Stomatitis medical therapy: Difference between revisions
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==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> | |||
*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> | |||
===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.<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> | |||
*In the absence of [[IBD]], [[topical corticosteroids]] are useful.<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> | |||
===Trench mouth or acute necrotizing ulcerative gingivitis=== | |||
*Nicotininc 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> | |||
**Amoxicillin, 250 mg TDS for 7 days | |||
**Metronidazole, 250 mg TDS for 7 days | |||
===Candidal stomatitis=== | |||
*[[Nystatin]] for disease limited to oral cavity | |||
*[[Fluconazole]] 100mg PO for 7 to 14 days for systemic [[candidiasis]] or [[clotrimazole]] 10 mg torches 5 times daily for 14 days | |||
===Herpetic stomatitis=== | |||
*IV [[acyclovir]] is used in case of immunocompromised individuals with [[HSV-1]] stomatitis<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> | |||
===Noma or Gangrenous stomatitis=== | |||
*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> | |||
===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 | |||
*Epiglotittis | |||
*Pneumonitis | |||
*Immunocompromised status | |||
*Poor oral intake | |||
==References== | ==References== | ||
Revision as of 21:13, 7 March 2017
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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]
Overview
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]
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.[3]
Pyostomatitis vegetans
- Treatment of underlying IBD is very effective in eradicating pyostomatitis vegetates lesions.[4]
- In the absence of IBD, topical corticosteroids are useful.[5]
Trench mouth or acute necrotizing ulcerative gingivitis
- Nicotininc acid[6]
- Local therapy
- For systemic involvement[7]
- Amoxicillin, 250 mg TDS for 7 days
- Metronidazole, 250 mg TDS for 7 days
Candidal stomatitis
- Nystatin for disease limited to oral cavity
- Fluconazole 100mg PO for 7 to 14 days for systemic candidiasis or clotrimazole 10 mg torches 5 times daily for 14 days
Herpetic stomatitis
Noma or Gangrenous stomatitis
- High dose IV penicillin[11]
Criteria for Hospitalization
The patient who develops the following conditions must be institutionalized[12]
- Encephalitis
- Epiglotittis
- Pneumonitis
- Immunocompromised status
- Poor oral intake
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.
- ↑ 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.
- ↑ 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.
- ↑ 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) - ↑ 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.