I. Overview of the Disease
y Stomatitis is the inflammation of the mouth. It may be of infectious origin or a symptom of systemic disease; it may be caused by mechanical or chemical trauma. y Jagged teeth, cheek biting, and mouth breathing may result in mechanical trauma. y Certain foods and drinks and sensitivity to mouthwashes and dentifrices may produce chemical trauma.

y The inflammatory sloughing of tissue allows

organisms to multiply. Thus, trauma may lead to infection by viruses, bacteria, yeasts, or molds. People who receive chemotherapy for cancer frequently develop severe, very painful stomatitis.
y described an inflammation of the mucous membranes

of the mouth
y condition referred to as mucositis y it is usually a short-term condition, lasting from just a

few days to a few weeks

Aphthous Stomatitis 
also known as recurrent aphthous ulcers or

canker sores, is a type of stomatitis that presents with shallow, painful ulcers that are usually located on the lips, cheeks, gums, or roof or floor of the mouth. 
this ulcers can range from pinpoint size to

up to 1 in (2.5 cm) or more in diameters.

STOMATITIS .

.Herpes Stomatitis can occur anywhere between six months and five years of age but it is most common in children one to two years old who have not been exposed to the herpes virus before.

B12 Deficiencies) y Excessive drinking of alcohol y Excessive use of tobacco .Causes: y Treatments (chemotherapy or radiation therapy) y Poorly fitted and appliances (denture) y Cheek biting y Hot and spicy foods y Disease (herpetic infection) y Poor oral hygiene y Nutritional Deficiencies (Vit.

y Lips. y Uvula. protects its anterior opening. is a fleshy fingerlike projection of the soft palate. . form its lateral walls. forms its posterior roof. Hard palate.Anatomy and Physiology Mouth (oral Cavity) y a mucous membrane. y Cheeks. Soft palate. which extends downwards from its posterior edge. forms its anterior roof. lined cavity.

. y Lingual tonsils. paired masses of lymphatic tissue. covers the base of tongue just beyond. secures the tongue to the floor of the mouth and limits its posterior movement. Oral Cavity proper. a fold of mucus membrane. y Lingual frenulum. occupies the floor of the mouth. y Palatine tonsils. y Tongue. space between the lips and cheeks externally and the teeth and gums internally.y Vestibule. area contained by the teeth.

y Oral mucosa is the mucous membrane epithelium of the mouth.y The important function of tonsils is. making swallowing difficult and painful. they partially block the entrance into the throat. . are part of the body¶s defense system. When the tonsils become inflamed and enlarged. along with other lymphatic tissues.

II. mucus membrane) Ulceration occurs if not detected or treated Irritation to the Mucous membrane Stomatitis . Pathophysiology RISK FACTORS: Treatments (Chemotherapy and radiation therapy) excessive alcohol intake excessive tobacco use hot and spicy foods cheek biting poor oral hygiene ill fitted oral appliances nutritional deficiency Inflammation occurs Kills rapid growing cells (esp.

daily foods intake. and the need to wear dentures. frequency of dental visits. discomfort caused by certain foods. Assessment A. awareness of any lesions or irritated areas in sputum. Nursing History 1. 2. . The history addresses the patient¶s normal brushing and flossing routine.III. use of alcohol and tobacco. Obtaining a health history allows the nurse to determine the patient¶s learning needs concerning preventive oral hygiene and to identify symptoms requiring medical evaluation.

A careful physical assessment follows the health history. Gloves are worn to palpate the tongue and abnormalities. the examination can be accomplished by using a bright light source (penlight) and tongue depressors. In general.3. Dentures are partial plates are removed to ensure a thorough inspection of the mouth. Both the internal and the external structures of the mouth and throat are inspected and palpated. .

Risk factors: Side effects of prescribed drugs Tobacco use Alcohol abuse Exposure to radiation. mercury. heavy metals Trauma from cheek biting. or illfitting orthodontia Sensitivity to toothpaste. lead. food dyes. mouth breathing. acids. mouthwash. preservatives and spices .

Physical Assessment .B.

The hard palate is examined for color and shape. a tongue blade is then inserted to expose the buccal mucosa for an assessment of color and lesions. and the presence of ulcerations and fissures. color. Gums Inspection Tongue Inspection . The odor of the breath is also rated. and symmetric.Parts to be assessed Technique to be used Purpose Lips Inspection Examine the lips for moisture. pink. retraction. The lips should be moist. and discoloration. A thin white coat and large. This provides the examiner with an opportunity to estimate the tongue¶s size as well as it¶s symmetry and strength (it assess the 12th cranial nerve ± hypoglossal). texture. bleeding. smooth. The gums are inspected for inflammation. color and lesions. hydration. The patient is instructed to open the mouth wide. vallate papillae in a ³V´ formation on the distal portion of the dorsum of the tongue are normal findings. The patient is instructed to protrude the tongue and move it laterally. The dorsum of the tongue is inspected for texture. symmetry.

yAny lesions of the mucosa or any abnormalities involving the frenulum or superficial veins in the undersurface of the tongue are assessed for location. which presents as a white or red plaque. color and pain. or a wary growth. . size.yFurther inspection of the ventral surface of the tongue and the floor of the mouth is accomplished by asking the patient to touch the roof of the mouth with the tip of the tongue. an indurate ulcer. yThis is a common area foe oral cancer.

and say ³ah´. Often this flattens the posterior tongue and briefly allows a full view posterior pharynx.y A tongue blade is used to depress the tongue for adequate visualization of the pharynx. It is pressed firmly beyond the midpoint of the tongue. . open the mouth wide. proper placement avoids a gagging response. y The patient is told to tip the head back. take a deep breath.

and immunosuppressed conditions resulting from medication therapy or AIDS may be manifested by changes in the oral cavity. such as cancer. These structures are inspected for color. including stomatitis. diabetes. . or enlargement. symmetry and evidence of exudates. this indicates an intact in vagus nerve-10th CN. ulcerations. Normally the uvula and soft palate rise symmetrically with a deep inspiration or ³ah´.  A complete assessment of the oral cavity is essential because many disorders.

Physical Examination Signs and symptoms:  Mouth ulcers or sores  Pain in mouth  Sensitivity to spicy foods  Reddened mucus membrane  Dry or swollen tongue  Difficulty swallowing  Inability to eat or drinks .

Herpes Stomatitis  Fever (38.3-40 c). often on the tongue or cheeks or roof of the mouth. which the pop and form ulcers Swollen gums Pain in the mouth Drooling Difficulty swallowing Foul-smelling breath . which may precede the        appearance of blisters and ulcers by one or two days Irritability and restlessness Blisters in mouth.

Aphthous Stomatitis  Burning or tingling sensation in the mouth prior to the onset of other symptoms  Skin lesions on the mucous membranes of the mouth. which begins as a red spot or bump. which is usually small (one to two mm to one cm in diameter) . then develop into an open ulcer.

Clinical Manifestations: y Allergy.Shiny erythema with slight edema. burning y Thrush-White. raised. diminished taste.curd patches. swelling. drying. fever. bleeding. itching. . bleeding of gums. milk. dryness of the mouth. lymphadenopathy gum retraction from teeth y Gingivitis-Redness. pain.

pseudomembrane on ulcers . bleeding gums. and inability to eat. increased salivation. difficulty talking and swallowing.Small. inflamed gums. yellowish.y Herpetic-Ulcers 3-4 cm in diameter scattered over mucous membranes. painful sores with red. fetid breath. enlarged lymph nodes y Canker sores. swollen. raised margins that often appear singly or in groups on the lips or in the corner of the mouth y Necrotizing-Necrotic ulceration of mucous membranes with severe pain. hardened.

C. Diagnostic/Laboratory Test .

Blood tests  May be done to determine if any infection is present .

Cultures  May be done to determine if an infectious agent may be the cause of the problem .

Medical and Surgical Management .IV.

Medical Management ‡Topical anesthetics for pain ‡Intravenous fluid ‡Viscous lidocaine or topical anesthetics.medicines that numb the mouth ‡Topical or systemic corticosteroids or acyclovir for herpetic lesions .

y Topical or oral tetracycline .Pharmacological management y Acetaminophen-for fever over 101 F (38.3 C) and to address pain y Antibiotics (antiviral) ± acyclovir. penciclovir.

it is not an anti inflammatory agent. Take the drug only for complaints indicated.Generic/ Brand name Classification Mechanism of Action Nursing Responsibilities Acetaminophen Analgesic and antipyretic medications Antipyretic: reduces fever by acting directly on the hypothalamic regulating center to cause vasodilation and sweating which helps dissipates the heat. Discontinue drug if hypersensitivity occur. .

Generic/ Brand name Classification Mechanism of Action Nursing Responsibilities Acyclovir Anti viral medications Anti viral activity. . rash. disease but should make you feel better and this drug may cause burning. notify to the health care provider if this are pronounce. itching. Oral acyclovir is inhibits viral DNA not a cure for your replication.

. Administer oral medication on an empty stomach.Generic/ Brand name Classification Mechanism of Action Nursing Responsibilities Oral Tetracycline Antibiotics and tetracycline Bacteriostatic: Inhibits protein synthesis of susceptible bacteria. Preventing cell replication. 1 hour before or 2-3 hours after meals.

V. Nursing Management .

1. . half strength hydrogen peroxide. or normal saline solution. If a patient cannot tolerate brushing or flossing.Promoting mouth care The nurse instructs the patient in the importance and techniques of preventive mouth care. an irritating solution of 1 type of baking soda to 8 oz of warm water.

 The nurse reinforces the need to perform oral care and provides such care to patients who cannot provide it for themselves.  If a bacterial or fungal infection is present. the nurse administers the medication at home  The nurse must monitor the patients physical and psychological response to treatment .

as well as alcohol and tobacco Encourage the patient to increase fluid intake . bulky and irritating foods and fluids.Advise the patients to avoid dry.

2.Ensuring adequate food and fluid intake  The patients weight age and level of activity are recorded to determine whether nutritional intake is adequate  A daily calories count may be necessary to determine the exact quantity of food and fluid ingested .

The frequency and pattern of eating are recorded to determine whether any psychosocial or physiological factors are affecting ingestion The goal is to help the patient attain maintain desirable body weight and level of energy. as well as to promote the healing of tissue .

Using a soft tooth brush may prevent secondary trauma It may be necessary to provide the patient with an analgesics such as viscous lidocaine or opiods as prescribed Topical medication such as sucralfate and aluminum magnesium liquid antacids may provide reliefs The nurse can reduce the patients fear of pain . hot or hard  A soft or liquid diet may be preferred  The patient is instructed about mouth care. Minimizing pain and comfort  providing information about pain control methods Strategies to reduce pain and discomfort include avoiding foods that are spicy.3.

4. Preventing Infection  Laboratory results should be evaluated frequently and the patients temperature checked every 4 to 8 hours or an elevation that may indicate infection  Visitors who might transmits microorganisms are prohibited if the patients immunologic system is depressed .

drainage. tenderness) are reported to the physician . swelling. Sensitive skin tissues are protected from trauma to maintain skin integrity and prevent infection  Aseptic technique is necessary when changing dressings  Signs of wound infection (redness.

 Check for oral burning.  Do oral exam noting evidence of lesions within the mouth and tongue. .  Cottage  Cheese  Buttermilk  Yogurt  Obtain history of radiation or chemotherapy regimen. pain. or change in tolerance to temperature.Nutritional Concepts  Some physician may be recommended a variety of dietary measures to treat stomatitis.

citrus fruit juices.Health Teachings about:  avoid commercial mouth washes. spicy foods. crusty or rough foods  use straw to facilitate fluids bypassing inflammed lesions (if indicated)  use soft tooth brush or toothettes for oral care  check for proper fit of dentures . extremes in food temperature.

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