Stomatitis and Unani Treatment

Oral inflammation and ulcers, known as stomatitis, may be mild and localized or severe and widespread. They are invariably painful. Stomatitis may involve swelling and redness of the oral mucosa or discrete, painful ulcers (single or multiple). Less commonly, whitish lesions form, and, rarely, the mouth appears normal (burning mouth syndrome) despite significant symptoms. Symptoms hinder eating, sometimes leading to dehydration and malnutrition. Secondary infection occasionally occurs. Some conditions are recurrent. Stomatitis may be caused by local infection, systemic disease, a physical or chemical irritant, or an allergic reaction. many cases are idiopathic. Because the normal flow of saliva protects the mucosa against many insults, xerostomia predisposes the mouth to stomatitis of any cause. The most common specific causes overall include

• Recurrent aphthous stomatitis (RAS)—also called recurrent aphthous ulcers (RAU)
• Viral infections, particularly herpes simplex and herpes zoster
• Other infectious agents (Candida albicans and bacteria)
• Trauma
• Tobacco
• Chemotherapy and radiation therapy
• Some causes usually also have extraoral, cutaneous findings.
•  Cutaneous bullae suggest SJS, pemphigus vulgaris, or bullous pemphigoid
• Prodrome of malaise, fever, conjunctivitis, and generalized macular target lesions suggests SJS. Pemphigus vulgaris starts with oral lesions, then progresses to flaccid cutaneous bullae. Bullous pemphigoid has tense bullae on normal-appearing skin. Nikolsky's sign is usually positive in SJS and pemphigus vulgaris.
• Cutaneous vesicles are typical with chickenpox or herpes zost
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• Unilateral lesions in a band after a dermatome suggest herpes zoster. Diffuse, scattered vesicular and pustular lesions in different stages suggest chickenpox.
• Kawasaki disease usually has a macular rash, desquamation of hands and feet, and conjunctivitis; it occurs in children, usually those < 5 yr. Oral findings include erythema of the lips and oral mucosa.
• Other cutaneous lesions may implicate erythema multiforme, hand-foot-and-mouth disease (from coxsackievirus), or secondary syphilis.
• Some causes have isolated oral findings, including RAS, most viral infections, acute necrotizing ulcerative gingivitis, primary syphilis, gonorrhea, and Candida.
• Location of oral lesions may help identify the cause. Interdental ulcers occur with primary herpes simplex or acute necrotizing ulcerative gingivitis. Lesions on keratinized surfaces suggest herpes simplex, RAS, or physical injury. Physical injury typically has an irregular appearance and occurs near projections of teeth, dental appliances, or where biting can injure the mucosa. An aspirin burn next to a tooth and pizza burn on the palate are common.
• Primary herpes simplex infection causes multiple vesicular lesions on the intraoral mucosa on both keratinized and nonkeratinized surfaces and always includes the gingiva. These lesions rapidly ulcerate. Clinical manifestation occurs most often in children. Subsequent reactivations (secondary herpes simplex, cold sore) usually appear starting in puberty on the lip at the vermilion border and, rarely, on the hard palate.
• Acute necrotizing ulcerative gingivitis causes severe inflammation and punched-out ulcers on the dental papillae and marginal gingivae. A severe variant called noma (gangrenous stomatitis) can cause full-thickness tissue destruction (sometimes involving the lips or cheek), typically in a debilitated patient. It begins as a gingival, buccal, or palatal (midline lethal granuloma) ulcer that becomes necrotic and spreads rapidly. Tissue sloughing may occur.
• Isolated oral gonorrhea very rarely causes burning ulcers and erythema of the gingiva and tongue, as well as the more common pharyngitis. Primary syphilis chancres may appear in the mouth. Tertiary syphilis may cause oral gummas or a generalized glossitis and mucosal atrophy. The site of a gumma is the only time that squamous cell carcinoma develops on the dorsum of the tongue. A common sign of HIV becoming AIDS is hairy leukoplakia (vertical white lines on the lateral border of the tongue).
• C. albicans and related species, which are normal oral flora, can overgrow in people who have taken antibiotics or corticosteroids or who are immunocompromised, such as patients with AIDS. C. albicans can cause whitish, cheesy plaques that leave erosions when wiped off. Sometimes only flat, erythematous areas appear (erosive form ofCandida).
• Testing:Patients with acute stomatitis and no symptoms, signs, or risk factors for systemic illness probably require no testing.
• If stomatitis is recurrent, viral and bacterial cultures, CBC, serum iron, ferritin, vitamin B12, folate, zinc, and endomysial antibody (for sprue) are done. Biopsy at the periphery of normal and abnormal tissue can be done for persistent lesions that do not have an obvious etiology.
• Systematically eliminating foods from the diet can be useful, as can changing brands of toothpaste, chewing gum, or mouthwash.

Diagnosis:  Diagnosis is based on appearance and on exclusion, because there are no definitive histologic features or laboratory tests.
Primary oral herpes simplex may mimic RAS but usually occurs in younger children, always involves the gingiva and may affect any keratinized mucosa (hard palate, attached gingiva, dorsum of tongue), and is associated with systemic symptoms. Viral culture can be done to identify herpes simplex. Recurrent herpetic lesions are usually unilateral.
Similar recurrent episodes can occur with Behçet's syndrome, inflammatory bowel disease, sprue, HIV infection, and nutritional deficiencies; these conditions generally have systemic symptoms and signs. Isolated recurrent oral ulcers can occur with herpes infection, HIV, and, rarely, nutritional deficiency. Viral testing and serum hematologic tests can identify these conditions.
Drug reactions may mimic RAS but are usually temporally related to ingestion. However, reactions to foods or dental products may be difficult to identify; sequential elimination may be necessary.
Unani Treatment:

1. Kath safaid, Dana eelaichi khurd, Kishneez khusk, Shab Yamani grind all in same quantity and sprinkle thispowder at ulcers.
2. Tabasheer, Gulnar, Kath safaid, Sandal safaid, Sandal surkh, Gul surkh, Gul sayoti, Posth Haleela zard, Asl alsoos muqassar, Dana eelaichi khurd each same in quantity and make powder, use this powder 6 gm twice a day along with Arq Zeera 50 ml.
3. Sharbat Neelofar 20 ml twice a day and Majoon Dabeedul ward 5gm at morning.
4. Qurs Tabasheer thrice a day and sharbath Amla 10 ml twice a day.
5. Gulkhand 10 gm at bed time.
6. Murmuki, Mazoo, kandar each same in quantity and make powder, sprinkle this powder at ulcers.