Stomatitis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2], Sara Mehrsefat, M.D. [3]
Overview
Stomatitis is an inflammation of the mucous lining of any of the structures in the mouth, which may involve the cheeks, gums, tongue, lips, throat, and roof or floor of the mouth. Most physicians do not regularly examine the mouth of patients and so stomatitis or triggering conditions can remain undiagnosed unless they become symptomatic.[1] The inflammation of the structures in the mouth can be caused by a condition limited just to the mouth, such as poor oral hygiene, poorly fitted dentures, or from mouth burns from hot food or drinks, or by conditions that affect the entire body, such as medications, allergic reactions, or infections. A form of stomatitis known as stomatitis nicotina can be caused by smoking cigars, cigarettes, and pipes, and is characterized by small red bumps on the roof of the mouth.[2]
When it also involves an inflammation of the gingiva, it is called gingivostomatitis. Irritation and fissuring in the corners of the lips is termed angular stomatits or angular cheilitis. In children a frequent cause is repeated lip-licking and in adults it may be a sign of underlying iron deficiency anemia, or vitamin B deficiencis (e.g. B2-riboflavin, B9-folate or B12-cobalamins), which in turn may be evidence of poor diets or malnutrition (e.g. celiac disease).
Historical Perspective
- Between 460-370 B.C., in relation to disorders of the mouth the term aphthae was first used by Hippocrates.[3]
- In 1898, the first clinical description of the aphthous stomatitis was reported by Von Mikulicz and Kumme as a Mikuliez aphthea
- In 1911, stomatitis aphthae recurrens cicatricicans was first described by Sutton.
- In 1961, stomatitis aphthae recurrens herpetiformis was first described by Cooke.[4]
Classification
According to the etiology, stomatitis may be classified into:[5][6]
Infectious Stomatitis
- Aphthous stomatitis
- Major aphthous stomatitis
- This type can last unto a few months and involves tonsils and the soft palate as well. It can subset for long intervals and then re appear.
- Minor aphthous stomatitis
- This is the characteristic form of aphthous stomatitis and is characterised by yellow-grey, painful minute ulcers in the anterior ora cavity in the buccal and oral mucosa with raised margins. They can last from a few days upto 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
- Major aphthous stomatitis
- Herpetic gingivostomatitis
- Necrotizing ulcerative stomatitis or stomatitis gangrenosa(NOMA)[7]
- Vesicular stomatitis
- Vincent's stomatitis (Trench Mouth)
- Enteroviral vesicular stomatitis with exanthem[8]
- Candidal stomatitis[9]
Other forms
- Angular stomatitis
- Denture stomatitis
- Ulcerative or Chronic ulcerative stomatitis[10][11]
- Contact stomatitis[12]
- Migratory stomatitis or geographic stomatitis
- Stomatitis nicotina
- Pyostomatitis vegetans[13][14]
- Bovine papular stomatitis[15]
- Chemotherapy induced stomatitis
Pathophysiology
Different mechanism are understood to cause different types of stomatitis:[16]
- 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 arm of the immunity.Recurrence is very common in aphthous ulcers.[17][18][5]
- Herpetic stomatitis:
- 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.[19]
- Encephalitis associated with herpetic stomatitis is due to the interaction of HSV1 with Toll-like receptor 2 or TLR2
- Chemotherapy associated stomatitis:
- 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.
- Denture stomatitis:
- Denture stomatitis effects upto 67% of denture wearers. It moct commonly affects the palatal mucosa.[20]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.[21][22]
- Noma or Gangrenous stomatitis:
- 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.[6]
- 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.[23][24]
- Pyostomatitis vegetans:
- 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.[13][14]
- The involvement of skin along with the oral mucosa is characterised by an entity called Pyodermatitis Pyostomatitis Vegetans.[25]
- Trench mouth or Acute necrotising ulcerative gingivitis:
- Hand Foot and Mouth disease:
- It is also called 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.[8]
- 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 hyper plastic or erythematous pictures due to the invasion by the virus. Glossitis has also been noticed.[9]
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Common Causes
The common causes of stomatitis include:[19][28][16]
- Aphthous stomatitis
- Dentures
- Folate deficiency
- Herpes
- Oropharyngeal candidiasis
- Vitamin B12 deficiency
- Chemotherapy
Gangrenous stomatitis
Following are a few causes of gangrenous stomatitis[6]
Trench mouth or Acute necrotising ulcerative gingivitis
Bovine papular stomatitis
Hand foot and mouth disease
Candidal Stomoatitis
Causes by Organ System
Causes in Alphabetical Order[31] [32]
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3Differentiating Stomatitis from other Diseases
Stomatitis should be differentiated from other disease as well as from possible underlying conditions causing stomatitis including:[6][33]
- Tumors of the tongue
- Squamous cell carcinoma
- It can prevent as a non healing ulcer or as a mass and is mostly caused by smoking or alcohol utilization.[34]
- Leukoplakia
- Melanoma
- It has the typical abcde characteristics including asymmetry, irregular borders, color change, increase in diameter and evolution and is usually diagnosed in its later stages.[37]
- Fordyce spots
- These are benign neoplasms with sebaceous features
- Torrus Paltinus
- It is a nodular mass on the hard palate, covered with normal mucosa[38]
- Squamous cell carcinoma
- Autoimmune diseases[13]
- Agranulocytosis
- Behcet's syndrome[18]
- Nicorandil induced ulcers
- It is a drug use in angina pectoris
- Burning mouth syndrome
- It is characterized by constant sensation of burning in the mouth in post menopausal women.
- There is no particular cause for it and no specific treatment is done.
- Syphilis
- Coxsackie virus accompanies involvement of the hands and the mouth
- HIV
- VZV or Chicken pox
Epidemiology and Demographics
Age
- Herpetic gingivostomatitis occurs mostly in children between 6 months to 5 years. It can also occur in other age groups.[19]
- Noma or gangrenous stomatitis is more common in children[6]
- Pyostomatitis vegetans usually occurs between the age of 20 to 50 years[39]
Gender
Season
- Herpetic gingivostomatitis has no seasonal preference.[41]
Risk Factors
The following risk factors are believed to influence the development of stomatitis:[42][43]
- Smoking
- Alcohol
- Trauma
- Psychological stress
- H. pylori
- Sensitivity to food
- Nutritional abnormalities
- Immunologic deficiencies e.g HIV
- Genetic factors
- Chemotherapy or radiotherapy[44]
Risk factors for denture stomatitis
Some risk factors for denture stomatitis include[20][22]
- Poor denture hygiene
- Overnight wearing of dentures
- pH of oral mucosal surfaces < 6.5
- Dietry deficiencies
- Hematological diseases
Bovine papular stomatitis
- Expoure to infected cow
Pyostomatitis Vegetans
- IBD specially ulcerative colitis[14]
Trench mouth or Acute ulcerative necrotizing gingivitis
- HIV[45]
Hand foot and mouth disease
Some risk factors for hand foot and mouth disease include[46]
- Fatigue
- Dehydrant drugs
- Maculopapular rash
Screening
Screening for stomatitis is not recommended.[47]
Natural History, Complications and Prognosis
Natural History
- If left untreated herpetic stomatitis resolves after the vesicles erupt and the ulcers heal. The HSV travels length nerves and moves to the ganglions where it stays in latent form. When the host becomes immunocompromised after taking medications or due to some other illness, the virus assesses the opportunity and through the same nerves becomes active once again manifesting symptoms such as oral vesicles.[19]
- The viral shedding can continue for 2-12 days after primary infection.[48]
Complications
Some complications of stomatitis include[19][49]
Life threatening complications
- Meningoencephalitis
Other Common Complications
- Recurrent skin and mouth infections
- Dissemination of the infection
Noma Complications
- Teeth loss
Prognosis
- Pyostomatitis vegetans has no malignant potential and treatment of underlying IBD is very effective to eradicate them. The prognosis is good.[50]
History and Symptoms
The diagnosis of stomatitis is mostly clinical. The location and features of the ulcers are also important findings in this regard. A detailed history followed by a physical exam is very helpful.[51][48]
History
Previous history of stomatitis is common among patients presenting with an episode. Some findings in the history are[19]
- Bad breath
- Refusal to drink or eat
General symptoms
Some general symptoms associated with herpetic stomatitis include[19]
- Fever
- Anorexia
- Irritability
- Drooling
- Maliase
- Headache
HEENT
- Painful swallowing
- Neck pain
Physical Examination
A comprehensive physical exam has great significance in the diagnosis of stomatitis. The exam findings may include[19]
- Oral pin-head vesicles
- Oral mucosal ulcers
- Submandibular lymphadenitis
- Halitosis
Laboratory Findings
History and physical examination are the mainstay of diagnosing stomatitis. If required laboratory findings can play an important role in diagnosing and differentiating the particular type of stomatitis.
Herpetic Stomatitis
- Viral culture
- Tzank smear for active lesions
- Serology
- Studies using immunofluorescent techniques
- PCR
Noma or Gangrenous stomatitis
The diagnosis of Noma or gangrenous stomatitis is made by:[6]
- Culture of organisms
- Biopsy showing deep tissue involvement
Pyostomatitis vegetans
- Immunofluorescence testing[13]
- Biopsy (showing hyperplasia of the stratified scams epithelium)[52]
- Eosinophils, neutrophils, plasma cells and lymphocytes in the connective tissue. Spongiotic changes may also be noticed.[53]
Medical Therapy
The therapy for stomatitis is governed by following principles:[54]
- 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.[55]
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.[20]
Pyostomatitis vegetans
- Treatment of underlying IBD is very effective in eradicating pyostomatitis vegetates lesions.[13]
- In the absence of IBD, topical corticosteroids are useful.[50]
Trench mouth or acute necrotizing ulcerative gingivitis
- Nicotininc acid[56]
- Local therapy
- For systemic involvement[45]
- 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[6]
Criteria for Hospitalization
The patient who develops the following conditions must be institutionalized[19]
- Encephalitis
- Epiglotittis
- Pneumonitis
- Immunocompromised status
- Poor oral intake
Surgical Therapy
Noma or Gangrenous stomatitis
Surgery may be require in Noma in the following conditions[6]
- Removal of the teeth that are loose
- Surgery for cosmetic reasons
Trench mouth
- Surgical debridement[45]
Primary Prevention
- Adequate hydration
- Oral hygiene
- Denture hygiene
- Prevention of exposure to bovine papular stomatitis virus infected cow
Secondary Prevention
References
- ↑ 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) - ↑ "Smoking and Noncancerous Oral Disease" (PDF). The Reports of the Surgeon General. 1969. Retrieved 2006-06-23.
- ↑ Ship, Jonathan A. "Recurrent aphthous stomatitis: an update." Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 81.2 (1996): 141-147.
- ↑ Kramer IR, Pindborg JJ, Bezroukov V, Infirri JS (1980). "Guide to epidemiology and diagnosis of oral mucosal diseases and conditions. World Health Organization". Community Dent Oral Epidemiol. 8 (1): 1–26. PMID 6929240.
- ↑ 5.0 5.1 Murray LN, Amedee RG (2000). "Recurrent aphthous stomatitis". J La State Med Soc. 152 (1): 10–4. PMID 10668310.
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 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) - ↑ Zwetyenga N, See LA, Szwebel J, Beuste M, Aragou M, Oeuvrard C; et al. (2015). "[Noma]". Rev Stomatol Chir Maxillofac Chir Orale. 116 (4): 261–79. doi:10.1016/j.revsto.2015.06.009. PMID 26235765.
- ↑ 8.0 8.1 8.2 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.
- ↑ 9.0 9.1 9.2 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.
- ↑ Anderson JG, Peralta S, Kol A, Kass PH, Murphy B (2017). "Clinical and Histopathologic Characterization of Canine Chronic Ulcerative Stomatitis". Vet Pathol: 300985816688754. doi:10.1177/0300985816688754. PMID 28113036.
- ↑ Katsoulas N, Chrysomali E, Piperi E, Levidou G, Sklavounou-Andrikopoulou A (2016). "Atypical methotrexate ulcerative stomatitis with features of lymphoproliferative like disorder: Report of a rare ciprofloxacin-induced case and review of the literature". J Clin Exp Dent. 8 (5): e629–e633. doi:10.4317/jced.52909. PMC 5149103. PMID 27957282.
- ↑ A. Tosti, B. M. Piraccini & A. M. Peluso (1997). "Contact and irritant stomatitis". Seminars in cutaneous medicine and surgery. 16 (4): 314–319. PMID 9421224. Unknown parameter
|month=ignored (help) - ↑ 13.0 13.1 13.2 13.3 13.4 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.
- ↑ 14.0 14.1 14.2 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.
- ↑ Kurosaki Y, Okada S, Nakamae S, Yasuda J (2016). "A loop-mediated isothermal amplification assay for rapid and sensitive detection of bovine papular stomatitis virus". J Virol Methods. 238: 42–47. doi:10.1016/j.jviromet.2016.07.031. PMID 27751948.
- ↑ 16.0 16.1 Sonis ST (2004). "The pathobiology of mucositis". Nat Rev Cancer. 4 (4): 277–84. doi:10.1038/nrc1318. PMID 15057287.
- ↑ Ship JA (1996). "Recurrent aphthous stomatitis. An update". Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 81 (2): 141–7. PMID 8665304.
- ↑ 18.0 18.1 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.
- ↑ 19.0 19.1 19.2 19.3 19.4 19.5 19.6 19.7 19.8 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.
- ↑ 20.0 20.1 20.2 20.3 Arendorf TM, Walker DM (1987). "Denture stomatitis: a review". J Oral Rehabil. 14 (3): 217–27. PMID 3298586.
- ↑ 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.
- ↑ 22.0 22.1 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.
- ↑ 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.
- ↑ 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) - ↑ 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.
- ↑ 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.
- ↑ Mizrahi Y (2014). "[NUG--necrotizing ulcerative gingivitis: a review]". Refuat Hapeh Vehashinayim (1993). 31 (3): 41–7, 62. PMID 25219100.
- ↑ 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) - ↑ Chan Y, Ma AP, Lacap-Bugler DC, Huo YB, Keung Leung W, Leung FC; et al. (2014). "Complete Genome Sequence for Treponema sp. OMZ 838 (ATCC 700772, DSM 16789), Isolated from a Necrotizing Ulcerative Gingivitis Lesion". Genome Announc. 2 (6). doi:10.1128/genomeA.01333-14. PMC 4276824. PMID 25540346.
- ↑ 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) - ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
- ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN140510368X
- ↑ Scully C (1999). "A review of common mucocutaneous disorders affecting the mouth and lips". Ann Acad Med Singapore. 28 (5): 704–7. PMID 10597357.
- ↑ 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) - ↑ D. Grady, J. Greene, T. E. Daniels, V. L. Ernster, P. B. Robertson, W. Hauck, D. Greenspan, J. Greenspan & S. Jr Silverman (1990). "Oral mucosal lesions found in smokeless tobacco users". Journal of the American Dental Association (1939). 121 (1): 117–123. PMID 2370378. Unknown parameter
|month=ignored (help) - ↑ Ann M. Gillenwater, Nadarajah Vigneswaran, Hanadi Fatani, Pierre Saintigny & Adel K. El-Naggar (2013). "Proliferative verrucous leukoplakia (PVL): a review of an elusive pathologic entity!". Advances in anatomic pathology. 20 (6): 416–423. doi:10.1097/PAP.0b013e3182a92df1. PMID 24113312. Unknown parameter
|month=ignored (help) - ↑ P. DeMatos, D. S. Tyler & H. F. Seigler (1998). "Malignant melanoma of the mucous membranes: a review of 119 cases". Annals of surgical oncology. 5 (8): 733–742. PMID 9869521. Unknown parameter
|month=ignored (help) - ↑ Barry Ladizinski & Kachiu C. Lee (2014). "A nodular protuberance on the hard palate". JAMA. 311 (15): 1558–1559. doi:10.1001/jama.2014.271. PMID 24737369. Unknown parameter
|month=ignored (help) - ↑ Hansen L.S., Silverman S., and Daniels T.E.: The differential diagnosis of pyostomatitis vegetans and its relation to bowel disease. Oral Surg Oral Med Oral Pathol 1983; 55: pp. 363-373
- ↑ Hansen L.S., Silverman S., and Daniels T.E.: The differential diagnosis of pyostomatitis vegetans and its relation to bowel disease. Oral Surg Oral Med Oral Pathol 1983; 55: pp. 363-373
- ↑ Kimberlin DW (2005). "Herpes simplex virus infections in neonates and early childhood". Semin Pediatr Infect Dis. 16 (4): 271–81. doi:10.1053/j.spid.2005.06.007. PMID 16210107.
- ↑ 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) - ↑ Carolina-Cavalieri Gomes, Ricardo-Santiago Gomez, Livia-Guimaraes Zina & Fabricio-Rezende Amaral (2016). "Recurrent aphthous stomatitis and Helicobacter pylori". Medicina oral, patologia oral y cirugia bucal. 21 (2): e187–e191. PMID 26827061. Unknown parameter
|month=ignored (help) - ↑ Kenji Momo (2015). "[Indomethacin Spray Preparation for the Control of Pain Associated with Stomatitis Caused by Chemotherapy and Radiotherapy in Cancer Patients]". Yakugaku zasshi : Journal of the Pharmaceutical Society of Japan. 135 (8): 931–935. doi:10.1248/yakushi.15-00112-1. PMID 26234349.
- ↑ 45.0 45.1 45.2 Atout RN, Todescan S (2013). "Managing patients with necrotizing ulcerative gingivitis". J Can Dent Assoc. 79: d46. PMID 23763733.
- ↑ Zhang D, Li R, Zhang W, Li G, Ma Z, Chen X; et al. (2017). "A Case-control Study on Risk Factors for Severe Hand, Foot and Mouth Disease". Sci Rep. 7: 40282. doi:10.1038/srep40282. PMC 5233949. PMID 28084311.
- ↑ U.S. Preventive Services Task Force http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=stomatitis Accessed on August 31, 2016
- ↑ 48.0 48.1 Amir J, Harel L, Smetana Z, Varsano I (1999). "The natural history of primary herpes simplex type 1 gingivostomatitis in children". Pediatr Dermatol. 16 (4): 259–63. PMID 10469407.
- ↑ Kurt-Jones, Evelyn A., et al. "Herpes simplex virus 1 interaction with Toll-like receptor 2 contributes to lethal encephalitis." Proceedings of the National Academy of Sciences of the United States of America 101.5 (2004): 1315-1320.
- ↑ 50.0 50.1 50.2 Hegarty AM, Barrett AW, Scully C (2004). "Pyostomatitis vegetans". Clin Exp Dermatol. 29 (1): 1–7. PMID 14723710.
- ↑ Amir J (2001). "Clinical aspects and antiviral therapy in primary herpetic gingivostomatitis". Paediatr Drugs. 3 (8): 593–7. PMID 11577924.
- ↑ Wang H, Qiao S, Zhang X, Liu C (2013). "A case of pyodermatitis-pyostomatitis vegetans". Am J Med Sci. 345 (2): 168–71. doi:10.1097/MAJ.0b013e31826c5a82. PMID 23138121.
- ↑ Abellaneda C, Mascaró JM, Vázquez MG, Pablo IM, Iranzo P (2011). "All that glitters is not pemphigus: Pyodermatitis-pyostomatitis vegetans misdiagnosed as IgA pemphigus for 8 years". Am J Dermatopathol. 33 (1): e1–6. doi:10.1097/DAD.0b013e3181d81ecb. PMID 20689401.
- ↑ 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.
- ↑ 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.
- ↑ 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.