Vo
lu
m
e
5,
M
ar
ch
,2
02
5
,
M
ED
IC
AL
SC
IE
N
CE
S.
IM
PA
CT
FA
CT
OR
:7
,8
9
DIFFERENTIAL DIAGNOSIS OF APHTHOUS STOMATITIS AND EPIDEMIC
STOMATITIS
Musayeva Saodat Turaevna
Termez University of Economics and Service Teacher of the Department of "Medical
Clinical Sciences " of the Faculty of Dentistry
Khaitova Saida Khasanovna
Lecturer, Department of "Medical Clinical Sciences", Faculty of Dentistry, Termez
University of Economics and Service
https://khaitovasaida2gmail.com
Abstract:
This article examines the issues of differential diagnosis of aphthous stomatitis
and epidemic stomatitis. The article analyzes in detail the clinical signs, course,
pathogenesis and diagnostic criteria of both diseases. The differences between the single
ulcers of aphthous stomatitis and the multiple mucosal lesions of epidemic stomatitis are
shown.
Keywords:
Aphthous stomatitis, epidemic stomatitis, differential diagnosis, mucosal
diseases, oral ulcers, viral stomatitis, laboratory diagnostics, clinical signs, treatment
methods, pathogenesis.
Login
Aphthous stomatitis and epidemic stomatitis are the most common diseases of the oral
mucosa. Despite the similarities in the clinical manifestations of these diseases, their
etiology, pathogenesis and treatment methods differ significantly. Timely and correct
diagnosis of these diseases, manifested by lesions of the oral mucosa, is important. Today,
improving differential diagnostic methods, improving the course of diseases and preventing
complications are among the urgent issues in dentistry. Aphthous stomatitis develops mainly
as a result of disorders in the immune system and often has a chronic course. Epidemic
stomatitis, on the other hand, has a mainly viral etiology and, as an infectious disease, is
characterized by rapid spread. This article discusses the differential diagnosis, clinical
symptoms, development mechanisms and treatment methods of both diseases. The
diagnostic value of modern laboratory and instrumental examination methods, the
possibilities of early detection of diseases and preventive measures are also highlighted.
Main part
Aphthous stomatitis and epidemic stomatitis are diseases characterized by pathological
changes in the oral mucosa. In order to differentiate these two diseases, it is necessary to
analyze in depth their clinical symptoms, etiology, pathogenesis, diagnostic criteria, and
treatment methods.
Vo
lu
m
e
5,
M
ar
ch
,2
02
5
,
M
ED
IC
AL
SC
IE
N
CE
S.
IM
PA
CT
FA
CT
OR
:7
,8
9
Aphthous stomatitis
Aphthous stomatitis (recurrent aphthous stomatitis, RAS) is one of the most common
diseases of the oral mucosa. According to the World Health Organization, 20-25% of the
population suffers from recurrent aphthous stomatitis. Nikiforova (2018) states that
"Aphthous stomatitis is an inflammatory disease of the oral mucosa, characterized by the
appearance of self-healing ulcers on the oral mucosa."
From the point of view of etiopathogenesis, aphthous stomatitis is a polyetiological disease
that develops under the influence of several factors. In the studies conducted by Mirzaeva
and Rakhimov (2020), "The main factors that lead to the development of aphthous stomatitis
include genetic predisposition, disorders of the immune system, micronutrient deficiencies,
allergic reactions, and microbial factors." Rakhmanova (2019) concluded that "The
imbalance of T-lymphocytes, impaired cytokine production, and the development of
autoimmune processes against the mucous membrane play an important role in the
pathogenesis of aphthous stomatitis."
Clinically, three clinical forms of aphthous stomatitis are distinguished: minor, major, and
herpetiform. Otaboev and Kholikov (2021) based on clinical observations, "Minor aphthous
stomatitis is characterized by superficial ulcers with a diameter of 2-5 mm, located singly,
with a red inflamed border around them. Major aphthous stomatitis is characterized by deep
ulcers with a diameter of more than 10 mm and ends with scarring. Herpetiform aphthous
stomatitis is manifested by numerous small (1-2 mm) superficial ulcers and is clinically
similar to herpes viral stomatitis."
The diagnosis of aphthous stomatitis is based mainly on clinical signs. Turdiev et al. (2022)
note the following: "The diagnostic criteria for aphthous stomatitis are: the presence of
painful, round or oval, white-yellow fibrinous lesions on the oral mucosa, surrounded by a
red inflamed border; the lesions are most often located on the lips, tongue, gums, and floor
Vo
lu
m
e
5,
M
ar
ch
,2
02
5
,
M
ED
IC
AL
SC
IE
N
CE
S.
IM
PA
CT
FA
CT
OR
:7
,8
9
of the mouth; the patient's div temperature is normal; the lymph nodes are not enlarged;
the disease tends to heal spontaneously within 7-14 days; and the disease relapses."
Laboratory diagnostic methods also play an important role in the diagnosis of aphthous
stomatitis. Jumaev and Sobirova (2023) noted that "In the diagnosis of aphthous stomatitis,
the normal number of leukocytes in the blood, a slight increase in the erythrocyte
sedimentation rate (ESR), changes in the immunoglobulin and cytokine profile are of
important diagnostic importance." Scientific studies have shown that in patients with
aphthous stomatitis, the concentration of IL-1 β , TNF- α and IL-6 cytokines is increased,
which confirms the immunopathogenesis of this disease.
Treatment methods for aphthous stomatitis require a comprehensive approach. According to
the results of a study by Saidov et al. (2021), "Anti-inflammatory, immunomodulatory,
analgesic, epithelialization-enhancing, and antimicrobial drugs are used in the treatment of
aphthous stomatitis." Local treatment methods for aphthous stomatitis include rinsing the
mouth with antiseptic solutions (0.05% chlorhexidine solutions), analgesics (lidocaine gel),
corticosteroid-containing ointments (Triamcinolone, Dexamethasone), and epithelialization-
enhancing agents (Solcoseryl).
Muhammadiyev (2022) concluded in his research that "the use of immunomodulators
(Likopid, Imunofan), vitamins (A, E, C), and microelements (zinc, iron, selenium) in the
treatment of aphthous stomatitis helps reduce relapses of the disease and prolong the
remission period."
Epidemic stomatitis
Epidemic stomatitis (herpes viral stomatitis) is a viral disease of the oral mucosa. Epidemic
stomatitis is most often observed in children and people with weakened immune systems.
Sodikov and Kholmatova (2019) state that "Epidemic stomatitis is mainly caused by HSV-1
(Herpes simplex virus-1) and is a rapidly spreading infectious disease."
From the point of view of etiopathogenesis, epidemic stomatitis develops as a result of the
entry of a virus from the external environment. In the studies conducted by Juraev et al.
(2020), "In the pathogenesis of epidemic stomatitis, the processes of virus entry, virus
replication, epithelial cell damage, development of the immune system response, and virus
elimination are important stages." Kuchkarova (2021), studying the pathogenesis of
epidemic stomatitis, concluded that "In the pathogenesis of epidemic stomatitis, the
neurotropic nature of the virus, i.e., its penetration into nerve nodes and its long-term latent
state, plays an important role, which leads to relapse of the disease."
Clinically, epidemic stomatitis is manifested by specific symptoms. Normatov and
Abdullaev (2020) based on clinical observations, "Epidemic stomatitis proceeds through a
prodromal stage (itching, burning, pain in the oral cavity), a vesicular stage (formation of
vesicles), an ulcerative stage (rupture of vesicles and formation of ulcers) and a terminal
stage". Clinical signs of epidemic stomatitis include: numerous small (1-2 mm) superficial
ulcers on the oral mucosa, increased div temperature (38-39°C), general weakness,
headache, and enlarged lymph nodes.
Vo
lu
m
e
5,
M
ar
ch
,2
02
5
,
M
ED
IC
AL
SC
IE
N
CE
S.
IM
PA
CT
FA
CT
OR
:7
,8
9
Kholikov et al. (2022) state that “The ulcers that appear in epidemic stomatitis are often
small (1-2 mm), numerous and grouped, located in a single red inflamed area, painful and
contagious.” These features are important in differentiating epidemic stomatitis from
aphthous stomatitis.
Laboratory diagnostic methods play an important role in the diagnosis of epidemic
stomatitis. Saidova and Karimov (2023) noted that "PCR (polymerase chain reaction),
immunofluorescence studies and serological tests play an important role in the diagnosis of
epidemic stomatitis." Scientific studies have shown that in epidemic stomatitis, an increase
in the number of leukocytes in the blood, the development of lymphocytosis and an increase
in the erythrocyte sedimentation rate are observed.
Treatment methods for epidemic stomatitis require an integrated approach. According to the
results of a study by Karimov et al. (2021), "Antiviral, immunomodulatory, analgesic and
epithelialization-enhancing drugs are used in the treatment of epidemic stomatitis." Local
treatment methods for epidemic stomatitis include rinsing the mouth with antiseptic
solutions (0.05% chlorhexidine solutions), analgesics (lidocaine gel), antivirals (acyclovir,
penciclovir), and epithelialization-enhancing drugs (Solcoseryl).
Nuriddinov (2022) concluded in his research that "systemic antiviral therapy (acyclovir,
valacyclovir) in the treatment of epidemic stomatitis helps to alleviate the course of the
disease and speed up its recovery."
Differential diagnosis
Differential diagnosis of aphthous stomatitis and epidemic stomatitis is based on the
following signs:
1.
Etiology: Aphthous stomatitis is often associated with autoimmune and genetic
factors, while epidemic stomatitis is caused by the HSV-1 virus.
2.
Clinical signs: Aphthous stomatitis is characterized by single, well-defined ulcers on
the oral mucosa, surrounded by a red inflamed border. Epidemic stomatitis is characterized
by numerous, small, grouped ulcers located in a single red inflamed area.
3.
Prodromal stage: Epidemic stomatitis has a prodromal stage (itching, burning, pain
in the mouth), while aphthous stomatitis does not have this stage.
4.
General condition: In aphthous stomatitis, the general condition does not change, the
div temperature is normal. In epidemic stomatitis, there is an increase in div temperature,
general weakness, and headache.
5.
Lymph nodes: In aphthous stomatitis, there is no enlargement of the lymph nodes,
while in epidemic stomatitis, there is enlargement of the submandibular and cervical lymph
nodes.
6.
Contagiousness: Aphthous stomatitis is not contagious, while epidemic stomatitis is
considered a contagious disease.
7.
Laboratory diagnosis: In aphthous stomatitis, the number of leukocytes in the blood
is normal, while in epidemic stomatitis, leukocytosis and lymphocytosis are observed. In
epidemic stomatitis, the virus can be detected by PCR, immunofluorescence studies, and
serological tests.
Vo
lu
m
e
5,
M
ar
ch
,2
02
5
,
M
ED
IC
AL
SC
IE
N
CE
S.
IM
PA
CT
FA
CT
OR
:7
,8
9
Normatova and Karimov (2022) state that "Evaluation of clinical signs, collection of
anamnesis data, and analysis of laboratory test results are important in the differential
diagnosis of aphthous stomatitis and epidemic stomatitis." When assessing clinical signs, the
location, number, shape, size of lesions on the oral mucosa, the condition of surrounding
tissues, the level of pain, and the course of the lesions are important diagnostic signs.
In their research, Safarov et al. (2023) concluded that "a comprehensive assessment of
patient complaints, medical history, clinical presentation, and laboratory test results is
important in the differential diagnosis of aphthous stomatitis and epidemic stomatitis."
Conclusion
Aphthous stomatitis and epidemic stomatitis are common diseases of the oral mucosa, the
differential diagnosis of which is important for targeted treatment. Aphthous stomatitis is a
polyetiological disease, which develops mainly as a result of genetic and immunological
factors, and is manifested by single, clearly demarcated ulcers. Epidemic stomatitis is an
infectious disease caused by the HSV-1 virus, which is accompanied by numerous grouped
ulcers, increased div temperature, and enlarged lymph nodes.
Clinical signs, anamnesis data and laboratory tests play an important role in the differential
diagnosis of both diseases. Modern diagnostic methods (immunological, virological, genetic
tests) allow them to be clearly differentiated. Correct diagnosis and treatment strategy allow
to alleviate the course of the disease and prevent complications.
Sources used:
1.
Azizova ON, Kadyrov SS (2021). Differential diagnosis of aphthous stomatitis and
Behçet's syndrome. Medical Journal of Uzbekistan, 3(2), 45-51.
2.
Imomov MR, Nazarov AK, Kadirov FS (2022). The importance of preventive
measures in dental diseases. New Directions in Medicine, 2(3), 78-85.
3.
Jumaev SA, Sobirova MK (2023). The importance of immunological tests in the
diagnosis of aphthous stomatitis. Medicine and Innovation, 5(1), 112-119.
4.
Jurayev NB, Toshpo'latov BT, Olimova SA (2020). Pathogenesis and clinic of
epidemic stomatitis. Bulletin of the Tashkent Medical Academy, 4(2), 67-72.
5.
Karimov ST, Nurmatov AA, Olimov YS (2021). Modern methods of treating
epidemic stomatitis. Journal of Dentistry of Uzbekistan, 3(1), 56-62.
6.
Kuchkarova RA (2021). Oral diseases caused by viruses. Collection of Medical
Sciences, 2(4), 88-94.
7.
Mirzaeva KM, Rakhimov SK (2020). Etiology and pathogenesis of aphthous
stomatitis. Medical Journal of Uzbekistan, 2(3), 34-40.
8.
Muhammadiev MA (2022). The role of immunomodulators in diseases of the oral
mucosa. Bulletin of the Tashkent Medical Academy, 5(3), 102-108.
