The child's mouth became inflamed. Diseases of the oral mucosa, features of the course of the disease in childhood. Epidemiology and pathogenesis

Oral diseases in children are associated with pathological processes occurring in internal organs, weakened immunity, adverse effects external factors. The causes are dental pathologies, lack of oral hygiene, unsystematic use of medications, trauma to the mucous membrane due to eating spicy or too hot food, and dehydration.

The disease can also be triggered by hormonal disorders, deficiency of vitamins and minerals, infections of the ENT organs (whooping cough, scarlet fever, influenza, whooping cough, sinusitis), various viruses, and fungi.

Types of inflammation of the oral mucosa in children

Oral diseases, depending on the reasons that caused their development, are divided into:

1. infectious;
2. viral or bacterial;
3. traumatic;
4. allergic;
5. fungal;
6. caused by concomitant diseases of the gastrointestinal tract, ENT organs, cardiovascular and endocrine systems;
7. hereditary.

Stomatitis

Stomatitis of the oral mucosa is common in children. The disease is accompanied by redness of the mouth, a whitish coating on the tongue, the inner surface of the cheeks, gums, bad breath, and fever. The child experiences pain and discomfort, refuses to eat, and becomes capricious and whiny.

General symptoms of diseases:

• bleeding yellow-white ulcers on the mucous tissues of the tongue, lips, cheeks, and gums;
• swelling and bleeding of the gums;
• increased secretion of salivary fluid;
• dry tongue;
• enlarged lymph nodes in the neck;
• painful sensations;
• loss of appetite;
• moodiness and tearfulness.

To relieve the inflammatory process and disinfect the affected areas, you need to rinse your mouth with antiseptic agents - a warm decoction of chamomile or sage, a solution of furatsilin, soda or hydrogen peroxide.

Herpetic stomatitis

The most common type of stomatitis is caused by the herpes virus. Acute form herpetic stomatitis – contagious disease. Children from 6 months to 3 years are especially susceptible to the disease. weak immunity. With age, the body's protective functions become stronger and the likelihood of infection decreases.

Symptoms of the disease in acute form:

1. body temperature often rises to 41ºС;
2. signs of general malaise - impotence, fatigue, headaches, pallor, increased painful sensitivity of muscles and skin;
3. lack of appetite;
4. nausea and vomiting;
5. swollen lymph nodes under the jaw and in the neck;
6. severe swelling and redness of the mucous tissues in the oral cavity;
7. a large number of ulcers on the inside of the lips, cheeks, gums and tongue;
8. in moderate and severe forms of the disease, the rash affects the outer skin around the mouth, earlobes and eyelids;
9. increased salivation;
10. bad breath;
11. bleeding gums;
12. dry and cracked lips;
13. in rare cases - nose bleed due to a blood clotting disorder caused by herpesvirus.

For treatment, drug and local therapy are prescribed. Medicines are recommended to enhance immunity (gamma globulin injections, Lysozyme, Prodigiosan, herpetic immunoglobulin, etc.); means of general therapy - Diphenhydramine, Suprastin, Pipolfen, calcium gluconate, etc.

Local therapy for the disease consists of treating the oral cavity with agents that relieve painful sensations, preventing the spread of rashes, stimulating the processes of regeneration of damaged tissues.

To destroy viruses, various ointments are prescribed (Oxolinic, Florenal, Heliomycin, Interferon, etc.). For antiseptic treatment, solutions of furatsilin, Etonium, Ethacridine, rosehip oil, Karatolin, Solcoseryl are used.

All dishes for feeding a child should be liquid or porridge-like (soups, broths, purees). To relieve intoxication, drinking plenty of fluids is recommended. Before eating, the oral cavity must be treated with an anesthetic (5% anesthetic emulsion), and after eating, rinse the mouth.

Aphthous stomatitis

Aphthous stomatitis can be of an allergic or infectious nature, alternating between periods of remission and exacerbation. The first symptoms of the disease are fever (+39… +40ºС), restlessness and moodiness of the child, lethargy, dry mouth.

Gradually, the oral mucosa swells, turns red, and hyperemia of the mucous tissues increases. Aphthae appear on days 3-4 in the form of round or oval erosive formations ranging in size from 1 to 5 mm with a yellow or gray coating, surrounded by a red rim. They affect the tongue, lips, cheeks, and can be single or multiple. The disease is accompanied by pain in the mouth, migraine, loss of appetite, stool problems, increased lymph nodes. The duration of the disease is 2-3 weeks.

Candidal stomatitis

Candidal stomatitis is an inflammation of the oral mucosa caused by Candida fungi. The disease begins with redness and swelling of the tongue, then a white cheesy coating appears on the mucous surface of the cheeks and lips. Under the plaque, ulcers and erosions form, which bleed and hurt.

The cause is a weakened immune system, and provokes the development of the disease and the spread of fungi dairy nutrition babies. For treatment, immunomodulatory drugs are prescribed, and the mouth is regularly treated soda solution. Good for removing Candida fungi 2% solution boric acid, which is used to treat the oral mucosa 3 times a day.

Gingivitis or gingivostomatitis

Gingivitis is a disease associated with inflammatory processes occurring in the gums. It is a consequence of dental damage (caries, plaque or tartar). Often, factors that provoke gingivitis can be vitamin deficiency, weakened immunity, hormonal imbalance, infections (herpes).

The disease is accompanied by pain that intensifies during eating and brushing teeth. The gums turn red, swell, become loose and bleeding. If the nature of the disease is infectious, then ulcerative or erosive formations may appear on the gums. Characteristic signs – bad smell from mouth, copious discharge salivary secretion. Without proper treatment, the disease can be complicated by the development of periodontitis and tooth loss.

To prevent the disease, it is necessary to carefully care for the oral cavity (teeth, gums) - regular hygiene, timely removal of tartar. For treatment, mouth irrigation with infusions is prescribed medicinal herbs– chamomile, sage, plantain. In order to exclude various pathologies internal organs, you should be examined by a pediatrician.

Thrush in children

Thrush is caused by the pathogenic proliferation of fungi of the genus Candida, caused by weakened immunity due to various diseases, dysbacteriosis due to long-term use antibiotics. The disease most often occurs in infants and children under 1 year of age. The pathology appears in the form of a white cheesy coating in the mouth and throat.

A baby can become infected with a fungus during childbirth, if the mother has vaginal candidiasis or due to poor hygiene during subsequent care, if the intestinal microflora is disrupted, which is often found in babies in the first six months of life.

Treatment of the disease consists of treating the oral cavity with a solution baking soda. If thrush is antibacterial in nature, Nystatin or Levorin is prescribed. To increase the level of immunity and normalize the intestinal flora, the child is prescribed good nutrition With high content vitamins (groups B, C, A, nicotinic acid).

Treatment and causes of cheilitis in children

Cheilitis is an inflammation of the lips caused by infection of a wound on the lips resulting from injury (cut, burn, mechanical damage from an impact, fall, etc.). Also, the causative agents of the pathology can be herpes viruses, erysipelas or eczema. Oral disease can also be caused by vitamin B2 deficiency.

The disease is accompanied by swelling of the lip and impaired mobility; the mucous membrane of the oral cavity becomes red and painfully sensitive. Sometimes symptoms appear general intoxication– weakness, headaches and muscle pain.

Zaeda or angular cheilitis is a subtype of cheilitis. The causative agents of the disease are streptococci or fungi. When caught, the corners of the mouth are affected by small but painful erosions, which crack and bleed when the mouth is opened, then become covered with crusts.

Antibiotics are prescribed to eliminate the infection. If an abscess forms, it must be opened and treated antiseptic. In case of inflammation of the labial glands, opening, drainage and cleaning of the infected areas are also indicated.

To treat a fungal infection, nystatin ointment is used, and a viral infection is treated with synthomycin emulsion or penicillin ointment. Vitamin B2 deficiency can be compensated for by consuming riboflavin. It is necessary to regularly clean the mouth, dishes and children's toys, use individual means hygiene (towel, washcloth, Toothbrush, dishes).

Traumatic lesions of the oral mucosa

Traumatic stomatitis can be caused by various one-time injuries or constant mechanical irritation of the oral mucosa. In children, injuries occur due to toys, when falling or biting the tongue or cheek, due to wearing braces; In infants, gum damage may be caused by tooth growth. As a result, pustules, abscesses, ulcers or erosions form at the site of violation of the integrity of the mucous membrane. If it doesn't hit the wound external infection, it heals quickly without side effects.

Treatment consists of eliminating the cause of the injury (the tooth fragment is removed or ground, tartar is removed, incorrect braces or dentures are corrected); wounds are treated with an antiseptic. If infection is present, anti-inflammatory drugs are additionally prescribed.

Glossitis or inflammation of the tongue

Glossitis is inflammatory lesion tongue, expressed in peeling of the skin layer and the formation of a whitish thickening in the form of a narrow strip. The affected surfaces are in the form of rings or semi-rings of a light red hue, sometimes merging into more large spots. This condition is called “geographical” tongue due to the loss of uniformity of the surface of the organ and its resemblance to a geographical map. There are no other signs in the form of pain or discomfort, redness or swelling; in rare cases, a slight burning sensation of the tongue is felt.

The causes of the disease are unknown, treatment is not prescribed. It is recommended to rinse the mouth with soda solution or Citral.

Other types of diseases

There are many diseases of the oral cavity, the most common of which are discussed above. Also in medicine, such pathologies of the oral mucosa are described as Infectious mononucleosis and viral warts.

Infectious mononucleosis is viral disease. It manifests itself as enlargement (to the size of a walnut) and soreness of the lymph nodes in the neck and under the jaw, the development of sore throat, stomatitis and changes in blood composition.

Infection occurs through the pharynx or nasopharynx and quickly spreads throughout lymphatic system and blood. The disease is accompanied by fever, headaches, drowsiness, lethargy and fatigue, nausea and vomiting. In young children, an increase in the size of the liver and spleen may be observed. The analysis shows an increase in leukocytes, lymphocytes and monocytes; atypical mononuclear cells also appear in the blood (15-30%).

Treatment of mononucleosis is aimed at relieving symptoms - prescribing painkillers and antipyretics, NSAIDs, vitamin and mineral complexes to boost immunity. As local therapy diseases, it is recommended to rinse the oral cavity with a solution of furatsilin. The patient is prescribed bed rest, isolation, high-calorie diet and plenty of fluids.

Viral warts in the oral cavity are neoplasms of benign etiology. There are flat and pointed ones. Most often they strike inner corners mouth and side walls of the tongue, less commonly may appear on the gums, lips or outside mouth In most cases, they accompany warts on the hands or genitals.

Treatment viral warts held Oxolinic ointment(3%), Bonafton (0.5%), Florenal (0.5%) and other antiviral ointments. Before applying the product, it is necessary to thoroughly rinse the mouth and brush the teeth.

Prevention of oral diseases

To avoid the development of various diseases of the child’s oral cavity, it is necessary to early childhood teach to follow the rules of care and hygiene - regularly brush your teeth, limit the consumption of sweets. Subsequently, children can be taught to use dental floss and rinse after each meal.

It is necessary to regularly, at least 2 times a year, visit the dentist with your child, treat caries in a timely manner, remove plaque and stones. Children's immunity should be strengthened by hardening, physical exercise, and swimming.

The child needs to be provided with adequate nutrition, rich in various vitamins and minerals. In winter, as prescribed by the pediatrician, the baby should be given various vitamins. It is important to remember that it is always easier to prevent the development of a disease than to treat its consequences.

Each of us has a lot of functions assigned to the oral cavity. Their implementation can be carried out only in one case - if the oral mucosa is completely healthy. According to statistics, not every child today can boast of such a phenomenon. In some cases, diseases of the oral cavity in children occur due to pathological abnormalities in the functioning of internal organs, in others - due to a decrease in protective forces body. The negative impact of external factors on the condition of the oral mucosa cannot be ruled out. In any case, timely consultation pediatric dentist is very important, and well-chosen therapy will help quickly return the child to comfort.

Photo: Consultation with a pediatric dentist

Why do problems arise?

Provoke oral diseases in childhood The following factors may:

• insufficient gum care;
• illiterate administration of medications;
• the damaging effects of spicy and hot foods;
• dehydration;
• hormonal imbalance;
• avitaminosis.

Photo: Oral diseases

Among the most likely reasons for the development of problems in a child’s oral cavity, experts identify. Pathogenic microorganisms, if the environment is favorable for them, they begin their activities immediately. Infection occurs when a child puts something into his mouth dirty hands and toys.

An equally likely source of infection is another child who already has an oral infection. Some diseases last quite a long time latent period, which means that at the beginning of their development they are able to escape the attention of parents and doctors. The spread of most infections by contact and airborne droplets significantly aggravates the situation.

Photo: Pathogenic microorganisms that cause oral diseases

Let's look at oral diseases that are often diagnosed in childhood.

Stomatitis

Inflammation of the oral mucosa occurs in childhood with disappointing regularity. With stomatitis, the inner surface of the cheeks becomes red, a white coating and ulcers form on the tongue, and bad breath occurs. The discomfort felt by the child is very high, as is the pain.

Photo: Stomatitis in a child

Stomatitis develops under the influence of pathogenic bacteria. Children with weakened immune systems and untreated teeth are at risk. It is possible that there are microtraumas in the oral cavity.

Depending on the causes of stomatitis, it happens:

• Viral

This type of stomatitis is also called herpetic stomatitis. Infection occurs by airborne droplets and contact routes. Children from one to four years old are affected. The disease begins like a cold, but the very next day parents notice small ulcers on the inside of the child’s cheeks and tongue. This stomatitis is very unpleasant, as it is accompanied by severe intoxication of the body.

Photo: Viral stomatitis

• Infectious

Most often, preschool and junior children suffer from this form of stomatitis. school age. Illness, pneumonia and sore throats develop. The disease is characterized by seasonality: most often children get sick in the autumn-winter period, when immunity is especially weakened.

Distinctive feature infectious stomatitis– yellow crust on the lips, preventing the full opening of the mouth.

Photo: Infectious stomatitis

Also distinguished traumatic stomatitis, in which the oral mucosa is negatively affected by mechanical influences, and allergic caused by certain types of allergies and reactions child's body for one or another pharmacological agent.

Any form of stomatitis should be treated in the company of a doctor. Therapy may include several methods of influence, which are selected taking into account individual characteristics body little patient and complexity of the disease. A distinctive feature of infectious stomatitis is a yellow crust on the lips,

Thrush

, or thrush, is especially common among infants and children of the first year of life. Cause illness yeast mushrooms genus Candida. IN human body they are available in limited quantities. Immunity instability, antibiotic use and dysbacteriosis act as an impetus for their more active reproduction. This, in turn, causes an inflammatory process in the oral mucosa. The disease is expressed in white spots on the tongue, mucous membranes of the mouth and pharynx.

Photo: Oral candidiasis

Infection of a child with thrush occurs during childbirth (if the mother is a carrier of the disease), with insufficient care after birth and disruption of the body's microflora.

To prevent the disease from having an extremely negative impact on the baby’s body, you should visit a pediatrician at its first manifestations. The doctor will assess the extent of the infection and prescribe effective treatment. This mainly involves treating the affected areas of the oral mucosa with a solution of regular baking soda.

Herpetic gingivitis

Infectious gingivitis develops when the herpes simplex virus gets into the gum mucosa. Preschool children are considered the most susceptible to it. The cause of the disease, according to doctors, is a violation of the structure of the oral mucosa.

Photo: Herpes virus

up to three years, its characteristic features are:

• swelling of the gums, their bleeding;
• formation of ulcers on the gums;
• changing the contours of the gums.

Photo: Gingivitis

More often, the disease is considered as a separate disease, but in exceptional situations, doctors classify it as accompanying primary stomatitis.

Timely diagnosis and properly selected therapy for gingivitis are very important. IN otherwise the illness may well turn out to be worse. This is known to lead to premature tooth loss.

Photo: Periodontitis

How to prevent the problem?

Prevention of diseases of the oral mucosa in children is based on several points. First - strengthening the immune system. Parents should take care to create for the child correct mode rest and wakefulness, monitor his diet. It is important to reduce the likelihood, that is, to eliminate the weakening of the body’s defenses. For this purpose, hardening procedures and taking vitamin complexes are recommended.

Photo: Taking vitamin complexes

An important point - timely visits to the pediatric dentist and the fight against existing problems of a corresponding nature. Even a small hole in one of the child’s teeth should serve as an impetus for contacting the clinic.

Basic oral hygiene is also often left undeservedly forgotten. From an early age, a child should learn to regularly clean their teeth with a toothbrush and paste, and rinse their mouth after eating.

Photo: Oral hygiene

Speaking of kids, you should take care of their safety while playing. Parents should ensure that foreign objects do not fall into the child's mouth. If contact occurs, it is recommended to examine the baby’s oral cavity for injuries, and if any, contact a specialist.

In children, the mucous membrane has a delicate structure and high permeability, therefore it is much more susceptible to attack by various pathogens than in adults.

Based on their occurrence, all diseases are divided into:

• viral (herpetic stomatitis).
• bacterial (aphthous stomatitis).
• fungal (candidiasis).

Damage to the mucous membrane can accelerate the development of the infectious-inflammatory process, because if its integrity is damaged, it will be easier for the pathogen to penetrate into the tissue.

Herpetic stomatitis

Herpetic stomatitis is inflammatory disease oral mucosa caused by herpes virus type 1 or 2.

It most often affects infants or children preschool age, since they have not yet fully developed local specific immunity.

Therefore, any hypothermia, stress, overheating or the presence of chronic diseases can trigger the appearance of herpetic stomatitis.

Symptoms

During primary infection, the disease occurs with well-defined symptoms:

• increase in body temperature up to 38 degrees;
• nausea, vomiting;
• runny nose;
• excessive salivation;
• blistering rash;
• white or yellowish coating on the mucous membranes of the mouth.

At severe course herpetic stomatitis also spreads to the skin of the face

Treatment

Treatment of herpetic stomatitis is carried out comprehensively using antiviral drugs, immunomodulators, local anesthetics, antipyretics and painkillers.

The lesions are treated with keratolytic agents (rosehip oil, vitamin A oil solution), which soften herpes blisters.

The baby should be fed liquid food and give as much drink as possible (water, juice, compote), before feeding, numb the mucous membrane of the mouth, and then rinse the mouth with a strong infusion of tea.

It is important to know: even after treatment, the herpes virus remains in the human body forever. Therefore, factors that can reduce the child’s immunity should be avoided.

Aphthous stomatitis

Aphthous stomatitis is a disease of the oral mucosa, which is characterized by the appearance of round erosions - aphthous.

Appears most often in children under 3 years of age as a result of infection or allergy.

Symptoms

The disease is diagnosed quite simply and lasts 10 days.

Main features:

• aphthae - erosion clearly rounded or irregular shape with a white coating in the center and red edges;
• white-yellow coating;
• bad breath;
• enlargement of the submandibular lymph nodes;
• increased sensitivity of mucous membranes;
• pain and discomfort while chewing.

Aphthae cover not only inner side cheeks, but also tongue, lips and even gums

The child becomes lethargic and irritable and refuses food.

Treatment

Basically, aphthous stomatitis is treated with antibiotics, antihistamines and vitamins. Very often the disease goes away on its own after 7-10 days, but to relieve the symptoms, you can use rinses herbal infusions(sage, chamomile, calendula) or antiseptic solutions.

During illness, you should eat and drink only at room temperature, avoid spicy and salty foods and carbonated drinks.

Note: To prevent recurrence of the disease, you need to try to prevent the development of caries and plaque deposits.

Candidiasis

Candidiasis (thrush) is a disease caused by fungi of the genus Candida.

Thrush in the mouth most often appears in infants due to poor hygiene or oral trauma, decreased immunity, while taking antibiotics, against the background diabetes mellitus or diseases of the digestive system.

Symptoms

A mild form of thrush occurs with the formation of a white coating mainly on the tongue, which is easily scraped off. If thrush is not treated for a long time, the fungus penetrates into the deep layers of the mucous membrane, blood comes to the surface and the plaque becomes yellow or dirty brown.

Candidiasis can cover not only the tongue, but also the mucous membrane of the lips and cheeks

Treatment

Treatment for thrush is carried out antifungal drugs with concomitant vitamin therapy.

The affected areas are treated with a 1% soda solution. All objects with which the child comes into contact are thoroughly disinfected, and the mother’s breasts are treated with a soda solution before each feeding.

Watch the video in which a dentist professor talks about the symptoms, treatment and prevention of childhood stomatitis:

Methodological development

IN CHILDREN'S DENTISTRY

AND PREVENTION OF DENTAL DISEASES

(For 5th year students of the Faculty of DentistryIX semester)

Discussed at a department meeting

Protocol No. ________

Introductory test control. Anatomical and physiological age-related features of the oral mucosa in children. Elements lesions of the oral mucosa. Methods for examining oral mucous membranes in children

Total lesson time – 6.0

academic hours

OBJECTIVE OF THE LESSON:

To identify the level of preparation of students for the topics of the semester in related disciplines, to assess the degree of mastery of the material obtained in related dental departments and when studying previous sections of propaedeutics of pediatric therapeutic dentistry and outpatient pediatric dentistry. Previously acquired knowledge will provide students with a complete understanding and assimilation of the material of the current semester.

Learn to understand the relationship between the structural features of the oral mucosa in children and the clinical manifestations of pathological conditions in the oral cavity in various age periods. Master the methods of examining the oral mucosa. Learn to diagnose traumatic injuries of the oral mucosa in children, differentiate them from similar diseases, master methods of treatment and prevention.

MATERIAL EQUIPMENT:

Tables, models, slides, radiographs, samples.

OBJECTIVES OF THE LESSON:

B) reprint stroke.

REQUIREMENTS FOR INITIAL LEVEL OF KNOWLEDGE

To master the material offered in the semester study, the student must repeat:

From normal anatomy - the structure of the mucous membranes and periodontal tissues.

From histology and embryology - the histological structure of the mucous membranes and periodontal tissues, their functions.

From pathological physiology - inflammation (signs, stages, chemical reactions).

From microbiology - the composition of the microflora of the oral cavity and dental plaque. From pediatrics - clinical manifestations

Gastrointestinal tract, kidneys, cardiovascular system, blood.

From therapeutic dentistry - clinical manifestations and pathogenesis of gum inflammation. From prevention dental diseases

- dental examination of the patient, state of oral hygiene, methods and means of individual prevention. From the nursery therapeutic dentistry - caries of temporary and permanent teeth with unfinished root formation

, non-carious lesions of hard dental tissues, pulpitis and apical periodontitis of temporary and permanent teeth with incomplete root formation.

CONTROL QUESTIONS

IN RELATED DISCIPLINES

1. Structure of the oral mucosa in adults. 2. Examination methods for.

diseases of the oral mucosa

3. Elements of damage in diseases of the oral mucosa in adults (primary, secondary).

4. Signs and stages of inflammation.

Test questions from related disciplines and previously studied sections of propaedeutics of pediatric therapeutic dentistry are offered to students in the form of a test control of the initial level of knowledge.

During the practical part of the lesson, after writing the test, students discuss with the teacher questions that caused difficulty or misunderstanding.

CHECK QUESTIONS ON THE TOPIC OF THE CLASS

1. Features of the structure of the oral mucosa in children:

b) at the age of 1 – 3 years, 4 – 12 years.

2. Methods of examination for diseases of the oral mucosa in children.

EDUCATIONAL MATERIAL

ANATOMICAL AND PHYSIOLOGICAL AGE FEATURES OF THE ORAL MUCOSA IN CHILDREN. ELEMENTS OF DAMAGE TO RESISTANCE. METHODS FOR INVESTIGATING OBORUS IN CHILDREN.

Modern scientists distinguish 3 types of mucous membrane: integumentary (mucous membrane of the lips, cheeks, transitional folds, floor of the mouth, soft palate), chewing (mucous membrane of the gums and hard palate) and specialized (back surface of the tongue).

Throughout its entire length, the oral mucosa (OM) is lined with stratified squamous epithelium, consisting of several layers of cells. Underneath it are the basement membrane, the mucous membrane itself and the submucosal layer. The ratio of these layers to various areas oral cavity is not the same. The hard palate, tongue, and gums, which are subject to the most intense pressure during food intake, have a more powerful epithelium. The lips and cheeks have a well-defined lamina propria, and the floor of the mouth and transitional folds have a predominantly developed submucosal base.

Epithelium directly facing the oral cavity and, due to desquamation of the upper layer, undergoes constant renewal. In some areas, the epithelium is capable of keratinization as a result of mechanical, physical and chemical influences. The keratinization is most pronounced on the hard palate, tongue and gums, where several rows of anucleate cells can be observed. Adjacent to the layer of anucleate cells is a granular layer, the cells of which are elongated and contain keratohyalin grains in their cytoplasm. This layer occurs only where the process of keratinization is expressed. In the area of ​​the cheeks, lips, floor of the mouth, transitional folds, in the gingival sulcus and on the lower surface of the tongue, keratinization is not normally observed. Here the surface is formed by flattened cells. Adjacent to them are several rows of polygonal polygonal cells, tightly connected to each other.

The deepest layer of the epithelium is the germ layer, formed by cylindrical cells. They are located in one row on the basement membrane, therefore they are called the basal layer. Basal cells contain a round nucleus with a nucleolus and a cytoplasm with numerous mitochondria. In addition to cylindrical cells, in the basal layer there are stellate-shaped cells with long processes ~ Langerhans cells. They can only be detected by silver impregnation. Regeneration of the epithelium occurs due to the germ layer.

basement membrane formed by a dense plexus of thin argyrophilic fibers and is a connecting link between the epithelium and the lamina propria of the mucous membrane.

The mucous membrane itself consists of connective tissue, represented by the ground substance, fibrous structures and cellular elements. This layer in the form of papillae protrudes into the epithelium in waves. The capillary network, nerve plexuses and lymphatic vessels are located here. The protective function of connective tissue is to create a mechanical barrier. In this regard, the substrate enzyme system is of great importance for the normal state of connective tissue: hyaluronic acid of the main substance - hyaluronidase. With an increase in the amount of tissue or microbial hyaluronidase, depolymerization of hyaluronic acid occurs, resulting in increased permeability of connective tissue.

Fibrous structures are represented by collagen and argyrophilic fibers. The largest number of collagen fibers is located in the mucous membrane of the gums and hard palate.

The cellular elements of the lamina propria are represented mainly by fibroblasts, macrophages, mast and plasma cells, and histiocytes (sedentary macrophages).

Fibroblasts are the main cellular form of connective tissue. They secrete precollagen, proelastin, etc.

Macrophages perform protective function. They phagocytose foreign bacterial particles, dead cells, and actively participate in inflammatory and immune reactions. During inflammation, histiocytes turn into macrophages, and after inflammation again into resting cellular forms.

Mast cells - functional cells of connective tissue - are characterized by the presence of granules in the protoplasm. More often they are localized along the vessels. There are more of these cells in the area of ​​the mucous membranes of the lips and cheeks, less in the area of ​​the tongue, hard palate, gums, i.e. where the epithelium becomes keratinized. Mast cells serve as carriers of biologically active substances that are triggers for inflammation; heparin and histamine. They regulate vascular permeability and participate in the process of allergic reactions.

Plasma cells carry out protective, immunological processes of the mucous membrane and contain large amounts of RNA. Formed under the influence of antigen from lymphocytes. Produce immunoglobulins.

When pathological processes occur in the oral mucosa, segmented leukocytes and lymphocytes appear. Histiocytes can transform into epithelioid cells, which in turn can form giant cells. Epithelioid cells are detected in specific diseases of the mucous membrane and candidiasis.

Submucosal layer presented loose connective tissue. In the mucous membrane of the tongue, gums and partially the hard palate, the submucosa is absent, but in the area of ​​the floor of the mouth, transitional folds of the lips, and cheeks it is well expressed. This layer contains a large number of small vessels, small salivary glands and Fordyce's sebaceous glands.

The mobility of the mucous membrane depends on the severity of the submucosal layer (except for the tongue, where mobility is determined by the muscles).

The tissues of the oral cavity, lips, teeth and anterior 2/3 of the tongue are innervated by the trigeminal nerve (peripheral processes of the nerve cells of the Gasserian ganglion). From the anterior 2/3 of the tongue, taste sensitivity is perceived facial nerve(7th pair). The sensory nerve of the posterior 1/3 of the tongue is the glossopharyngeal nerve (9th pair). Sympathetic fibers penetrate along the arteries from the superior cervical ganglion. They affect the blood supply to the mucous membrane and secretion salivary glands.

Features of the structure of the oral mucosa in children

In children, there are 3 age periods of development of the oral mucosa (Mergembaeva Kh.S., 1972):

I - neonatal period (from 1 to 10 days) and infant period (from 10 days to 1 year).

II ~ early childhood period (1-3 years).

III - primary (4-7 years) and secondary (8-12 years) childhood periods.

In newborns, epithelial The cover of the mucous membrane is thin and consists of 2 layers - basal and spinous. The papillary layer is not developed. The basement membrane is very thin and delicate. The epithelium contains large amounts of glycogen and RNA.

In its own layer of the mucous membrane, the connective tissue is loose and unformed. The fibrous structures are poorly differentiated, but their sharp fuchsinophilia is revealed, which indicates the presence of mature protein structures in the tissues. This fact can be regarded as the result of the placental transfer of protein structures to the fetus from the mother. During the breast period, the immune properties of the tissue acquired during the antenatal period begin to be lost.

The submucosal layer contains a significant number of cellular elements, mainly fibroblasts. There are a small number of histiocytes, lymphocytes and young inactive mast cells.

Such structural features of the oral mucosa in newborns determine its easy vulnerability and high ability to regenerate, as well as high resistance to viral and bacterial stomatitis.

In infancy the epithelium thickens, parakeratosis appears in the area of ​​the masticatory mucosa and at the tops of the filiform papillae, and the amount of glycogen in these areas decreases. The basement membrane remains thin, the connective tissue of the oral mucosa's own layer is poorly differentiated.

In early childhood(1-3 years) regional differences in the educational system are clearly defined. A relatively low amount of glycogen is detected in the epithelium of the tongue, lips, and cheeks. The basement membrane of the specialized and integumentary mucosa still tends to loosen.

A large number of cellular elements in the own layer of the mucosa, as well as around blood vessels in the specialized and integumentary mucosa, contributes to high permeability vascular wall in these areas. This may be one of the reasons frequent lesions it is these areas in acute herpetic stomatitis.

The epithelial cover of the chewing mucous membrane thickens. It reveals the processes of keratinization and parakeratosis.

During the primary childhood period(4-7 years) the intensity of metabolic processes decreases, the number of blood vessels and cellular elements in the own layer of the mucous membrane decreases. The epithelium thickens, and the content of glycogen and RNA in it slightly increases, which is explained by a decrease in their consumption during this period.

In the secondary childhood period(8-12 years) there is a decrease in the amount of glycogen and an increase in the number of protein structures in the epithelium. The basement membrane becomes dense, and the number of reticulin, elastic and collagen fibers in its layer increases.

The number of lymphoid-histiocytic infiltrates around the vessels increases, which indicates the presence of sensitization in the child’s body and the formation of protective mechanisms (production of antibodies). During this period, the tendency to diffuse reactions in the oral cavity decreases and diseases of the oral mucosa associated with allergies appear. There are quantitative and qualitative changes in mast cells- their number decreases, and their activity increases due to the accumulation of heparin monosulfate in their cytoplasm, which acts as nonspecific factor protection, blocks proteolytic and mucolytic enzymes of blood and tissues, normalizes capillary permeability.

The morphological features of the oral mucosa, indicating a decrease in its permeability during this period, create the preconditions for a protracted chronic process in the oral cavity.

At the age of 12-14 years, under the influence of hormonal changes in the oral cavity, diseases such as juvenile gingivitis and soft leukoplakia predominate.

Individual parts of the oral mucosa (gums, hard and soft palate, etc.) in children may have a number of structural features, but in general they differ little from those in adults.

Desna - the part of the mucous membrane immediately surrounding the lips. It isolates the periodontium from external environment and participates in tooth fixation. The gum is divided into 3 elements: interdental papillae, a marginal part, freely adjacent to the neck of the tooth, and an attached part, which is firmly fused with the periosteum of the alveolar process. Between the marginal gum and the neck of the tooth there is a gingival groove, lined with non-keratinizing stratified squamous epithelium and filled with gingival fluid. At the bottom of the gingival groove there is an epithelial attachment to the tooth.

Gums in children are characterized by a number of signs:

1. More vascularized, the epithelium has a thinner layer of keratinizing cells (up to 2.5-3 years the keratinizing layer

absent or weakly expressed), and therefore the color of the gums is brighter.

2. Has a less pronounced granular surface due to a slight deepening of the epithelial papillae (papillary layer).

3. Differs in low density of connective tissue.

4. Characterized by greater depth of gingival grooves than in adults.

5. During the period of teething, the gingival margin has rounded edges with symptoms of edema and hyperemia.

6. The basement membrane is thinner and has a delicate structure.

7. In children under 2.5-3 years of age, the oral mucosa, including the gums, contains a lot of glycogen. Towards the end of the formation of a temporary occlusion, the appearance of glycogen in the gum indicates inflammation of this area. This is the basis for diagnosis using the Schiller-Pisarev test.

8. Collagen fibers of the own layer of the gum mucosa are loosely located, insufficiently oriented, elastic fibers are absent.

9. During the period mixed bite the layer of gum epithelium thickens, its surface layer becomes keratinized, collagen matures and the tendency to diffuse reactions decreases. The permeability of histohematic barriers also decreases due to the appearance of perivascular accumulations of lymphocytes and histiocytes, which creates the preconditions for a chronic course pathological process in the gum.

10. During the period permanent dentition Children's gums have a mature, differentiated structure. Surface layer it is keratinized, with the exception of the epithelium lining the gingival sulcus, which is weak point when gingivitis occurs.

Solid sky covered with stratified squamous keratinizing epithelium and motionlessly fused with the periosteum of the palatine bones. There are 4 zones of the mucous membrane of the palate:

1. Fatty zone - located in the anterior third of the hard palate, its submucosa contains adipose tissue. In this zone, at right angles to the palatal suture, the palatal folds diverge, based on thick bundles of collagen fibers. These folds are most pronounced in the fetus and smooth out significantly after birth.

2. Glandular zone - located in the middle and posterior thirds of the hard palate and contains end sections mucous palatal salivary glands. The submucosa is poorly expressed.

3. Palatal suture area - stretches in the form of a narrow strip along the center of the hard palate from front to back. There is no submucosal layer in this area. A characteristic feature of the mucous membrane of the hard palate in the suture area is the presence in the lamina propria of rounded accumulations of epithelial cells (epithelial pearls), which are remnants of the epithelium from the embryonic period during the fusion of the palatine processes.

4. Lateral (marginal) zone - corresponds to the areas of transition of the hard palate to the gum. In this zone there is no submucosa.

At the core lips lies the orbicularis oris muscle. The lip consists of 3 sections:

1. Cutaneous section - has the structure of the skin, covered with stratified squamous keratinizing epithelium, contains hair, sweat sebaceous glands, and muscle fibers.

2. Red border - covered with stratified squamous keratinizing epithelium, contains single sebaceous glands. The papillary layer with capillary loops is well defined, which gives the lip a red color. There are a large number nerve endings. There are no salivary glands in this area, which can cause dry lips. The zone of transition of the red border into the mucosa is called Klein's line. The epithelium of this zone undergoes parakeratosis, and in newborns it is covered with epithelial outgrowths (villi), which are considered a device for sucking.

3. Mucous section - lined with non-keratinizing stratified squamous epithelium, which contains a significant amount of glycogen. The lamina propria consists of fibrous connective tissue and capillaries. The submucosa is adjacent to the muscles and contains a number of vessels, adipose tissue and the terminal sections of the mixed salivary glands, excretory ducts which open into the vestibule of the oral cavity.

Cheek limits the lateral wall of the oral cavity; it is based on the buccal muscle. The dermis and submucosal layer contain a large amount of adipose tissue and elastic fibers. The epithelium of the buccal mucosa is multilayered, flat, non-keratinizing. Along the line where the teeth meet, the epithelium may become keratinized and have a paler color. Epithelial cells contain large amounts of glycogen.

The lamina propria of the mucosa forms a low papillary layer, which is embedded in the epithelium by 1/4 of its thickness and contains collagen fibers.

In the submucosal layer there are mixed buccal salivary glands, which are more numerous in the posterior sections. In the subepithelial mucosa of the cheek, sebaceous glands (Fordyce glands) can be found, which look like yellowish grains on the surface of the mucous membranes, often in the distal sections.

Soft sky - This is a fold of the mucous membrane with a muscular-fibrous base. It has a brighter color compared to the hard palate, since it is covered with a relatively thin layer of stratified squamous epithelium, through which the capillary network is visible. It has its own mucous membrane. In the anterior section of the soft palate there is a submucosal layer in which the terminal sections of the mucous salivary glands are located.

The posterior (nasal) surface of the soft palate is covered with a single-layer multirow prismatic ciliated epithelium. In the lamina propria there are lymph nodes and ducts of small salivary glands.

Mucous membrane of the floor of the mouth covered with thin multilayered squamous non-keratinizing epithelium, under which is the lamina propria, penetrated by a large number of blood and lymphatic vessels. The submucosal layer is well defined, containing lobules of adipose tissue and small salivary glands.

Underside of the tongue covered with thin stratified squamous non-keratinizing epithelium. It has its own mucous and submucosal layers. In the anterior section there are mixed salivary glands.

Upper surface of the tongue (specialized mucous membrane) covered with single-layer squamous keratinizing epithelium. The submucosal layer is absent. There is an accumulation of lymphoid tissue on the posterior third of the tongue Pink colour or with a bluish tint. This is the lingual tonsil, which is part of the lymphoepithelial pharyngeal ring and performs a protective function. Lingual tonsil reaches its greatest development in childhood and undergoes involution after puberty. Under the mucous membrane, especially in posterior section, there are small salivary glands, the excretory ducts of which open to the surface. According to the nature of the secretion, serous, mucous and mixed glands are distinguished.

The epithelium and the mucous membrane itself on the back of the tongue form papillae: filiform, leaf-shaped, mushroom-shaped and grooved.

The filiform papillae cover the entire surface of the tongue, do not contain taste buds, and form a strong abrasive surface with which the tongue presses the bolus of food against the hard palate. The epithelium in the area of ​​the apices of the papillae undergoes keratinization and desquamation. When desquamation slows down, the tongue becomes coated. As desquamation of the epithelium accelerates, pink desquamative areas are formed.

Leaf-shaped papillae are well developed in children, located in the form of 8-15 folds on the lateral surfaces of the tongue in the distal sections and contain taste buds.

The fungiform papillae are located among the filiform papillae at the tip of the tongue in the form of red dots and contain taste buds. They are covered with a thin layer of non-keratinizing multilayer squamous epithelium. The blood in the vessels is visible through a thin layer of epithelium, giving these papillae a red color.

The circumvallate papillae (surrounded by a shaft) - the largest papillae of the tongue - are located in the shape of the letter V closer to the root and are surrounded by a ridge and a groove. Their walls contain a large number of taste buds.

At the border of the body of the tongue and the root, behind the grooved papillae, there is a blind opening - a consequence of an overgrown thyroglossal duct.

Pathological processes

Pathological processes in the mucous membranes can be divided into 2 groups: inflammatory lesions and tumors.

Inflammation is a protective vascular-tissue reaction of the body to the action of an irritant. According to morphology they distinguish 3 phases of inflammation: alterative, exudative and proliferative. According to the flow, inflammation can be acute, subacute and chronic. At acute course Alterative and exudative changes predominate, and in chronic cases - proliferative ones.

Alternative the inflammation phase is characterized by the predominance of dystrophic and necrotic processes in cells, fibrous structures and in the interstitial substance of the mucosa.

Exudative the inflammatory phase is characterized by a predominance of hyperemia, edema and infiltration. Following a short-term reflex narrowing of the lumen of the capillaries, their persistent expansion. Slowing blood flow leads to stasis and thrombosis of mucosal vessels. The tone of the vessels decreases, and the permeability of their walls is impaired. Blood plasma (exudation) and formed blood elements (emigration) leave the vessels.

Violation of vascular permeability is caused by the release of a large amount of biologically active substances (acetylcholine, histamine, serotonin, kinins) as a result of cell lysis. In this case, swelling and infiltration of the walls of blood vessels and connective tissue of the mucous membrane of the PR are observed. The infiltrate can be leukocyte, lymphoid, plasma cells and with a predominance of erythrocytes.

Proliferative the inflammatory phase is characterized by the processes of cell proliferation and transformation. The proliferation of connective tissue cells underlies the formation of granulation tissue. During the process of fibroblastic proliferation, new formation of connective fibers occurs. This is the outcome of the acute process.

Chronic inflammation of the mucous membrane is characterized by the proliferation of connective tissue cells (lymphocytes, plasma cells, fibroblasts, etc.). Young, cell-rich granulation tissue is then formed. The outcome of productive inflammation is the formation of mature connective tissue, i.e. development of sclerosis and fibrosis.

As a result of neurovascular disorders, focal necrosis often appears in the connective tissue structures of the mucosa. Surface defects - erosions - are formed when the integrity of only the superficial layers of the epithelium is violated. If the connective tissue layer is damaged, a scar is formed as a result of healing.