II. Definitions
- Stomatitis
- Inflammation of the mouth and lips
- Broader term that includes Oral Mucositis
- Mucositis
- Painful inflammation and ulceration of the Gastrointestinal Tract
- Typically caused by Chemotherapy or Radiation Therapy
III. Causes: Stomatitis
-
Vitamin Deficiency (typically associated with recurrent Aphthous Ulcers)
- Iron Deficiency Anemia
- Vitamin B1 Deficiency (Thiamine deficiency)
- Vitamin B2 Deficiency (Riboflavin deficiency)
- Vitamin B6 Deficiency (Pyridoxine deficiency)
- Vitamin B9 Deficiency (Folic Acid Deficiency)
- Vitamin B12 Deficiency (Cobalamin Deficiency)
- Specific lesions
- Angular Stomatitis
- Aphthous Stomatitis
- Herpes Gingivostomatitis
- Involves Tongue and Hard Palate
- Nicotinic Stomatitis
- Acute Necrotizing Ulcerative Gingivitis (Vincent's Stomatitis)
- Reactive Infectious Mucocutaneous Eruption (RIME)
- Follows respiratory tract infections
- Local Trauma or reaction
- Ill-fitting dentures
- Contact Dermatitis
- Mouth Chemical Burn Causes
- Oral Mucositis associated with high dose Chemotherapy or head/neck Radiation Therapy
- Often involves Buccal mucosa
- May be complicated by Oral Candidiasis (Thrush) or Herpes Gingivostomatitis
- Allergic Contact Stomatitis (Delayed-Type Hypersensitivity) Causes
- Chlorhexidine Gluconate (Peridex)
- Topical Corticosteroids
- Budesonide (Rhinocort)
IV. Management
- See Oral Ulcer
- See Pharyngitis Symptomatic Treatment
- Evaluate for complications of mucositis and poor oral intake (esp. Chemotherapy and Radiation Therapy related)
- Severe Dehydration
- Electrolyte abnormalities (e.g. Hyponatremia, Hypokalemia)
- Failure to Thrive
- Secondary Oral Infections
- Antifungal rinses may be used prophylactically
- Bleeding lesions
- Keep Platelet Count >20,000
- Apply local pressure
- Topical Tranexamic Acid (TXA)
- Treat specific causes
- Symptomatic management
- General measures
- Consider debriding with soft ToothBrush
- Saline rinses
- Prepare one teaspoon salt in 32 ounces water
- Some recipes recommend adding bicarbonate
- Topical over-the-counter agents
- Amphojel (coats lesions)
- Zilactin (forms film over the lesion)
- Topical prescription agents (expensive)
- Episil (viscous gel)
- Mugard (oral rinse)
- Gelclair (viscous gel)
- Consider topical combination agents
- Viscous Lidocaine
- Exercise caution in dosing and toxicity
- Magic Mouthwash
- Typically compounded (e.g. Lidocaine, Benadryl, Maalox, with or without a Corticosteroid and/or Antibiotic)
- First Mouthwash BLM (commercially prepared)
- Viscous Lidocaine
- Avoid unhelpful or harmful agents
- Avoid Sucralfate (ineffective)
- Avoid Chlorhexidine (ineffective)
- Avoid Alcohol-based rinses (may exacerbate pain)
- Avoid Hydrogen Peroxide (may delay healing)
- Other agents used in Chemotherapy and Radiation Therapy induced mucositis
- Doxepin 0.5% solution
- Morphine 2% mouthwash preparation
- Keratinocyte growth factor preparation
- Systemic Analgesics
- General measures
V. References
- Negrin in Drews (2014) Oral Toxicity Associated with Chemotherapy, UpToDate, accessed online 11/05/2014
- Swaminathan and Dibbs in Herbert (2020) EM:Rap 20(8): 2
- (2014) Presc Lett 21(11): 64
- Nolan (1991) J Oral Pathol Med 20(8):389-91 [PubMed]
- Sun (2014) J Oral Pathol Med [PubMed]
- Thongprasom (2001) Southeast Asian J Trop Med Public Health 32(3):643-7 [PubMed]