Ulcerative Stomatitis.
Synonyms:—Fetid stomatitis; putrid sore mouth; stomatitis ulcerosa.
Definition:—An inflammation of the mucous membranes of the mouth, specific and ulcerative in character, with an inclination for the ulceration to spread widely, and accompanied with extreme fetor of the breath.
Etiology:—The disease is undoubtedly of microbic origin, as it is plainly infectious in character, and occurs occasionally in epidemic form. The specific microbe, however, has not, as yet, been isolated. It occurs during dentition in children up to six or eight years of age, especially those uncared for and of unhygienic environment. It is not uncommon also among adults of bad habits who are careless of the mouth and teeth, especially those associated together in an unhealthy condition, as those occupying poor-houses and jails, and soldiers in barracks. Children in asylums or "homes" are apt to be attacked in numbers. It also follows the specific infectious fevers, and scurvy. Those employed where lead is used and in the manufacture of phosphorus are especially liable to attacks. This condition is more apt to appear as precursory of other severe or protracted disease, when the patient has become greatly debilitated, the system devitalized and the blood impoverished.
Symptomatology:—There is usually a mild fever at the onset, with a slightly accelerated pulse, but this is often overlooked. There is marked loss of appetite, with some nausea, and occasionally vomiting, especially later, when the putrid ulceration is more deeply seated, when there is often also an offensive and somewhat intractable diarrhea.
There is local tenderness and swelling, which advances quite rapidly, the gums soon becoming very red and spongy, bleeding readily. There is a marked tendency for the gums to separate from the teeth and slough, leaving deep ulcers around the teeth, exposing the roots and loosening the teeth. In severe cases the inflammation may extend to the periosteum of the alveoli, and necrosis follow. The inflammation begins on the front of the gums and soon extends between the teeth, later involving the entire gums, the lining of the lips and cheeks. As the disease progresses the tongue becomes dark red, swollen, pits easily, and is tender, and the salivary glands are swollen. There is a profuse flow of saliva and a characteristic fetid odor occurs quite early. Mastication of food is often impossible, because of the soreness and pain.
The disease is at first acute in character, and extremely debilitating to the patient, and unless at once controlled, tends to become chronic.
Diagnosis:—The cachectic appearance of the patient, the fetid breath and the salivation will at once locate the disease, almost before the mouth is examined. The appearance of the gums, soft and spongy; the peculiar pultacious exudate at the location of an ulcer; the characteristic dirty, ragged, deep ulceration, all unmistakably confirm the character of the disease.
Prognosis:—Specific treatment should allay the aggravating symptoms at once, although the disease is persistent in character, and with careless treatment often intractable and of long duration.
When the disease progresses to necrosis, deformity may follow. In greatly prolonged cases the debility becomes very great, with impoverishment of the blood, and from these causes death has resulted, although a fatal termination from this disease is rare.
Treatment:—This disease permits of no temporizing in the treatment. It must be treated positively and specifically from the start, and for that purpose it must at once be recognized. A simple, palliative, expectant course will permit the disease to become deeply seated, and constitutional infection and debility will become marked and difficult to overcome. The patient should be isolated and kept scrupulously clean. The fever should be met with aconite in small doses, and with this, phytolacca in drop doses, and echinacea in from three to ten drop doses should be given every hour at first. Subsequently, when the temperature becomes normal, the aconite should be omitted, and the other remedies continued, with hydrastis canadensis every two hours. This is important treatment. Locally, a wash should be prepared, of the chlorate of potassium one dram, tincture of myrrh two drams, and after first thoroughly cleansing the month with hydrogen peroxid, this should be used freely. There are some cases in which from the tendency to the formation of an exudate the use of dilute sulphurous acid will be of the utmost importance in the thorough destruction of such formation. To counteract the tendency to a breaking down of the tissues, or when that condition has occurred, the occasional direct application of echinacea of full strength, or the frequent washing of the mouth with a solution of echinacea three drams, thuja one dram, distilled extract of hamamelis one-half ounce, water two ounces, will be of marked benefit.
Other tonic astringent washes will be found of service. I have obtained excellent results from the crude infusion of alnus, quercus and rumex, named in aphthous stomatitis. This is an unpalatable combination, and hence not frequently prescribed. I have combined quercus alba, pinus canadensis and boric acid with fine results. To this hydrastis or potassium chlorate could be added.
The tonic and restorative treatment in these cases is of the utmost importance. The patient should have hydrastis in some form constantly, and to this nux vomica and iron should be added when indicated. The quinine bisulphatemay be added to these with benefit when there is much feebleness and necessity for quick restoration. The use of fluid extract of cola nut, fluid extract of the red cinchona bark, of each one ounce, in the elixir of hydrastis two ounces, a teaspoonful every two or three hours, will quickly restore the physical tone in this debility, as it will in many cases of disease when the debility has increased rapidly from the first. The use of cod liver oil and the hypophosphites is important where there is cachexia.
