Recurrent stomatitis - the urgency of the problem and the solutions

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

This nosological unit can be independent, and may be a complication of the underlying disease.

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Causes of the recurrent stomatitis

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

1. Traumatization of the oral mucosa: 
   1. mechanically (coarse food, poor-quality prosthesis, fragmentation tooth, bite of the mucosa), 
   2. chemically (containing sodium lauryl sulfate in many toothpastes and mouthwashes - dry the mucous membrane of its shell and thereby make it vulnerable, with the accidental ingress of various acids and alkalis), 
   3. by physical means (hot, sour food, accidental steam burn, etc.). 
2. Inadequate nutrition with insufficient vitamins, micro- and macronutrients in food. 
3. Nervous overstrain, stress and sleep disturbances. Many note the relapse of stomatitis in the period of stressful situations. 
4. Reduced immunity, due to any disease. 
5. Allergic reactions to food and medicines. 
6. Various infectious diseases: 
   1. infection of viral genesis (acute respiratory viral infection, influenza, herpes, various forms of lichen, etc.) 
   2. infection caused by a fungus of the genus Candida, 
   3. venereal diseases (syphilis, gonorrhea), 
   4. infections of bacterial origin (tuberculosis, various pustular diseases). 
7. Genetic predisposition. If parents have recurrent stomatitis, then their chances of having children are higher than those of others. 
8. Hormonal factors. For example, in some women, relapse of stomatitis is observed during menstruation.
9. Disruption of the digestive system (dysbacteriosis, gastritis, colitis, etc.), endocrine pathology, etc. 
10. Alcohol abuse and smoking.

[2], [3], [4]

Symptoms of the recurrent stomatitis

There are symptoms of recurrent stomatitis common and local.

Common symptoms include: weakness, fever, sleep disturbances, irritability, reluctance to eat. If recurrent stomatitis in a child, then - tearfulness, capriciousness. Possible complication of regional lymphadenitis (painful and enlarged lymph nodes).

Local symptoms of recurrent stomatitis: 

• the formation of areas of redness on the mucous membrane of the oral cavity (in any place, in a variety of forms and in different numbers), the so-called. Catarrhal form of stomatitis. In the place of redness, there are unpleasant sensations in the form of burning, tingling, itching. 
• with the progression of stomatitis at the site of reddening, erosions (aphthae) are subsequently formed in aphthous progressive stomatitis, and in herpetic - at first vesicles (vesicles) are formed, which are opened, and then ulcers are formed in their place. With yeast stomatitis in the hyperemic area, a milky-white bloom is formed, after removal of which, a bleeding spot is formed. 
• the appearance of lesions (vesicles, erosions) of the oral mucosa is accompanied by severe pain syndrome, especially when eating food or liquids. 
• characterized by excessive salivation, an unpleasant odor from the mouth is possible.

Chronic recurrent aphthous stomatitis

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

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

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

• food products (most often citrus fruits, chocolate, nuts, etc.); 
• helminthic invasions; 
• toothpastes; 
• home or industrial dust;
• medications.

But some predisposing factors for the onset of chronic aphthous stomatitis are not always enough. An important role in its occurrence is played also by concomitant diseases: 

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

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

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

1. Prodromic period (precursor of the disease). Characterized by a minor soreness, a feeling of tingling or burning in the mouth. During the examination of the mucous membrane of the mouth, there is a reddening area and a slight puffiness.
2. Stage of rash. Comes a couple of hours after the initial stage. In the place of reddening of the mucous membrane of the mouth there are characteristic defects - aphthae (ulcers), they are very painful when touched, have a round or oval shape and are covered with a fibrinous coating of grayish-white color. Aphids can appear on any part of the oral mucosa, but their favorite place is the inner surface of the lips, cheeks and lateral surface of the tongue.
3. The period of extinction of the disease. It comes, on average, seven days after the advent of aft. Usually, aphthae heal without leaving scars behind. In untimely and inadequate treatment of aft, with non-observance of personal hygiene, aphthae last longer (for two to three weeks), they can leave scars behind them (Setton's aphthae).

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

• In the case of easy flow, single aphthae appear one to two times a year. 
• At an average severity level, aphthae appear every two to three months. 
• In severe cases, they may appear weekly, with an increase in their number, depth of lesion, and duration of healing (Setton's aphthae).

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

[5], [6], [7], [8], [9]

Recurrent herpetic stomatitis

Recurrent herpetic stomatitis occurs after a previous herpetic infection. Scientifically proved that 70% - 90% of the population remain lifelong carriers of the herpes virus. The virus is retained in the ganglia (nodes) of nerve cells in the form of a latent infection and under certain conditions makes itself felt by herpetic stomatitis.

The provoking factors of herpetic stomatitis.

1. Subcooling. 
2. Excess insolation (overheating). 
3. Heavy physical activity. 
4. Constant stress. 
5. Microtrauma mucous membrane of the mouth. 
6. Postponed disease with high fever. 
7. Decreased immunity. 
8. Previously transferred operations.

The incubation period lasts from several days to several weeks. 

• On a certain area of the mucosa appears redness of varying severity. 
• There are unpleasant sensations in the place of the lesion: itching, tingling, burning. 
• After a couple of hours or even earlier, single or group vesicles (vesicles) appear in the reddening of the mucosa, which are soon opened and small erosions are formed. 
• There is no swelling of the tissues at the lesion site. 
• Then the epithelization of erosion occurs, leaving no changes afterwards. 
• Recovery in mild cases occurs in 4-5 days.
• The general condition in the period of exacerbation of herpetic stomatitis is characterized by severe weakness, aching joints, muscle pain, increased temperature, nervousness. The expressed general symptomatology is noted at the early stages of the chronic process, with time - with each subsequent exacerbation, the symptoms of a general nature become easier.

Forms of recurrent herpetic stomatitis:

• Light - exacerbation of the disease once a year or absent. Rashes single, quickly heal, overall health does not suffer. 
• Medium-severe - exacerbation of stomatitis two - four times a year. Eruptions can be already group - several groups of vesicles, the general condition may slightly worsen. 
• Heavy - more than five times a year. Because of frequent exacerbations on the mucous membrane of the oral cavity, there are lesions at different stages of development. The general or common symptomatology is strongly expressed.

Recurrent herpetic stomatitis in children

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

In 50% of children after a previous acute herpetic stomatitis later there are relapses. This suggests that adequate antiviral treatment does not begin in time. Also, the emergence of exacerbations of herpetic stomatitis in children depends on the features of the formation of the immune system.

Symptoms of herpetic stomatitis in children are the same as in adults, only the general symptoms are more pronounced, especially up to 3 years.

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

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

Diagnostics of the recurrent stomatitis

Usually the diagnosis of recurrent stomatitis does not cause difficulties. To diagnose an experienced and attentive doctor (dentist, ENT doctor, therapist, pediatrician), there will be enough complaints, clinical symptoms and history of the anamnesis (medical history). If necessary, additional research methods are appointed: 

• PCR - diagnosis of the herpes virus, candida fungi. 
• smears from the pharynx and from the place of erosion (aphthae), their subsequent sowing with the definition of sensitivity to the antibiotic, antiseptic.

In severe therapy, stomatitis is prescribed a broader examination and consultation with other specialists to identify the underlying disease that caused recurrent stomatitis.

[10], [11]

Treatment of the recurrent stomatitis

Treatment of recurrent stomatitis has the following objectives. 

1. Relieve pain syndrome. 
2. Improve the healing of erosion (aft). 
3. Warn the occurrence of relapses or reduce their number.

Principles of treatment of recurrent aphthous stomatitis.

1. Exclusion of predisposing factors that are allergic in nature (if there is an allergy to citrus fruits, then exclude them from the diet, with allergies to nuts, honey, chocolate, etc. - exclude them, etc.).
2. Treatment of concomitant diseases (it is necessary to treat inflammatory diseases of the nasopharynx in time - otitis, rhinitis, tonsillitis, taking vitamins, etc.)
3. Compliance with diet. Exclude from the diet rough, spicy and sour food, so that there is no additional irritation of the ulcers. Do not eat too cold or hot food, but only in a warm form. In your menu include more vegetable (fruits, vegetables) and protein foods (lean meat, cottage cheese, fish, eggs)
4. Careful oral hygiene, preferably after eating, rinse the oral cavity with an antiseptic solution (for example, a decoction of chamomile or rotocan, etc.).
5. Local therapy of the oral mucosa and aphthous (erosive) eruptions is in the antiseptic treatment. Sanitation can be performed by a specialist (dentist, ENT doctor) or at home by the patient himself. It consists in the periodic rinsing of the oral cavity:
   • solutions of antiseptics (solution furatsillina, rotokan, rekutan, etc.) 
   • decoctions of medicinal herbs (chamomile, turn, sage, etc.).
6. In the period of exacerbation with aphthous stomatitis, when aphthae are fresh, metrogonadine gel (metronidazole + chlorhexidine), which has a local antibacterial, antiseptic, healing effect, is often used to remove inflammation after sanitation. After applying the gel, it is desirable to refrain from eating food and liquids for 30 minutes.
7. In the period of exacerbation with herpetic stomatitis, after antiseptic treatment, local antiviral drugs (acyclovir, penciclovir, herpevir) are used.
8. The specialist prescribes pain medication locally: 
   • 5% or 10% mixture of anestesin in glycyrin; 
   • lidocaine 1% or 2% solution can be used; 
   • apply also a 3% solution of diclofenac based on hyaluron, etc.

In the severe course of chronic aphthous stomatitis, when severe pain is severe, additionally, the drugs can be administered either inside or intramuscularly (ketanov, movalis, dicloberte).

9. In the presence of necrotic plaque on the nails, proteolytic enzymes have a good effect, they gradually and painlessly eliminate it (lidase, trypsin, etc.).
10. When the healing (epithelization) of erosions begins, keratoplastic substances are used: sea buckthorn oil, dog rose, vinyllin, propolis, solcoseryl. They accelerate and improve the healing of ulcers.
11. If a high fever is prescribed antipyretic drugs (Nurofen, paracetamol, ibuprofen).
12. With recurrent herpetic stomatitis, antiviral therapy is always prescribed from the very beginning of the disease (interferon, Anaferon, viburkol).
13. Must be used multivitamin complexes, t. Recurrent stomatitis is a consequence of hypovitaminosis (multifort, vitrum).
14. Because stomatitis has a chronic recurrent course, this suggests that the strength of the immune system is weakened and needs help. Therefore, necessarily appointed immunomodulators of general action (echinacea, Anaferon). You can also use the means to increase the local immunity of the oral mucosa (Immudone).
15. Given the possible allergic nature of recurrent stomatitis, often prescribed antihistamines, which will additionally help to remove inflammation and swelling at the site of eruption (erius, phencarol, fenistil).
16. Often recurrent aphthous stomatitis is complicated by regional lymphadenitis. In such a case, lymphomyositis is used, which alleviates inflammation and soreness in the lymph nodes.
17. Physiotherapeutic treatment is used mainly in severe aphtha, long-term healing and often recurrent (photophore of drugs - oxoline, tetracycline ointment, etc., helium-neon laser).

Prevention

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

• oral hygiene; 
• it is necessary to avoid stressful situations, over-cooling, overheating, heavy physical exertion; 
• prevention of damage to the oral mucosa; 
• timely identification and adequate treatment of diseases of the digestive system, nervous, etc .; 
• to eat properly and fully, so that there are enough vitamins and microelements in the diet; 
• prevent the action of allergens on the body (avoid contact with them); 
• identification and removal of chronic foci of infection; 
• to lead a healthy lifestyle (to exclude alcohol, smoking); 
• rejuvenate your body (swimming, walking).

Performing these simple actions you will forget about recurrent stomatitis and give yourself good health.

[12], [13], [14], [15], [16], [17]