What is stomatitis?

The term stomatitis is derived from the Greek word "stoma", which means "mouth". The ending "itis" describes an inflammation in medicine. According to the definition, oral mucosal inflammation can be an independent disease, but it can also be a side effect of other diseases or the side effect of treatments. There are various possible causes for the oral mucosal inflammation.

Forms of stomatitis

Depending on the location and trigger of the stomatitis, doctors differentiate between several forms of stomatitis. Some examples are:

• Mycotic stomatitis: inflammation of the oral mucosa caused by fungi, often caused by the yeast Candida albicans (Candida stomatitis or stomatitis candida);
• Aphtous stomatitis (also herpetic stomatitis or oral rot ): The cause is the herpes simplex virus type 1 (HSV 1), which is one of the herpes viruses. The virus usually affects the face and lips. Typical are fever and fluid-filled, painful blisters in the mouth.
• Nicotine stomatitis: nicotine from tobacco products
• Mercuruialis stomatitis: poisoning with mercury
• Bismuth stomatitis: poisoning with bismuth
• Allergic stomatitis: allergies
• Venous stomatitis: The oral mucosa comes into direct contact with the allergy trigger, for example when antibiotics and other drugs are used locally
• Diabetic stomatitis: diabetes Diabetes mellitus
• Angular stomatitis: stomatitis mainly affects the corners of the mouth
• Ulcerative stomatitis: inflammation of the oral mucosa is accompanied by deep ulcers; It is mostly caused by bacteria.

Acute or Chronic? The duration of stomatitis

The duration of the oral mucosal inflammation depends on the cause . Acute stomatitis usually heals within a few days if doctors treat it properly. On the other hand, some develop chronic inflammation of the oral mucosa. This takes longer and causes significant problems with eating and drinking for patients.

If the changes in the oral mucous membrane do not go away within a few days, always consult a dentist or general practitioner. A tissues sample from the lining of the mouth helps to find out the cause of the stomatitis. It could be cancer or precancerous lesions.

Symptoms of stomatitis

Most patients find the symptoms of oral mucosal inflammation extremely uncomfortable. If the symptoms are very pronounced, the quality of life often suffers considerably. Because food intake is more difficult and normal eating and drinking are no longer possible. If the oral mucosa is inflamed, the following symptoms of stomatitis appear:

• Redness and swell of the lining of the mouth
• Pain in the mouth, burning of the lining of the mouth
• Tingling, itching, numbness in the mouth
• dry oral mucosa,  inflammation of the gums
• If the oral mucous membranes are inflamed, the body temperature sometimes increases because the organism fights the inflammation
• The oral mucosa appears white because of the patchy or large-scale coverings (often fungal infections )
• coated tongue
• Aphthae: Doctors mean painful, gray-white damage to the mucous membranes; the causes are often not known.
• Blisters on the oral mucosa, for example if herpes viruses are the cause.
• Ulcers when bacteria are involved
• Death of larger areas of the mucous membrane (necrosis), the oral mucous membrane becomes detached;
• Bad breath that cannot be removed even by brushing your teeth
• Bleeding of the mucous membranes
• impaired taste sensation
• Problems chewing and swallowing if the mucous membranes in the throat and esophagus are also inflamed

 

Causes of stomatitis

The causes of stomatitis are extremely diverse. Doctors first differentiate between infectious triggers (bacteria, viruses, fungi) and non-infectious causes, for example toxins or general diseases.

Virus infections

• Herpes viruses are often behind the inflammation of the oral mucosa. An important characteristic of herpes viruses is that they persist in the nerve endings and can become active again, for example if the immune system is weakened. An important stomatitis virus is the herpes simplex virus (HSV 1), which causes oral rot (aphthous stomatitis) in children. Adults, on the other hand, develop cold sores later when this virus is reactivated. The varicella zoster virus ( chickenpox ) also affects the oral mucosa and causes blisters there. If the virus wakes up again later, adults develop painful shingles (herpes zoster). The rash often appears on the back or in the chest area - the oral mucosa is not affected in shingles.
• Infection with the HI virus ( HIV ), the cause of the immunodeficiency AIDS . The viruses also attack the mucous membranes in the mouth and throat. The infectious disease can now be treated well thanks to new drugs. Patients have an almost normal life expectancy.
• Measles virus
• Enteroviruses are a group of very different viruses that are responsible for different clinical pictures: One example are the so-called Coxsackie A viruses, which cause hand, mouth and foot disease. Most often the disease occurs in children. Typical are high fever and a rash on the hands, feet and mouth. Blisters form on the tongue, gums and the oral mucosa, from which painful damage to the mucous membrane later develops (canker sores). Doctors only treat the symptoms of hand, foot and mouth disease; there is no causal therapy. The infectious disease subsides after one to two weeks.

Bacteria attack the oral mucosa

Millions of bacteria settle in the oral cavity. Good and pathogenic germs keep each other in check if the oral flora is healthy. If the immune system is weakened or oral hygiene is poor , the "bad" germs take over and multiply. They not only affect the teeth and gums, but also cause inflammation of the oral mucosa. Often these arise on the breeding ground of inflammation of the gums (gingivitis) or caries .

A pneumonia(often Streptococcus pneumoniae) shows up in some cases as stomatitis. In addition, the pathogens in sexually transmitted diseases (English sexually transmitted diseases, abbreviated to STD) also attack the oral mucosa. Examples are the bacteria Neisseria gonorrhoeae ( gonorrhea ) or Treponema palladium ( syphilis ).

Yeasts

The yeast Candida albicans lives in the oral cavity, but does not usually make you sick. In people with weaken immune systems, however, the yeast spreads in the mouth. The typical white deposits are formed. Candida infections are often found in people who take certain medications. Examples are antibiotics for bacterial infections, the anti-inflammatory drug cortisone or chemotherapy for cancer.

Mechanical injuries to the oral mucosa

If you scrub your teeth and gums with a toothbrush that is too hard, you often damage the oral mucosa - it becomes inflamed. Badly fitting prostheses (so-called “prosthetic stomatitis”), braces or teeth with sharp edges have the same damaging effect . Oral mucosal inflammation also develops if you bite the inside of the lips or cheeks and bite wounds occur, have a piercing or consume very hot food.

Allergic reaction

In some people, stomatitis develops due to an allergic reaction. The immune system normally classifies harmless substances as “foreign” and reacts excessively to them. Such allergy triggers (allergens) are: substances from food, oral care products, prostheses or medicines.

Diseases and health problems

Some diseases take place elsewhere on the body, but also appear on the oral mucosa. Examples are:

• Nutritional deficiency symptoms, for example vitamin deficiency (especially vitamins B and C) or iron deficiency
• dry oral mucosa, especially in old age; the reason is that seniors often do not drink enough fluids and the mouth dries out.
• hormonal fluctuations: In some phases of human life, the hormonal balance gets mixed up. This is especially true during puberty, pregnancy or menopause.
• Skin diseases
• Blood disorders such as blood cancer ( leukemia )
• Inflammatory bowel disease (IBD): Crohn's disease, ulcerative colitis
• Inflammatory rheumatic diseases: rheumatoid arthritis , collagenoses ( rheumatism of connective tissue)

Medicines and luxury foods

Stomatitis can develop as a side effect of certain medications. Examples are gold-containing drugs, anticancer drugs, anti-inflammatory drugs, and barbiturates. The latter have a calming and narcotic effect. Today they are no longer used as sleeping pills, but only for epilepsy and anesthesia. In addition, excessive alcohol and nicotine consumption damage the oral mucosa.

Poisoning

Sometimes stomatitis arises from exposure to toxins. Heavy metals such as mercury, arsenic or lead cause extremely severe poisoning. And these phenomena show up on the oral mucosa.

Chemotherapy and radiation stomatitis

Stomatitis is a common side effect of cancer treatments. Chemotherapy is often associated with inflammation of the lining of the mouth. Often stomatitis affects the tongue, the mucous membranes of both cheeks, the roof of the mouth and the floor of the mouth. Most often, stomatitis develops seven to ten days after starting chemotherapy. It can take to two weeks for the inflammation of the oral mucosa to heal - depending on the severity of the stomatitis.

The "chemo" uses cell poisons, so-called cytostatics. They work throughout the body, primarily targeting cells that are dividing quickly. This applies to cancer cells, but also to cells of the oral mucosa or hair.

A second important pillar of cancer treatment is radiation therapy. Patients with malignant tumors in the head and neck area almost always develop stomatitis. It is limited to the regions that radiologists irradiate. The oral mucosal inflammation sets in about three weeks after the start of the irradiation and reaches its peak after about six weeks.

Stomatitis prophylaxis - this is how you can prevent it

There are a few tip that can help prevent or keep the oral mucosa at bay. Examples of stomatitis prophylaxis are:

• Maintain good oral hygiene every day. Use a mild, non-irritating toothpaste. Choose a soft toothbrush that does not damage the oral mucosa mechanically. Tooth-cleaning chewing gums are also a good way to protect yourself.
• If you have dentures or braces, clean them particularly well every day. If possible, take them out and clean them under running water. Regular bathing in the denture or braces cleaner also removes bacteria and impurities.
• Visit your dentist if the denture or braces are badly seated and rub against the oral mucosa. Otherwise, have dental check-ups twice a year.
• Make sure that your oral mucosa is always well moistened. Dry mouth is a risk factor for stomatitis. Drink enough, preferably sugar-free, low-calorie drinks. 1.5 to two liters of fluids per day are recommended.
• Eat a healthy diet that prevents deficiency symptoms. Eat a lot of fresh fruits, vegetables and whole grains, for example, which provide sufficient vitamins and minerals.

Treatment of an inflammation of the lining of the mouth

What helps against inflammation of the oral mucosa? This is the question most people ask themselves when eating and drinking becomes a torture due to the pain in the mouth. But there is help with inflamed oral mucosa. Doctors usually treat stomatitis locally in the form of pain-relieving mouthwashes and gels; You apply the latter directly to the inflamed oral mucosa.

Drugs for stomatitis

The main drugs and means in stomatitis treatment are:

• Mild cleaning agent that do not irritate the oral mucosa: Examples are a stomatitis solution with the active ingredient dexpanthenol, physiological saline solution or tea; use it to rinse your mouth after eating and in between meals.
• Pain relievers that numb the mucous membranes; Frequently used active ingredients are paracetamol or ibuprofen
• local anesthetics, such as the active ingredient lidocaine; the herbs relieve pain, itching and burning
• disinfecting mouthwashes with the active ingredient chlorhexidine
• Glucocorticoids, which have anti-inflammatory and anti-allergic effects
• Antihistamines for allergic reactions
• Prosthetic stomatitis: Treatment is often with antifungal agents (antifungal agents) because the yeast Candida albicans is a common cause. Chlorhexidine (mouthwash, lozenges), hexetidine or tea tree oil also help in some cases. The dentist also checks whether the prosthesis fits well and professionally cleans the dentures from pathogens.
• Medicines that form a protective film on the oral mucosa and counteract irritation. Examples are the active ingredients sucralfate or hyaluronic acid.

Treat underlying diseases and severe stomatitis

Stomatitis is also the cause of certain underlying diseases. If so, doctors treat them first. After that, the oral mucosal inflammation should also improve and subside. In severe cases of stomatitis, local treatment of the oral mucosal inflammation is not sufficient. Doctors use drugs that work throughout the body (systemic). This is the case, for example, with extensive infections with bacteria, viruses or fungi. Doctors then use antibiotics against bacteria, antivirals against viruses, and antimycotics against fungi.

Home remedies for inflammation of the oral mucosa

Certain home remedies can relieve the symptoms of inflammation of the lining of the mouth. They work against pain, burning and itching and slow down stomatitis. Prepare a tea from the plants and use it as a mouthwash and for gargling. It is important that the tea varieties selected are of pharmacist quality. Pharmacies and the Internet mail order business also offer ready-made solutions, drops and tinctures for rinsing and brushing the oral mucosa.
The following plants and foods are helpful against inflammation of the oral mucosa:

• Chamomile has anti-inflammatory, antibacterial and analgesic properties
• Sage fights bacteria and prevents fungal infections
• Thyme eliminates bacteria and protects against fungal attack, the plant also ensures fresh breath
• Marigold has a disinfecting effect and strengthens the immune system
• Mallow relieves pain, dampens inflammation, and promotes healing
• Peppermint has a disinfectant effect
• Frozen pineapple pieces work well against inflammation of the oral mucosa. The home remedy has a decongestant and anti-inflammatory effect; suck the cool fruit for a few minutes.

First aid for stomatitis

• Make sure that your lips stay plump, for example with an eye and nose ointment or aniseed butter.
• Do not eat spicy, salted, bitter, sour and smoked foods, which irritate the oral mucosa
• Avoid hot food, rather prefer cool food; suck ice cubes or eat ice cream, for example.
• Drink enough, for example herbal tea or still water; Better to avoid coffee or black tea - both drinks irritate the mucous membranes. A straw makes drinking easier.
• Avoid nicotine and alcohol, or at least try to limit consumption.
• Choose soft, pureed, and mushy foods that are easier to swallow; Examples are soups, potatoes, pasta, pudding, yogurt or milkshakes.
• Do not use dental floss to clean the spaces between your teeth if you have low blood counts. Incorrect handling of the floss can result in injuries.