, are hospitalized.

Herpetic stomatitis, which acquires a neglected severe form, can be transformed into an ulcerative-necrotic, intoxication form.

Symptoms of allergic stomatitis

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

• Catarrhal allergic stomatitis.
• Hemorrhagic stomatitis.
• Bladder-erosive appearance.
• Ulcerative necrotic allergic stomatitis.
• Combined view.

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

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

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

• Allergy to medications in the form of stomatitis is a catarrhal, catarrhal-hemorrhagic stomatitis. The patient feels itching, burning in the gums, the mouth is dry, painful, especially when eating. The mucous membrane swells, swells, turns red. Papillae of the tongue atrophy and it looks like "lacquered."
• Allergy to fillings, dentures. Patients complain of dry mouth, increased salivation (saliva atypically viscous), burning in the gums, on the tongue. Prosthetic bed - the mucosa is inflamed exactly within the boundaries of the prosthesis, the gingiva tissue loosens, hyperemic. Against the background of reddened gums, hypertrophic sprouting is often noted. Typical symptoms of allergic stomatitis of this kind are clear prints of teeth on the inner zone of the cheeks, edema of the tongue, palate, pharynx, difficulty in swallowing food, erosive damage to the mucosa is possible.

A specific difference between the clinic of allergic stomatitis is the withdrawal syndrome of the provoking factor, as soon as the triggering cause is eliminated, the symptomatology subsides.

Symptoms of viral stomatitis

Stomatitis is often provoked by viruses among which the herpes virus retains the leading position for many years, less often such inflammation is caused by the virus of varicella, parainfluenza and influenza, adenovirus, enterovirus.

Herpetic lesions of the oral cavity according to the statistics of WHO rank second after the flu, the symptoms of herpes virus caused by herpes are: 

• An acute onset, a sharp rise in body temperature from 37 to 40 degrees in a few hours.
• Two days later on the reddened mucous mouth formed edema, hiding the smallest rashes (vesicles). Vesicles can be multiple and merge with each other, there is exudate inside them. If the vesicles burst, then in their place erosive areas are formed, hidden by a touch, a crust.
• There is hypersalivation, while saliva is very viscous, thick, foaming.
• Vesicles spread to the rim of the lips, the corners of the lips, even to the nasal mucosa and other organs, if the disease is in severe form.
• The period of viral stomatitis rarely exceeds 3 weeks, after a week the symptomatology subsides and recovery comes, of course, with adequate treatment.

Symptoms of viral stomatitis can be a manifestation of vesicular stomatitis, which the clinic is very similar to the signs of influenza. Vesicular appearance is a zoonotic infection, which is rare in humans. Most often, signs of vesicular inflammation can be found in workers of zoos, farms, in those who often and constantly contact animals.

A person has a strong headache, fever develops, after 2-3 days vesicles are formed, usually in the oral cavity. The vesicles are filled with a clear liquid, itching at the dissection, transforming into ulcers.

Symptoms of stomatitis in the tongue

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

Symptoms of stomatitis in the language are as follows:

• Burning, itching at the top of the tongue, rarely in the hyoid area.
• Sensation of a foreign body in the mouth.
• Swelling, swelling of the tongue.
• Increased salivation.
• Dullness of taste, often a loss of taste.
• Sensation of atypical aftertaste in the mouth.
• Painful sensations in the root of the tongue when swallowing.
• Puffiness of the tongue causes difficulties in speaking (slurred speech, slow speech).

Symptoms of an inflammatory process in the area of the tongue: 

• Persistent edema of the tongue.
• Change in the structure of the surface of the tongue, the pattern of papillae changes.
• Possible raids, the nature of which depends on the type of stomatitis (white, curdled, white, purulent and so on).
• Redness and ulceration of the tongue.
• Running erosions can develop into an abscess of the tongue, which is manifested by pulsation, a strong increase in the abscess zone, swelling of the entire tongue, hypersalivation, and fever.

Symptoms of stomatitis in the throat

Some types of stomatitis can actually manifest themselves clinically in atypical for themselves places - 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 during such a course of the disease that aphthae can spread beyond the cheeks, palate, and gums. The generalized form of aphthous, ulcerative necrotic inflammation of the mucous membrane of the mouth is often accompanied by the appearance of characteristic ulcers not only in the oral cavity, but also on the mucous palate, throat, larynx, but almost never on tonsils. It should be noted that the symptoms and signs of stomatitis in the throat may be clinical manifestations of the throat itself - tonsillitis, tonsillitis and so on. In this case, stomatitis is a consequence of the primary pathology, and not the root cause.

In addition to aphthous, the symptomatology, localized in the throat, can cause almost any kind of infectious stomatitis in a chronic, neglected form. Streptococci, staphylococci, diplococci, fungi and other pathogenic microorganisms easily penetrate deep into the oral cavity, if the disease is not diagnosed and is not 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 chronic - it is untreated at an early stage of stomatitis, characterized by a prolonged course and relapses. Primary stomatitis includes catarrhal, fibrinous proliferative form of the disease. Secondary, chronic stomatitis is erosive, aphthous, ulcerative stomatitis.

Morphology: 

• A simple form is 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, the types of stomatitis can differ in the nature and intensity of the inflammatory process, these are such varieties as: 

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

We describe the most common types of inflammatory process in the oral cavity: 

1. Catarrhal, simple stomatitis, which is characterized by inflammation of the mucosa without ulceration and the formation of aphthae.
2. Ulcerative stomatitis, which is often formed as a consequence of untreated primary catarrhal disease. Actually, the ulcerative form of stomatitis is the second stage of undiagnosed catarrhal appearance. The peptic ulcer differs quite a serious course of inflammation and is diagnosed mainly on the background of chronic gastrointestinal diseases, iron deficiency, anemia. Ulcers penetrate the entire depth of the mucous membrane, accompanied by severe pain when eating, talking, the body temperature can increase, lymph nodes increase and symptoms of general intoxication can be noted.
3. Aphthous variety of stomatitis differs by special formations in the oral cavity - aftami. These are specific vesicles that quickly break up and transform into small ulcers. Ulcers have a characteristic appearance - on top are covered with a thin fibrous film, along the edges they have a bright red rim. Aphthae are usually localized in the tongue, its tip, on the cheeks and the hard palate. The tongue looks burned, swollen, salivation increases. Aphthous stomatitis often recurs in the autumn or spring season, aphthae heal hard, slowly, often merging into one large ulcer.
4. Ulcerative necrotic form 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, fever, hypersalivation and a characteristic putrefactive odor from the oral cavity.
5. Herpetic stomatitis, which, as a rule, proceeds acutely and is characteristic of small children and low immunity. Herpetic eruptions are very similar to aphthae, but contain a characteristic serous fluid inside, develop faster, accompanied by intense symptoms - increased body temperature, increased submandibular lymph nodes. The herpetic appearance is often transformed into a ulcerative without proper treatment and care of the oral cavity.
6. Candidiasis stomatitis (candidiasis of the oral cavity, thrush). This is an inflammation caused by yeast-like microorganisms - fungi. Most often, newborn babies with low immune status suffer from oral mammary disease, elderly patients with persistent, chronic diseases.
7. Traumatic variety of stomatitis is characteristic of adults, especially those who use dentures. The stomatitis forks, caused by injury to the oral cavity, usually develop as a catarrhal inflammation and with timely diagnosis are treated quickly. The more severe cases are associated with the attachment of a microbial infection, when ulcers and infiltrates can develop in the oral cavity.
8. Vesicular form of stomatitis is very similar to the symptomatology of influenza. The person starts to hurt his head, breaks bones, aching muscles, developing a febrile state. Such signs accompany the formation of vesicles, which are visible 2-3 days after the appearance of the first symptoms. Untreated vesicles are transformed into erosive ulcers.
9. Intoxicative stomatitis, which is a consequence of poisoning with salts of heavy metals. Ulcers with this form are resistant, poorly amenable to therapy, a person can not take food because of pain, feels a characteristic taste of metal. When intoxication very quickly manifested clinic poisoning - dyspepsia, weakness, a drop in blood pressure, and stomatitis is just one of the signals about the accumulation of toxins in the body.

Simple stomatitis

A simple stomatitis is a catarrhal surface appearance of the inflammatory process in the oral cavity or simple gingivitis - gingivitis simplex.

Simple stomatitis often proceeds acutely with such symptoms: 

• Reddening of the mucous membrane of the mouth.
• Puffiness of the mouth, tongue.
• Erosive formations along the edge of the gums, in areas where there is tartar or caries.
• Rounding, smoothing of the papillae.
• Perhaps a feeling of loosening of the teeth in the alveoli.
• On the language in the early days there is a whitish coating, then it gets dark.
• The mucous membrane is thinned, and the imprints of teeth are visible on it.
• There is hypersalivation - increased salivation.
• There is a smell from the mouth.
• Eating can cause pain.

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

• With timely diagnosis and treatment, the symptoms of stomatitis subsided, the disease ends and does not recur.
• If catarrhal stomatitis is not treated, it passes into a persistent chronic form, 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 is transformed into a deep form.
• Recurring catarrhal stomatitis is one of the typical signs of the pathology of the digestive tract, as well as helminthic invasion.

Vesicular stomatitis

Symptomatic vesicular stomatitis is very similar to SARS, acute respiratory infections and influenza. Stomatitis, which is not accidentally called Indiana fever or stomatitis vesiculosa contagiosa, as 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 contagious, contagious disease of cattle, horses, pigs. People with this kind of stomatitis are very seldom sick and only in case of constant, close contact and 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 organisms of virtually all vertebrates, easily replicates in animal cells.

In humans, the vesicular appearance of oral inflammation is very rare, if such cases are diagnosed, then the treatment is carried out according to the therapy of the influenza virus. The prognosis is favorable in 100%, recovery comes in 5-7 days.

Catarrhal stomatitis

Catarrhal stomatitis is the most simple, safe and non-contagious form of oral inflammation. The disease rarely lasts more than 2 weeks, has no consequences in the form of defects in the mucous membrane - ulcers, infiltrates, aphthae. Etiology of the catarrhal form of stomatitis lies in non-observance of personal hygiene rules, poor oral care, teeth, in fact, such stomatitis is a disease of dirty hands and unclean teeth. Most often catarrhal stomatitis is diagnosed in young children, who pull everything into their mouths, but adults can also suffer from such a disease because of persistent untreated caries, the presence of calculus. In addition, the catarrhal form of stomatitis can be a consequence of intolerance of the filling material in the treatment of teeth, prostheses or allergies to certain types of medicines.

The main symptomatology is manifested in the form of hyperemia of the oral mucosa, tongue, puffiness, plaque in the tongue, burning sensation. Possible unpleasant odor, bleeding gums, loosening of teeth. The acute stage can go on to chronic form without proper treatment, in such cases the catarrhal form grows into aphthous and other types of stomatitis with more serious symptoms and consequences.

As a rule, treatment consists in observing a diet that excludes irritating foods (sharp, acidic, hot dishes, foods that have a firm consistency). Also, intensive sanitation of the oral cavity is performed, rinses, vitamins B, vitamin C and A are prescribed. Caries teeth treatment and scaling are mandatory, and personal hygiene rules for oral care are considered to be the main preventive measures.

[6], [7], [8],

Acute stomatitis

The acute form of stomatitis is diagnosed when in a patient's anamnesis such manifestations appear for the first time. In the future, if after treatment stomatitis again manifests itself with one or another symptomatology, it is considered chronic, relapsing, which may be a sign of either inadequate therapy or a missed systemic pathological process in internal organs.

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

The most acute form is borne by newborn children, they refuse to eat, lose weight, their general condition worsens day by day. Therefore, attentive parents should be alarmed at the appearance of a white scurf on the tongue, the inner side of the baby's cheeks, pay attention to its any atypical behavior - capriciousness, bad sleep, continuous crying.

The most dangerous acute herpetic stomatitis, the disease is extremely contagious, flowing with painful symptoms. Herpetic form of oral inflammation has an incubation period from 2 to 4 days. Symptoms manifest swiftly, sharply: 

• Perhaps a sharp increase in body temperature to 39-40 degrees.
• There is pain in the mouth when eating, talking.
• The mucous membrane of the whole mouth is hyperemic, small vesicles are formed on it, which are often not visible.
• The stage of vesicular vesicles lasts no more than a day, they quickly transform into sores.
• If treatment is not started, erosive ulcers pass to the sky, tongue and lips.
• The heavier form, which can acquire acute stomatitis of herpetic etiology, is accompanied by an increase in regional lymph nodes. This form of stomatitis in children is treated under stationary conditions.
• Despite the acute debut this kind of stomatitis passes after 2-3 weeks with adequate therapy.

Any acute stomatitis in clinical practice is divided into three forms - light, medium and heavy, and the disease proceeds in five stages: 

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

[9], [10], [11]

Chronic stomatitis

The chronic form of stomatitis is a typical consequence of either self-treatment, or altogether lack of therapeutic measures in the manifestation of an acute form of inflammation of the oral cavity. Chronic stomatitis can disturb a person for many months, and sometimes even years, alternating with short periods of remission. In addition to self-treatment, uncontrolled prima medicaments or lack of therapy as such, the following can be the causes of chronic recurrent stomatitis: 

• Sluggish, latent pathological processes in the organs of the digestive tract - gastritis, colitis, dysbacteriosis.
• Decreased immunity, immunodeficiency caused by either a sluggish disease of internal organs or systems, or a serious disease, such as tuberculosis, venereal diseases, HIV. In addition, premature newborn babies can also have extremely low immune activity and suffer from chronic stomatitis for many months.
• Permanent mechanical irritation of the oral cavity due to uncomfortable prostheses, braces.
• Sore teeth, such as chipped, protruding roots, permanently injuring the mucous membrane of the mouth and opening access to its infection.
• Teeth, caries.
• Avitaminosis, anemia.
• Streptococcal, staphylococcal infection, systemic candidiasis.
• Harmful habits such as smoking, habit of nibbling nails, neurotic habits to keep in hand pens, matches, other objects that can carry a bacterial or fungal infection into the mouth.
• Persistent non-observance of the rules of personal hygiene, including the oral cavity, the habit of using someone else's toothbrushes, dishes, cosmetics.

Chronic stomatitis, depending on the type, can be manifested by the periodic reddening of the oral mucosa or its ulceration. Often there is a subfebrile temperature, which is not associated with other specific diseases - the common cold, inflammation and so on. The constant formation of ulcers, aphthous erosions, non-treatable, enlarged lymph nodes, paroxysmal edema of the tongue is far from a complete list of signs of a chronic course of stomatitis.

Despite the variety of symptoms, they are united by one thing - systematic repetition and relapses.

Treatment of chronic stomatitis pursues a specific goal - elimination of the root cause, therapy is performed using both local procedures and by prescribing per os (orally).

[12], [13]

Ulcerative stomatitis

Ulcerative stomatitis is usually a consequence of an 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 form of inflammation, since in the catarrh only the upper layer of the mucosa is damaged, and in the ulcerative form the whole tissue of the membrane is eroded. Ulcers so deeply penetrate deep into that the superficial epithelium is necrotic, merges and forms rather large erosion. Ulcers can spread even into the bone tissue of the jaw and provoke osteomyelitis.

Symptoms of ulcerative stomatitis: 

• The beginning looks like a catarrhal form - hyperemia of the mucosa, swelling of the tongue, burning.
• There is a characteristic putrefactive smell from the mouth.
• Ulcers develop rapidly and cause symptoms typical of general intoxication - weakness, fever (subfebrile temperature), headache.
• After 2-3 days on the cheeks and under the tongue, white-gray coatings are formed covering the erosive mucous membrane.
• Lymph nodes increase from the first days of the disease.
• Eating, talking, smiling cause acute pain.

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

Timely begun medical measures allow to reduce the period of epithelialization of erosions to one week. After the painful symptoms subsided, systemic sanitation of the oral cavity is prescribed.

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

• Subcooling.
• Starvation.
• Hypovitaminosis.
• Alcoholism.
• Intoxication with salts of heavy metals.
• Calculus (tartar).
• Systematic irritation of the oral cavity with prostheses, splinters of molars.
• Unsanitary conditions.
• Severe course of viral infection.
• Mononucleosis.
• Exudative erythema.
• Oncology.
• The consequence of oncology treatment is chemotherapy.

Vincent's stomatitis is mainly caused by young men, begins as an inflammation of the tonsils, then the tongue becomes inflamed and the process spreads to the entire oral cavity, reaching deep layers of the mucous membrane, up to the bone tissue of the jaw.

The symptomatology of the disease is specific: 

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

Ulcerative stomatitis of this kind is treated in a complex way, primarily anesthesia, anesthesia, then detoxification is indicated, and the mouth is sanitized. With timely intensive treatment, the prognosis is favorable, ulcers are delayed within a week. A chronic, neglected process needs more prolonged therapy, in addition, it is often accompanied by periodontitis, which requires systematic monitoring of the oral cavity during the year.

Angular stomatitis

An angular stomatitis is what is called a seizure in everyday life. The name comes from the Latin word angulus or angle, that is, inflammation in the corners of the mouth.

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

Angular stomatitis is a typical process in young children, in the body of which staphylococcal, streptococcal or candidosis infection is detected.

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

Stages of an angular process: 

• Hyperemic corners of the lips.
• Maceration of skin, mucous (softening).
• Formation of pustules (purulent vesicles) in the corners of the lips.
• Pustules burst and form erosion.
• Movement with lips, mouth while eating, talking, smiling provokes cracking of corners.
• Cracks regularly bleed, crusted.
• Failure to comply with the rules of treatment can lead to the spread of pustules all over the face (impetigo).

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

An angular form of stomatitis can be caused by candidiasis, then the absence of treatment can provoke the spread of the process throughout the mucous membrane of the mouth inside. The disease can last for many months, periodically cease and again recur. It is with etiological variability that an important role of precise diagnosis is associated, which should include laboratory methods of microscopy to identify a particular pathogen. In addition, angular cheilitis should be differentiated from cheilitis caused by syphilis or tuberculosis.

[14]

Purulent stomatitis

Purulent stomatitis or pyostomatitis is a form of inflammation of the mouth caused by a microbial, bacterial infection. The most common cause of purulent stomatitis are microtraumas of the oral mucosa. Injuries, in turn, can be provoked by gross mechanical damage (scratch, cut), as well as by a thermal burn from ingesting excessively hot food, by incorrect arrangement of molars, by fragments of untreated teeth and so on. The thing is that every year the mucous membrane of the mouth becomes more vulnerable, the saliva of an adult contains many times less than in the childhood of antibacterial protection - lysozyme. When wounds are formed in the mouth, this means that the risk of infection and the development of bacterial stomatitis is increasing. In addition, purulent stomatitis can be a consequence of chronic inflammation of the nasopharynx - sore throat, otitis, sinusitis.

Symptoms of a purulent form of inflammation are nonspecific, purulent pustules can form on the lips, that is, outside, but also purulent ulcers can be located inside - on the gum, on the cheeks and even on the tongue.

In addition, in dentistry, dermatology, a separate definition of purulent stomatitis has been singled out - vegetative piostomatitis. This disease is described in the rubric of skin and venereal diseases as pyostomatitis vegetans - a purulent inflammatory process of the oral cavity. Symptoms are small vegetations with purulent contents, similar in appearance to an abscess. Piostomatitis is characterized by multiple ulcers, which quickly turn into deep ulcers, eroded areas. Pustules open within a day, ulcers also quickly epithelialized, leaving on the mucous membrane scars, later papillomatosis.

Gonococcal stomatitis

Gonococcal or gonorrheal stomatitis is now very rare, because it mainly develops in utero and when the child passes through the infected birth canal of the mother. Each woman, when registered for pregnancy, undergoes a comprehensive examination, so gonorrhea is identified and treated before the baby can become infected with it.

Rare cases of infection with gonococcal stomatitis are noted when a sick person contacts a healthy, usually oral. Nevertheless gonococcal stomatitis occurs in dermatological practice and is worthy of a brief description.

In most diagnosed diseases gonococcus affects not only the oral cavity, but the entire nasopharynx. Diagnosis of gonococcal stomatitis can be difficult, since the initial stage of the disease is asymptomatic, moreover, gonorrhea is in principle prone to episodes of false self-healing and remission. When the patient falls into the field of vision of the doctor, the process is already spread throughout the throat, tonsils, in the mouth.

The most common type of stomatitis is diagnosed in the following categories of the population: 

• Newborns whose mothers do not become obstetric-gynecologic and conduct an antisocial lifestyle.
• Persons entering orogenital contacts (more often unconventional homosexual orientation).

Symptomatic gonococcal stomatitis is characterized by lethargy, blotchiness, can manifest itself with such nonspecific signs: 

• Subfebrile body temperature.
• Transient sore throat.
• Hyperemic mucosa of the oral cavity.
• Small erosive patches in the mouth.
• Isolation of a viscous, purulent secret along with saliva.
• The appearance of ulcers on the inner side of the cheeks, gums, tongue is a symptom of a severe form of the process.

Differentiate the form of stomatitis is helped by histological examination of the contents of eroded, ulcerated areas. Extragenital gonorrhea is treated in the form of stomatitis in the same way as the genital form - with the help of antibiotics, in addition, topically prescribed aseptic lotions, applications.

Herpetiform stomatitis

Herpetiform stomatitis is a very rare form of aphthous recurrent stomatitis, which outwardly resembles a viral variant of oral inflammation, herpes. With herpetiform stomatitis, as with herpes, multiple rashes are formed in the form of minute sores that cover the entire mucosa. Aphids are very small and this differs from typical rather large aft (rash) in the classical form of aphthous stomatitis. Ulcers are not clearly defined, have a grayish tinge, the mucosa around them is not hyperemic. One of the specific features of this rare species can be the localization of aft - under the tongue, at the bottom of the oral cavity. Herpetiform stomatitis is prone to recurrence and periodic remissions. Ulcers heal fairly quickly - within a week.

This form of the disease is more common in young women under the age of 28-30 years. Etiological reasons are not fully understood.

Consequences and complications of stomatitis

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

Stomatitis is vainly considered a safe disease, its complications can seriously affect the health status.

As a rule, catarrhal stomatitis is most simple and quick, but even without proper treatment it can be transformed into a ulcerative necrotic process, affecting not only soft gum tissue, but also the osteomyelitis of the jawbone. More severe complications may look like gangrenous inflammation, such pathologies are diagnosed with gonococcal stomatitis, stomatitis caused by tuberculosis, syphilis.

In addition, the consequence and complications of stomatitis in neglected form is a potential threat of tooth loss, as the inflammation quickly flows into a chronic form, provoking periodontal disease.

The main danger of any stomatitis is its transformation into a relapsing 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.

[15], [16], [17], [18], [19]

Diagnosis of stomatitis

Diagnosis of stomatitis in general is not difficult, but all changes on the oral mucosa are non-specific, so differential methods are mandatory. Precise diagnosis of stomatitis allows in the shortest time to stop the process, to stop the spread of symptoms and provide a therapeutic effect that provides a stable remission without relapses. It is for this reason that not only the dentist, but also the dermatologist, the therapist, and the pediatrician (in the case of diseases of the toddlers), and possibly the dermatovenerologist, should be engaged in determining the type and nature of stomatitis.

Specialized tests or samples with stomatitis do not exist, diagnosis usually takes place in several stages: 1.

1. Collection of anamnesis, medical history.
2. Visual inspection of the oral cavity: 
   • Appearance of the mucosa.
   • Appearance of aphthus, sores, their shape, quantity, structure.
   • Determination of the aureole, erosion boundaries, characteristics of the edges.
   • Presence of plaque on ulcers.
   • Presence of a plaque on the mucosa.
   • Characteristics, color, structure of the deposit.
   • Localization of ulcers, plaque.
3. Identification of concomitant 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 on the tank seed, blood test and so on only confirm the primary assumption of the doctors. In addition, stomatitis must be differentiated according to the types associated with different etiologic factors, from the definition of a specific type - infectious, traumatic, allergic, symptomatic, depends on the success and timing of treatment.

[20], [21], [22], [23]

Analyzes for stomatitis

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

Analyzes for stomatitis are conducted to specify the diagnosis, for these purposes, the following activities are prescribed: 

• UAC is a general blood test.
• Blood chemistry.
• Blood to the level of sugar.
• Blood for antibodies to treponema, gonococci for suspected venereal etiology of stomatitis.
• Immunofermentogram to clarify the activity of immunity.
• Bacteriological culture of saliva for the determination of bacterial infection and a particular pathogen.
• Cytology, histology of swabs with inflamed mucous membrane.
• Virological study of nasopharyngeal flushes and fluid contained in vesicles, vesicles.

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

[24], [25], [26], [27], [28], [29]