The following guide is about Stomatitis, Nursing Management of Stomatitis, Nursing Treatment for Stomatitis, Nursing Interventions for Stomatitis, and and 1 Stomatitis Nursing Intervention Template. It can be used to create nursing care plans for Stomatitis.
What is Stomatitis?
Stomatitis disease is an inflamed and sore inside of the cheeks, gums, tongue, lips, and palate. Stomatitis can severely affect speech; eating ability, nutrition, body image, sleep, and overall quality of life. Ulceration causes pain, bleeding, and infection. Stomatitis treatment includes oral hygiene, antiviral medication, topical or parental analgesia. Nurses play an important role in maintaining and restoring a healthy oral cavity through nursing interventions. The patient will report less discomfort in her mouth while eating or drinking and mucous membranes will be free from harmful plaque. The nurse will help to prevent secondary infection throughout the hospital stay.
Definition of Stomatitis
Stomatitis refers to inflammation of the mucous membrane of the mouth including the inside of the cheeks, gums, tongue, lips, and palate.
What are the Different Types of Stomatitis?
There are three types of stomatitis, those are-
- Kanker Sore (Aphthous Stomatitis),
- Cold Sore (Fever Blisters),
- Herpes Stomatitis.
These are discussed below:
1. Kanker Sore (Aphthous Stomatitis):
Kanker Sore (Aphthous Stomatitis) is a single pill or a cluster of small pits or ulcers in the mouth. Usually canker sore appears on the cheeks, tongue, or inside the lip.
2. Cold Sore (Fever Blisters):
Cold Sore (Fever Blisters) is filled with fluid that usually appears on the lip or around the lips.
More About Cold Sores
Cold sores are caused by the herpes simplex virus (HSV) and are sometimes called fever blisters. The painful sores can appear on the lips, chin, cheeks, inside the nostrils or inside the mouth. They are extremely common. More than half the population in the United States has cold sores from a herpes infection.
Cold sores last on average seven to 10 days before they heal, usually without treatment, and are extremely contagious. Once an individual has been infected with HSV they remain infected for life and cold sores will come and go. These individuals are especially likely to develop cold sores when their immune system is not functioning well.
When cold sores first appear they can feel itchy or tingly. This usually progresses to a fluid-filled sore which will eventually burst and ooze. After that, a yellow crust will form on top of the sore which will then scab and heal. People who get cold sores often get them in the exact same place repeatedly. The lower lip is the most common place to get them.
You should avoid kissing anyone while you have a cold sore, sharing Chapstick or drinks, or touching the cold sore to prevent the spread of the infection. If you touch your cold sore by accident, wash your hands with soap and water immediately.
3. Herpes Stomatitis:
Herpes Stomatitis is a viral infection of the mouth that causes sores and ulcers. Usually in age children between six months to five years aged. Herpes simplex1 (HSV1) virus is the cause of infection.
What are the Causes of Stomatitis?
Various types of causes for stomatitis are mentioned below:
- Bacteria/Virus (Herpes Simplex type-1).
- Nutritional deficiency (Vitamin B12, Folic acid, Iron, or Zinc).
- Sudden weight loss.
- Food sensitivities to potatoes, citrus, fruits, strawberries, chocolate, eggs, cheese, or nuts.
- Inflammatory bowel disease.
- HIV/ AIDS.
- Weak immune system.
- Hormonal changes.
- Stress and lack of sleep.
- Use of certain medications such as Chemotherapy, Diuretics, Anticholinergics, Antihistamines and decongestants, Steroids, Antidepressants.
- Allergic reaction.
- Accidental injury.
- Sharp tooth surface, dental braces, or retainers.
- Tobacco or irritating foods or chemicals.
What are the Signs and Symptoms of Stomatitis?
There are different types of sign and symptoms for stomatitis disease are mentioned below:
- Blister over gums, palate, cheek, tongue, or lip,
- The difficulty of eating, drinking, and swallowing,
- Drooling, pain and swelling,
- Red patches,
- Oral dysaesthesia,
- Burning mouth syndrome.
What are the Various Ways of Test and Diagnosis Systems for Stomatitis?
Various ways of test and diagnosis system for stomatitis disease are given in the following:
- Bacterial or viral swabs culture,
- Patch tests,
- Blood test.
Nursing Management of Stomatitis
Stomatitis associated with mTOR inhibitors such as everolimus is a very common adverse event, with an incidence of 44-78% in clinical trials. Although stomatitis is a common side effect caused by traditional cytotoxic chemotherapy and radiation, stomatitis associated with mTOR inhibitors presents differently and thus needs different management strategies. The oral lesions associated with everolimus-induced stomatitis have an underlying inflammatory mechanism and clinically resemble the common aphthous ulcer or canker sore rather than typical chemotherapy-induced mucositis.
Early recognition and initiation of treatment are key to reducing toxicity and thus keeping patients on treatment. The most effective trials investigating the management of everolimus-associated stomatitis invovle topical high-potency corticosteroids, such as dexamethasone 0.1mg/mL or clobetasol gel 0.05%.
Other management strategies include:
- avoid acidic, spicy, hard, and hot foods and liquids
- practice good oral hygiene, using a mild toothpaste
- avoid mouth washes containing alcohol, hydrogen peroxide, iodine or thyme (as this may exacerbate the condition)
- cleansing with baking soda rinses may also be helpful
- avoid “magic” mouth rinses with multiple ingredients that may be unnecessary, including antifungals, unless clear fungal infection identified
Additionally, stomatitis may require dose modifications based on severity:
- Grade 1: non-alcoholic mouth rise or salt water
- Grade 2: hold until grade 1, no dose change, if recurs at grade >2, hold again and then lower dose
- Grade 3: hold until grade < 1, then dose reduce
When to See a Healthcare Provider
You should see a healthcare provider if you have unexplained symptoms of stomatitis or symptoms that last longer than a week or two. You should also seek medical attention if you are having trouble eating and drinking and could be in danger of dehydration. Other reasons to see a healthcare provider may include white patches on the tongue or sores in the mouth accompanied by a high fever. Do not hesitate to contact a healthcare provider for worrisome symptoms.
Nursing Treatment for Stomatitis
What Treatment Options are Available for Stomatitis?
There are different types of treatment for stomatitis disease; those are mentioned below:
- Oral hygiene,
- Identify and treat the cause,
- Use antiviral drug acyclovir,
- Coating agents such as bismuth Salicylate, Sucralfate, or other Antacids,
- Topical Analgesics, such as Benzydamine Hydrochloride,
- In severe pain use Topical Anesthetics, such as Lidocaine viscous (might impair gag reflex for a short period),
- Oral or parenteral analgesics such as Tylenol or ibuprofen when not controlled by the above medication,
- Apply a paste of Triamcinolone,
- Water-soluble lubricants for mouth and lips,
- Rinse and expectorate after meals with Inj.Dexamethasone (0.5mg) / 5ml water.
- In nutritional deficiency is the cause of Stomatitis take folate (folic acid), vitamin B12.
Treatment of severe stomatitis sore may include-
- Aphthasol paste (Anti-inflammatory paste),
- Lidex gel,
- Peridex mouthwash.
Prevention of Stomatitis Disease:
Different types of prevention for stomatitis disease are given in the following:
- Wash hands frequently,
- Keep toys, brush clean and don’t share with others,
- Don’t share dishes, cups, or eating utensils,
- Don’t kiss the affected person.
Nursing Interventions for Stomatitis
What are the Nursing Interventions for Stomatitis?
There are various types of nursing interventions for stomatitis disease, those are mentioned below:
- Give cool, noncarbonated, non-acidic drinks, such as water, milkshakes, or diluted apple juice to the patient.
- Encourage the use of a straw to make swallowing easier.
- Provide a high in protein and vitamins containing diet to promote healing and new tissue growth.
- Serve frequent small meals or snacks spaced throughout the day to maintain fluid balance and nutrition.
- Offer cool, bland, easy-to-swallow foods such as frozen pops, ice cream, mashed potatoes, gelatine, or applesauce to the patient to avoid tissue trauma and pain.
- Encourage the client to suck on vitamin C or sugarless candy or chew sugarless gum to stimulate salivation.
- Encourage a fluid intake of at least 2500 ml/day unless contraindicated.
- Apply topical analgesia over the lesion 15 to 20 minutes before meals, or painted on each lesion immediately before mealtime.
- Give Acyclovir to the patient that fights the virus causing the infection.
- Give pain killer acetaminophen or ibuprofen for pain as order.
- Administer medications, which may include antifungal agents or topical or systemic analgesics.
- Give mouth care and gently brush teeth every day instruct and assist the client to perform oral hygiene using a soft bristle toothbrush or sponge-tipped swab.
- Discontinue flossing if it causes pain.
- Encourage the client to rinse mouth frequently with warm saline solution, baking soda, and water, or Chlorhexidine, Gluconate (Peridex) or mist oral cavity frequently using a spray bottle.
- Numbing medicine (Viscous Lidocaine) apply to a patient’s mouth to ease severe pain.
- Avoid the use of products that contain lemon and glycerine and mouthwashes containing alcohol.
- Lubricate the client’s lips frequently.
- If stomatitis is not severe, encourage the client to use artificial saliva to lubricate the oral mucous membrane.
- Make sure to get plenty of sleep and rests as much as possible.
- Encourage the client to chew on the ice during chemotherapy infusion, especially if receiving 5-fluorouracil.
- Avoid serve hot beverages, salty, spicy, and citrus-based foods and explain to the patient.
1 Stomatitis Nursing Intervention Template