Stomatitis is an inflammation of mucous membranes in the mouth due to fungal, viral or bacterial in a vitamin deficiency, trauma, etc.
Prolonged painful stomatitis may contribute to malnutrition or dehydration in children: always treat carefully and show the mother how to treat.
Clinical signs and treatment:
– Pain, discomfort food, dysphagia, anorexia, sometimes nausea and vomiting.
Before these non-specific signs, examine the lining of the mouth, especially in children.
– In all cases: maintain feeding and hydration (use a nasogastric tube for 3 days, only if pain prevents the patient from eating) and ensure good oral hygiene to prevent secondary infections or recurrence.
Stomatitis infectious:
– Candidiasis
Candida albicans infection, common in infants, malnourished children and HIV infected patients.
Presence of white patches on the tongue, which can extend to the entire oral cavity.
• Clean the mouth with sodium bicarbonate 4 times a day (1/2 teaspoon in 250 ml of boiled and cooled water).
• Apply locally Nystatin, between meals: 4 lozenges of 100 000 IU / day in 4 divided doses for 7 days. In young children, crush them before applying them to the oral mucosa.
• Otherwise, apply gentian violet 2 times / day for 7 days.
• Treat intestinal home for persistent thrush despite correct local treatment: nystatin PO
Children: 400 000 IU / day in 4 divided doses for 20 days
Adult: 2 million IU / day in 4 divided doses for 20 days
• In patients with extensive forms or with frequent recurrences, consider HIV infection. Do a thorough clinical examination and for treatment.
– Herpes
Primary infection: very painful lesions caused by herpes simplex virus, type of vesicles, erosions, ulcerations yellowish lips and buccal mucosa with general malaise, satellite nodes and fever. Especially in children.
Recurrence: vesicles bouquet of nasolabial area.
The 2 forms are contagious. Recurrences may accompany an infectious disease such as malaria, pneumonia).
• Clean the mouth with sodium bicarbonate + polyvidone iodine 4 times a day (preparation: 1/2 teaspoon baking soda 1 teaspoon + povidone iodine 10% in 250 ml of boiled and cooled water ).
• Treat pain with paracetamol PO.
• Changes to the spontaneous resolution in 7 to 10 days. Secondary infections may develop.
• In patients with extensive forms or with frequent recurrences, consider HIV infection. Do a thorough clinical examination and for treatment.
– Other infectious causes
See angina, diphtheria, measles.
For scarlet fever (scarlet tongue, “raspberry”, associated with rash):
phenoxymethylpenicillin (penicillin V) PO for 10 days
Children less than one year: 250 mg / day in 2 divided doses
Children from 1 to 5 years: 500 mg / day in 2 divided doses
Children 6 to 12 years: 1 g / day in 2 divided doses
Adult: 2 g / day in 2 divided doses
Stomatitis by vitamin deficiencies:
– Stomatitis from scurvy
Bleeding gums caused by vitamin C deficiency; associated in infants with lower limb pain due to hematoma formation subperiosteal. Contexts of poor food or total dependence in relation to food aid (refugee camps).
• Clean the mouth and apply gentian violet as above.
• ascorbic acid (vitamin C) PO
Children: 150 to 200 mg / day in 3 divided or 4 sockets
Adult: 500-750 mg / day in 3 divided or 4 sockets
Treatment is continued until symptoms improve (1-2 weeks) followed by prevention (children and adults: 25 to 50 mg / day), as the situation requires.
– Other stomatitis
Other vitamin deficiencies can cause mouth lesions: angular stomatitis of the lips and glossitis deficiency in vitamin B2 (riboflavin), vitamin PP or niacin, vitamin B6 (pyridoxine).
Iron deficiency can also cause angular stomatitis of the lips.
Give the corresponding vitamins at curative doses. Multivitamins are insufficient for the treatment of real deficiencies.
