What are common causes of mouth sores and growths. How can different types of oral lesions be identified. When should a person seek medical attention for mouth sores. What treatment options are available for various oral growths.

Understanding Mouth Sores and Growths: An Overview

Mouth sores and growths can originate from various types of tissues in and around the oral cavity, including connective tissues, bone, muscle, and nerve. These lesions most commonly form on the lips, gums, tongue, and inner cheeks. While some growths may cause pain or irritation, others can be asymptomatic. It’s crucial to understand that mouth growths can be classified into three main categories:

• Noncancerous (benign)
• Precancerous (dysplastic)
• Cancerous (malignant)

The majority of mouth growths are noncancerous. However, any persistent lump or raised area on the gums (gingiva) should be evaluated by a dental professional. Such abnormalities may be caused by a gum or tooth abscess, irritation, or in rare cases, could be indicative of a more serious condition.

Common Types of Noncancerous Mouth Growths

Noncancerous growths in the oral cavity are relatively common and can often be attributed to irritation. These growths can typically be removed surgically if necessary. However, it’s important to note that in 10 to 40% of cases, noncancerous growths on the gums may reappear if the underlying irritant remains. Prolonged irritation can occasionally lead to precancerous changes, emphasizing the importance of proper oral care and regular dental check-ups.

Warts in the Oral Cavity

Ordinary warts (verrucae vulgaris) can infect the mouth if an individual sucks or chews on a wart growing on their finger. Additionally, genital warts, also caused by the human papillomavirus (HPV), can be transmitted to the mouth through oral sex. For mouth warts, surgical removal is typically the preferred treatment method.

Thrush: A Common Yeast Infection

Thrush is a yeast infection that affects moist areas of the body, including the mouth. It often appears as whitish, cheese-like patches that stick tightly to the mucous membranes. When wiped away, thrush leaves a red patch underneath. This condition is most common among individuals with diabetes, those with suppressed immune systems, and people taking antibiotics.

Torus: Bony Growths in the Mouth

A torus is a slow-growing, rounded projection of bone that can form in two main areas of the mouth:

• Torus palatinus: Located in the middle of the roof of the mouth
• Torus mandibularis: Found on the lower jaw by the side of the tongue

These hard growths are both common and harmless. In most cases, even large tori can be left untreated unless they interfere with eating or denture placement. However, multiple bony growths, particularly along the angle of the lower jaw, may indicate Gardner syndrome, a hereditary disorder of the digestive tract associated with numerous polyps in the colon that often become cancerous.

Keratoacanthomas: Sun-Exposed Growths

Keratoacanthomas are growths that typically form on sun-exposed areas such as the lips, face, forearms, and hands. These lesions usually reach their full size of ½ to 1 inch (about 1 to 3 centimeters) in diameter within 1 or 2 months. After a few months, keratoacanthomas often begin to shrink and may eventually disappear without treatment.

Historically, all keratoacanthomas were considered noncancerous. However, current medical opinion suggests that those which do not diminish in size may be slow-growing cancerous tumors. As a result, removal is often recommended for persistent keratoacanthomas.

Cysts: Fluid-Filled Swellings in the Jaw

Cysts are hollow, fluid-filled swellings that can cause jaw pain and swelling. They are often found next to an impacted wisdom tooth and have the potential to destroy considerable areas of the jawbone as they expand. It’s important to note that certain types of cysts are more likely to recur after surgical removal, necessitating close follow-up and monitoring.

When to Seek Medical Attention for Mouth Growths

While many mouth growths are benign, it’s crucial to have any unusual or persistent lesions evaluated by a healthcare professional. Reasons to seek medical attention include:

• Growths that persist for more than two weeks
• Lesions that bleed easily or do not heal
• Sudden changes in the appearance or size of existing growths
• Pain or difficulty in speaking, chewing, or swallowing
• Numbness or tingling in the mouth area

Early detection and treatment of potentially serious conditions can significantly improve outcomes and quality of life.

Diagnostic Approaches for Mouth Growths

When evaluating mouth growths, healthcare professionals may employ various diagnostic techniques to determine the nature of the lesion. These may include:

1. Visual and physical examination
2. Biopsy (tissue sample analysis)
3. Imaging studies (X-rays, CT scans, or MRI)
4. Blood tests to check for underlying conditions or infections

The specific diagnostic approach will depend on the characteristics of the growth and the patient’s medical history.

Treatment Options for Oral Lesions

Treatment for mouth growths varies depending on the type, location, and severity of the lesion. Some common treatment options include:

• Watchful waiting for benign growths that may resolve on their own
• Topical or oral medications for infections or inflammatory conditions
• Surgical removal of problematic or potentially cancerous growths
• Laser therapy for certain types of lesions
• Cryotherapy (freezing) for warts and other benign growths

In cases of precancerous or cancerous lesions, more aggressive treatments such as radiation therapy or chemotherapy may be necessary.

Preventing Mouth Sores and Promoting Oral Health

While not all mouth growths can be prevented, there are several steps individuals can take to promote overall oral health and reduce the risk of developing certain types of lesions:

• Practice good oral hygiene, including regular brushing and flossing
• Avoid tobacco products and limit alcohol consumption
• Protect the lips and face from excessive sun exposure
• Maintain a balanced diet rich in vitamins and minerals
• Stay hydrated to keep the mouth moist and healthy
• Attend regular dental check-ups for early detection of potential issues

By following these preventive measures and seeking prompt medical attention for any concerning oral symptoms, individuals can maintain optimal oral health and address potential issues before they become more serious.

Understanding the various types of mouth sores and growths, their potential causes, and when to seek medical attention is crucial for maintaining oral health. While many oral lesions are benign and may resolve on their own, others can be indicative of more serious conditions. Regular dental check-ups, good oral hygiene practices, and a healthy lifestyle can go a long way in preventing and managing mouth sores and growths. If you notice any persistent or concerning changes in your oral cavity, don’t hesitate to consult with a dental professional for proper evaluation and treatment.

Mouth Growths – Mouth and Dental Disorders

By

Bernard J. Hennessy

, DDS, Texas A&M University, College of Dentistry

Reviewed/Revised Feb 2022 | Modified Sep 2022

VIEW PROFESSIONAL VERSION

Topic Resources

Growths can originate in any type of tissue in and around the mouth, including connective tissues, bone, muscle, and nerve. Growths most commonly form on the

Some growths cause pain or irritation.

Mouth growths can be

• Noncancerous (benign)

• Precancerous (dysplastic)

• Cancerous (malignant)

Most mouth growths are noncancerous.

A variety of noncancerous growths may occur in and around the mouth. A persistent lump or raised area on the gums (gingiva) should be evaluated by a dentist. Such a lump may be caused by a gum or tooth abscess or by irritation. But, because any unusual growths in or around the mouth can be cancer, the growths should be checked by a doctor or dentist without delay.

Noncancerous growths due to irritation are relatively common and, if necessary, can be removed by surgery. In 10 to 40% of people, noncancerous growths on the gums reappear because the irritant remains. Occasionally such irritation, particularly if it persists over a long period of time, can lead to precancerous changes.

Ordinary warts Warts Warts (verrucae) are small skin growths caused by human papillomavirus infection. Warts are caused by human papillomaviruses. Raised or flat growths appear on any part of the skin. Most warts… read more (verrucae vulgaris) can infect the mouth if a person sucks or chews one that is growing on a finger. A different type of wart also caused by the human papillomavirus—a genital wart Human Papillomavirus (HPV) Infection Human papillomavirus (HPV) can be sexually transmitted and causes changes in cells, which can lead to genital warts or to precancer or cancer of the cervix, vagina, vulva, anus, or throat. Different… read more —may be transmitted to the mouth through oral sex. Among the several methods used to remove warts (see Warts: Treatment Treatment Warts (verrucae) are small skin growths caused by human papillomavirus infection. Warts are caused by human papillomaviruses. Raised or flat growths appear on any part of the skin. Most warts… read more ), surgical removal is the preferred method for mouth warts.

Thrush Symptoms is a yeast infection of moist areas of the skin and other moist areas (such as the mouth and vagina). In the mouth it often appears as whitish, cheeselike patches. Thrush sticks tightly to the mucous membranes and when wiped away, leaves a red patch. Thrush is most common among people with diabetes or a suppressed immune system and in those who are taking antibiotics.

A torus is a slow-growing, rounded projection of bone that forms in the middle of the roof of the mouth (torus palatinus) or on the lower jaw by the side of the tongue (torus mandibularis). This hard growth is both common and harmless. Even a large growth can be left alone unless it gets scraped during eating or the person needs a denture that covers the area. Multiple bony growths, particularly along the angle of the lower jaw, may indicate Gardner syndrome Familial Adenomatous Polyposis Familial adenomatous polyposis is an inherited disorder in which many (often 100 or more) precancerous polyps develop throughout the large intestine and rectum during childhood or adolescence… read more , a hereditary disorder of the digestive tract where the person has numerous polyps in the colon that often become cancerous.

Keratoacanthomas Keratoacanthomas Keratoacanthomas are round, firm, usually pink or flesh-colored growths that have a central crater that is scaly or crusted. Some keratoacanthomas may be a form of squamous cell carcinoma. Keratoacanthomas… read more are growths that form on the lips and other sun-exposed areas, such as the face, forearms, and hands. A keratoacanthoma usually reaches its full size of ½ to 1 inch (about 1 to 3 centimeters) or more in diameter within 1 or 2 months, then begins to shrink after another few months and may eventually disappear without treatment. Once, all keratoacanthomas were considered to be noncancerous, but some experts now consider those that do not diminish in size to be slow-growing cancerous tumors and recommend they be removed.

Cysts (hollow, fluid-filled swellings) of many types cause jaw pain and swelling. Often they are next to an impacted wisdom tooth and can destroy considerable areas of the jawbone as they expand. Certain types of cysts are more likely to recur after surgical removal. Various types of cysts may develop in the floor of the mouth. Often, cysts are surgically removed because they make swallowing uncomfortable or because they are unattractive. By far the most common cyst occurs in the lip and is called a mucocele or mucus retention cyst. It is usually the result of accidentally biting the (lower) lip and occurs when saliva draining into the mouth from a minor salivary gland is blocked. Most mucoceles disappear in a week or two but can be surgically removed if annoying.

Odontomas are overgrowths of tooth-forming cells that look like either small, misshapen extra teeth or a large mass of tooth material. In children, they may get in the way of normal teeth coming in. In adults, they may push teeth out of alignment. If odontomas grow large, they may cause the upper or lower jaw to become enlarged as well. They are usually removed surgically.

Most (75 to 80%) salivary gland tumors are noncancerous, slow-growing, and painless. They usually occur as a single, soft, movable lump beneath normal-looking skin or under the lining (mucosa) of the inside of the mouth. Occasionally, when hollow and fluid-filled, they are firm. The most common type (called a mixed tumor or pleomorphic adenoma) occurs mainly in women older than 40. This type can become cancerous and is removed surgically. Unless completely removed, this type of tumor is likely to grow back. Other types of noncancerous tumors are also removed surgically but are much less likely to become cancerous or to grow back once removed.

Oral Fibroma

The oral growth shown here, called a fibroma, is caused by chronic irritation. In this case, it formed as the result of constant rubbing due to orthodontic braces.

DR P. MARAZZIN/SCIENCE PHOTO LIBRARY

Common Wart in the Mouth

This photo shows an ordinary wart (raised, rounded, flesh-colored growth) on the surface of the tongue.

DR P. MARAZZI/SCIENCE PHOTO LIBRARY

Genital Wart in Mouth

This photo shows a wart caused by a type of human papillomavirus that typically causes genital warts.

CLINICA CLAROS/SCIENCE PHOTO LIBBRARY

Torus Palatinus

The hard, bony mass shown on the midline of the roof of the mouth (hard palate) is common and called a torus palatinus.

DR P. MARAZZI/SCIENCE PHOTO LIBRARY

White, red, or mixed white-red areas that are not easily wiped away, persist for more than 2 weeks, and are not definable as some other condition may be precancerous. The same risk factors are involved in precancerous changes as in cancerous growths, and precancerous changes may become cancerous if not removed.

Leukoplakia is a flat white spot that may develop when the moist lining of the mouth (oral mucosa) is irritated for a long period. The irritated spot appears white because it has a thickened layer of keratin—the same material that covers the skin and normally is less abundant in the lining of the mouth.

Erythroplakia is a red and flat or worn-away area that results when the lining of the mouth thins. The area appears red because the underlying capillaries are more visible. Erythroplakia is a much more ominous predictor of oral cancer than leukoplakia.

Mixed white-red areas contain both leukoplakia and erythroplakia and also may become cancer over time.

People who use tobacco, alcohol, or both are at much greater risk (up to 15 times) of oral cancer Mouth and Throat Cancer Mouth and throat cancers are cancers that originate on the lips, the roof, sides, or floor of the mouth, tongue, tonsils, or back of the throat. Mouth and throat cancers may look like open sores. .. read more . For those who use chewing tobacco and snuff, the insides of the cheeks and lips are common sites of oral cancer. In other people, the most common sites for oral cancer include the sides of the tongue, the floor of the mouth, and the throat. Cancers caused by oral infection with human papillomavirus Human Papillomavirus (HPV) Infection Human papillomavirus (HPV) can be sexually transmitted and causes changes in cells, which can lead to genital warts or to precancer or cancer of the cervix, vagina, vulva, anus, or throat. Different… read more (HPV), especially type 16, usually occur at the back of the throat, base of tongue, and tonsils. HPV infection is now a more common cause of cancers at these sites than tobacco. Rarely, cancers found in the mouth region have spread there from other parts of the body, such as the lungs, breast, or prostate.

Oral cancer can have many different appearances but typically resembles precancerous lesions (for example, white, red, or mixed white-red areas that are not easily wiped away).

The following information can help people decide when a doctor’s evaluation is needed and help them know what to expect during the evaluation.

Certain symptoms and characteristics are cause for concern. They include

• Weight loss

• Firm lump in the neck

• A sore throat that will not go away

• Difficulty swallowing

People with a mouth growth that does not go away in a week or two should see their doctor or dentist when convenient. Warning signs suggest a higher risk of cancer, and people with warning signs (particularly those who use tobacco) should not put off being evaluated.

Because oral cancer often causes no symptoms early on, it is important for people to have a yearly examination of the mouth. Such an examination can be done during an annual dental check-up.

Doctors first ask questions about the person’s symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination can help suggest a cause of the mouth growth.

Doctors ask people about how long the growth has been present, whether it is painful, and whether there was any injury to the area (for example, biting a cheek or scraping by a sharp tooth edge or dental restoration). Other things they ask about include

• The amount and duration of use of alcohol and tobacco

• Risk factors for thrush (caused by the fungus Candida albicans), including use of antibiotics and a history of diabetes Diabetes Mellitus (DM) Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar (glucose) levels to be abnormally high. Urination and thirst are… read more or HIV infection Human Immunodeficiency Virus (HIV) Infection

• Whether the person has lost weight or been feeling generally ill

• How frequently the person has oral sex and the number of sexual contacts with whom they engage in oral sex

The physical examination focuses on the mouth and neck. Doctors look carefully at all areas of the mouth and throat, including under the tongue. They feel the sides of the neck for swollen glands (lymph nodes), which indicate possible cancer or chronic infection.

If a growth has the appearance of thrush, doctors examine scrapings under a microscope. For other growths that have lasted longer than a few weeks, most doctors recommend removing all or part of the growth for examination in a laboratory (biopsy). Biopsy is often necessary to make sure a growth is noncancerous.

Treatment differs depending on the cause, cosmetic effects or other symptoms, and possibility of cancerous transformation of the growth.

• Most mouth growths are noncancerous.

• Warts, yeast infections, and repeated trauma (such as biting or rubbing against a sharp tooth edge) are common causes of noncancerous growths.

• Use of alcohol and tobacco and oral human papillomavirus (HPV) infection are risk factors for oral cancer.

• Because cancerous growths are difficult to recognize by their appearance, doctors frequently recommend a biopsy.

The following is an English-language resource that may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

• MouthHealthy.org: Provides information on oral health, including nutrition and guidance on selecting products that carry the American Dental Association’s seal of approval. There is also advice on finding a dentist and how and when to see one.

NOTE:


This is the Consumer Version.


DOCTORS:



VIEW PROFESSIONAL VERSION

VIEW PROFESSIONAL VERSION

Copyright © 2023 Merck & Co. , Inc., Rahway, NJ, USA and its affiliates. All rights reserved.

Test your knowledge

Take a Quiz!

Recurrent Aphthous Stomatitis – Mouth and Dental Disorders

By

Bernard J. Hennessy

, DDS, Texas A&M University, College of Dentistry

Reviewed/Revised Feb 2022 | Modified Sep 2022

VIEW PROFESSIONAL VERSION

Topic Resources

Recurrent aphthous stomatitis (canker sores, or aphthous ulcers) is the presence of small, painful sores (ulcers) inside the mouth that typically begin in childhood and recur frequently.

• Mouth injury, stress, and some foods may trigger an attack.

• People feel burning pain, and a day or so later a canker sore develops on the soft tissue of the mouth.

• Doctors or dentists make the diagnosis based on the pain and the appearance of the canker sores.

• Treatment is with mouth rinses and sometimes corticosteroids.

(See also Mouth Sores and Inflammation Mouth Sores and Inflammation Mouth sores and inflammation vary in appearance and size and can affect any part of the mouth, including the lips (see Lip Sores and Inflammation). People may have swelling and redness of the… read more .)

Recurrent aphthous stomatitis (RAS) is very common. The cause is unclear but probably involves multiple factors, including disorders or abnormal function of the immune system, exposure to preservatives and toothpaste ingredients, and a genetic predisposition. RAS usually begins in childhood, and 80% of people with RAS are

People who have RAS get canker sores repeatedly. Some have only one or two canker sores a few times a year. Others have almost continuous outbreaks. Attacks usually decrease in frequency and severity with aging.

Many factors seem to predispose to or trigger attacks, but allergic reactions do not seem to be involved. Such factors include injury to the mouth, stress (for example, a college student may get canker sores during final exam week), and certain foods (particularly chocolate, coffee, peanuts, eggs, cereals, almonds, strawberries, cheese, and tomatoes). People with AIDS Human Immunodeficiency Virus (HIV) Infection Human immunodeficiency virus (HIV) infection is a viral infection that progressively destroys certain white blood cells and is treated with antiretroviral medications. If untreated, it can cause… read more often have large canker sores that persist for weeks.

For unknown reasons, pregnant women, people who are taking oral contraceptives, and people who are using tobacco products are less likely to develop canker sores. However, the health risks of tobacco use outweigh any protective effect in preventing canker sores.

Symptoms usually begin with pain or burning, followed in 1 to 2 days by a canker sore. There is never a blister. Pain is severe—far more so than would be expected from something so small—and lasts 4 to 7 days. The canker sores almost always form on soft, loose tissue such as that on the inside of the lip or cheek, on the tongue, on the floor of the mouth, on the soft palate, or in the throat. Sores appear as shallow, round, or oval spots with a yellow-gray center and a red border. Usually, sores are small, about 1/8 to 3/8 inches (less than 1 centimeter) in diameter, and often appear in clusters of two or three. They usually disappear by themselves within 10 days and do not leave scars. Larger sores, about ½ to 1½ inches (less than 3 centimeters) in diameter, are less common. These larger ulcers are irregularly shaped, can take many weeks to heal, and frequently leave scars.

People with a severe outbreak may also have a fever, swollen lymph nodes in the neck, and a generally run-down feeling.

A doctor or dentist identifies recurrent aphthous stomatitis by its appearance and the pain it causes.

Treatment consists of relieving the pain with the same general measures used for other mouth sores (see Topical treatments Treatment Mouth sores and inflammation vary in appearance and size and can affect any part of the mouth, including the lips (see Lip Sores and Inflammation). People may have swelling and redness of the… read more ). In addition, doctors often recommend chlorhexidine mouth rinses. If there are many canker sores, doctors sometimes also recommend a corticosteroid such as dexamethasone applied as a rinse. If there are fewer canker sores, doctors recommend other corticosteroids such as fluocinonide or clobetasol applied as an ointment or mixed in a protective carboxymethylcellulose paste. People who have repeated outbreaks of canker sores may start using the mouth rinse as soon as they feel a sore developing. People using these corticosteroids may develop stomatitis caused by Candida albicans (see Symptoms of Candidiasis Symptoms Candidiasis is a fungal infection caused by several species of the yeast Candida, especially Candida albicans. The most common type of candidiasis is a superficial infection of… read more ).

If the corticosteroids that are applied directly to the affected area do not work, prednisone tablets may be taken by mouth. However, before prescribing a corticosteroid, a doctor must ensure that the person does not have oral herpes simplex infection Oral infection Herpes simplex virus infection causes recurring episodes of small, painful, fluid-filled blisters on the skin, mouth, lips (cold sores), eyes, or genitals. This very contagious viral infection… read more , which would be made worse by taking corticosteroids. Corticosteroid rinses and tablets are absorbed by the body more than are corticosteroids given in gel form, so the side effects may be a concern (see sidebar Corticosteroids: Uses and Side Effects Corticosteroids: Uses and Side Effects ).

The following is an English-language resource that may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

• MouthHealthy.org: Provides information on oral health, including nutrition and guidance on selecting products that carry the American Dental Association’s seal of approval. There is also advice on finding a dentist and how and when to see one.

NOTE:


This is the Consumer Version.


DOCTORS:



VIEW PROFESSIONAL VERSION

VIEW PROFESSIONAL VERSION

Copyright © 2023 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. All rights reserved.

Test your knowledge

Take a Quiz!

Mouth and throat ulcers in pediatric cancers

Mouth and throat ulcers are a common side effect of childhood cancer treatment. The medical name for this condition is oral mucositis.

What is oral mucositis?

The word “oral” refers to the mouth and throat. Mucositis is swelling of the mucous membrane (wet inner lining of some organs of the body). Mucositis can develop anywhere in the digestive tract, including the mouth, stomach, intestines, and anus. Often it leads to the formation of painful ulcers.

More than half of children with cancer have symptoms of mucositis. More than 75% of patients who have had a hematopoietic cell transplant (also called a bone marrow or stem cell transplant) are likely to experience this side effect. Many patients report that mucositis is one of the most annoying side effects of cancer treatment.

Mouth and throat ulcers are a cause for concern because they can:

• Cause pain and discomfort
• Difficulty eating and drinking
• Increase the risk of infection
• Lead to a change in treatment plan

This side effect is treatable but cannot be completely prevented. To cope with ulcers in the mouth and throat will help:

• Prevention
• Pain and discomfort relief
• Treatment of infections
• Nutritional support

Risk factors and causes

Risk factors that increase the likelihood of mouth and throat ulcers:

• High-dose chemotherapy
• Hematopoietic cell transplant (also called bone marrow or stem cell transplant) preceded by high-dose chemotherapy
• Irradiation of the head and neck area
• Neutropenia
• Poor condition of teeth

Chemotherapy and radiation therapy work on rapidly dividing cancer cells. However, some normal cells, including those lining the mouth, pharynx, and digestive tract, also divide rapidly. Chemotherapy drugs and radiation can also damage these healthy cells.

Chemotherapy causes the death of rapidly growing cells. Energy centers of cells (mitochondria) trigger a chain of reactions that cause inflammation of the mucous membranes of the mouth and throat.

When the cells die, the integrity of the oral mucosa is broken.

Signs and symptoms

The patient and family should report the following symptoms to the doctor or nurse:

• Irritation or pain in the lips, mouth or throat
• Difficulty swallowing
• Increased discharge from the mouth (salivation) or throat
• White plaque or sores in the mouth or throat
• Bleeding gums
• Body temperature above 38.0°C

Diagnosis

Ulcers in the mouth and throat are diagnosed:

• Medical examination of the mouth and throat. The doctor will examine the skin of the lips, the mucous membrane behind the right and left cheeks, on the lower and lateral surfaces of the tongue, the floor of the mouth, hard and soft palate and pharynx.
• When the patient complains of pain and inability to eat and drink.

The doctor will rate the severity of mucositis (from 1 to 4) depending on the severity of the condition. The severity of the problem determines the tactics of treatment. Grades 3-4 are considered severe – the stronger the manifestations, the higher the likelihood of complications.

1. Ulcers and redness
2. Ulcerated but still able to eat
3. Bleeding ulceration, only liquid food remains
4. Tissue necrosis, significant haemorrhage, life-threatening consequences

Prophylaxis

In some cases, mouth and throat ulcers cannot be prevented. But patients can take certain steps to reduce the severity of symptoms.

• Dental Exam – Your child should have a dental exam if possible before starting treatment. The dentist needs to know that your child has cancer. The examination will identify problems with the teeth that are subject to treatment or observation.
• It may be necessary to remove braces or other corrective appliances in the mouth before starting treatment.
• Daily Oral Care – Follow your doctor’s instructions, even if oral care is painful.
  • Gently brush your teeth with a soft bristled toothbrush. Brushing your teeth must be done with extreme care. This process can cause the gums to bleed, thereby allowing pathogenic bacteria to enter the bloodstream. If brushing is not possible, swabs or mouth sponges can be used.
  • Use only mouthwash recommended by your doctor. Antibacterial mouthwashes such as chlorhexidine can eliminate bacteria from the mouth.
  • If the patient has mouth ulcers, flossing may be contraindicated. Check with your doctor before flossing. It can damage tissue and cause bleeding and infection.
  • At the beginning of a course of chemotherapy, a dietitian will likely recommend a “soft” diet to prevent oral microtrauma. In addition, soft foods are easier to chew and swallow. Patients are advised to avoid food with a rough texture, spicy or sour food. They may also consciously avoid very hot or cold foods.
• Your healthcare team may recommend measures to prevent dry mouth. These include drinking plenty of water, using saliva substitutes or rinsing your mouth, and eating sugar-free hard candies and chewing gum.
• Lip Care – Use your doctor’s recommended lip moisturizer.
• Ice treatment – Slowing down ice packs before and during chemotherapy can slow the formation of mouth ulcers. This process is called cryotherapy. Cold reduces blood flow in the mouth.
• Palifermin – The drug palifermin is sometimes recommended as a prophylaxis for patients who are about to undergo autologous hematopoietic cell transplantation.

The possibility of using photomodulation (low intensity laser therapy) as a method of prevention and treatment is currently being investigated. Light stimulates tissue regeneration, reduces inflammation, swelling and relieves pain.

Treatment

Treatment is aimed at relieving pain, controlling infections and providing adequate nutrition to the patient.

Pain relief

Pain relief may be local or systemic and depends on the patient’s symptoms.

Topical treatments include the following:

• Rinse or “Magic Rinse”—Your doctor or nurse may recommend certain rinse solutions or “Magic Rinse”. There are many different types of “magic rinse”. Each pediatric medical center uses different ingredients. Typically, medications are included to help relieve pain, fight infections, and reduce swelling.
• Topical Gels – Doctor-recommended gels may temporarily relieve discomfort.

Systemic treatments include various types of pain medications. Your doctor may recommend other methods of pain relief that do not require the use of drugs.

Nutritional Support

If the patient has difficulty eating and drinking, this can lead to dehydration and/or malnutrition.

In some cases, patients may require enteral tube feeding or total parenteral nutrition (TPN).

Treatment of infections

Mouth and throat ulcers are a gateway for pathogenic microorganisms (bacteria, viruses, fungi) to enter the patient’s body, which can lead to infection.

Treatment of the infection may include antibiotics, antivirals and/or antifungals. The treatment team may consult with an infectious disease physician to develop a treatment plan.

–
Modified January 2019

types, symptoms, treatment, advice from doctors

Periodontics

2125

Sometimes painful growths of a small size appear in the mouth. They are almost invisible to the eye, but create discomfort. The frequency may vary. In some patients, ulcers appear every month, in others – once every 1-2 years. This pathology is called stomatitis. It is characterized by inflammatory processes in the oral cavity, as a reaction of the body to various stimuli.

If you do not deal with the treatment of stomatitis, then the ulcers will gradually spread throughout the oral cavity. Pathology is more characteristic of children, however, in modern realities, with poor ecology and reduced immunity, the disease often occurs in adults.

Etiology

The mucous membrane is a protective screen not only for the teeth, but also for the digestive organs. In the case of mechanical or aggressive chemical action, the soft tissues of the oral cavity react instantly, preventing harm to the body.

Often the patient learns about the presence of the disease only after examination by the dentist. Therefore, a regular preventive visit to the doctor allows you to identify the pathology at an early stage, and prevent complications. If you develop painful white growths on your tongue, gums, or inside of your lips, it’s important to see your dentist right away.

There are many reasons for the appearance of stomatitis in the mouth. It can be an unbalanced diet, when the diet lacks vitamins and minerals. Especially B vitamins, zinc, iron. Or lack of proper hygiene: washing hands before eating, eating dirty fruits and vegetables. Inflammation can be caused by poor-quality toothpastes containing sulfates and other chemicals.

But the main provoking factor is mucosal injury: burns, mechanical damage or exposure to an aggressive chemical environment. For example, the patient may bite his lip and cheek, injure the gum with a fragment of a tooth or excessively hard, sour, spicy food.

Other reasons for the development of stomatitis in the oral cavity include:

• Poor dental treatment. Injury to the soft tissues of the mucous overhanging crown, denture or orthodontic construction.
• Allergic reactions and hormonal changes (especially during pregnancy).
• Medication, chemotherapy.
• Bad habits – smoking and frequent drinking.

Pathology can also occur against the background of major diseases of the body. For example, disruption of the gastrointestinal tract, neuralgia, fever, diabetes, bronchial asthma, anemia.

Risk of infection

If you consult a doctor immediately after detecting the first signs of the disease, the treatment of stomatitis will be quick and painless. A non-contagious form of the disease is inflammation in the oral cavity caused by an allergic reaction, mechanical injury or due to intoxication.

The infectious, fungal and herpetic form of the disease is transmitted by contact. In the case of children, these can be toys, dishes, personal hygiene items. The type of pathology and the danger of infection can only be determined by a doctor upon examination.

Symptoms

How to recognize the disease? It all starts with a slight reddening of the mucous membrane. Further, redness turns into a painful neoplasm (ulcer). As a rule, it has a round or oval shallow shape. The ulcer is covered with a white, gray or yellow film, with smooth edges. In the advanced form, swelling, burning, bleeding of ulcers appear, the temperature rises.

The duration of the course of the disease is from 4-20 days, depending on the cause. An important point: if the patient once had stomatitis, the likelihood of recurrence is very high. Without treatment, stomatitis in adults often becomes chronic, and periodically worries the patient.

Classification

Various microorganisms are constantly present in the oral cavity: bacteria, fungus, etc. Normal salivation restrains pathogenic microflora, cleanses the teeth and soft tissues of the mucosa from destructive effects. If an imbalance of the microflora of the oral cavity appears, inflammatory processes develop under the influence of bacteria.

The type of stomatitis is determined by the cause of its occurrence. The most common form, bacterial, occurs due to the penetration of staphylococci and streptococci into the mucous membrane. Abscesses appear on the surface of soft tissues, which then open up and turn into wounds.

The radiation form is formed as a result of chemotherapy. It is characterized by compaction of soft tissues in the oral cavity, as well as the appearance of erosion. Chemical stomatitis is the body’s reaction to an acidic or alkaline environment. It looks like a burn, after the healing of which a scar forms.

The erosive form occurs due to the transferred concomitant diseases, with the appearance of erosion in the soft tissues of the oral cavity.

A type of viral pathology, herpetic stomatitis appears due to a herpes infection. It is characterized by voluminous rashes that are filled with a clear liquid. After opening, the “bubbles” turn into erosion. Similar neoplasms appear in the mouth with HIV infection.

Ulcer pathology

The most common reason for visiting a dentist is ulcerative or aphthous stomatitis. It is caused by the appearance of small ulcers in any area in the oral cavity. For effective treatment of stomatitis in this case, it is important to determine the form of the disease:

• Formation of ulcers with a white film due to impaired circulation in the oral mucosa (fibrinous). Healing of aft occurs within 1-2 weeks.
• The appearance of erosion due to the death of the soft tissues of the oral cavity (necrotic). Occurs rarely.
• The appearance of ulcers near the minor salivary glands due to reduced salivation (granular). Here, a scarring form may occur, due to the appearance of microcracks in the connective tissue of the excretory ducts of the glands.
• The occurrence of ulcers in case of damage, deformation of the lips and palate (deforming).

At a young age, aphthous stomatitis occurs as a result of reduced immunity and a lack of B vitamins. The main symptoms are ulcers with a yellow film, purulent processes, redness of the soft tissues around the aphthae.

Fungal stomatitis

While taking antibiotics to eliminate another disease, the patient may develop fungal or candidal stomatitis. The fungus of the same name against the background of weakened immunity contributes to the appearance of a large number of ulcers in the oral cavity, which are covered with a dense white coating. They are also called “curd spots”. After removal of plaque, erosions form on the surface of the mucosa. The healing of the pathology is quite long from 15 to 30 days.

The appearance of candidal stomatitis in children is due to the fact that the child often pulls everything into his mouth. So the fungus enters the mucous membrane through dirty hands, toys, street “snacks”, etc.

Ulcers in throat, tongue and lips

Stomatitis in the mouth can appear anywhere. Often the pathology occurs in the throat, on the lips, cheeks and tongue. Sore throats are not the most common occurrence. It occurs in no more than 20% of the population. It is characterized by the formation of gray or yellow aphthae on the upper, lower palate, tongue and throat. The duration of treatment is 1-2 weeks.

Another type of stomatitis, on the lip, often occurs on the inside of the lower lip, because. the skin in this area is thinner. Prerequisites for the development of the disease: burns of the mucous membrane, herpes, influenza, fungal stomatitis, chickenpox, measles. During pregnancy, it may appear due to hormonal changes in the body.

Symptoms are similar to the general ones: redness of the soft tissues of the oral cavity, the appearance of neoplasms filled with fluid or pus, ulcers. In severe form, ulcers begin to bleed.

Ulcers on the palate are formed mainly in babies due to poor hygiene. Or the infection is transmitted from an infected child by contact.

Aphthous stomatitis on the gums develops in the early stages. There is excessive dryness in the mouth. After a couple of days, a white coating appears, which gradually affects the entire mucous membrane: the inner surface of the cheeks, lips, and also the tongue. Cracks may form at the corners of the mouth.

Stomatitis in the tongue appears against the background of reduced immunity, chronic stress and genetic predisposition. Treatment of stomatitis in the tongue is carried out with medication.

Therapy

To eliminate the pathology, it is important to determine its form and cause. At the first stage, the doctor conducts a thorough examination of the oral cavity. All types of stomatitis are treated comprehensively, with dental procedures, plus restorative therapy at home. The set of measures includes taking pills, rinsing the mouth with antiseptics, using dental ointments and gels. If the patient has severe pain, the doctor prescribes painkillers.

The bacterial form in the early stage can be cured at home, strictly following the doctor’s instructions. In this case, it is necessary to follow a diet, exclude excessively acidic, spicy and salty foods from the diet. It is also important to avoid temperature fluctuations.

Treatment of candidiasis stomatitis includes taking antifungal drugs. For example, Clotrimazole, Nystatin, Levorin. The affected areas of the mucous membrane should be treated with wound healing ointments and gels. The name of the drugs and the dosage are determined by the dentist, based on the diagnosis. Independent attempts to eliminate stomatitis in the mouth can lead to serious health complications.

Aft healing

Treatment of the ulcerative form depends on the degree of damage to the soft tissues of the oral cavity. Therapy for aphthous stomatitis is carried out in stages:

• Cleaning aphthae, rinsing the mouth with an antiseptic solution (as recommended by a doctor).
• Intravenous injections of sodium thiosulfate may be given to detoxify the body.
• Taking multivitamins, antihistamines. If necessary, anesthetics.

Due to the fact that the aphthous form develops against the background of systemic disorders in the body, it is important to eliminate the root cause of the disease. This will prevent a recurrence in the future.

Herpes stomatitis

As a rule, the herpes virus is found in the blood of most of the population. The disease is due to a weakened immune system. The viral form is characterized by the appearance of ulcers on the lip, tongue and under the tongue.

Often patients do not go to the doctor, and treat herpetic stomatitis on their own. This is due to the fact that there is practically no pain during the development of pathology.

Painful sensations arise already in a neglected form. Therefore, the initial stage of eliminating the disease is taking painkillers. To relieve inflammation, the dentist prescribes antiseptics (for external use): Solcoseryl, Cholisal, Karotolin and their analogues. For oral administration, drugs such as Acyclovir, Zovirax are used.

To prevent stomatitis on the tongue or lip from becoming chronic, the patient is shown vitamin therapy and taking immunostimulants.

Do not forget that viral stomatitis is contagious, so for the duration of treatment it is important to exclude any contact, use separate dishes and personal hygiene products.

Apparatus for the treatment of stomatitis

The cause of stomatitis in the mouth can be poor hygiene. In this case, professional teeth cleaning is recommended, which effectively and painlessly removes soft plaque and tartar. The procedure uses two methods:

• Ultrasonic treatment. Helps to get rid of even large dental deposits that provoke the development of gum disease.
• Treatment of the dentition with a directed flow of water and air, with an admixture of powder (AirFlow). Cleans soft plaque, brightens teeth to a natural shade.

Both methods are safe: they do not damage the enamel of the teeth and do not injure the soft tissues of the oral cavity.

To prevent diseases, it is enough to carry out a professional hygiene procedure once every six months.

Also, in order to eliminate pathogenic microflora, it is necessary to promptly sanitize the oral cavity: remove carious cavities, restore damaged teeth, and clean periodontal pockets from accumulation of bacteria.

Home therapy for stomatitis

Summarizing the above, the treatment of stomatitis at home includes:

• Taking antibiotics and antiviral drugs (for ulcerative and herpetic forms).
• Antihistamines (for the allergic form). For example, Tavegil, Suprastin and analogues.
• Antifungal drugs (for candidal form).

The general therapy for all types of stomatitis is the improvement of the body’s immune responses. As well as dietary adjustments. It is important to include in the diet more fresh vegetables, fruits, herbs, nuts.

As folk recipes, the use of herbal decoctions for rinsing the mouth is effective: chamomile, calendula, St. John’s wort, sage. Rose hips, cranberries, sea kale, walnuts, ginseng are natural immunostimulants.

At the time of rehabilitation therapy, it is important to stop smoking, alcohol, eating sweet and excessively hard foods (crackers, seeds, chips).

Do not forget that the treatment of stomatitis at home is prescribed by a doctor after a thorough examination and diagnosis.

Complications after stomatitis

With strict adherence to the doctor’s recommendations, the disease is not dangerous to the patient’s health. Problems begin if you do not seek dental care in time, or engage in therapy on your own. In this case, the pathology can become chronic.

Complications in the treatment of stomatitis in adults include bleeding gums, inflammation of the tonsils, loss of teeth (with the penetration of a secondary infection). In women, an untreated fungal form can cause the development of genital candidiasis. The most negative scenario is the spread of infection throughout the body. Therefore, qualified dental treatment is the only reasonable and quick way to get rid of the disease. Not advice from anonymous experts on online forums and social media.

Prevention of stomatitis

Practice shows that if preventive measures are followed, the development of stomatitis can be avoided. It is also important to remember that prevention is much cheaper than cure. And not only from the financial side. The main rule is regular oral hygiene and timely elimination of body diseases.

It is important to take care of your health, maintain immunity, take vitamin and mineral complexes in the off-season, play sports, do not overcool, and monitor nutrition.