Oral Health Quiz on Stomatitis Types

Introduction

• Common investigations and procedures in GIT disorders have been covered.
• Management of oral and oesophageal disorders will be discussed.
• Conditions covered include simple catarrhal stomatitis, Vincent's stomatitis, hepatic stomatitis, monilia stomatitis (oral thrush), parotitis, achalasia, gastroesophageal reflux, and hiccups.

Objectives

• Define stomatitis.
• Describe different types of stomatitis and their management.
• Discuss oesophageal disorders and their management.

Stomatitis

• Stomatitis is a generalized inflammation of the mouth.
• Types of stomatitis: simple catarrhal stomatitis, Vincent's stomatitis, hepatic stomatitis, monilia stomatitis (oral thrush), and parotitis.

Simple Catarrhal Stomatitis

• Inflammation of the mouth's mucous membranes, with increased mucus and exudates.
• More common in children than adults.

Causes of Simple Catarrhal Stomatitis

• Microorganisms (bacteria).
• Poor oral hygiene.
• Ingestion of hot foods or drinks.
• Foreign objects in the mouth.
• Exposure to strong acids or alkalis.
• Systemic infections.

Signs and Symptoms of Simple Catarrhal Stomatitis

• Low-grade fever.
• Dry mucous membranes.
• Sores in the mouth.
• Mouth pain (especially while eating).
• Reddened mucous membranes.
• Loss of appetite; craving for cold drinks.

Treatment of Simple Catarrhal Stomatitis

• Antipyretics (like panadol).
• Mouthwashes with antiseptics.
• Soft diet.
• Address the underlying systemic condition if applicable.

Vincent's Stomatitis

• Severe inflammation of the mouth and gums.
• Also considered severe gingivitis.

Causes of Vincent's Stomatitis

• Bacteria.
• Poor oral hygiene.
• Immunosuppression.

Signs and Symptoms of Vincent's Stomatitis

• Mouth pain.
• Swelling of affected areas.
• Bleeding gums.
• Reddened mucous membranes.
• Bad taste.
• Halitosis (bad breath).
• Fever (due to infection).

Diagnosis of Vincent's Stomatitis

• Physical examination (reveals mouth and gum swelling, inflamed gums, and gum redness).
• Dental x-rays.
• Patient history.

Treatment of Vincent's Stomatitis

• Oral antibiotics (like penicillin, erythromycin).
• Antiseptic mouthwashes.
• Hydrogen peroxide rinses.
• Regular brushing.
• Professional dental cleaning.

Hepatic Stomatitis

• Contagious viral infection of the mouth.
• Causes ulcers and inflammation.
• Primarily affects children.

Causes of Hepatic Stomatitis

• Herpes viruses (Herpes virus hominis)
• Epstein-Barr virus.
• Varicella-zoster virus.

Signs and Symptoms of Hepatic Stomatitis

• Mouth blisters (often on tongue or cheeks).
• Decreased food intake even with hunger.
• Dysphagia (difficulty swallowing).
• Drooling.
• Fever (may occur 1 to 2 days prior to blister/ulcer appearance).
• Irritability.
• Mouth pain.
• Swollen gums.
• Mouth ulcers (form after blisters pop).

Diagnosis of Hepatic Stomatitis

• History taking.
• Physical examination.

Treatment of Hepatic Stomatitis

• Antiviral medications (acyclovir).
• Liquid diet (cool-to-cold, non-acidic).
• Topical anaesthetics (lidocaine) for severe pain.
• Caution is required when administering topical anaesthetics to avoid swallowing issues and mouth/throat burns.

Monilia Stomatitis/Oral Thrush

• Mouth infection caused by a yeast-like fungus (Candida albicans).
• Common in people with lowered immunity or prolonged antibiotic use.

Predisposing Factors for Monilia Stomatitis

• Lowered immunity.
• Prolonged use of antibiotics (tetracycline, chloramphenicol).

Signs and Symptoms of Monilia Stomatitis

• Lesions in the mouth and on the gums which bleed easily on contact.

Treatment of Monilia Stomatitis

• Hydrogen peroxide and normal saline mouthwashes.
• Clotrimazole tablets (dissolved in the mouth 5 times daily).
• Nystatin suspension/pastilles, or amphotericin lozenges.
• Fluconazole for oropharyngeal candidiasis.
• Oral hygiene.

Parotitis

• Inflammation of one or both parotid glands.

Causes of Parotitis

• Bacterial infections (Staphylococcus aureus).
• Mycobacterium (tuberculosis).
• Mumps virus.
• HIV.
• Obstructions in the main parotid duct or its branches.
• Systemic infections.

Signs and Symptoms of Parotitis

• Swollen, painful glands, often visible at the jaw angle.
• Dry mouth.
• Severe pain while swallowing.
• Pus-like discharge from the gland.
• Skin redness (erythema).
• Ulcers.
• Fever.

Diagnosis of Parotitis

• Patient history.
• Physical examination (checking for enlarged glands).

Treatment of Parotitis

• Antibiotics.
• Mouthwashes.
• Warm salty water rinses for soothing and maintaining mouth moisture.
• Warm compresses.
• Increased fluid intake.
• Drainage of any abscesses (if needed).

Achalasia

• Gastrointestinal disorder characterized by the lack of peristaltic movement in the esophagus and the inability of the lower esophageal sphincter to relax.
• Results in the accumulation and stagnation of food and fluids in the esophagus, causing irritation and inflammation.

Cause of Achalasia

• Unknown exact cause, but possibly related to degeneration or malfunctioning of the nerve plexus in the esophageal muscle tissue.

Signs and Symptoms of Achalasia

• Progressive dysphagia (difficulty swallowing).
• Regurgitation of undigested food.
• Weight loss.
• Halitosis (due to regurgitation of ingested food).
• Coughing when lying horizontally.
• Chest pains that increase after eating.

Diagnosis of Achalasia

• Barium swallow (shows esophageal dilation and lack of peristalsis).
• Esophagoscopy (shows lower esophageal sphincter dilation and potential cancer/candida changes).
• Esophageal manometry (measures muscle contractions in the esophagus during swallowing, revealing lower esophageal sphincter failure to relax and lack of esophageal peristalsis).
• Biopsy (tissue sample during endoscopy which shows hypertrophied muscles and lack of specific nerve cells in the esophageal lining).

Treatment of Achalasia

• Medications (calcium channel blockers like nifedipine, and nitrates like nitroglycerin to relax the lower esophageal sphincter).
• Balloon (pneumatic) esophageal dilatation (to stretch the lower esophageal sphincter).
• Surgery (Heller myotomy or cardiomyotomy, which surgically separates the lower esophageal muscle).

Gastroesophageal Reflux

• A condition where stomach contents flow back into the esophagus (without vomiting or belching).
• A GIT condition due to abnormal gastric content regurgitation into the esophagus.

Cause of Gastroesophageal Reflux

• Changes in the barrier between the stomach and esophagus.
• Abnormal relaxation of the lower esophageal sphincter.
• Anatomical abnormalities such as hiatus hernia (stomach portion moves above the diaphragm).

Predisposing Factors for Gastroesophageal Reflux

• Obesity.
• Zollinger-Ellison syndrome (high gastric acidity).
• Pregnancy.
• Smoking.
• Hypocalcemia (increased gastrin production and acidity).
• Food types (high-fat, high-acid foods).
• Alcohol intake.

Signs and Symptoms of Gastroesophageal Reflux

• Heartburn (burning sensation behind the breastbone, usually after eating).
• Regurgitation.
• Chest pain that radiates to the neck and throat (from acid regurgitation).
• Dysphagia (difficulty swallowing).
• Odynophagia (painful swallowing).
• Nausea.
• Coughing, hoarseness, or wheezing (at night).
• Belching.
• Flatulence.
• Hiatus hernia.
• Nasogastric tube placement (>4 days).

Diagnosis of Gastroesophageal Reflux

• Esophagoscopy (to identify damage).
• Barium swallow (to assess esophageal damage).
• Continuous esophageal pH monitoring (to measure acid reflux).
• Esophageal manometry.
• Positive stool occult blood test (may indicate bleeding from esophageal irritation).

Treatment of Gastroesophageal Reflux

• Dietary changes (avoiding foods that trigger symptoms, managing weight if obese).
• Lifestyle changes (raising the head of the bed, avoiding lying down for hours after eating, quitting smoking).
• Medications (antacids for neutralization, proton pump inhibitors to reduce stomach acid production).
• Surgery (Nissen fundoplication to repair the lower esophageal sphincter, or vagotomy to reduce stomach stimulation).

Hiccups

• Esophageal contraction of the diaphragm that repeats frequently.
• A spasm of the diaphragm leading to a rapid, involuntary inhalation that is stopped by a sudden closure of the glottis, accompanied by a distinctive sound.

Causes of Hiccups

• Central and peripheral nervous system disorders (from injury/irritation of phrenic and vagus nerves)
• Toxic or metabolic disorders.
• Chemotherapy (certain drugs).
• Carbonated drinks/alcohol/spicy food.
• Prolonged laughter.
• Eating too fast.

Treatment of Hiccups

• Ordinary hiccups usually resolve without interventions.
• Home remedies (fright/shock, peanut butter, vinegar, water, breath holding, altered breathing patterns).
• Sedatives (diazepam, chlorpromazine) for severe, persistent hiccups.

Summary

• Discussion of mouth and esophagus conditions, with stomatitis defined as generalized inflammation in the mouth.
• Different types of stomatitis addressed (simple catarrhal, Vincent's, Hepatic, Monilia, parotitis).
• Diseases of the esophagus (achalasia, GERD) and hiccups also discussed.

Assignment

• State the common manifestations (signs and symptoms) of GIT conditions.