Stomatitis Nursing Management

Definition
  • Stomatitis is the inflammation of the oral mucosa.
Risk Factors
Infectious agents
  • Viruses (e.g. herpes simplex virus, which causes acute herpetic stomatitis)
  • Fungi (e.g. Candida albicans, which causes candidiasis or thrush)
Damage from mechanical trauma
  • Irritation from jagged teeth, cheek biting, mouth breathing, use of a stiff toothbrush, can cause characteristic lesions.
Excessive dryness of the mouth (i.e. xerostomia)
  • is a common sequel of oral cancer in clients receiving psychopharmacologic agents, clients with human immunodeficiency virus infection and clients who are predominantly mouth breathers.
Irritants and toxic agents
  • That can produce stomatitis include strong mouthwashes or toothpastes, tobacco, and chemotherapeutic agents.
Hypersensitivity.
  • Causes of apthous ulcers, suspected predisposing factors include stress, allergies, vitamin deficiencies, and viral infection
Pathophysiology
  • Destruction of the inner mucosal layer of the oral cavity results in decreased lubrication of the mucosa and disruption of the protective layers. Any fluid or food in the oral cavity further irritates the mucosa and causes inflammation, resulting in pain.
Assessment/Clinical Manifestations/Signs and Symptoms
Vary with the type of stomatitis:

Acute herpetic stomatitis

  • Is marked by small, clear vesicles in single or multiple eruptions, commonly preceded by sore throat, headache, nausea, vomiting, and malaise. It usually lasts about 1 week.

Candidiasis.

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  • Produces characteristic raised, white patches and ulcers. The infection may spread to other areas of the GI tract, the skin, or the respiratory system.

Mechanical trauma.

  • Produces various manifestations. Small lacerations or abrasions with bleeding or exudates are common.

Xerostomia

  • Is marked by cracked and parched lips, tongue, and oral mucosa. The oral mucosa may bleed, have ulceration or retract.

Chemical irritation

  • Typically produces generalized redness and edema. Chemotherapy may cause edematous, easily bruised mucosa and possibly produces ulcerations with exudates.

Aphthous ulcers

  • Appear as well-circumscribed lesions with white centers and reddish rings around the periphery.
Nursing Management
Maintain integrity of the oral mucosa.
  • Instruct the client to brush and floss his teeth and massage his gums several times daily.
  • Advise the client to use gauze or a sponge toothette to clean the oral mucosa when pain prevents the use of a toothbrush.
  • Recommend the use of water, saline, or a dilute solution of hydrogen peroxide instead of toothpaste or mouthwash.
Promote adequate food and fluid intake.
  • Advise the client to eat a bland diet.
  • Suggest that the client consume lukewarm, or cold food and fluids, which may minimize discomfort and result in increased intake.
Administer medications, which may include antifungal agent, or topical or systemic analgesics.