Aphthous Stomatitis.
Synonyms:—Follicular stomatitis; fibrinous stomatitis; disseminated vesicular stomatitis; stomatitis aphthosa.
Definition:—That form of catarrhal stomatitis in which there appears upon the edges of the tongue, and upon the mucous membranes of the gums and the cheeks an eruption of white patches, which soon develop into vesicles. The bases of the vesicles become red and inflamed, and later small round or oval discrete ulcers appear.
Etiology:—This form of stomatitis occurs more frequently in children under five years of age, but is not uncommon in adult life. It occurs as a complication to persistent gastro-intestinal disorders, and the consequent malnutrition, especially during dentition. It also accompanies anemia, tuberculosis, and the acute infectious and ex-anthematous disorders. It is more common in the spring and summer. No specific parasite has been isolated, but the presence of decomposing and toxic remnants of food, with bacteria, are undoubtedly exciting causes.
Symptomatology:—There is a slight fever, with worry and fretfulness. Distress and pain are expressed upon attempting to take food, as there is an exquisite tenderness and soreness, and often a burning sensation of the mouth and tongue. The tongue is coated, there is usually a loss of appetite, and either diarrhea or constipation may be present.
There is an increased secretion of saliva, which constantly dribbles from the mouth, and the breath exhales a peculiar, though not necessarily an offensive, odor.
The appearance of the vesicles is somewhat characteristic. These soon rupture, and the aphthous ulcers immediately develop. They are found on the inside of the lips and on the edges of the gums, along the frenum, on the edges of the tongue, and on the inside of the cheeks. A single one only may at first develop, but soon many appear.
When the condition accompanies the specific eruptive or infectious fevers, the aphthae tend to coalesce and ultimately to form large irregular ulcers, which characterize the form known as confluent aphthous stomatitis. The ordinary course and duration of the disease occupies about seven days, but where the patients are neglected, or where malnutrition or marasmus are present, or where there are conspicuous blood changes or a dyscrasia, the course may be greatly prolonged.
Diagnosis:—This is determined by the characteristic appearance of the membranes and the herpetic vesicle, from which the ulcer soon develops. The location of the ulcers on the sides and edges of the tongue and along the frenum is important in diagnosis. The extreme soreness and tenderness are characteristic.
Prognosis:—If all conditions be taken into consideration, the disease should readily yield to treatment. In apparently intractable cases constitutional measures, for the correction of blood faults or disorders of the stomach or bowels, and for the general upbuilding of the patient, are of the utmost importance. There will be no recurrence of the disease if all factors are effectually considered in the treatment.
Treatment:—The first consideration in the treatment of this disorder is absolute cleanliness. This is of the utmost importance; not only cleanliness of the mouth should be demanded, but cleanliness of the patient and his clothes and surroundings. The use of aconite and phytolacca is required to overcome the fever and allay local and glandular irritation. The latter remedy should be continued when the fever has abated. The mouth should be thoroughly cleansed by the free use of a dilute solution of boric acid, and all foreign particles must be gently removed from the teeth.
Antiseptic precautions—thorough sterilization—should be observed with the bottle and nipples in bottle-fed babies, and no rubber tubes should be used. Where the ulcers are deep, hydrogen peroxid should be freely applied, and the cleansing solution again used. The use of a solution of one part of colorless hydrastis, two parts of distilled extract of hamamelis and three parts of water as a healing application is of service. This should be used every two hours. I have made an infusion of alnus rubra, quercus alba and rumex crispus, one ounce of each in about twenty-four ounces of water. For extreme intractable cases I have boiled this down to one pint; and have both thoroughly washed the mouth with it and have given it internally in teaspoonful doses four or five times daily. With this I have cured cases which were apparently intractable to all other measures. I have never obtained benefit from cauterizing ulcers. The use of the measures advised, and occasionally of thuja applied in full strength or diluted with one or two parts of water, will be found sufficient. Where it is desirable to stop the excessive secretion of saliva, atropin in 1/100 grain doses two or three times daily, will be sufficient. Where there is bluish discoloration of the tissues, baptisia will be of service, in conjunction with phytolacca, which is continued. Echinacea is of much value as an alterative if there is an unpleasant odor to the breath. It may be used to correct any dyscrasia present. Attention must be paid to the stomach and intestinal tract, and to the nervous system. Bland, non-irritating and easily digestible food only must be partaken of.
