Inflammation of the mouth results from many causes, but particularly from local infection by bacteria. It differs greatly in severity and is divided into catarrhal, ulcerative, mycotic, and gangrenous forms.

Catarrhal Stomatitis

This, the commonest form, results from the action of irritants, such as hot liquids, chemicals, tobacco, decaying teeth, or from a depressed condition of the general system. There is marked hyperemia with desquamation of the epithelium. In chronic cases there is frequently a thickening of the mucous membrane with the formation of whitish areas. The mucous glands may enlarge and form small cysts. Associated with the stomatitis there is an increased activity of the salivary glands.

Ulcerative Stomatitis

Ulcerative Stomatitis is usually found in children who are not well nourished. Occurs in malnutrition, tuberculosis, and in other chronic conditions, also in mineral poisonings, particularly by mercury and phosphorus. Is met with most commonly on the gums, although other parts may be involved. The gums become red and swollen and even hemorrhagic at the junction with the teeth. They become changed into a soft, necrotic mass that bleeds readily. The epithelium is destroyed and although the inflammation is usually superficial it may extend and give rise to periostitis, ostitis and even necrosis of the alveolar process. Suppuration may ensue and the teeth become so loosened that they fall out. The inflammatory process may extend to the cheek and the tongue. There is marked increase of saliva, which has a bad odor. Mercury in small doses may cause it in some people who are especially susceptible; is then known as salivation.

Fig. 147. - Spirocieeta Vincenti from Case of Ulcerative Stomatitis (X 1200) (Todd).

Mycotic Stomatitis

Mycotic Stomatitis is that which is directly due to micro-organismal infection. Of this variety the aphthous or follicular stomatitis is an example. It occurs usually in children who are in poor physical condition. On the mucous membranes of the mouth there appear small whitish spots surrounded by an inflammatory zone. These areas consist of degenerated epithelium and fibrin, and the condition is therefore sometimes spoken of as croupous stomatitis. Ulceration seldom occurs. The condition may last for some time, the exudate finally being absorbed and the epithelium regenerating.

Thrush

Thrush is that variety of mycotic stomatitis caused by the oïdium albicans which involves those structures covered by squamous epithelium. The tongue is most frequently involved primarily, but secondary infections through contact may develop. Usually occurs in marasmatic infants, but sometimes in debilitated adults. There is at first a diffuse reddening of the mucous membrane, then the formation of patches of a shining, whitish false membrane that adheres at first rather tightly to the underlying tissue, but finally becomes loose. The patches may coalesce, forming large areas of a pseudo-membrane that is composed of desquamated epithelium and parasitic threads. If the membrane is removed it soon reappears. The disease may spread from the tongue to the pharynx and esophagus, and it has been known to extend into the stomach and bronchi.

The Oidium Albicans

The OïDium Albicans is a budding fungus resembling the yeast and forms long mycelial. Can be cultivated upon acid media that contain sugar. Longer threads form when grown on an alkaline medium.

Gangrenous Stomatitis Or Noma

Gangrenous Stomatitis Or Noma is a rapid necrotic process involving the mucous membrane of the cheek. It occurs in children between two and twelve years of age whose general condition is extremely poor, either as the result of chronic or severe acute disease. Near the angle of the lip on the buccal surface there appears a livid area that rapidly becomes gangrenous. Penetration through to the skin may occur or the process may remain localized in the mucous membrane and underlying tissues. When the skin is involved vesicles are formed and the tissue soon breaks down into a foul-smelling mass. Death from exhaustion and secondary infection usually follows. The slough may separate and the patient recover, with usually marked deformity from the cicatrization. Although more common in female children, noma may occur in either sex and at any age. This process has been met with in the genital regions.

Syphilitic Stomatitis

Syphilitic Stomatitis may occur either as the primary chancre or, what is more common, as the secondary mucous patch. The primary form may appear on the lip, tongue, or tonsil in either a soft or an indurated form. Is accompanied by enlargement of the lymph-nodes. The mucous patches are superficial ulcers following cellular infiltration. Other secondary lesions may be present. The epithelium of the mucous membrane may become greatly thickened, leukoplakia, and eventually undergo malignant change. Gumma are also found either in the corners of the mouth or more commonly on the palate. Are generally small and prone to undergo softening with ulceration and subsequent cicatrization.

Tuberculosis

Tuberculosis may rarely be primary, but is usually secondary to infection from tuberculosis of the larynx or pharynx or by infected sputum. Usually involves the posterior portion of the tongue, where small nodular tubercles of a yellowish-red color appear. They soon degenerate and form ulcers with thickened edges. The lesions may very closely resemble epithelioma.

Actinomycosis

Actinomycosis may result from the infection of an abraded surface by the fungus. It generally gains entrance to the alveolar border of the jaw by way of carious teeth. The process is generally a slow one of swelling with destruction of the adjoining tissues. There may be quite widespread involvement of the lymphatic nodes of the neck and jaw.