22-Stomatitis.power point presentations.

Stomatitis ppt

2. Stomatitis
By:
Jay Aries T. Gianan, EMT-B, RM, RN, LPT, MAN
Assistant Professor II

3. Learning objectives:
•What is stomatitis?
•Causes
•Signs & symptoms
•Pathophysiology
•Complications
•How to manage stomatitis?

4. ANESTHETICS
G T
ULCER
U R G
T O I
EVITAMINS
N D G
I
V
A
Across
1.any agent that produces a local or general loss of
sensation, including pain
2.an open, painful sore.
3.group of substances that are needed for normal
cell function, growth, and development.
Down
1.a protein naturally found in some grains including
wheat, barley, and rye.
2.Aka “corticosteroids”, are anti-inflammatory
medicines used to treat a range of conditions.
3.Aka “gums”
1 2
1
2
3
3

5. What is Stomatitis?

6. Stomatitis
•Aka:
•“Canker sore”
•“Aphthous stomatitis”
•“Aphthous ulcers”
•“Mouth ulcers”
•inflammation of the oral mucosa
•small, painful ulcers that appear on
•inside of the lips, cheeks, or soft palate;
•on the floor of the mouth;
•on thegingivaof the teeth;
•onthe tongue

7. Risk factors
•Infectious agents
•Viruses
•Herpes simplex virus
•Fungi
•Candida albicans
•Damage from mechanical trauma
•jagged teeth, cheek biting, mouth breathing, stiff
toothbrush
•Excessive dryness of the mouth
•i.e. xerostomia
•mouth breathers, taking cancer or HIV drugs
•Irritants & toxic agents
•Mouthwashes, toothpastes, tobacco, &
chemotherapeutic agents.
•Hypersensitivity.
•stress, allergies, vitamin deficiencies, & viral infection
Risk factors
Infectious
Agents
Mechanical
trauma
Excessive
dryness in
mouth
Irritants
Hypersensit
ivity
Immunolog
ical factors

8. Causes
•Idiopathic & multifactorial
•Cell-mediated immune system
•Biting of tongue/cheek
•Vitamin deficiency
•Viral infection
•Digestion problem
•Hormonal changes
•Food allergies

9. Signs & symptoms
•Vary with the type of stomatitis:
•Acute herpetic stomatitis
•small, clear vesicles in single or multiple eruptions
•preceded by sore throat, headache, N/V, & malaise
•usually lasts about 1 week
•Candidiasis
•raised, white patches & ulcers
•Mechanical trauma
•Small lacerations or abrasions with bleeding or exudates
•Xerostomia
•cracked & parched lips, tongue, & oral mucosa
•may bleed, have ulceration or retract
•Chemical irritation
•generalized redness & edema
•edematous, easily bruised mucosa
•produces ulcerations with exudates
•Aphthous ulcers
•well-circumscribed lesions with white centers
•reddish rings around the periphery
•2 to 5 mm diameter

10. Signs & symptoms
•Burning mouth pain
•Extreme tenderness of the oral mucosa
•Malaise
•Lethargy
•Anorexia
•Irritability
•Fever
•Burning, pain, tingling
•herpetic stomatitis
•Bleeding & swollen gums
•papulovesicularulcers
•red, open sores on the oral mucosa
•Submaxillary lymphadenitis

11. Idiopathic
Biting of tongue/cheek
Vitamin deficiency
Viral infection
Digestion problem
Hormonal changes
Food allergies
Stomatitis
Destruction of the mucosal
epithelium
T cell-mediated immune
dysfunction
Alterations in several intercellular
mediators
Inflammatory process occur
Elevations in interferon gamma,
tumor necrosis factor-alpha, &
interleukins (IL)-2, IL-4 & IL-5
Stomatitis
Leading to
What really happen
?
Meningoencephalitis
Recurrent skin & mouth infections
Dissemination of infection
Teeth loss
Cracked, parched lips
Redness & edematous
Pain
Well-circumscribed lesions
Ulcerations with exudatesComplications
S/S

12. Complications
•Meningoencephalitis
•Recurrent skin & mouth infections
•Dissemination of the infection
•Teeth loss
•Dysphagia
•Sepsis
•in an immunocompromised patient
•Ocular or central nervous system
involvement
•herpetic stomatitis

13. What is Stomatitis?

14. Diagnostic assessment
•Clinical & laboratory testing
•Physical assessment
•Smear of ulcer exudate
•identifies the causative organisms
•complete blood count(CBC)
•hematinic deficiency such as iron, folate, or vitamin
B12.
•serum anti-endomysium antibody &
transglutaminase assay
•Gluten-sensitive enteropathy (celiac disease)
•HIV testing
•persistent herpetiformor major aphthousstomatitis
•Viral cultures
•identify the virus
•Tzancksmear
•identifies multinucleated giant cells of herpetic
stomatitis.

15. Nursing Diagnosis
•Acute pain
•Impaired Oral Mucous Membranes
•Imbalanced nutrition: Less than
body requirements
•Ineffective health maintenance
•Anxiety
•Risk for infection
•Knowledge deficit

16. Nursing Intervention
•Maintain integrity of the oral mucosa
•every after meals
•brush & floss his teeth
•soft-bristled toothbrush
•must be free of sodium lauryl
•massage his gums several times daily
•use gauze or a sponge toothette
•when pain prevents the use of a toothbrush.
•Rinse the mouth q2-3h
•water, saline, or a dilute solution of
hydrogen peroxide
•instead of toothpaste or mouthwash
•sodium bicarbonate
•baking soda solution

17. Nursing Intervention
•Remove dentures
•For severe stomatitis or oral pain
•Administer medications
•antifungal agent
•topical or systemic analgesics
•monitor it’s effectiveness

18. Diet
•Adequate food & fluid intake
•lukewarm, ice or cold fluids
•minimize discomfort
•Soft, pureed, bland or liquid, as
tolerated
•assist the patient
•selecting soft, blend, & nonacid foods
•include:
•high in protein & vitamin C
•to promote healing
•scrambled eggs, bananas, custards,
pudding, ice cream
•avoid:
•hard, spicy, salty & acidic foods/fluids

19. •Supplements
•iron, zinc, or vitamins B1, B2, B6,
B12, or C
•Gluten-free diet
•for those with celiac disease.
Diet

20. Treatment
•major or minor Aphthous stomatitis
•1
st
line treatment
•topical steroids in gel or emollient paste
•2% viscous lidocaine
•Orabase
•to shorten the duration
•one-time local steroid injection
•Triamcinolone
•Liquid diphenhydramine
•For swelling
•severe refractory or persistent cases
•systemic steroids
•dexamethasone or prednisone

21. Treatment
•Topical agents
•local anesthetics
•benzocaine
•coating or occlusive agents
•bismuth subsalicylate
•Sucralfate
•2-octyl cyanoacrylate
•various bio-adherent emollient pastes
•Antiseptics
•Clobetasol
•Dexamethasone
•Fluocinonide, & triamcinolone

22. •Amlexanox& metalloprotease
inhibitors
•antimicrobials
•tetracycline, doxycycline, minocycline
•Honey
•Immunosuppressants
•For severe aphthousstomatitis
•esp. unresponsive to other therapies
•immunomodulatory agents
•amlexanox, colchicine,
•cyclosporine, cyclophosphamide,
dapsone, methotrexate,
•montelukast, thalidomide, or retinoids
Treatment

23. •Coating agents
•Attapulgite
•to protect the natural mucosal
barrier
•For recurrent Aphthous ulcers
•Topical 0.2% hyaluronic acid
•If condition is severe
•IVF as ordered
Treatment

24. Surgery
•Chemical cautery
•with silver nitrate or sulfuric acid

26. Question:
•For a client with stomatitis
resulting from chemotherapyfor
leukemia, the care planshould
includewhich intervention:
a.inspect the mouth every week
for fungus
b.encourage foods with neutral or
cool temperatures
c.give the client spicy foods to
d.perform frequent oral hygiene a
commercial alcohol-based
mouthwash

27. Question:
•Which of the following
interventionsis most appropriate
for a client with stomatitis?
a.Drinking hot tea at frequent
intervals
b.Gargling with antiseptic wash
c.Electric toothbrush
d.Eating a soft bland diet

28. Question:
•A 35 y/o pt. has been receiving
chemotherapyto treat cancer.
Which assessment finding
suggeststhat the client has
developed stomatitis?
a.White, cottage cheese-like
patches on the tongue
b.Yellow tooth discoloration
c.Red, open sores on the oral
mucosa
d.Rust-colored sputum