Stomatitis medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Stomatitis}} | {{Stomatitis}} | ||
{{CMG}}; {{AE}} {{SaraM}} | {{CMG}}; {{AE}} {{SaraM}}, {{USAMA}} | ||
==Overview== | ==Overview== | ||
[[Preventive care|Preventive measures]] and avoidance of the inciting cause is enough for the treatment of most non-infectious causes of stomatitis. Pain medications may also be required to manage the pain caused by stomatitis. [[Antibiotic therapy|Antibiotic medical therapy]] is the mainstay of treatment for [[infectious]] stomatitis. The medical therapy varies among different causes and types of stomatitis. | |||
==Medical Therapy== | ==Medical Therapy== | ||
The therapy for stomatitis is governed by following principles:<ref name="pmid7036816">{{cite journal| author=Wade JC, Newton B, McLaren C, Flournoy N, Keeney RE, Meyers JD| title=Intravenous acyclovir to treat mucocutaneous herpes simplex virus infection after marrow transplantation: a double-blind trial. | journal=Ann Intern Med | year= 1982 | volume= 96 | issue= 3 | pages= 265-9 | pmid=7036816 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7036816 }} </ref> | |||
*[[Hydration|Oral or IV hydration]] | |||
*[[Pain]] control | |||
*Application of a barrier cream or jelly | |||
*Zilactin, a combination of [[lidocaine]] and [[hydroxypropyl cellulose]], can be used to prevent the [[ulcers]] from further [[trauma]] and [[irritation]].<ref name="pmid1401597">{{cite journal| author=Rodu B, Mattingly G| title=Oral mucosal ulcers: diagnosis and management. | journal=J Am Dent Assoc | year= 1992 | volume= 123 | issue= 10 | pages= 83-6 | pmid=1401597 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1401597 }} </ref> | |||
===Criteria for Hospitalization=== | |||
The patient who develops the following conditions must be institutionalized<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]] | |||
*[[Epiglottitis]] | |||
*[[Pneumonitis]] | |||
*[[Immunocompromised]] status | |||
*Poor oral intake | |||
===Infectious Types=== | |||
====Trench mouth or acute necrotizing ulcerative gingivitis==== | |||
*[[Nicotinic acid]]<ref>King, J. D. "Nutritional and other Factors in" Trench Mouth," with Special Reference to the Nicotinic Acid Component of the Vitamin B2 Complex." Brit. dent. J. 74.6 (1943): 141-7.</ref> | |||
*Local therapy | |||
*For [[systemic]] involvement<ref name="pmid23763733">{{cite journal| author=Atout RN, Todescan S| title=Managing patients with necrotizing ulcerative gingivitis. | journal=J Can Dent Assoc | year= 2013 | volume= 79 | issue= | pages= d46 | pmid=23763733 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23763733 }} </ref> | |||
**Preferred regimen (1): [[Amoxicillin]], 250 mg TDS for 7 days {{withorwithout}} [[Metronidazole]], 250 mg TDS for 7 days | |||
*If [[debridement]] is delayed:<ref name="123urlAcute Necrotizing Ulcerative Gingivitis (ANUG) - Dental Disorders - Merck Manuals Professional Edition">{{cite web |url=http://www.merckmanuals.com/professional/dental-disorders/periodontal-disorders/acute-necrotizing-ulcerative-gingivitis-anug |title=Acute Necrotizing Ulcerative Gingivitis (ANUG) - Dental Disorders - Merck Manuals Professional Edition |format= |work= |accessdate=October 25, 2016}}</ref> | |||
**[[Amoxicillin]] 500 mg every 8 hours for 3 days | |||
**[[Erythromycin]] 250 mg every 6 hours for 3 days | |||
**[[Tetracycline]] 250 mg every 6 hours for 3 days | |||
*For a detailed review of the medical therapy for [[Trench mouth]], click '''[[Trench mouth medical therapy|here]]''' | |||
====Candidal stomatitis==== | |||
*Preferred regimen for disease limited to oral cavity: [[Nystatin]] | |||
*Preferred regimen for systemic [[candidiasis]] : [[Fluconazole]] 100mg PO for 7 to 14 days or [[clotrimazole]] 10 mg torches 5 times daily for 14 days | |||
*Alternate regimen for systemic [[candidiasis]] : [[Clotrimazole]] 10 mg torches 5 times daily for 14 days | |||
*For detailed review of the therapy for [[candidiasis]], click '''[[Candidiasis medical therapy|here]]''' | |||
====Herpetic stomatitis==== | |||
*[[HSV]] shedding is increased in [[HIV]]-infected persons. Whereas [[AIDS antiretroviral drugs|antiretroviral therapy]] reduces the severity and frequency of symptomatic [[genital herpes]], frequent subclinical [[Viral shedding|shedding]] still occurs.<ref name="Posavad-2004">{{Cite journal | last1 = Posavad | first1 = CM. | last2 = Wald | first2 = A. | last3 = Kuntz | first3 = S. | last4 = Huang | first4 = ML. | last5 = Selke | first5 = S. | last6 = Krantz | first6 = E. | last7 = Corey | first7 = L. | title = Frequent reactivation of herpes simplex virus among HIV-1-infected patients treated with highly active antiretroviral therapy. | journal = J Infect Dis | volume = 190 | issue = 4 | pages = 693-6 | month = Aug | year = 2004 | doi = 10.1086/422755 | PMID = 15272395 }}</ref> | |||
*Preferred regimen in case of [[Immunocompromised|immunocompromised individuals]] with [[HSV-1]] stomatitis (1): IV [[acyclovir]] <ref name="pmid17632484">{{cite journal| author=Thomas E| title=A complication of primary herpetic gingivostomatitis. | journal=Br Dent J | year= 2007 | volume= 203 | issue= 1 | pages= 33-4 | pmid=17632484 | doi=10.1038/bdj.2007.585 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17632484 }} </ref><ref name="pmid7048914">{{cite journal| author=Meyers JD, Wade JC, Mitchell CD, Saral R, Lietman PS, Durack DT et al.| title=Multicenter collaborative trial of intravenous acyclovir for treatment of mucocutaneous herpes simplex virus infection in the immunocompromised host. | journal=Am J Med | year= 1982 | volume= 73 | issue= 1A | pages= 229-35 | pmid=7048914 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7048914 }} </ref><ref name="pmid6113352">{{cite journal| author=Mitchell CD, Bean B, Gentry SR, Groth KE, Boen JR, Balfour HH| title=Acyclovir therapy for mucocutaneous herpes simplex infections in immunocompromised patients. | journal=Lancet | year= 1981 | volume= 1 | issue= 8235 | pages= 1389-92 | pmid=6113352 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6113352 }} </ref> | |||
*For a detailed review of treatment of [[Herpes simplex]] infection click '''[[Herpes simplex treatment|here]]''' | |||
====[[Noma]] or [[Gangrenous]] stomatitis==== | |||
*Preferred regimen: High-dose [[IV]] [[penicillin]]<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> | |||
===Non-infectious Types=== | |||
====Denture stomatitis==== | |||
*In most cases, correction of [[denture]] fitness, avoidance of [[Plaque|plaque development]], and avoidance of continuous wearing of dentures helps correct the defect. [[Antiseptic]] and [[antifungal]] agents are not required in most cases, but [[pain medications]] are usually required.<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> | |||
====Pyostomatitis vegetans==== | |||
*Treatment of underlying [[IBD]] is very effective in eradicating pyostomatitis vegetates [[lesions]].<ref name="pmid28153136">Magliocca KR, Fitzpatrick SG (2017) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=28153136 Autoimmune Disease Manifestations in the Oral Cavity.] ''Surg Pathol Clin'' 10 (1):57-88. [http://dx.doi.org/10.1016/j.path.2016.11.001 DOI:10.1016/j.path.2016.11.001] PMID: [https://pubmed.gov/28153136 28153136]</ref> | |||
*Preferred regimen in the absence of [[IBD]]: [[Topical steroid|Topical corticosteroids]]<ref name="pmid14723710">{{cite journal| author=Hegarty AM, Barrett AW, Scully C| title=Pyostomatitis vegetans. | journal=Clin Exp Dermatol | year= 2004 | volume= 29 | issue= 1 | pages= 1-7 | pmid=14723710 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14723710 }} </ref> | |||
*For the details about the medical therapy of [[IBD]], click '''[[Irritable bowel syndrome medical therapy|here]]''' | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[Category:Dermatology]] | [[Category:Dermatology]] | ||
[[Category: | [[Category:Emergency mdicine]] | ||
[[Category:Disease]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
[[Category:Otolaryngology]] | |||
[[Category:Gastroenterology]] | |||
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
Preventive measures and avoidance of the inciting cause is enough for the treatment of most non-infectious causes of stomatitis. Pain medications may also be required to manage the pain caused by stomatitis. Antibiotic medical therapy is the mainstay of treatment for infectious stomatitis. The medical therapy varies among different causes and types of stomatitis.
Medical Therapy
The therapy for stomatitis is governed by following principles:[1]
- Oral or IV hydration
- Pain control
- Application of a barrier cream or jelly
- Zilactin, a combination of lidocaine and hydroxypropyl cellulose, can be used to prevent the ulcers from further trauma and irritation.[2]
Criteria for Hospitalization
The patient who develops the following conditions must be institutionalized[3]
- Encephalitis
- Epiglottitis
- Pneumonitis
- Immunocompromised status
- Poor oral intake
Infectious Types
Trench mouth or acute necrotizing ulcerative gingivitis
- Nicotinic acid[4]
- Local therapy
- For systemic involvement[5]
- Preferred regimen (1): Amoxicillin, 250 mg TDS for 7 days ± Metronidazole, 250 mg TDS for 7 days
- If debridement is delayed:[6]
- Amoxicillin 500 mg every 8 hours for 3 days
- Erythromycin 250 mg every 6 hours for 3 days
- Tetracycline 250 mg every 6 hours for 3 days
- For a detailed review of the medical therapy for Trench mouth, click here
Candidal stomatitis
- Preferred regimen for disease limited to oral cavity: Nystatin
- Preferred regimen for systemic candidiasis : Fluconazole 100mg PO for 7 to 14 days or clotrimazole 10 mg torches 5 times daily for 14 days
- Alternate regimen for systemic candidiasis : Clotrimazole 10 mg torches 5 times daily for 14 days
- For detailed review of the therapy for candidiasis, click here
Herpetic stomatitis
- HSV shedding is increased in HIV-infected persons. Whereas antiretroviral therapy reduces the severity and frequency of symptomatic genital herpes, frequent subclinical shedding still occurs.[7]
- Preferred regimen in case of immunocompromised individuals with HSV-1 stomatitis (1): IV acyclovir [8][9][10]
- For a detailed review of treatment of Herpes simplex infection click here
Noma or Gangrenous stomatitis
- Preferred regimen: High-dose IV penicillin[11]
Non-infectious Types
Denture stomatitis
- In most cases, correction of denture fitness, avoidance of plaque development, and avoidance of continuous wearing of dentures helps correct the defect. Antiseptic and antifungal agents are not required in most cases, but pain medications are usually required.[12]
Pyostomatitis vegetans
- Treatment of underlying IBD is very effective in eradicating pyostomatitis vegetates lesions.[13]
- Preferred regimen in the absence of IBD: Topical corticosteroids[14]
- For the details about the medical therapy of IBD, click here
References
- ↑ Wade JC, Newton B, McLaren C, Flournoy N, Keeney RE, Meyers JD (1982). "Intravenous acyclovir to treat mucocutaneous herpes simplex virus infection after marrow transplantation: a double-blind trial". Ann Intern Med. 96 (3): 265–9. PMID 7036816.
- ↑ Rodu B, Mattingly G (1992). "Oral mucosal ulcers: diagnosis and management". J Am Dent Assoc. 123 (10): 83–6. PMID 1401597.
- ↑ 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.
- ↑ King, J. D. "Nutritional and other Factors in" Trench Mouth," with Special Reference to the Nicotinic Acid Component of the Vitamin B2 Complex." Brit. dent. J. 74.6 (1943): 141-7.
- ↑ Atout RN, Todescan S (2013). "Managing patients with necrotizing ulcerative gingivitis". J Can Dent Assoc. 79: d46. PMID 23763733.
- ↑ "Acute Necrotizing Ulcerative Gingivitis (ANUG) - Dental Disorders - Merck Manuals Professional Edition". Retrieved October 25, 2016.
- ↑ Posavad, CM.; Wald, A.; Kuntz, S.; Huang, ML.; Selke, S.; Krantz, E.; Corey, L. (2004). "Frequent reactivation of herpes simplex virus among HIV-1-infected patients treated with highly active antiretroviral therapy". J Infect Dis. 190 (4): 693–6. doi:10.1086/422755. PMID 15272395. Unknown parameter
|month=ignored (help) - ↑ Thomas E (2007). "A complication of primary herpetic gingivostomatitis". Br Dent J. 203 (1): 33–4. doi:10.1038/bdj.2007.585. PMID 17632484.
- ↑ Meyers JD, Wade JC, Mitchell CD, Saral R, Lietman PS, Durack DT; et al. (1982). "Multicenter collaborative trial of intravenous acyclovir for treatment of mucocutaneous herpes simplex virus infection in the immunocompromised host". Am J Med. 73 (1A): 229–35. PMID 7048914.
- ↑ Mitchell CD, Bean B, Gentry SR, Groth KE, Boen JR, Balfour HH (1981). "Acyclovir therapy for mucocutaneous herpes simplex infections in immunocompromised patients". Lancet. 1 (8235): 1389–92. PMID 6113352.
- ↑ 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) - ↑ Arendorf TM, Walker DM (1987). "Denture stomatitis: a review". J Oral Rehabil. 14 (3): 217–27. PMID 3298586.
- ↑ 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
- ↑ Hegarty AM, Barrett AW, Scully C (2004). "Pyostomatitis vegetans". Clin Exp Dermatol. 29 (1): 1–7. PMID 14723710.