Stomatitis pathophysiology: Difference between revisions

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{{Stomatitis}}
{{Stomatitis}}
{{CMG}}; {{AE}} {{SaraM}}  
{{CMG}}; {{AE}} {{SaraM}}, {{USAMA}}  


==Overview==
==Overview==
Stomatitis is the inflammation of the mucosal surfaces in the mouth. Various factors can contribute to the pathogenesis of stomatitis depending on the type of stomatitis.<ref name="pmid15057287">{{cite journal| author=Sonis ST| title=The pathobiology of mucositis. | journal=Nat Rev Cancer | year= 2004 | volume= 4 | issue= 4 | pages= 277-84 | pmid=15057287 | doi=10.1038/nrc1318 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15057287  }} </ref>
Stomatitis is the [[inflammation]] of the [[mucosal]] surfaces in the mouth. Various factors can contribute to the [[pathogenesis]] of stomatitis depending on the type of stomatitis.<ref name="pmid15057287">{{cite journal| author=Sonis ST| title=The pathobiology of mucositis. | journal=Nat Rev Cancer | year= 2004 | volume= 4 | issue= 4 | pages= 277-84 | pmid=15057287 | doi=10.1038/nrc1318 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15057287  }} </ref>


==Pathophysiology==
==Pathophysiology==
Different mechanism are understood to cause different types of stomatitis:<ref name="pmid15057287">{{cite journal| author=Sonis ST| title=The pathobiology of mucositis. | journal=Nat Rev Cancer | year= 2004 | volume= 4 | issue= 4 | pages= 277-84 | pmid=15057287 | doi=10.1038/nrc1318 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15057287  }} </ref>
Different mechanism are understood to cause different types of stomatitis:<ref name="pmid15057287">{{cite journal| author=Sonis ST| title=The pathobiology of mucositis. | journal=Nat Rev Cancer | year= 2004 | volume= 4 | issue= 4 | pages= 277-84 | pmid=15057287 | doi=10.1038/nrc1318 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15057287  }} </ref>


*[[Aphthous stomatitis]]:
===Infectious Causes===
**It is the most common cause of oral ulcers. A definitive pathogenesis does not exist for aphthous stomatitis but the proposed mechanism involves immune system abnormalities and the presence of autoimmune antibodies. It is thought to be caused by some types of cytokine and T cell accumulation manifesting as a defective cell mediated arm of the immunity.Recurrence is very common in aphthous ulcers.<ref name="pmid8665304">{{cite journal| author=Ship JA| title=Recurrent aphthous stomatitis. An update. | journal=Oral Surg Oral Med Oral Pathol Oral Radiol Endod | year= 1996 | volume= 81 | issue= 2 | pages= 141-7 | pmid=8665304 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8665304 }} </ref><ref name="pmid17343257">{{cite journal| author=Dalghous AM, Freysdottir J, Fortune F| title=Expression of cytokines, chemokines, and chemokine receptors in oral ulcers of patients with Behcet's disease (BD) and recurrent aphthous stomatitis is Th1-associated, although Th2-association is also observed in patients with BD. | journal=Scand J Rheumatol | year= 2006 | volume= 35 | issue= 6 | pages= 472-5 | pmid=17343257 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17343257  }} </ref><ref name="pmid10668310">{{cite journal| author=Murray LN, Amedee RG| title=Recurrent aphthous stomatitis. | journal=J La State Med Soc | year= 2000 | volume= 152 | issue= 1 | pages= 10-4 | pmid=10668310 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10668310  }} </ref>
*'''[[Herpetic stomatitis]]:'''
*[[Herpetic stomatitis]]:
**This type is causes by [[HSV-1|HSV-1 virus]]. It is caused by the destructive effect of the virus on the tissues in the form of break down of the infected cells. The [[infection]] may start as [[vesicles]] that are typically pin-head like and ultimately rupture, resulting [[ulceration]]. As a characteristic to the [[virus]] these ulcers are painful, irregular in appearance and often have a yellow-grey covering layer.
**This type is causes by [[HSV1]] virus. It is caused by the destructive effect cause by the virus on the tissues in the form of break down of the infected cells. The infection may start as vesicles that are typically pin-head like and ultimately rupture, resulting ulceration. As a characteristic to the virus these ulcers are painful, irregular in appearance and often have a yellow-grey covering layer.
**After the lesions resolve, the [[virus]] travels though the [[nerves]] to the nerve cells and goes into a latent stage. It can then reactivate when the person becomes [[immunocompromised]] and cause symptoms.<ref name="pmid16451405">{{cite journal| author=Kolokotronis A, Doumas S| title=Herpes simplex virus infection, with particular reference to the progression and complications of primary herpetic gingivostomatitis. | journal=Clin Microbiol Infect | year= 2006 | volume= 12 | issue= 3 | pages= 202-11 | pmid=16451405 | doi=10.1111/j.1469-0691.2005.01336.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16451405 }} </ref>
**After the lesions resolve, the virus travels though the nerves to the nerve cells and goes into a latent stage. It can then reactivate when the person becomes immunocompromised and cause symptoms.<ref name="pmid16451405">{{cite journal| author=Kolokotronis A, Doumas S| title=Herpes simplex virus infection, with particular reference to the progression and complications of primary herpetic gingivostomatitis. | journal=Clin Microbiol Infect | year= 2006 | volume= 12 | issue= 3 | pages= 202-11 | pmid=16451405 | doi=10.1111/j.1469-0691.2005.01336.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16451405 }} </ref>
**[[Encephalitis]] associated with [[herpetic stomatitis]] is due to the interaction of [[HSV-1]] with [[Toll-like receptor 2]] or  [[TLR2]].
**Encephalitis associated with herpetic stomatitis is due to the interaction of [[HSV1]] with Toll-like receptor 2 or  [[TLR2]]
*'''Zoster stomatitis or [[chicken pox]]:'''
*Chemotherapy associated stomatitis:
**[[Zoster]] stomatitis is caused by [[VZV]].
**The Chemotherapy causes RNA and DNA damage by the reactive oxygen species leading to an excessive production of inflammatory cytokines. These cytosines cause inflammation thus causing breaks in the epithelium.
**The [[vesicles]] of [[zoster]] stomatitis are found in a cluster on one side of the [[hard palate]]. The [[vesicles]] can also be found the [[buccal mucosa]], gingival tissue and the [[tongue]].
*Denture stomatitis:
 
**Denture stomatitis effects upto 67% of denture wearers. It moct commonly affects the palatal mucosa.<ref name="pmid3298586">{{cite journal| author=Arendorf TM, Walker DM| title=Denture stomatitis: a review. | journal=J Oral Rehabil | year= 1987 | volume= 14 | issue= 3 | pages= 217-27 | pmid=3298586 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3298586 }} </ref>The material used in fillings and dentures are porus because of the chemicals used and to give it a better grip. Pathogens like candida alibicans can colonize such suitable sites leading to an inflammatory response and thus denture stomatitis. The irritaitive effect of the foreign denture material can also contribute to the pathogenesis.<ref name="pmid28130176">{{cite journal| author=Abduljabbar T, Al-Askar M, Baig MK, AlSowygh ZH, Kellesarian SV, Vohra F| title=Efficacy of photodynamic therapy in the inactivation of oral fungal colonization among cigarette smokers and non-smokers with denture stomatitis. | journal=Photodiagnosis Photodyn Ther | year= 2017 | volume=  | issue=  | pages=  | pmid=28130176 | doi=10.1016/j.pdpdt.2017.01.182 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28130176 }} </ref><ref name="pmid25082257">{{cite journal| author=Marinoski J, Bokor-Bratić M, Čanković M| title=Is denture stomatitis always related with candida infection? A case control study. | journal=Med Glas (Zenica) | year= 2014 | volume= 11 | issue= 2 | pages= 379-84 | pmid=25082257 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25082257  }} </ref>
*'''Noma or [[Gangrenous stomatitis]]:'''
*Noma or Gangrenous stomatitis:
**[[Gangrenous stomatitis]] is also known as [[Noma]] or 'cancrum doris'. [[Noma]] or [[gangrenous stomatitis]] is focal and destructive [[infection]] caused by [[Borrelia]] vincentii, [[Fusobacterium]] and [[Bacteroides]]. It is an acute [[infection]] of the tissues in the orofacial region. [[Immunocompromised]] individuals are predisposed to develop this condition. Noma or [[gangrenous stomatitis]] is more common in children. The infection can begin as a spot or vesicle on the gingival surface of the mandibular [[molars]] and [[premolars]]. This spot or [[vesicle]] is red initially and painful and develops into an [[ulcer]]. The lesion has cone shaped expansion with [[bone]], [[teeth]] and tissue underneath being exposed after the soft tissue sloughs off.<ref name="Gangrenous stomatitis">{{cite book |last1=Mandell |firs1t=Gerald |last2=Gouglas |first2=Gordon |last3=Bennett |first3=John |date= |title=Principles and Practice of Infectious Diseases |location= Harvard Medical School |publisher=WILEY MEDICAL |page=383 |isbn=0-471-87643-7}}​</ref>
**Gangrenous stomatitis is also known as Noma or 'cancrum Doris'. Noma or gangrenous stomatitisIt is focal and destructive infection caused by [[Borrelia]] vincentii, [[Fusobacterium]] and [[Bacteroides]]. It is an acute infection of the tissues in the orofacial region. Immunocompromised individuals are predisposed to develop this condition. Noma or gangrenous stomatitis is more common in children. The infection can begin as a spot or vesicle on the gingival surface of the mandibular molars and premolars. This spot or vesicle is red initially and painful and develops into an ulcer. The lesion has cone shaped expansion with bone, teeth and tissue underneath being exposed after the soft tissue sloughs off.<ref name="Gangrenous stomatitis">{{cite book |last1=Mandell |firs1t=Gerald |last2=Gouglas |first2=Gordon |last3=Bennett |first3=John |date= |title=Principles and Practice of Infectious Diseases |location= Harvard Medical School |publisher=WILEY MEDICAL |page=383 |isbn=0-471-87643-7}}​</ref>
*'''[[Bovine papular stomatitis]]:'''
*[[Bovine papular stomatitis]]:
**[[Bovine papular stomatitis]] is a [[zoonotic]] disease. It is caused by [[bovine papular stomatitis virus]], starting as a single lesion and becoming a nodular mass ultimately. The [[virus]] has [[chemokine]] binding proteins that prevent the [[neutrophils]] and [[monocytes]] from migrating to the site of the [[pathology]].<ref name="pmid27936239">{{cite journal| author=Sharif S, Nakatani Y, Wise L, Corbett M, Real NC, Stuart GS et al.| title=A Broad-Spectrum Chemokine-Binding Protein of Bovine Papular Stomatitis Virus Inhibits Neutrophil and Monocyte Infiltration in Inflammatory and Wound Models of Mouse Skin. | journal=PLoS One | year= 2016 | volume= 11 | issue= 12 | pages= e0168007 | pmid=27936239 | doi=10.1371/journal.pone.0168007 | pmc=5148066 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27936239 }} </ref><ref name="bovine papular stomatitis">{{cite book |last1=Mandell |firs1t=Gerald |last2=Gouglas |first2=Gordon |last3=Bennett |first3=John |date= |title=Principles and Practice of Infectious Diseases |location= Harvard Medical School |publisher=WILEY MEDICAL |page=988 |isbn=0-471-87643-7}}​</ref>
**[[Bovine papular stomatitis]] is a [[zoonotic]] disease. It is caused by [[bovine papular stomatitis virus]], starting as a single lesion and becoming a nodular mass ultimately. The virus has chemokine binding proteins that prevent the [[neutrophils]] and [[monocytes]] from migrating to the site of the pathology.<ref name="pmid27936239">{{cite journal| author=Sharif S, Nakatani Y, Wise L, Corbett M, Real NC, Stuart GS et al.| title=A Broad-Spectrum Chemokine-Binding Protein of Bovine Papular Stomatitis Virus Inhibits Neutrophil and Monocyte Infiltration in Inflammatory and Wound Models of Mouse Skin. | journal=PLoS One | year= 2016 | volume= 11 | issue= 12 | pages= e0168007 | pmid=27936239 | doi=10.1371/journal.pone.0168007 | pmc=5148066 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27936239 }} </ref><ref name="bovine papular stomatitis">{{cite book |last1=Mandell |firs1t=Gerald |last2=Gouglas |first2=Gordon |last3=Bennett |first3=John |date= |title=Principles and Practice of Infectious Diseases |location= Harvard Medical School |publisher=WILEY MEDICAL |page=988 |isbn=0-471-87643-7}}​</ref>
 
*Pyostomatitis vegetans:
*'''[[Trench mouth]] or Acute necrotizing ulcerative gingivitis:'''
**Pyostomatitis vegetans is characterised by numerous painless, yellow, superficial pinpoint pustules with oedema of the mucosa of the mouth. It is found in patients with [[ulcerative colitis]]. The vesicles can combine and involve the [[vermillion border]] of the upper as well as the lower lips. Snail track ulcerations are typical for pyostomatitis vegetans.<ref name="pmid28153136">{{cite journal| author=Magliocca KR, Fitzpatrick SG| title=Autoimmune Disease Manifestations in the Oral Cavity. | journal=Surg Pathol Clin | year= 2017 | volume= 10 | issue= 1 | pages= 57-88 | pmid=28153136 | doi=10.1016/j.path.2016.11.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28153136 }} </ref><ref name="pmid24713996">{{cite journal| author=Pellicer Z, Santiago JM, Rodriguez A, Alonso V, Antón R, Bosca MM| title=Management of cutaneous disorders related to inflammatory bowel disease. | journal=Ann Gastroenterol | year= 2012 | volume= 25 | issue= 1 | pages= 21-26 | pmid=24713996 | doi= | pmc=3959344 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24713996  }} </ref>
**[[Trench mouth]] also known as [[vincent's angina]], presents as ulceration and severe oral pain accompanied by gingival [[necrosis]]. It is characterised by acute onset of [[bad breath]] and the [[ulceration]] and destruction of the part of gum tissue present between the teeth. The scrapings from the necrotic ulcer contains [[fibrin]], [[leukocytes]], [[erythrocytes]], [[bacteria]] and [[necrotic tissue]]. [[Fever]] and [[lymphadenopapthy]] may accompany.<ref name="pmid26376700">{{cite journal| author=Hu J, Kent P, Lennon JM, Logan LK| title=Acute necrotising ulcerative gingivitis in an immunocompromised young adult. | journal=BMJ Case Rep | year= 2015 | volume= 2015 | issue= | pages= | pmid=26376700 | doi=10.1136/bcr-2015-211092 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26376700 }} </ref><ref name="pmid25219100">{{cite journal| author=Mizrahi Y| title=[NUG--necrotizing ulcerative gingivitis: a review]. | journal=Refuat Hapeh Vehashinayim (1993) | year= 2014 | volume= 31 | issue= 3 | pages= 41-7, 62 | pmid=25219100 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25219100 }} </ref>
**The involvement of skin along with the oral mucosa is characterised by an entity called Pyodermatitis Pyostomatitis Vegetans.<ref name="pmid22068794">{{cite journal| author=Matias Fde A, Rosa DJ, Carvalho MT, Castañon MC| title=Pyodermatitis-pyostomatitis vegetans: case report and review of medical literature. | journal=An Bras Dermatol | year= 2011 | volume= 86 | issue= 4 Suppl 1 | pages= S137-40 | pmid=22068794 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22068794 }} </ref>
 
*Trench mouth or Acute necrotising ulcerative gingivitis:
*'''[[Hand-foot-and-mouth disease|Hand Foot and Mouth disease]]:'''
**Trench mouth presents as ulceration and pain accompanied by gingival necrosis. It is characterised by the ulceration and destruction of the part of gum tissue present between the teeth.<ref name="pmid26376700">{{cite journal| author=Hu J, Kent P, Lennon JM, Logan LK| title=Acute necrotising ulcerative gingivitis in an immunocompromised young adult. | journal=BMJ Case Rep | year= 2015 | volume= 2015 | issue= | pages= | pmid=26376700 | doi=10.1136/bcr-2015-211092 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26376700 }} </ref><ref name="pmid25219100">{{cite journal| author=Mizrahi Y| title=[NUG--necrotizing ulcerative gingivitis: a review]. | journal=Refuat Hapeh Vehashinayim (1993) | year= 2014 | volume= 31 | issue= 3 | pages= 41-7, 62 | pmid=25219100 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25219100 }} </ref>
**It is also called [[Hand-foot-and-mouth disease|enteroviral vesicular stomatitis with exanthem]]. It is caused by [[Coxsackie A virus|coxsackie virus group A]] and involves [[maculopapular rash]] on the skin of the [[hands]] , the [[feet]] and the mouth including [[vesicles]] and [[ulcers]] on the [[tongue]], [[gums]], [[buccal mucosa]] and the [[soft palate]].<ref name="pmid14492892">{{cite journal| author=ROBINSON CR, RHODES AJ| title=Vesicular exanthem and stomatitis. Report of an epidemic due to Coxsacke virus Group A, Type 16. | journal=N Engl J Med | year= 1961 | volume= 265 | issue= | pages= 1104-5 | pmid=14492892 | doi=10.1056/NEJM196111302652207 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14492892  }} </ref>
*Hand Foot and Mouth disease:
 
**It is also called [[Hand-foot-and-mouth disease|Enteroviral vesicular stomatitis with exanthem]]. It is caused by [[Coxsackie Virus]] Group A and involves maculopapular rash on the skin of the hands , the feet and the mouth including vesicles and ulcers on the [[tongue]], [[gums]], [[buccal mucosa]] and the [[soft palate]].<ref name="pmid14492892">{{cite journal| author=ROBINSON CR, RHODES AJ| title=Vesicular exanthem and stomatitis. Report of an epidemic due to Coxsacke virus Group A, Type 16. | journal=N Engl J Med | year= 1961 | volume= 265 | issue=  | pages= 1104-5 | pmid=14492892 | doi=10.1056/NEJM196111302652207 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14492892  }} </ref>
*'''Candidal Stomatitis:'''
*Candidal Stomatitis:
**[[Candidal]] stomatitis is also known as [[oral candidiasis]]. It can occur exclusively or as part of systemic [[candidiasis]] in [[immunocompromised]] individuals. It can be can present a [[hyperplastic]] or [[erythematous]] pictures due to the invasion by the virus. [[Glossitis]] has also been noticed.<ref name="pmid28232964">{{cite journal| author=Zhou PR, Hua H, Liu XS| title=Quantity of Candida Colonies in Saliva: 
A Diagnostic Evaluation for Oral Candidiasis. | journal=Chin J Dent Res | year= 2017 | volume= 20 | issue= 1 | pages= 27-32 | pmid=28232964 | doi=10.3290/j.cjdr.a37739 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28232964  }} </ref>
**Candidal stomatitis is also known as [[oral candidiasis]]. It can occur exclusively or as part of systemic candidiasis in immunocompromised individuals. It can be can present a hyper plastic or erythematous pictures due to the invasion by the virus. Glossitis has also been noticed.<ref name="pmid28232964">{{cite journal| author=Zhou PR, Hua H, Liu XS| title=Quantity of Candida Colonies in Saliva: 
A Diagnostic Evaluation for Oral Candidiasis. | journal=Chin J Dent Res | year= 2017 | volume= 20 | issue= 1 | pages= 27-32 | pmid=28232964 | doi=10.3290/j.cjdr.a37739 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28232964 }} </ref>
 
*'''[[HIV]]:'''
**[[Ulcers]] in the mouth are very common presentation for [[HIV]]-1 infected individuals. The [[ulcers]] are superficial and have a clear demarcation. [[Autoimmune]] deficiency is thought to be the [[Pathogenic|pathogenic factor]] behind the [[oral ulcers]] and stomatitis related to [[HIV]].<ref name="pmid11361765">{{cite journal| author=Lapins J, Gaines H, Lindbäck S, Lidbrink P, Emtestam L| title=Skin and mucosal characteristics of symptomatic primary HIV-1 infection. | journal=AIDS Patient Care STDS | year= 1997 | volume= 11 | issue= 2 | pages= 67-70 | pmid=11361765 | doi=10.1089/apc.1997.11.67 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11361765 }} </ref><ref name="pmid2190456">{{cite journal| author=Sarti GM, Haddy RI, Schaffer D, Kihm J| title=Black hairy tongue. | journal=Am Fam Physician | year= 1990 | volume= 41 | issue= 6 | pages= 1751-5 | pmid=2190456 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2190456  }} </ref><ref name="pmid12544709">{{cite journal| author=Ramírez-Amador V, Esquivel-Pedraza L, Sierra-Madero J, Anaya-Saavedra G, González-Ramírez I, Ponce-de-León S| title=The Changing Clinical Spectrum of Human Immunodeficiency Virus (HIV)-Related Oral Lesions in 1,000 Consecutive Patients: A 12-Year Study in a Referral Center in Mexico. | journal=Medicine (Baltimore) | year= 2003 | volume= 82 | issue= 1 | pages= 39-50 | pmid=12544709 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12544709 }} </ref>
 
===Non-infectious Types===
*'''[[Aphthous stomatitis]]:'''
**It is the most common cause of [[oral ulcers]]. A definitive pathogenesis does not exist for aphthous stomatitis, but the proposed mechanism involves [[immune system]] abnormalities and the presence of [[autoimmune]] [[antibodies]]. It is thought to be caused by some types of [[cytokine]] and [[T cell]] accumulation manifesting as a defective [[Cell mediated immunity|cell mediated arm of the immunity]]. It presents as round [[ulcers]] with a grey base. Recurrence is very common in [[aphthous ulcers]].<ref name="pmid8665304">{{cite journal| author=Ship JA| title=Recurrent aphthous stomatitis. An update. | journal=Oral Surg Oral Med Oral Pathol Oral Radiol Endod | year= 1996 | volume= 81 | issue= 2 | pages= 141-7 | pmid=8665304 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8665304 }} </ref><ref name="pmid17343257">{{cite journal| author=Dalghous AM, Freysdottir J, Fortune F| title=Expression of cytokines, chemokines, and chemokine receptors in oral ulcers of patients with Behcet's disease (BD) and recurrent aphthous stomatitis is Th1-associated, although Th2-association is also observed in patients with BD. | journal=Scand J Rheumatol | year= 2006 | volume= 35 | issue= 6 | pages= 472-5 | pmid=17343257 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17343257 }} </ref><ref name="pmid10668310">{{cite journal| author=Murray LN, Amedee RG| title=Recurrent aphthous stomatitis. | journal=J La State Med Soc | year= 2000 | volume= 152 | issue= 1 | pages= 10-4 | pmid=10668310 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10668310 }} </ref>
**It may take the following forms:
***'''Major [[aphthous stomatitis]]'''
****This type can last up to a few months and involves [[tonsils]] and the [[soft palate]] as well. It can subside for long intervals and then reappear.
***'''Minor [[aphthous stomatitis]]'''
****This is the characteristic form of [[aphthous stomatitis]]; it is characterized by yellow-grey, painful minute [[ulcers]] in the anterior oral cavity in the [[Buccal mucosa|buccal]] and [[oral mucosa]] with raised margins. They can last from a few days up to 2 weeks.
***'''Herpetiform stomatitis'''
****These are multiple in number and effect the [[tongue]] at the lateral part and the tip. [[Ulcers]] are grey and very painful and are often accompanied by inability to eat. Intra nuclear inclusions can be found in the [[ulcers]].
 
*'''[[Chemotherapy]]-associated stomatitis:'''
**The [[chemotherapy]] causes [[RNA]] and [[DNA]] damage by the [[reactive oxygen species]] leading to an excessive production of inflammatory [[cytokines]]. These [[cytokines]] cause [[inflammation]] thus causing breaks in the [[epithelium]].
 
*'''[[Denture]] stomatitis:'''
**[[Denture]] stomatitis effects upto 67% of [[denture]] wearers. It moct commonly affects the palatal [[mucosa]].<ref name="pmid3298586">{{cite journal| author=Arendorf TM, Walker DM| title=Denture stomatitis: a review. | journal=J Oral Rehabil | year= 1987 | volume= 14 | issue= 3 | pages= 217-27 | pmid=3298586 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3298586 }} </ref> The material used in fillings and dentures are porous because of the chemicals used and to give it a better grip. Pathogens like [[candida albicans|''candida albicans'']] can colonize such suitable sites, leading to an inflammatory response and thus [[denture]] stomatitis. The irritating effect of the foreign denture material can also contribute to the [[pathogenesis]].<ref name="pmid28130176">{{cite journal| author=Abduljabbar T, Al-Askar M, Baig MK, AlSowygh ZH, Kellesarian SV, Vohra F| title=Efficacy of photodynamic therapy in the inactivation of oral fungal colonization among cigarette smokers and non-smokers with denture stomatitis. | journal=Photodiagnosis Photodyn Ther | year= 2017 | volume=  | issue=  | pages=  | pmid=28130176 | doi=10.1016/j.pdpdt.2017.01.182 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28130176  }} </ref><ref name="pmid25082257">{{cite journal| author=Marinoski J, Bokor-Bratić M, Čanković M| title=Is denture stomatitis always related with candida infection? A case control study. | journal=Med Glas (Zenica) | year= 2014 | volume= 11 | issue= 2 | pages= 379-84 | pmid=25082257 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25082257  }} </ref>
 
*'''Pyostomatitis vegetans:'''
**Pyostomatitis vegetans is characterized by numerous painless, yellow, superficial pinpoint [[pustules]] with [[oedema|edema]] of the [[mucosa]] of the mouth. It is found in patients with [[ulcerative colitis]]. The vesicles can combine and involve the [[vermillion border]] of the upper as well as the lower lips. Snail track ulcerations are characteristic of pyostomatitis vegetans.<ref name="pmid28153136">{{cite journal| author=Magliocca KR, Fitzpatrick SG| title=Autoimmune Disease Manifestations in the Oral Cavity. | journal=Surg Pathol Clin | year= 2017 | volume= 10 | issue= 1 | pages= 57-88 | pmid=28153136 | doi=10.1016/j.path.2016.11.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28153136  }} </ref><ref name="pmid24713996">{{cite journal| author=Pellicer Z, Santiago JM, Rodriguez A, Alonso V, Antón R, Bosca MM| title=Management of cutaneous disorders related to inflammatory bowel disease. | journal=Ann Gastroenterol | year= 2012 | volume= 25 | issue= 1 | pages= 21-26 | pmid=24713996 | doi= | pmc=3959344 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24713996  }} </ref>
**The involvement of skin along with the [[oral mucosa]] is characteristic of an entity called pyodermatitis pyostomatitis vegetans.<ref name="pmid22068794">{{cite journal| author=Matias Fde A, Rosa DJ, Carvalho MT, Castañon MC| title=Pyodermatitis-pyostomatitis vegetans: case report and review of medical literature. | journal=An Bras Dermatol | year= 2011 | volume= 86 | issue= 4 Suppl 1 | pages= S137-40 | pmid=22068794 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22068794  }} </ref>
 
*'''Nicotinic stomatitis:'''
**As the name indicates, nicotinic stomatitis is caused by use of nicotine in [[cigarette]] or pipe smokers. It normally occurs on the [[hard palate]] of individuals who use pipes to smoke. The pathogenesis is explained by the heat and not the [[tobacco]], and thus there is no malignant potential. The condition improves within 1 to 2 weeks of [[smoking cessation]].<ref name="pmid20455505">{{cite journal| author=| title=Oral pathology quiz. Case number 2. Nicotine stomatitis. | journal=J N J Dent Assoc | year= 2010 | volume= 81 | issue= 1 | pages= 15, 19 | pmid=20455505 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20455505  }} </ref><ref name="pmid: 20306871">{{cite journal| author=Dreyer WP, de Waal J| title=Oral medicine case book 23. Case 1--snuff dipper's lesion, Case 2--nicotinic stomatitis. | journal=SADJ | year= 2009 | volume= 64 | issue= 10 | pages= 490-1 | pmid=: 20306871 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20306871  }} </ref><ref name="pmid14557730">{{cite journal| author=Taybos G| title=Oral changes associated with tobacco use. | journal=Am J Med Sci | year= 2003 | volume= 326 | issue= 4 | pages= 179-82 | pmid=14557730 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14557730  }} </ref>
*'''Contact stomatitis:'''
**[[Allergic]] substances present in products used for oral hygiene can lead to contact stomatitis. The pathogenesis of contact stomatitis involves an [[allergic]] response to the aromatic substances in the oral, cosmetic, or hygiene products.<ref name="pmid28084550">{{cite journal| author=Larsen KR, Johansen JD, Reibel J, Zachariae C, Pedersen AM| title=Symptomatic oral lesions may be associated with contact allergy to substances in oral hygiene products. | journal=Clin Oral Investig | year= 2017 | volume=  | issue=  | pages=  | pmid=28084550 | doi=10.1007/s00784-017-2053-y | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28084550  }} </ref>
 
==Genetics==
==Genetics==
Though the genetics of stomatitis have not been studied extensively. It is understood that genetic polymorphism is associated with the occurrence of stomatitis.<ref name="pmid26827061">{{cite journal| author=Gomes CC, Gomez RS, Zina LG, Amaral FR| title=Recurrent aphthous stomatitis and Helicobacter pylori. | journal=Med Oral Patol Oral Cir Bucal | year= 2016 | volume= 21 | issue= 2 | pages= e187-91 | pmid=26827061 | doi= | pmc=4788798 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26827061  }} </ref>
Though the genetics of stomatitis have not been studied extensively, it is understood that genetic [[polymorphisms]] are associated with the occurrence of stomatitis. Inherited [[epidermolysis bullosa]] is a known inherited disease and is associated with weak epithelium. <ref name="pmid26827061">{{cite journal| author=Gomes CC, Gomez RS, Zina LG, Amaral FR| title=Recurrent aphthous stomatitis and Helicobacter pylori. | journal=Med Oral Patol Oral Cir Bucal | year= 2016 | volume= 21 | issue= 2 | pages= e187-91 | pmid=26827061 | doi= | pmc=4788798 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26827061  }} </ref>
 
==Associated Conditions==
==Associated Conditions==
The following conditions can be associated with stomatitis.<ref name="pmid16451405">{{cite journal| author=Kolokotronis A, Doumas S| title=Herpes simplex virus infection, with particular reference to the progression and complications of primary herpetic gingivostomatitis. | journal=Clin Microbiol Infect | year= 2006 | volume= 12 | issue= 3 | pages= 202-11 | pmid=16451405 | doi=10.1111/j.1469-0691.2005.01336.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16451405  }} </ref><ref>{{Cite journal
The following conditions can be associated with stomatitis.<ref name="pmid16451405">{{cite journal| author=Kolokotronis A, Doumas S| title=Herpes simplex virus infection, with particular reference to the progression and complications of primary herpetic gingivostomatitis. | journal=Clin Microbiol Infect | year= 2006 | volume= 12 | issue= 3 | pages= 202-11 | pmid=16451405 | doi=10.1111/j.1469-0691.2005.01336.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16451405  }} </ref><ref>{{Cite journal
Line 56: Line 86:
*[[Diabetes]]
*[[Diabetes]]
*[[HIV]]
*[[HIV]]
*[[Hand-foot an mouth disease]]
*[[Hand-foot-and-mouth disease|Hand, foot and mouth disease]]
*[[Candidiasis]]
*[[Candidiasis]]
*[[Syphilis]]
*[[Chicken pox]]


==Gross Pathology==
==Gross Pathology==
The gross pathology of stomatitis of stomatitis can vary from redness and inflammation to presence of vesicles or pustules. Oral candidiasis for example may present a hyper plastic picture, erythematous picture or whitish pseudomembrane ([[thrush]]).
The gross pathology of stomatitis can vary from [[redness]] and [[inflammation]] to presence of [[vesicles]] or [[pustules]]. [[Oral candidiasis]] for example may present a [[hyperplastic]] picture, [[erythematous]] picture or whitish pseudomembrane ([[thrush]]).
===Herpetic Stomatitis===
[[File:Stomatitis herpeticaa.jpg|thumb|left|Herpetic stomatitis. Source: Wikimedia Commons<ref>title="By Klaus D. Peter, Gummersbach, Germany (Own work) [CC BY 3.0 de (http://creativecommons.org/licenses/by/3.0/de/deed.en)], via Wikimedia Commons" href="https://commons.wikimedia.org/wiki/File%3AStomatitis_herpetica.jpg"><img width="512" alt="Stomatitis herpetica" src="https://upload.wikimedia.org/wikipedia/commons/thumb/8/84/Stomatitis_herpetica.jpg/512px-Stomatitis_herpetica.jpg"</ref>|500px]]
 
<br style="clear:both" />
 
===Aphthous stomatitis===
[[Image:Aphthous stomatitis.jpg|thumb|left|Aphthous stomatitis with visible mucosal lesion. Source:Wikimedia Commons<ref>title="By Farhan 9909 (Own work) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons" href="https://commons.wikimedia.org/wiki/File%3AAphthous_stomatitis_on_the_labial_mucosa.jpg"><img width="512" alt="Aphthous stomatitis on the labial mucosa" src="https://upload.wikimedia.org/wikipedia/commons/thumb/d/d3/Aphthous_stomatitis_on_the_labial_mucosa.jpg/512px-Aphthous_stomatitis_on_the_labial_mucosa.jpg"</ref>|500px]]
 
<br style="clear:both" />


==Microscopic Pathology==
==Microscopic Pathology==
The microscopic pathology helps to confirm the diagnosis and to differentiate different types of stomatitis.<ref> title="By Klaus D. Peter, Gummersbach, Germany (Own work) [CC BY 3.0 de (http://creativecommons.org/licenses/by/3.0/de/deed.en)], via Wikimedia Commons" href="https://commons.wikimedia.org/wiki/File%3AStomatitis_herpetica.jpg"><img width="512" alt="Stomatitis herpetica" src="https://upload.wikimedia.org/wikipedia/commons/thumb/8/84/Stomatitis_herpetica.jpg/512px-Stomatitis_herpetica.jpg"</ref>
The microscopic pathology helps to confirm the diagnosis and to differentiate different types of stomatitis.<ref>title="By Klaus D. Peter, Gummersbach, Germany (Own work) [CC BY 3.0 de (http://creativecommons.org/licenses/by/3.0/de/deed.en)], via Wikimedia Commons" href="https://commons.wikimedia.org/wiki/File%3AStomatitis_herpetica.jpg"><img width="512" alt="Stomatitis herpetica" src="https://upload.wikimedia.org/wikipedia/commons/thumb/8/84/Stomatitis_herpetica.jpg/512px-Stomatitis_herpetica.jpg"</ref>
===[[Vesicular stomatitis virus]]===
 
[[Image:Vesicular stomatitis virus (VSV).jpg|Vesicular stomatitis virus|frame|left|Source:Wikimedia commons<ref>title="By Klaus D. Peter, Gummersbach, Germany (Own work) [CC BY 3.0 de (http://creativecommons.org/licenses/by/3.0/de/deed.en)], via Wikimedia Commons" href="https://commons.wikimedia.org/wiki/File%3AStomatitis_herpetica.jpg"><img width="512" alt="Stomatitis herpetica" src="https://upload.wikimedia.org/wikipedia/commons/thumb/8/84/Stomatitis_herpetica.jpg/512px-Stomatitis_herpetica.jpg"</ref>|left|500px]]
<br style="clear:both" />


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


{{WH}}
{{WS}}


[[Category:Dermatology]]
[[Category:Dermatology]]
[[Category:Primary care]]
[[Category:Emergency mdicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
 
[[Category:Otolaryngology]]
 
[[Category:Gastroenterology]]
{{WH}}
{{WS}}

Latest revision as of 00:18, 30 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2], Usama Talib, BSc, MD [3]

Overview

Stomatitis is the inflammation of the mucosal surfaces in the mouth. Various factors can contribute to the pathogenesis of stomatitis depending on the type of stomatitis.[1]

Pathophysiology

Different mechanism are understood to cause different types of stomatitis:[1]

Infectious Causes

Non-infectious Types

  • Denture stomatitis:
    • Denture stomatitis effects upto 67% of denture wearers. It moct commonly affects the palatal mucosa.[16] The material used in fillings and dentures are porous because of the chemicals used and to give it a better grip. Pathogens like candida albicans can colonize such suitable sites, leading to an inflammatory response and thus denture stomatitis. The irritating effect of the foreign denture material can also contribute to the pathogenesis.[17][18]
  • Pyostomatitis vegetans:
    • Pyostomatitis vegetans is characterized by numerous painless, yellow, superficial pinpoint pustules with edema of the mucosa of the mouth. It is found in patients with ulcerative colitis. The vesicles can combine and involve the vermillion border of the upper as well as the lower lips. Snail track ulcerations are characteristic of pyostomatitis vegetans.[19][20]
    • The involvement of skin along with the oral mucosa is characteristic of an entity called pyodermatitis pyostomatitis vegetans.[21]
  • Nicotinic stomatitis:
    • As the name indicates, nicotinic stomatitis is caused by use of nicotine in cigarette or pipe smokers. It normally occurs on the hard palate of individuals who use pipes to smoke. The pathogenesis is explained by the heat and not the tobacco, and thus there is no malignant potential. The condition improves within 1 to 2 weeks of smoking cessation.[22][23][24]
  • Contact stomatitis:
    • Allergic substances present in products used for oral hygiene can lead to contact stomatitis. The pathogenesis of contact stomatitis involves an allergic response to the aromatic substances in the oral, cosmetic, or hygiene products.[25]

Genetics

Though the genetics of stomatitis have not been studied extensively, it is understood that genetic polymorphisms are associated with the occurrence of stomatitis. Inherited epidermolysis bullosa is a known inherited disease and is associated with weak epithelium. [26]

Associated Conditions

The following conditions can be associated with stomatitis.[2][27][1]

Gross Pathology

The gross pathology of stomatitis can vary from redness and inflammation to presence of vesicles or pustules. Oral candidiasis for example may present a hyperplastic picture, erythematous picture or whitish pseudomembrane (thrush).

Herpetic Stomatitis

Herpetic stomatitis. Source: Wikimedia Commons[28]


Aphthous stomatitis

Aphthous stomatitis with visible mucosal lesion. Source:Wikimedia Commons[29]


Microscopic Pathology

The microscopic pathology helps to confirm the diagnosis and to differentiate different types of stomatitis.[30]

Vesicular stomatitis virus

Source:Wikimedia commons[31]


References

  1. ↑ 1.0 1.1 1.2 Sonis ST (2004). "The pathobiology of mucositis". Nat Rev Cancer. 4 (4): 277–84. doi:10.1038/nrc1318. PMID 15057287.
  2. ↑ 2.0 2.1 Kolokotronis A, Doumas S (2006). "Herpes simplex virus infection, with particular reference to the progression and complications of primary herpetic gingivostomatitis". Clin Microbiol Infect. 12 (3): 202–11. doi:10.1111/j.1469-0691.2005.01336.x. PMID 16451405.
  3. ↑ Mandell; Gouglas, Gordon; Bennett, John. Principles and Practice of Infectious Diseases. Harvard Medical School: WILEY MEDICAL. p. 383. ISBN 0-471-87643-7. Unknown parameter |firs1t= ignored (help)​
  4. ↑ Sharif S, Nakatani Y, Wise L, Corbett M, Real NC, Stuart GS; et al. (2016). "A Broad-Spectrum Chemokine-Binding Protein of Bovine Papular Stomatitis Virus Inhibits Neutrophil and Monocyte Infiltration in Inflammatory and Wound Models of Mouse Skin". PLoS One. 11 (12): e0168007. doi:10.1371/journal.pone.0168007. PMC 5148066. PMID 27936239.
  5. ↑ Mandell; Gouglas, Gordon; Bennett, John. Principles and Practice of Infectious Diseases. Harvard Medical School: WILEY MEDICAL. p. 988. ISBN 0-471-87643-7. Unknown parameter |firs1t= ignored (help)​
  6. ↑ Hu J, Kent P, Lennon JM, Logan LK (2015). "Acute necrotising ulcerative gingivitis in an immunocompromised young adult". BMJ Case Rep. 2015. doi:10.1136/bcr-2015-211092. PMID 26376700.
  7. ↑ Mizrahi Y (2014). "[NUG--necrotizing ulcerative gingivitis: a review]". Refuat Hapeh Vehashinayim (1993). 31 (3): 41–7, 62. PMID 25219100.
  8. ↑ ROBINSON CR, RHODES AJ (1961). "Vesicular exanthem and stomatitis. Report of an epidemic due to Coxsacke virus Group A, Type 16". N Engl J Med. 265: 1104–5. doi:10.1056/NEJM196111302652207. PMID 14492892.
  9. ↑ Zhou PR, Hua H, Liu XS (2017). "Quantity of Candida Colonies in Saliva: 
A Diagnostic Evaluation for Oral Candidiasis". Chin J Dent Res. 20 (1): 27–32. doi:10.3290/j.cjdr.a37739. PMID 28232964.
  10. ↑ Lapins J, Gaines H, Lindbäck S, Lidbrink P, Emtestam L (1997). "Skin and mucosal characteristics of symptomatic primary HIV-1 infection". AIDS Patient Care STDS. 11 (2): 67–70. doi:10.1089/apc.1997.11.67. PMID 11361765.
  11. ↑ Sarti GM, Haddy RI, Schaffer D, Kihm J (1990). "Black hairy tongue". Am Fam Physician. 41 (6): 1751–5. PMID 2190456.
  12. ↑ Ramírez-Amador V, Esquivel-Pedraza L, Sierra-Madero J, Anaya-Saavedra G, González-Ramírez I, Ponce-de-León S (2003). "The Changing Clinical Spectrum of Human Immunodeficiency Virus (HIV)-Related Oral Lesions in 1,000 Consecutive Patients: A 12-Year Study in a Referral Center in Mexico". Medicine (Baltimore). 82 (1): 39–50. PMID 12544709.
  13. ↑ Ship JA (1996). "Recurrent aphthous stomatitis. An update". Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 81 (2): 141–7. PMID 8665304.
  14. ↑ Dalghous AM, Freysdottir J, Fortune F (2006). "Expression of cytokines, chemokines, and chemokine receptors in oral ulcers of patients with Behcet's disease (BD) and recurrent aphthous stomatitis is Th1-associated, although Th2-association is also observed in patients with BD". Scand J Rheumatol. 35 (6): 472–5. PMID 17343257.
  15. ↑ Murray LN, Amedee RG (2000). "Recurrent aphthous stomatitis". J La State Med Soc. 152 (1): 10–4. PMID 10668310.
  16. ↑ Arendorf TM, Walker DM (1987). "Denture stomatitis: a review". J Oral Rehabil. 14 (3): 217–27. PMID 3298586.
  17. ↑ Abduljabbar T, Al-Askar M, Baig MK, AlSowygh ZH, Kellesarian SV, Vohra F (2017). "Efficacy of photodynamic therapy in the inactivation of oral fungal colonization among cigarette smokers and non-smokers with denture stomatitis". Photodiagnosis Photodyn Ther. doi:10.1016/j.pdpdt.2017.01.182. PMID 28130176.
  18. ↑ Marinoski J, Bokor-Bratić M, Čanković M (2014). "Is denture stomatitis always related with candida infection? A case control study". Med Glas (Zenica). 11 (2): 379–84. PMID 25082257.
  19. ↑ Magliocca KR, Fitzpatrick SG (2017). "Autoimmune Disease Manifestations in the Oral Cavity". Surg Pathol Clin. 10 (1): 57–88. doi:10.1016/j.path.2016.11.001. PMID 28153136.
  20. ↑ Pellicer Z, Santiago JM, Rodriguez A, Alonso V, Antón R, Bosca MM (2012). "Management of cutaneous disorders related to inflammatory bowel disease". Ann Gastroenterol. 25 (1): 21–26. PMC 3959344. PMID 24713996.
  21. ↑ Matias Fde A, Rosa DJ, Carvalho MT, Castañon MC (2011). "Pyodermatitis-pyostomatitis vegetans: case report and review of medical literature". An Bras Dermatol. 86 (4 Suppl 1): S137–40. PMID 22068794.
  22. ↑ "Oral pathology quiz. Case number 2. Nicotine stomatitis". J N J Dent Assoc. 81 (1): 15, 19. 2010. PMID 20455505.
  23. ↑ Dreyer WP, de Waal J (2009). "Oral medicine case book 23. Case 1--snuff dipper's lesion, Case 2--nicotinic stomatitis". SADJ. 64 (10): 490–1. PMID 20306871 : 20306871 Check |pmid= value (help).
  24. ↑ Taybos G (2003). "Oral changes associated with tobacco use". Am J Med Sci. 326 (4): 179–82. PMID 14557730.
  25. ↑ Larsen KR, Johansen JD, Reibel J, Zachariae C, Pedersen AM (2017). "Symptomatic oral lesions may be associated with contact allergy to substances in oral hygiene products". Clin Oral Investig. doi:10.1007/s00784-017-2053-y. PMID 28084550.
  26. ↑ Gomes CC, Gomez RS, Zina LG, Amaral FR (2016). "Recurrent aphthous stomatitis and Helicobacter pylori". Med Oral Patol Oral Cir Bucal. 21 (2): e187–91. PMC 4788798. PMID 26827061.
  27. ↑ R. Morgan, J. Tsang, N. Harrington & L. Fook (2001). "Survey of hospital doctors' attitudes and knowledge of oral conditions in older patients". Postgraduate medical journal. 77 (908): 392–394. PMID 11375454. Unknown parameter |month= ignored (help)
  28. ↑ title="By Klaus D. Peter, Gummersbach, Germany (Own work) [CC BY 3.0 de (http://creativecommons.org/licenses/by/3.0/de/deed.en)], via Wikimedia Commons" href="https://commons.wikimedia.org/wiki/File%3AStomatitis_herpetica.jpg"><img width="512" alt="Stomatitis herpetica" src="https://upload.wikimedia.org/wikipedia/commons/thumb/8/84/Stomatitis_herpetica.jpg/512px-Stomatitis_herpetica.jpg"
  29. ↑ title="By Farhan 9909 (Own work) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons" href="https://commons.wikimedia.org/wiki/File%3AAphthous_stomatitis_on_the_labial_mucosa.jpg"><img width="512" alt="Aphthous stomatitis on the labial mucosa" src="https://upload.wikimedia.org/wikipedia/commons/thumb/d/d3/Aphthous_stomatitis_on_the_labial_mucosa.jpg/512px-Aphthous_stomatitis_on_the_labial_mucosa.jpg"
  30. ↑ title="By Klaus D. Peter, Gummersbach, Germany (Own work) [CC BY 3.0 de (http://creativecommons.org/licenses/by/3.0/de/deed.en)], via Wikimedia Commons" href="https://commons.wikimedia.org/wiki/File%3AStomatitis_herpetica.jpg"><img width="512" alt="Stomatitis herpetica" src="https://upload.wikimedia.org/wikipedia/commons/thumb/8/84/Stomatitis_herpetica.jpg/512px-Stomatitis_herpetica.jpg"
  31. ↑ title="By Klaus D. Peter, Gummersbach, Germany (Own work) [CC BY 3.0 de (http://creativecommons.org/licenses/by/3.0/de/deed.en)], via Wikimedia Commons" href="https://commons.wikimedia.org/wiki/File%3AStomatitis_herpetica.jpg"><img width="512" alt="Stomatitis herpetica" src="https://upload.wikimedia.org/wikipedia/commons/thumb/8/84/Stomatitis_herpetica.jpg/512px-Stomatitis_herpetica.jpg"

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