DDX - Oral Ulceration - Mucositis, Stomatitis

Definition

Inflammation of mucous lining of any of the structures in the mouth, cheeks, lip, tongue, gingiva, and floor or roof of the mouth. 

Differential Diagnosis

• Infectious
• Hand-foot-mouth disease (coxsackie virus),  herpangina
  
• Scarlatina (scarlet fever)
  
• Reactive arthritis
  
• Noma (gangrenous stomatitis)
  
• Autoimmune 
• Recurrent aphthous stomatitis, may be associated with colitis, celiac
• Erythema multiforme/Stevens-Johnson syndrome
• Behçet disease 
• Pemphigus vulgaris
  
• Bullous pemphigoid
  
• Oral lichen planus
  
• Metabolic
• Angular stomatitis
• Uremic stomatitis
  
• Neoplastic
• Cyclic neutropenia
  
• Cancers of oral mucosa, for example, squamous carcinoma (90% of oral cancers)
• Other - unknown etiology
• Burning mouth syndrome
  
• Periodic Fever, Aphthous ulcers, Pharyngitis, and Adenopathy Syndrome (PFAPA)

Mouth Anatomy

Management

• Pain Control 
  
• Such on ice chips or ice pops 
• Magic Mouthwash -  2% viscous lidocaine, Benadryl, and Maalox
• Ibuprofen 
• Dietary Modifications 
• Eat moist or soft foods 
• Avoid foods that require a lot of chewing 
• Avoid acidic, spicy, salty, and hot foods 
• Oral Care
• rinse mouth 5-6 times per day
• brush teeth with soft tooth brush

Works Consulted

• 5-Minute Clinical Consult - Stomatitis
  
• JAMA - Mucositis (or Stomatitis)