1. Stomatitis
   

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   • This refers to generalized inflammation of the oral mucosa

   • A variety of lesion types may be seen including vesicobullous lesions (VB) and ulcers (U).

   • Some agents e.g. Candida sp. produce characteristic lesions.

   
   

CAUSES OF STOMATITIS

• Candidiasis

• Usually attributable to infection with C. albicans but other species can be causative

• Risk factors include immunosuppression, altered oral microflora (e.g. broad-spectrum antibiotics), denture use and endocrine disorders e.g. poorly controlled diabetes mellitus

• There are numerous manifestations of oral candidiasis and some of the main ones are outlined:

Thrush: “pseudomembranous candidiasis”—loosely adherent white pseudomembrane (fungi,

inflammatory cells, debris, fibrin and bacteria) overlies inflamed mucosa

Angular stomatitis: infection in deep grooves of the lips

Candidal leukoplakia: tightly adherent membrane—?associated with heavy cigarette smoking

Chronic mucocutaneous candidiasis: skin, nails and other mucous membranes involved; many variants including familial, sporadic and those assoc. with various endocrine and chronic disorders

• Vincent’s disease (Acute necrotizing ulcerative gingivitis)

• Incompletely understood but factors such as emotional stress and smoking may suppress immune system and predispose to infection by commensal organisms such as Bacteroides sp.

• Characterized by gingival necrosis, ulceration and pseudomembrane formation

• Aphthous stomatitis ( Recurrent aphthous ulcers)

• Condition characterized by recurrent shallow ulcers (aphthae); may be single or multiple

• 10 to 20% of individuals affected—the most common disease of the oral mucosa; women>men; 10 to 30 yr.

• Seen in healthy people; occasionally assoc. with certain diseases e.g. Crohn’s

• Cause still unknown—? Trauma/stress/food products/nutritional deficiency/hormones

• Aphthae last 1 to 3 weeks, subsequent episodes vary in frequency and the condition eventually spontaneously disappears in most people

Acquired immunodeficiency syndrome

• Oral lesions are prominent, often early features in HIV-related diseases

• Refractory candidiasis e.g. thrush is often the first manifestation

• Specific oral lesion of HIV is hairy leukoplakia—bilateral, soft, white, hairy excrescences on the lateral margins of the tongue: squamous hyperplasia that appears to be induced by EBV ? in assoc. with Candida or HPV.

Oral Manifestations of AIDS

Pharyngitis

• Very common condition; seen especially in children and caused mainly by viruses

• Approx. 15 to 20% of all pharyngeal infections are caused by beta-hemolytic streptococci—children between 5 and 15 years of age are most susceptible

• Important complications of beta-hemolytic strep pharyngitis are rheumatic fever and poststreptococcal glomerulonephritis

• Other forms of bacterial pharyngitis include diphtheria (pharynx and tonsils covered by adherent membrane) and gonorrhea (lesions often ulcerative)

• Noninfectious causes of pharyngitis include allergies, pollutants and smoking

Tonsillitis

• Seen also predominantly in children and causative agents similar to pharyngitis

• The inflamed tonsils are usually covered by a yellow-white exudate

• The adenoids may also be affected and associated hyperplasia of these organs may cause blockage of the eustachian tube and otitis media

• Inadequately treated tonsillitis may result in tonsillar ulceration and peritonsillar abscess

Category: Pathology Notes