Ulcerative Stomatitis.

Synonyms.—Fetid Stomatitis; Putrid Sore Mouth.

Definition.—A stomatitis characterized by the formation of ulcers on the gums and cheeks, attended by an offensive breath.

Etiology.—This is a disease of childhood, though it is sometimes met with in the adult. The predisposing causes are similar to those of aphthous stomatitis and thrush; viz., poor hygienic conditions, bad air, light, and food; poor clothing, damp and filthy quarters, and all conditions that impoverish the blood. Neglect of the mouth, and bad teeth, also favor the disease. No doubt the infectious fevers favor the generation of the virus whatever that may be. It is most likely due to a specific germ; but, as yet, the specific cause has not been discovered.

Symptoms.—"On examining the mouth, we find the gums red, swollen, and spongy, and where the ulcer is situated, a grayish, pultaceous material, on removing which, the surface is raw and bleeding. It generally commences on the front part of the gums, but gradually passes between the teeth, affects the posterior surface; continuing, it destroys the gum both before and behind, and, passing to the lips and cheeks adjacent, forms irregular ulcerations, covered by the same material. If it continues long, the tongue is swollen, and is marked by the teeth; the saliva becomes thick and very offensive, often streaked with blood, the gums bleeding at the slightest touch. The stomach is usually deranged, the bowels irregular, the tongue covered with a dirty coat, and more or less febrile action." (Scudder.)

Diagnosis.—The soft, spongy condition of the gums, the characteristic ulceration, the foul breath, the vitiated saliva, together with the cachectic appearance of the patient, render the diagnosis easy.

Prognosis.—The disease usually yields readily to treatment, and even in those cases due to impoverished blood a cure will result in a few weeks under specific medication.

Treatment.—After thoroughly cleansing the mouth with pyrozone, boracic acid solution, or listerine, and the removal of carious teeth, we put the patient on potassium chlorate and hydrastis, both for its local and systemic use. It will fit more cases than any other remedy. For the nasty, dirty, pasty coating upon the tongue, which tells of sepsis, use sodium sulphite. If the sub-maxillary glands are involved, phytolacca will prove our best remedy. When the tissues are dusky, baptisia or echinacea will prove the better agents.

The ulcers may be touched with thuja, or with nitric acid, applied on a pine pencil. The gastric and intestinal disturbance may call for nux vomica or small doses of Podophyllin. Drop doses of Howe's acid solution of iron is a good tonic, as well as quinia and hydrastis. To harden the spongy gums, an application of tincture of myrrh and glycerin, three times per day, is useful. The diet should be nutritious and given in fluid form.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.