THE MOUTH
Stomatitis.—The term stomatitis is applied to any inflammation of the buccal mucous membrane. The catarrhal form is often associated with the presence of carious teeth or an infected wound; the mucous membrane is hyperæmic and swollen, and exudes an excessive amount of viscid mucous secretion, and the epithelium desquamates in patches, leaving small superficial erosions or ulcers, which are very sensitive. The aphthous form, met with in unhealthy, underfed children, is characterised by the occurrence of patches of fibrinous exudate into the superficial layers of the mucous membrane; the epithelium is shed, leaving a series of whitish spots surrounded by a red hyperæmic zone, which may become confluent and form small ulcers. The condition known as thrush, which closely resembles aphthous stomatitis, is met with in infants during the period of teething, and is due to the oïdium albicans, a fungus met with in sour milk. The spots, which are most numerous on the lips, tongue, and throat, have the appearance of curdled milk.
The treatment of these forms consists in improving the general condition of the patient, and in employing a mouth-wash, such as peroxide of hydrogen, Condy's fluid, chlorate of potash, or boro-glyceride. The superficial ulcers may be touched with silver nitrate or with a 1 per cent. solution of chromic acid.
Ulcerative stomatitis is frequently met with in debilitated subjects with decayed teeth, and is specially liable to occur during the course of acute febrile diseases in which sordes accumulate about the teeth and gums. It also occurs in syphilitic subjects while under treatment by mercury—mercurial stomatitis. Some patients show a special susceptibility to mercury, and one of the first signs of intolerance of the drug is some degree of stomatitis, which may ensue after a comparatively small quantity has been administered. It begins in the gums, which become swollen and spongy, growing on to the teeth and into the interstices. The gums assume a bluish-red colour and bleed readily, and the teeth may become loose and fall out. The tongue may share in the swelling—mercurial glossitis. There is also profuse salivation, and the breath has a characteristically offensive odour. In severe cases the alveolar margin of the jaw undergoes necrosis. A similar condition occurs in lead and in phosphorus poisoning, and in patients suffering from scurvy.
The treatment consists in removing the cause, and in employing antiseptic and astringent mouth-washes. The internal administration of chlorate of potash is also indicated, as this drug is excreted in the saliva. Loose teeth should not be removed as they become fixed again when the stomatitis subsides.
Gangrenous stomatitis, or cancrum oris ([Fig. 245]), has already been described (Volume I., p. 102).
Fig. 245.—Cancrum Oris.
(Mr. D. M. Greig's case.)
Roof of the Mouth.—Suppuration in the muco-periosteum of the palate is usually secondary to suppuration at the root of a carious tooth. It may also arise in excoriations caused by an ill-fitting tooth-plate, or from the impaction of a foreign body, such as a fish or game bone, in the mucous membrane. The inflammation begins close to the alveolus, and may spread back along the palate. The muco-periosteum becomes swollen, red, and exceedingly tender, and, as pus forms, is raised from the bone, forming a prominent, firm, elongated swelling, which on bursting or being incised gives exit to foul-smelling pus.