Diseases of the oral mucosa in children. Diseases of the oral mucosa in children: causes, prevention and treatment. Period of resorption of the roots of baby teeth

Diseases of the oral mucosa in children

Chronic recurrent aphthous stomatitis (CRAS)– one of the most common diseases that can be classified as infectious-allergic. HRAS is characterized by periods of remission and exacerbation and manifests itself in the form of aphthae – superficial painful defects of the mucous membrane. Aphthae have a round or oval shape, are covered with a fibrinous coating, and red hyperemic rims are visible around the afta. The appearance of aphthae is not preceded by the formation of blisters. HRAS can occur in a mild form (1-2 aphthae) and in a severe form, when recurrent deep scarring aphthae are formed, the period of epithelization of which lasts up to 2-3 weeks. At the same time, relapses of the disease are very frequent (can occur monthly).
The treatment regimen includes a diet with the exclusion of irritating foods, the prescription of immunocorrectors and immunomodulators (after consultation with an immunologist), vitamins B and C, and desensitizing therapy. The child's oral cavity is treated locally with antiseptic solutions, applications of proteolytic enzymes are used, and lubricated with oil solutions of vitamins.

Acute herpetic stomatitis
Much more dangerous and, unfortunately, widespread is another form - acute herpetic stomatitis. Infection of children with the herpes simplex virus is 60% under the age of 5 years, and 90% by the age of 15 years. In addition, acute herpetic stomatitis in children with reduced immunity is very contagious. The disease is spreading by airborne droplets and through contact and everyday life. How older child, the lower the probability of purchasing acute form herpetic stomatitis due to acquired immunity.
The disease occurs in mild, moderate and severe forms. Incubation period up to 17 days (in newborns – up to 3 days). A child with acute herpetic stomatitis may have a fever (up to 37-39o C, depending on the severity of the disease). The mucous membrane of the oral cavity is hyperemic, then single or grouped lesions appear. In more severe forms, rashes can appear both in the oral cavity and on the skin in the perioral area. The disease is accompanied by symptoms of catarrhal gingivitis (inflammation and bleeding of the gums
The most reliable method for diagnosing herpes infection is the polymerase test. chain reaction(PCR diagnostics)

Treatment of acute herpetic stomatitis.
The treatment is complex. First of all, it is necessary to provide the child good nutrition, however, excluding all traumatic factors from food (food should not be hard, spicy, salty, hot, etc.). It is important to ensure you drink plenty of fluids. Before each feeding of the child, his mucous membrane must be anesthetized (2-5% oil solution of anesthesin or lidochlor gel). Antiviral therapy involves taking special antiviral drugs (as prescribed by a doctor. For epithelization of the affected areas, ointments based on proteolytic enzymes of animal origin, as well as oil solutions of vitamins are used. Antiviral drugs must be combined with immunomodulators (as prescribed by a doctor). When using a laser, fibrinous plaque is cleansed from the aphthae , healing processes are accelerated.
To prevent relapses, it is necessary to strengthen the child’s immunity naturally: hardening, swimming, good nutrition, etc. Thorough sanitation of the oral cavity is also important: removal of dental plaque, treatment of caries and its complications.

Pyoderma
Treatment of pyoderma in children
Pyoderma is streptostaphylococcal lesions of the oral mucosa, lips (cracks), and skin of the perioral area. They are found in weakened children, with low immunity, as well as in children who do not receive a balanced diet. Children with diabetes are extremely susceptible to pyoderma, which creates a good breeding ground for bacteria. Provoking factors are: hypothermia, fatigue, overheating of the body, systemic diseases of other organs.
With pyoderma, body temperature can rise to 38-39 degrees. C, lymphadenitis is observed. Blisters-pustules form on the surface of the mucous membrane, the surface around which is hyperemic, and with rashes on the skin, purulent pustules and crusts appear. If left untreated, the infection can easily spread to other parts of the body (eyes, hands, etc.).
Treatment of pyoderma is determined by the nature of the pathogen. Therefore it is necessary to carry out bacteriological culture to determine the causative agent of infection and its sensitivity to certain antibacterial drugs, and only after that the doctor can prescribe adequate treatment. Self-medication without tests can only blur the picture without destroying the causative agent of the infection.

Catarrhal stomatitis in children
Lesions of the oral mucosa caused by taking medications. When taking many medications (antibiotics, serums, vaccines, sulfonamides, novocaine, iodine, phenol, etc.), lesions of the oral mucosa can occur, which can be combined under the general name “catarrhal stomatitis.”
This group of diseases of the oral mucosa in children also includes allergic reaction for medicines. The mucous membrane is hyperemic, edematous, covered with multiple blisters, after opening of which erosions may remain. The tongue and lips are also swollen. At the same time, the child may experience hives, muscle and joint pain, dyspepsia, and even anaphylactic shock.
Treatment is aimed primarily at identifying the cause of stomatitis. If taking, for example, antibiotics is necessary in the future, it must be combined with antifungal treatment and antihistamines. Rinses, painkillers, and ointments are used locally to promote healing and epithelization of the mucosa.

Diseases of traumatic origin

Diseases of the oral mucosa in children of traumatic origin should be included in a special group. The mucous membrane, due to its physiological characteristics, has a high regenerative ability. However, if it is mechanically damaged, dangerous pathogens can easily enter the wound, which will lead to its inflammation. A child can get injuries to the oral mucosa when brushing teeth, eating solid food, or during dental procedures. This may be trauma from sharp broken teeth or orthodontic devices in the oral cavity. The child may bite his tongue, lips, or cheek. If you carelessly wipe the mouth of a newborn, you can cause injury, which causes so-called neonatal aphthae.
Treatment traumatic injuries treatment of the oral mucosa begins with eliminating the causes of injury. Then antiseptics that relieve inflammation and agents that promote healing (oils, solcoseryl gel, etc.) are prescribed locally.
In case of chemical damage to the child’s oral mucosa (accidental exposure of strong chemicals to the mouth), it is necessary to immediately rinse the child’s mouth with plenty of water and a neutralizing solution (for example, alkaline for an acid burn). In the future, painkillers, antidotes, and agents that stimulate epithelialization are used. The nature of diseases of the oral mucosa in children is largely determined by the age-related characteristics of the structure of the mucosa.

Thrush (acute candidiasis)
In infancy, the epithelium of the oral mucosa is very thin, so fungal infection when immunity decreases, saliva very easily attaches to the surface of the mucosa. Symptoms of thrush
At the first stage of the disease, red spots appear. They can be found on the tongue, mucous membrane of the cheeks, lips and gums. After a few days, white cheesy rashes appear in place of the red areas. They look like the remains of cottage cheese or kefir in a child's mouth.
The white plaque is difficult to separate, and the wounds that are opened begin to bleed, bacteria that are in the oral cavity, which can lead to various complications. Thrush in the mouth is painful. Because of this, children refuse to eat, cannot swallow saliva, and become restless. If you discover a manifestation of the disease, you should consult a doctor and only then begin treatment for oral thrush in children.
In severe cases of the disease, the temperature rises, the baby becomes lethargic, and symptoms of intestinal diseases appear.
Treatment depends on the extent of the disease. It is necessary to treat the baby's cavity regularly. Even if there are visible improvements, it is necessary to continue treatment according to the doctor’s prescription. Since this is a fungal disease, it can appear again and again. Treatment of thrush in children continues until the infection disappears completely, as evidenced by repeated laboratory tests.
If thrush is found in the mother, then the child will definitely have it too.

Prevention of thrush
Follow the rules of hygiene for children: bathe your baby regularly, boil pacifiers, bottles, toys. Strengthen your child's immunity with walks fresh air, vitamins from fresh vegetables and fruits, therapeutic massage and, of course, love your baby, give him enough time and attention, and then he will grow up healthy.

Diseases of the oral mucosa in children

Features of the structure of the oral mucosa in childhood

In the oral cavity, two sections are distinguished: the anterior, or anterior oral cavity, and the posterior, or oral cavity itself. The oral cavity is formed before the end of the 2nd month of intrauterine development from five facial processes. During this period, developmental anomalies predominantly form. The nasolacrimal groove develops from the nasal processes, as well as the middle part of the upper lip and the alveolar process in the incisor area. From the two maxillary processes, the right and left parts of the upper jaw develop, then processes of the hard palate are formed, which grow together along the midline, delimiting the oral cavity from the nasal cavity. The processes grow together after immersion of the epithelium contained between them. If the frontal process of the medial nasal process does not fuse with one or both processes of the upper jaw, then a lip gap (the so-called cleft lip) occurs. If the right and left processes of the hard palate do not fuse, a gap in the hard palate appears (so called cleft palate). As a result of the fusion of the upper and lower jaw processes, the oral gap is shortened, the degree of growth of which determines the size of the lips.

The epithelium located closer to the oral fissure has ectodermal origin, closer to pharynx - endodermal . Thus, the mucous membrane of the lips, cheeks, tongue, hard and soft palate with minor salivary glands, epithelium of the major salivary glands, gums, tooth enamel are of ectodermal origin.

The oral mucosa has three layers: epithelium, lamina propria and submucosa (small 127).

The epithelium of the mucous membrane is multilayered flat, has three layers: basal, fizzing e cl The branches of the basal layer are cylindrical in shape and are located parallel to the basement membrane. The cytoplasm of these cells contains ribonucleic acid.

The cells of the spinous layer are localized more superficially and have a polygonal shape. Closer to the surface, the cells gradually flatten and form surface layer flat cells.

Cells of the basal layer and the adjacent spinous layer are capable of mitosis , which is especially pronounced in young people. One cell is divided into an average of 1000 basal cells, therefore the renewal of the mucous membrane of the oral cavity lasts 6-7 days (skin - 21 days). Most pronounced mitosis observed at the attachment points of the gingival epithelium.

Between the layers of flat epithelium of the mucous membrane of the oral cavity there are leukocytes: per 100 basal cells - on average 4 leukocytes. They penetrate through the epithelium of the gingival sulcus, gum pockets into the oral cavity and accumulated are dripping with saliva.

The epithelium also contains a melanocyte, which produces melanin.

The lamina propria tunica mucosae is formed by tissue that consists of fibrous structures with blood vessels, cellular elements and intercellular substance. Structures located closer to the epithelium form str. papillare, which in the form of papillae resort to the epithelium, where in gaps capillary branches are located. The second layer of fibrous structures is str. reticulare contains connecting capillaries and small vessels, which are parallel to the surface.

Fibrous structures are formed by collagen and reticular fibers. Of the cellular elements are fibroblasts , macrophages and tissue basophils.

The basis of the intercellular substance of connective tissue is glycoproteins and glycosaminoglycans. The mucous membrane of the oral cavity can be dense or lush depending on its mobility. A dense mucous membrane covers the alveolar processes and hard palate, the back of the tongue. The epithelium of the dense mucous membrane is weak to keratinization under normal conditions. Lush connective tissue covers the cheeks and floor of the mouth.

With age, the structure of the oral mucosa in children changes. In newborns, the epithelium is thin, the epithelial papillae are not developed. Epithelial cells of all parts of the oral cavity contain a significant amount of glycogen, RNA, acidic glycosaminoglycan o in . The basement membrane is poorly developed. Connective fibrous structures are not sufficiently differentiated. This indicates the presence in the tissues of mature protein structures that make up collagen and elastic fibers. It is believed that mature protein structures are transmitted to the fetus from the mother through the placenta.

The predominant cellular elements are fibroblast s, there are a small number of histiocytes, lymphocytes, plasma cells; fabric basophil s - young, inactive. These data indicate slight irritability of the mucous membrane at this age and its high ability to regenerate.

During infancy, the volume of the epithelium increases. In the mucous membrane of the gums and hard palate, the basement membrane and fibrous structures of the lamina propria of the mucous membrane are denser. The number of cellular elements and blood vessels decreases. Elements of parakeratosis appear, especially at the tips of the filiform papillae of the tongue. In addition, glycogen disappears in these areas. In other parts of the oral cavity, the basement membrane is thin, and the connective tissue of the lamina propria of the mucous membrane is poorly differentiated.

In early childhood (1-3 years), the mucous membrane of the oral cavity acquires a certain structure in accordance with itsmorphofunctional s mi features of this period.

The epithelium of the mucous membrane of the gums and hard palate becomes more dense, there is a significant number of flat epithelial cells with the appearance of zones of parakeratosis and keratinization, the disappearance of glycogen. The basement membrane becomes denser, the fibrous structures acquire a clear orientation. The number of blood vessels decreases compared to other areas of the oral mucosa.

In the epithelium of the tongue, lips, cheeks there is a small amount of glycogen, the basement membrane is lush, collagen and elastic fibers are also lush, without a clear orientation, which indicates their immaturity.

In the actual mucous membrane of the oral cavity there is a significant amount of cellular elements, too many in the area of ​​the connective tissue papillae and around the blood vessels. This is especially true for fabrics basophil o in , which are represented by young inactive forms. The number of plasma cells and histiocytes is insignificant. Along with this, it should be noted that there are a large number of blood vessels in children of this age. These morphological features of the oral mucosa determine the acute course of the pathological process in it.

In preschool age (3-7 years) there is a significant decrease in intensity metabolic processes in the mucous membrane. During this period, the volume of the epithelium increases, its glycogen content increases and RNA compared with the period of early childhood. Along with this, the number of blood vessels and cellular elements, especially tissue ones, decreases basophil o in . The basement membrane thickens, the number of collagen and elastic structures increases. Collagen fibers have a pronounced fuchsinophilia , which indicates collagen maturity.

The cellular composition of connective tissue changes: the amount oflymphoid-histiocytic y x elements that form a perivascular infiltrate. The appearance of these elements indicates that in children at this age there is significant sensitization of the body and the process of formation of defense mechanisms is taking place. The morphological features of the mucous membrane in children during this period contribute to the development of chronic pathological processes in the oral cavity.

The period of primary and secondary school age (8-12 years) is characterized by an increase in glycogen content in the epithelium, an increase in tissue volume, and the completion of collagenogenesis A. The appearance of glycogen in the mucous membrane of the gums and hard palate at this age predetermines the development of various diseases of the marginal periodontium. In children 12-14 years old, changes in the mucous membrane occur under the influence of hormonal regulation factors, which entails the predominance of gingivitis and soft leukoplakia.

Classification of diseases of the oral mucosa

In dental practice, a convenient classification of diseases of the oral mucosa is based on a complex of etiological, pathogenetic and clinical data on diseases of the oral mucosa in children.

Classification of diseases of the oral mucosa in children (T.F. Vinogradova, 1987)

I. Poetiology:

1. Viral diseases of the oral mucosa:

acute herpetic stomatitis;

herpangina ( coxsackievirus stomatitis);

viral warts;

vesicular stomatitis;

AIDS.

2. Fungal diseases:

acute and chronic candidiasis;

candidomycosis, etc.

3.Bacterial diseases:

Vincent's ulcerative necrotizing stomatitis; tuberculous stomatitis;

gonorrheal stomatitis;

syphilis of the oral cavity.

4.Allergic diseases:

exudative erythema multiforme.

5. Changes in the oral mucosa, which are symptoms of pathological changes in different organs and body systems:

for diseases of the digestive system (recurrent oral aphthae);

for acute infectious diseases (measles, etc.);

for blood diseases (desquamative Gunther's glossitis for anemia, ulcerative stomatitis for leukemia, etc.;

for skin diseases ( epidermolysis bullosa, Dühring's dermatitis, etc.);

for cardiovascular, neuropsychic, endocrine and other systemic diseases.

6. Damage to the mucous membrane of the oral cavity as a result of mechanical, physical and chemical trauma ( afta Bednar, decubital ya afta , erosion, wound, thermal, chemical and radiation burns, soft leukoplakia).

II. According to the clinical course: acute and chronic (recurrent and permanent).

III. According to localization: stomatitis, papillitis, gingivitis, glossitis, palatinite, etc.

IV. According to morphological changes:

1. Primary inflammations (catarrhal, fiber cool, alternative and proliferative);

rash (blisters, wheals, papules).

2. Secondary inflammation:

erosions, aphthae, ulcers, spots, scars

At the Department of Pediatric Therapeutic Dentistry of the National Medical University, the following classification of diseases of the oral mucosa is used in the educational process and medical work.

1. Traumatic damage (mechanical, chemical, physical) - Bednar's aphtha, decubital I erosion, ulcer, thermal, chemical and radiation burns, soft leukoplakia, etc.

2. Viral diseases of the oral mucosa:

acute herpetic stomatitis;

recurrent herpetic stomatitis;

herpangina ( coxsackievirus stomatitis);

viral warts.

3. Changes in the mucous membrane of the oral cavity during acute viral and infectious diseases (measles, chicken pox, O herpes zoster, scarlet fever, diphtheria, whooping cough, infectious mononucleosis, AIDS, etc.).

4. Fungal diseases of the oral mucosa:

acute candidiasis;

chronic candidiasis.

5. Allergic diseases: (Quincke's edema, exudative erythema multiforme, Stevens-Johnson syndrome, Lyell's syndrome, chronic recurrent aphthous stomatitis).

6. Manifestations on the mucous membrane of the oral cavity in some systemic diseases (disease of the digestive, blood, cardiovascular, endocrine systems; hypovitaminosis, etc.).

7. Changes in the oral mucosa due to specific diseases (gonorrhea, tuberculosis, syphilis).

8. Anomalies and independent diseases of the tongue (folded, rhomboid, desquamative glossitis).

9. Cheilitis:

independent;

manifestations in pathological conditions of various organs and systems.

The dentist must have a clear understanding not only of the clinical manifestations of diseases of the oral mucosa, but also of the pathological condition nervous system, circulatory organs, alimentary canal, endocrine glands, metabolic disorders in the body, structural and functional changes in the body of a child who is growing. The doctor should focus on individual approach to each patient, possess examination techniques, the ability to evaluate the results of the study, draw up a plan complex treatment and prevention of dental diseases, as well as to be familiar with the basics of clinical examination under modern conditions.

Anatomically, the mucous membrane of the oral cavity belongs to the initial section of the digestive canal, therefore from birth the child is susceptible to systematic influence external factors and simultaneously reproduces various pathological processes in the body. The pediatric dentist should be especially careful to conduct a comprehensive clinical examination of a child with oral tissue pathology together with a pediatrician, gastroenterologist, neurologist or other specialists. A peculiarity of the child’s body is that most diseases of the mucous membrane of the oral cavity are quite acute, with a pronounced violation of the general condition. The effectiveness of treatment depends on a correct assessment of the relationship between oral diseases and pathology internal organs and metabolic disorders in children.

Elements of damage to the oral mucosa

Development of any disease SOPR characterized by the appearance of peculiar lesion elements on its surface. The rashes observed on the skin and CO consist of individual elements, which, based on their manifestations, can be combined into several groups:

1) CO color change;

2) change in surface topography;

3) fluid accumulation is limited;

4) layering on the surface;

5) CO defects.

The elements of damage are conventionally divided into:

primary, which arise on unchanged CO

secondary, which are a consequence of transformation or damage to existing elements.

The formation of identical primary elements on CO is considered monomorphic, and different ones - as a polymorphic rash.

Knowledge of the elements of a rash makes it possible to correctly navigate numerous diseases SOPR and lips And a comparison of the clinical picture of local changes with the state of the whole organism, with environmental factors that adversely affect both the affected area and the body as a whole, makes it possible to correctly make a diagnosis.

The primary elements of the rash include a spot, a nodule (papule), a node, a hump, pus (pustule), cyst, blister, wheal.

Secondary elements are considered to be erosion, aftu , ulcer, crack, scale, excoriation, crust, scar, lichenization.

Rice. 15. A hot spot on the gums (a), its schematic representation (b):

And - epithelium. 2 - lamina propria of the mucous membrane. From - dilated blood vessels

Vascular spots may be the result of temporary vasodilation and inflammation. Inflammatory spots have different colors, often red, less often bluish color. When you press on these spots (diascopies), they disappear, and after you stop pressing they appear again.

Erythema - unlimited, without clear contours of CO redness.

Roseola - small round erythema diameter from 1.5-2 to 10 mm, with limited contours. Observed at infectious diseases(measles, scarlet fever, typhus).

Hemorrhages are spots, the occurrence of which is caused by violations of the integrity of the vascular wall. Their sizes are different. The color of such spots depends on the degree of decomposition of the blood pigment and can be red, blue stunning red, greenish, yellow and the like. With diascopy, discoloration hemorrhage not happening. Over time, they disappear without a trace.

Petechiae are pinpoint hemorrhages.

Ekhimosi - large hemorrhages round or oval shape.

Telangiectasias are spots that appear as a result of persistent non-inflammatory dilation of blood vessels or their neoplasm. They are formed by thin tortuous vessels that anastomose with each other. During diascopytelangiectasiapale a little.

Pigment spots arise due to the deposition of dyes of exo- and endogenous origin in CO substances. They can be innate or acquired. Congenital pigmentations are called nevi. Acquired pigmentation is of endocrine origin or develops as a result of infectious diseases.

Exogenous pigmentation is caused by penetrations of CO from external environment substances that color it. Such substances are industrial dust, smoke, chemical substances, in particular medicines etc. Pigmentation in the case of penetration of heavy metals and their salts into the body has a clearly defined shape. Its color depends on the type of metal. Yes, the color of stains caused by mercury is black, lead and bismuth are dark gray, tin compounds are pitch-black, zinc are gray, copper is greenish, silver is black or slate.

A papule, or nodule (papula), is a cavity-free element that protrudes above the surface of the CO. The papule infiltrate is located in the mamillary layer of the lamina propria (Fig. 16). The shape of papules can be pointed, semicircular, round, keglepod o bnoy . Their diameter is 3-4 mm. In the case of papules merging, plaques are formed. With reverse development, the papule leaves no trace.

Rice. 16. Nodule (papule) on the mucous membrane of shock (o), its schematic image (b):

And - epithelium. 2 - lamina propria of the mucous membrane. From - increased epithelium

Node (nodus) - a compaction of considerable size (from a hazelnut to a chicken egg) that reaches the submucosa (Fig. 17). The formation of nodes can be a consequence of the inflammatory process, benign and malignant tumor growth, as well as the deposition of calcium and cholesterol into the tissue.

Inflammatory nodes formed due to nonspecific and specific infiltration (with leprosy, scrofuloderma, syphilis, tuberculosis) rapidly increase. Their reverse development depends on the type of underlying disease. They can dissolve, necrotize, melt with the formation of ulcers, and later in their place - deep scars

Rice. 17. Node on the mucous membrane of the lip (a), its schematic image (b):

I - epithelium; 2 - lamina propria of the mucous membrane; 3 - tissue proliferation

The hump (tuberculum) is an infiltrative cavityless element of a rounded shape, the size of a pea, which protrudes above the CO level (Fig. 18). The infiltrate captures all CO layers. A feature of the hump, which at first looks like a nodule, is that its central part, and sometimes the entire element, becomes necrotic. This leads to the formation of an ulcer, which scars or resolves without disturbing the integrity of the epithelium, with the formation of cicatricial atrophy. The humps tend to cluster or merge. They are primary elements for lupus, tuberous syphilis, leprosy.

Hump ​​on the mucous membrane of the upper lip (a), its schematic representation

I - epithelium: 2 - lamina propria of the mucous membrane: J - infiltrate

A blister (vesiculum) is a cavity element the size of a millet grain to a pea, filled with liquid. He would):

Rice. 19 Blister on the lower lip (a), its schematic image (b)

i - epithelium 2 - own wall with a thin shell inside epitheldial cavity

is formed in the spinous layer of the epithelium, most often has a serous, less often hemorrhagic content (Fig. 19) Blister eruptions can be observed both on an unchanged and on a hyperemic and edematous base. Due to the fact that the walls of the blister are formed by a thin layer of epithelium, its cover quickly ruptures with the appearance of erosion, along the edges of which fragments of the blister remain. With the reverse development of the blister, it leaves no trace. Often, blisters ro form in groups Blisters form V a consequence of vacuolar and balloon dystrophy, usually due to various viral diseases (herpes, etc.).

Blister (bulla) is a cavity element of significant size (like a chicken egg), filled with liquid ( small 20) Forming

Small 20 Blister on if true shell of the tongue (a), its schematic representation (b)

I - epithelium 2 - own and ste nka with l from the shell

It distinguishes between the operculum, the bottom and the contents. The exudate can be serous or hemorrhagic. The operculum of the subepithelial blister is thick, which is why it exists on CO longer than int a rhenepithelial blister, the covering of which is thin and ruptures quickly. The erosion that forms at the site of the blister heals without forming a scar.

Pustula - limited accumulation of purulent exudate ( small 21) Pustules are primary and secondary Primary pustules develop on unchanged CO and are immediately filled with purulent contents of a yellowish to whitish color Secondary pustules arise from blisters and blisters Formations pus o in caused mainly by the action of enzymes and toxins from waste products on the epithelium staphylo- and streptococci. Pustules can be superficial or deep.

Cyst - a cavity formation that has a wall and contents (Fig. 22). Cysts are of epithelial origin and re tensional. The latter arise as a result of blockage of the outlet n ducts of the small mucous (salivary) glands. Epithelial cysts have a wall of connective tissue lined with epithelium. The content of the cyst is serous, serous-purulent or bloody exudate Retention cysts are located on the lips, palate and cheeks, filled with transparent contents, which become purulent when infected.

Small 22 Cyst of the oral mucosa (a), schematic image (b)

and - cavity 2 - epithelial rash

Rice. 23 Scales on the lower lip (a), their schematic representation (b):

/ - epithelium 2 - lamina propria CO -3 - scales

Rice. 24 Erosion on the mucous membrane of the lateral surface of the tongue (a), schematic and image (b):

1 - epithelium, 2 - lamina propria. 3 - epithelial defect

Secondary elements of the lesion.

Scales (squama) - a plate that consists of desquamovana y x zrogov evshi x epithelial cells

Rice. 25 Afta on CO lower lip(a), schematic illustration(b)

Scales arise as a result hyper- and parakeratosis. As a rule, in places of reverse development of spots, papules, humps, there are spots of different colors and sizes. Can develop under mild conditions leukoplakia, exfoliative cheilitis e, ichthyosis To diagnose lesions with the formation of scales, their location, thickness, color, size, and consistency are important.

Rice. 26 Ulcer on the lateral surface of the tongue (a), schematic image (b)

1-epithelium 2 - lamina propria CO

Erosion (erosio) - defect of the surface layer of the epithelium. Since the lesion is not deep, after its healing there is no trace left (Fig. 24). Erosion occurs from the rupture of a blister, the destruction of papules, traumatic injury. When a blister ruptures, erosion follows its contour. In the case of erosion confluence, large erosion surfaces with diverse contours are formed

Rice. 27 Crack of the red border of the lower lip (a), its schematic representation (6)

1 - epithelium 2 - lamina propria CO3 - linear tissue defect CO

On SOPR eroded surfaces can g ut appear without a previous blister, for example, erosive papules with syphilis, erotic - ulcerative red form lichen planus and lupus erythematosus. The formation of such erosions is a consequence traumatization easily damaged by inflamed CO. The surface defect of CO that occurs due to mechanical damage is called excoriation

Rice. 28 Crust on upper lip(a), its schematic representation

and - epithelium 2 - own P lamina CO 3 - crust

Aphta - superficial defect of the epithelium of round or oval shape, diameter 0.3-0.5 mm placed on the inflamed area CO (Fig. 25)

The aphtha is covered with fibrinous a discharge that gives the affected element a white or yellow tint. On the periphery aphtha surrounded by a bright red rim

Rice. 29 Hypertrophic scar on the mucous membrane of the lower lip (a), its schematic and image (b)

I - epil and th 2 - own wall of CO

An ulcer (ulcus) is a CO defect within a layer of connective tissue (Fig. 26). Its healing occurs with the formation of a deep scar. Since the formation of an ulcer is characteristic of a number of pathological processes, to facilitate differential diagnosis, the nature of the lesion, the depth, shape of the ulcer, the condition of its edges and surrounding tissues are clarified etc

Rice. ZO Atrophic scar on the lower surface of the tongue (a), its schematic image (b)

The edges of the ulcer are undermined and hanging above the bottom, vertical and saucer-shaped. They, as well as the bottom of the ulcer, can be soft and hard. At the bottom of the ulcer, purulent plaque, necrotic masses, and granulation growths are often observed. It can bleed easily when touched. Often the edges of the ulcer contain remnants of the underlying pathological process. Sometimes the ulcer spreads to the underlying tissues (muscles, bone) and even destroys them.

It should be emphasized that only a clinical assessment of an ulcer is insufficient to clarify the diagnosis of the disease. It is necessary to apply the entire complex of laboratory tests, and also certainly conduct a general examination of the patient.

A crack (rhagas) is a linear tear of the CO or red border of the lips, which occurs when they are excessively dry or lose elasticity, as well as during inflammatory infiltration (Fig. 27). Most often, cracks are observed in places of natural folds or in areas that are subject to trauma and stretching.

There are superficial and deep cracks. The superficial crack is localized within the epithelium and heals without a scar. A deep crack extends to connective tissue lamina propria, heals with the formation of a scar.

crust (crusta) is formed due to the drying of the exudate, which flows out after the blister, blister, pustule breaks ( small 28).

The crust is a mixture of coagulated tissue fluid and blood plasma, as well as blood cells and epithelial cells. The color of the crusts depends on the nature of the exudate. In the case of serous exudate drying out, honey-yellow crusts are formed, purulent - dirty gray or greenish-yellow, hemorrhagic - bloody yellow -brown When the crust is forcibly removed, an erosive or ulcerative surface is exposed, and after natural falling off, an area of ​​regeneration, a scar or cicatricial atrophy is exposed.

Tripe (cicatrix) - a section of connective tissue that replaces the CO defect that occurs when it is damaged or pathological process The scar consists mainly of collagen fibers, covered with a thin layer of epithelium in which there are no epithelial projections. The shape and depth of the scars are different.

There are hypertrophic and atrophic scars. Hypertrophic ( keloid new) scars (Fig. 29) occur after injury and surgical interventions. They have a linear shape, are dense, and often limit mobile CO. Atrophic scars (Fig. ZO ) are formed after the healing of elements of tuberculosis, syphilis, red lupus.

Such scars have a characteristic appearance for a particular disease, from which the cause of their occurrence can be determined with great accuracy. Yes, scars that occur after lupus erythematosus are noted irregular shape and significant depth; the scars that formed after the healing of a tuberculous ulcer are relatively shallow, after rubber they are smooth and shiny, retracted. With congenital syphilis, the scars are radial and located around the mouth

Such scars have a characteristic appearance for a particular disease, from which the cause of their occurrence can be determined with great accuracy. The scars that formed after the healing of a tuberculous ulcer are relatively shallow, after rubber they are smooth and shiny, retracted. With congenital syphilis, the scars are radial and located around the mouth.

Viral diseases of the oral mucosa.

Changes in the oral cavity during viral diseases are predominantly inflammatory nature. They depend on the course of the disease, the general condition of the body, and the presence of irritants in the child’s oral cavity that complicate the course of the disease.

Acute herpetic stomatitis (A GS)

According to the literature, O HS accounts for 80% of cases of stomatitis in children (T.F. Vinogradova and with about aut., 1973).

Etiology. The disease is caused by the herpes simplex virus, which belongs to the neurotropic group. The disease most often occurs in children aged 6 to 3 years, but can also occur in older children. Source infections and children with acute forms of the disease, relapses of herpes infection, adults. Transmission of infection occurs by contact and airborne droplets. It often occurs in the form of epidemic outbreaks in children's groups. This is facilitated by the short duration of the incubation period of the disease (2-6 days).

GGS As a typical infection, it has 5 periods of development: incubation, prodromal, height of the disease, extinction and clinical recovery. The incubation period lasts from 2 to 17 days. The occurrence of the disease is facilitated by trauma to the integumentary tissue.

After the infectious agent enters the child’s body, it begins to multiply in the cells of local tissues and adjacent lymph nodes. After local infection, the virus can spread by hematogenous and neurogenic routes (primary viremia). Accumulating in various organs (liver, spleen, etc.) and tissues, it causes their damage with the formation of necrotic areas.

After the accumulation of the virus in these organs, secondary viremia occurs, during which the virus infects the skin and mucous membranes, where its intracellular reproduction occurs.

Clinic. Depending on the degree of manifestation of clinical symptoms, mild, middleweight mild and severe forms of herpetic stomatitis. The disease is characterized by intoxication of the body, a pronounced inflammatory reaction of the oral mucosa, and suppression of local immunity; Characteristic is lymphadenitis of the submandibular, less often - cervical lymph nodes, which precedes the development of the disease and persists for 7-12 days after epithelization in the oral cavity.

The disease begins with an increase in body temperature from 37.5 to 38-39 °C. During this period, the child’s general condition worsens, weakness, headache, nausea, and pale skin are observed. In the oral cavity there is hyperemia and bleeding gums (catarrhal gingivitis). During the development of the disease, after 1 - 2 days, against the background of increased hyperemia, single or multiple lesions appear, which are located on the mucous membrane of the lips, cheeks, tongue, soft and hard palate, and gums. These are areas of superficial epithelial necrosis or blisters diameter 1-3 mm with transparent or cloudy content, which quickly rupture, forming secondary elements - erosion or aphthae. Aphthae are covered with yellowish fibrinous plaque m, have a round or oval shape and a thin red frame, sharply painful when touched, the size of a millet grain to a cherry pit (Fig. 27).

In a mild form of the disease, the number of aphthae reaches 3-5, the rash is one-time, the disease lasts 4-7 days. On the skin prirotovo Typical herpetic blisters are observed in the third area, eyelids, and ear particles. The elements merge and form large areas of necrosis, their number depends on the severity of the disease.

Moderate form GGS characterized by a longer course (7-12 days), the presence of 5-15 elements of the lesion, their relapses up to 2-3 times, significant intoxication.

Severe form of HGS observed much less frequently. The child's body temperature rises to 39-40 °C. Large areas of the oral mucosa are affected as a result of a large number of elements. Characteristic numerous relapses of rashes (Fig. 28 - see color insert). Catarrhal gingivitis turns into ulcerative-necrotic. Severe changes in the oral cavity are accompanied by manifestations of inflammation of the nasal mucosa, respiratory tract. Severe intoxication is observed. Disturbances in the circulatory system and digestive canal (carry-over) often occur. There are significant changes in the blood (leukopenia, eosinophilia, shift of the leukogram to the left), suppression of humoral and local immunity factors is observed.

Feature of GGS is a sharp pain in the affected areas, aft. It intensifies during touching and eating. The act of the tongue is disrupted as a result of pain when moving the tongue. Stomatitis is accompanied by increased salivation, unpleasant smell from the mouth.

The period of clinical recovery is characterized by a decrease in inflammatory manifestations, clearing of lesions from fibrinous plaque and epithelization of lesion elements.

GGS need to be differentiated from acute infectious childhood diseases with similar clinical manifestations, many form en noi exudative erythema, drug-induced stomatitis.

Diagnosis of HGS is based on data from clinical manifestations, anamnesis regarding the epidemiological environment, results of virological, serological, cytologists and immunofluorescence studies. At cytolo In a clinical study, the stage of degeneration is characterized by huge multinucleated cells; their sizes may exceed the size of ordinary epithelial cells. Their shape is round, the cytoplasm is blue, the number of nuclei is 2 or more.

Treatment depends on the child’s age, pathogenesis, severity of the clinical course, period of disease development, and the presence of concomitant diseases. Bed rest and isolation of the child are necessary.

IN mild case forms from the first days of the disease, local treatment should be carried out to anesthetize the mucous membrane of the oral cavity, prevent relapses, the emergence of new elements and accelerate the epithelization of lesions.

To anesthetize the mucous membrane of the oral cavity, you should use: 3-5% oil mixture of anesthesin, 1% solution pyromicain a, usinate sodium in glycerin or juniper balsam with the addition of 2% anesthesin.

Pain relief is carried out by carefully lubricating the affected areas of the oral mucosa, lips for 3-5 xv to treatment or feeding the child.

From the first days of treatment, it is necessary to use antiviral drugs to block the reproduction of viruses in cells and eliminate them. For this, use Oksolin (0.25% ointment), tebrofen (1,2,3 and 5% ointment), florenal (0.5% ointment).

It is advisable to use newer antiviral drugs, such as bonaftone, riodoxol , gossypol. Bonafton and riodoxol used in the form of 0.25,0,5,7% ointment. Gossypol is applied to the affected mucous membrane of the oral cavity in the form of 3% liniment or 0.1% aqueous solution, which is made from gossypol powder.

Promising new antiviral drugs are the so-called abnormal nucleosides . Among them, the most effective is acyclovir (Zovirax) ). It has a selective antiviral effect.

Antiviral effect Zovirax predetermined by its specific interaction with the viral enzyme - thymidine kinase . Under influence thymidine kinase transformation occurs acyclovir on mono-, di- and triphosphate acyclovir . The latter interacts with viral DNA, which is synthesized for new viruses. Thus, defective viral DNA is formed, which leads to inhibition of the replication of new generations of viruses. The drug acts as termshator DNA synthesis. Zovirax is available in tablets, ointments, and creams (5%).

A separate group of antiviral drugs consists of interferons. They have a wide spectrum of action on both viruses that contain RNA and DNA. For this purpose, dry human leukocyte interferon is used, 1000 MO antiviral activity in the form of tablets or hygroscopic powder of white or pink color in ampoules. Interferon is prescribed by instillation into each nasal passage or inhalation for 2-3 days at least 5 times a day. Among interferons important place takes laferon - medical form of humanrecombinanta-2p-interferon synthesized by Escherichia coli cells. Laferon has an antiviral effect.

It is prescribed to children, including newborns, intranasally 4-6 drops in each nasal passage 3-6 times a day for 3-5 days; for newborns - 20,000-50,000 MO/ml, for older children - 100,000 MO/ml.

In case of a pronounced inflammatory reaction and a large amount fibrinous plaque, preparations of proteolytic enzymes are indicated - trypsin, chymotrypsin, deoxyribonuclease.

With moderate form of HGS treatment time is significantly reduced with local application emulsions with nystatin, prednisolone and retinol (O.I. Marchenko and spivavt., 1988).

After eliminating acute inflammation of the oral mucosa and clearing the aphthae from fibrinous plaque for the purpose of epithelialization, it is recommended to prescribe oil solutions of retinol and tocopherol acetate, rosehip oil, carotoline, solcoseryl , Libyan aerosol, vinylin, Kalanchoe juice, etc.

How sim t omatic effective treatment is prescribedI'm pposepsibilizing medicinal drugs, salicylates , analgesics, vitamins. Because the herpetic infection suppresses immune system, children with middle-heavy and severe forms GGS useful to prescribe immunomodulator levamisole . Mechanism of action levamisole associated with the activation and proliferation of!-lymphocytes, an increase in the number of monocytes, an increase in the activity of macrophages, and an increase in the chemotaxis of neutrophil granulocytes.

In a hospital setting with severe forms GGS use prodigiosan , broad-spectrum antibiotics,sulfonamidesdrugs, carry outdetoxificationyu therapy (intravenous jet injection of 10% glucose solution, rheopolyglucin, plasma, albumin ). Among the physical methods of treatment, ultraviolet irradiation is indicated.

In complex therapeutic measures play an important role balanced diet and caring for a sick child. The diet should include a sufficient amount of proteins, vitamins, microelements; as a result of intoxication, the child needs to drink a lot. Food should be soft and not irritate the mucous membrane.

Prevention involves identifying people with recurrent herpes simplex among service personnel in children's groups and parents, timely isolation of a sick child and examination of children who have been in contact with her, monitoring a group of high-risk children aged 1-3 years, who often get sick at GRVH , isolation of the treatment room for the admission of children sick with GGS , in order to prevent contact with other children who visit the clinic.

Classification of diseases of the oral mucosa

(according to etiological principle)

Damage to the oral mucosa of traumatic origin as a result of mechanical, physical and chemical trauma (decubital ulcer, Bednar's aphthae, burn);

Diseases of the oral mucosa caused by viral, bacterial and fungal infections (acute herpetic stomatitis, Vincent's ulcerative necrotizing gingivostomatitis, candidomycosis);

Oral diseases caused by a specific infection (syphilis, tuberculosis);

4. Damage to the oral mucosa due to dermatoses (lichen planus, pemphigus vulgaris);

5. Diseases of the oral mucosa caused by allergies (manifestation medicinal disease in the oral cavity, exudative erythema multiforme, Stevens-Johnson syndrome, chronic recurrent aphthous stomatitis).

6. Changes and diseases of the oral mucosa, which are symptoms of diseases of internal organs and body systems, and occur during: a) acute infectious diseases; b) blood diseases; c) pathologies of the gastrointestinal tract; d) cardiovascular diseases; d) endocrine pathology.

7. Precancerous diseases of the oral mucosa (leukoplakia, papillomatosis)

Traumatic lesions of the oral mucosa

The oral mucosa is constantly exposed to mechanical, physical and chemical factors. If these irritants do not exceed the threshold of irritability of the oral mucosa, then it does not change due to its protective function. In the presence of more pronounced suprathreshold stimuli, changes occur on the mucous membrane, the nature of which depends on the type of stimulus, its intensity and duration of action. The degree of these changes is also determined by the place of influence of the external factor, the characteristics of the body’s reactivity, etc.

Acute mechanical trauma of the oral mucosa may occur as a result of impact, biting with teeth or injury by various sharp objects. A hematoma, abrasion, erosion or deeper damage usually occurs at the site of impact. As a result of secondary infection, these wounds can turn into long-term non-healing chronic ulcers and cracks.

Chronic mechanical injury – the most common cause of damage to the oral mucosa. Traumatic factors can be sharp edges of teeth, defects in fillings, poorly made or worn-out single crowns, fixed and removable dentures, and orthodontic appliances. When exposed mechanical injury First of all, hyperemia and swelling occur on the oral mucosa. Then erosion may appear in this place, and in the future decubital ulcer . As a rule, this is a single, painful ulcer, surrounded by an inflammatory infiltrate: its bottom is smooth, covered with fibrinous plaque. The edges of the ulcer are uneven, scalloped, and become denser over a long period of time. Regional lymph nodes are enlarged and painful on palpation. The ulcer may become malignant. A traumatic (decubital) ulcer must be differentiated from cancerous, tuberculous, syphilitic and trophic.

One of the causes of decubital ulcers in children in the first weeks or months of life is trauma to the teeth or one tooth that erupted before the birth of the child or in the first days and weeks after birth. Usually one or two central incisors erupt prematurely, mainly on the lower jaw. The enamel or dentin of these teeth is underdeveloped, the cutting edge is thinned and during breastfeeding it injures the frenulum of the tongue, which leads to the formation of an ulcer. Under these conditions, an ulcer can also occur on the alveolar process of the upper jaw. A decubital ulcer of the cheek or lip can appear during the period of changing teeth, when the root of a baby tooth, which has not resolved for any reason, is pushed out by a permanent tooth, perforates the gum and, protruding above its surface, permanently injures the adjacent tissues. An ulcer can occur in children with decayed teeth with uneven, sharp edges, as well as in children with bad habit bite or suck the tongue, mucous membrane of the cheeks or lips between the teeth.

One of the manifestations of chronic injury in weakened children who are bottle-fed is afta Bednar (it is usually believed that aphtha is an erosion covered with fibrin; it is a round-shaped surface defect of the epithelium, located on an inflamed underlying base; there is a rim of hyperemia in the circumference of the element). Hypotrophy is the background against which minor tissue traumatization by a long pacifier or while wiping the child’s mouth is sufficient to disrupt the epithelial cover. Erosions are often located symmetrically at the border of the hard and soft palate, respectively, projecting onto the mucous membrane of the hook of the pterygoid process of the main bone. The defeat can also be one-sided. The shape of the erosion is round, less often oval, the boundaries are clear, the surrounding mucous membrane is slightly hyperemic, which indicates a state of hypergia. The surface of the erosions is covered with a loose fibrinous coating, sometimes clear, brighter in color than the surrounding mucous membrane of the palate. The size of the erosions ranges from a few millimeters to extensive lesions that merge with each other and form a butterfly-shaped lesion. When a secondary infection occurs, erosions can turn into ulcers and even cause perforation of the palate. Bednar's aphthae can also occur during breastfeeding if the mother's nipple is very rough. Erosion in this case is located along the midline of the palate or in the area of ​​the alveolar processes of the upper and lower jaws. The child becomes restless. Having started to actively suck, after a few seconds he stops sucking with tears, which is usually the reason for contacting a doctor.

Treatment traumatic lesions comes down to eliminating the cause, antiseptic treatment of the affected area, and the use of keratoplasty agents.

Prematurely erupted baby teeth should be removed because their structure is defective. They quickly wear off and, in addition to trauma to the mucous membrane, can cause odontogenic infection.

With Bednar's aphthae, it is necessary, first of all, to establish feeding of the child: natural through a shield (if the mother's nipples are rough) or artificial through a shorter nipple, which would not reach the eroded surface when sucking.

To treat the child’s oral cavity, weak antiseptic solutions should be used (3% hydrogen peroxide solution, herbal infusions with an antiseptic effect). Vigorous wiping of the mouth and the use of cauterizing substances are not permitted. Treatment of the oral cavity should be carried out with cotton balls, making blotting movements. To accelerate epithelization, the affected area is treated with an oil solution of vitamin A and other keratoplasties. It should be borne in mind that Bednar's aphthae heal very slowly - within several weeks.

Stomatitis in infectious diseases

Local changes in the oral cavity during infectious diseases are predominantly inflammatory in nature. They are expressed differently depending on the general condition of the body, the degree of its reactivity and resistance. For a number of infectious diseases, the oral cavity is the entrance gate. This explains the fact that in some infections the primary lesion occurs in the oral cavity in the form of local changes.

Scarlet fever

The primary localization of pathological changes in scarlet fever is the tonsils and the mucous membrane of the pharynx and pharynx. Changes in the oral mucosa during scarlet fever are very often early and characteristic symptoms of the disease.

The causative agent of the disease, according to most scientists, is hemolytic streptococcus. Infection occurs by droplets and contact. The incubation period lasts from 3 to 7 days, but can be shortened to 1 day and extended to 12 days. Mostly children from 2 to 6-7 years old are affected.

Clinic. Acute onset, temperature up to 39-40°C, nausea, vomiting, headache. After a few hours, pain appears when swallowing. Changes in the oral cavity occur simultaneously with an increase in temperature. The mucous membrane of the tonsils and soft palate becomes bright red, and the focus of hyperemia is sharply limited. On the 2nd day, small punctate enanthema appears on the hyperemic area, giving the mucous membrane an uneven appearance. Then the mucus spreads to the mucous membrane of the cheeks and gums, and appears on the skin on the 3-4th day. On the 2-3rd day, tonsillitis: catarrhal, lacunar, necrotic. From the 1st day, the tongue is covered with a grayish coating; in severe cases, the coating has a brownish color and is difficult to remove. From the 2-3rd day, cleansing of the tip and lateral surfaces of the tongue begins as a result of deep desquamation of the epithelium. In plaque-free areas, the mucous membrane of the tongue is bright red with a crimson tint, the fungiform papillae are swollen and enlarged in size (crimson tongue). After a few days, the tongue is completely cleared of plaque, becomes smooth, “varnished”, and painful when eating. The filiform papillae are gradually restored, the tongue acquires normal look. The lips are swollen and have a bright crimson, raspberry or cherry color. Sometimes on the 4-5th day of illness, cracks and ulcers appear on them. Regional lymph nodes are enlarged and painful from the first days of the disease. It is necessary to differentiate scarlet fever from diphtheria, measles, tonsillitis (catarrhal, lacunar, necrotic), and blood diseases.

Measles

The causative agent of the disease is a filterable virus. Infection occurs by airborne droplets. The incubation period is 7-14 days. Measles most often affects children from 6 months to 4 years, but not rarely at older ages. Clinical signs in the oral cavity appear in the prodromal period, when there are no other symptoms.

1-2 days before the appearance of the skin rash, red, irregularly shaped spots the size of a pinhead to a lentil appear on the mucous membrane of the soft and partially hard palate - measles enanthema, which in severe cases takes on a hemorrhagic character. After 1-2 days these spots merge with general background hyperemic mucous membrane. Simultaneously with enanthema, and sometimes earlier, Filatov-Koplik spots appear on the mucous membrane of the cheeks in the area of ​​the lower molars. They develop as a result of inflammatory changes in the mucous membrane. Against the background of limited erythema, the epithelium within the inflammatory focus undergoes degeneration and partial necrosis, followed by keratinization. As a result, whitish-yellow or whitish-bluish dots are formed in the center of the inflammatory focus of varying sizes, but not exceeding the size of a pinhead. They resemble splashes of lime scattered over the surface of a hyperemic spot and slightly rising above the level of the mucous membrane. When erased with a cotton ball, the lines do not disappear. When palpating the affected areas, unevenness is felt. The number of spots varies: from a few pieces to tens and hundreds. They are located in groups and never merge. Filatov-Koplik spots last for 2-3 days and gradually disappear with the appearance of a rash on the skin. The mucous membrane of the cheeks remains hyperemic for several more days. With a deterioration in general condition and an increase in intoxication, the development of ulcerative stomatitis, osteomyelitis of the jaw bone. Complications more often occur in weakened children with an unsanitized oral cavity.

It is necessary to differentiate lesions of the oral mucosa during measles with thrush, acute aphthous stomatitis, and scarlet fever.

Acute herpetic stomatitis (AHS)

Herpes infection is currently one of the most common human infections. Children of all ages are affected by AHS, but most often in the period from 6 months to 3 years. This happens because at this age the antibodies received from the mother intraplacentally disappear, and their own methods of protection are in their infancy. OHS is caused by the herpes simplex virus. Many people, including children, are carriers of the virus, the clinical manifestations of which can be provoked by cooling, ultraviolet radiation, trauma, etc. The virus penetrates through direct contact with a sick person or a virus carrier through airborne droplets, as well as through infected household items and toys.

The diagnosis of acute herpetic stomatitis is established on the basis of the clinical picture and epidemiology of the disease. To clarify the diagnosis, it is recommended to carry out a cytological examination of material from herpetic erosions in order to detect the so-called giant multinucleated cells, which are characteristic of herpes.

Clinic OGS consists of symptoms of general toxicosis and local manifestations on the oral mucosa. The severity of the disease is assessed by the severity and nature of these 2 groups of symptoms. There are mild, moderate and severe degrees of AHS. Proceeding like an infectious disease, AHS has four main periods: prodromal, catarrhal, rash and extinction of the disease.

Before the vesicles appear, there is often an increase in temperature, chills, headache, loss of appetite, sometimes vomiting, arthralgia, myalgia, etc. From the initial stage of the disease, symptoms of lymphadenitis of varying degrees of severity appear. Catarrhal period characterized by the involvement in the pathological process of the mucous membranes of the body with varying degrees of generalization: the mucous membrane of the oral cavity, pharynx, upper respiratory tract, eyes, genitals. On the mucous membrane of the palate, alveolar process, tongue, lips, cheeks, itching, burning or pain is felt, then hyperemia and rashes of vesicles with a diameter of 1-2 mm with transparent contents appear. The blisters very soon open, forming superficial painful erosions with a bright pink bottom. The erosions are covered with fibrin and surrounded by a bright red rim (aftha). Blisters on the skin and red border of the lips last longer; their contents become cloudy and shrink into crusts that last for 8-10 days. Due to the fact that the rash continues to occur for several days, during examinations you can see the elements of the lesion located on different stages development. A mandatory symptom of acute herpetic stomatitis is hypersalivation, saliva becomes viscous and viscous, and there is bad breath. Already in the catarrhal period of the disease, pronounced gingivitis often occurs, which later, especially in severe forms, becomes erosive and ulcerative in nature. There is severe bleeding of the gums and oral mucosa. In the blood of children with a severe form of the disease, leukopenia, a band shift to the left, eosinophilia, single plasma cells, and young forms of neutrophils are detected. Sometimes protein appears in the urine.

Table. Clinical symptoms and treatment of AGS at varying degrees of severity of the disease:

Fungal stomatitis

Candidiasis(syn.: candidiasis) is a disease caused by exposure to yeast-like fungi of the genus Candida. They are widespread in the external environment, grow in the soil, on fruits, vegetables and fruits, and are found on household items. They live on the skin and mucous membranes as saprophytes. By persisting inside epithelial cells and multiplying in them, fungi surrounded by a microcapsule are protected from drug exposure, which is sometimes the reason for long-term treatment. The depth of their penetration into the epithelium can reach the basal layer.

The disease was first described by B. Langenberg in 1839.

Candidiasis can develop due to infection from the outside and due to its own saprophytes, often representing an autoinfection. Pathogenetically, the disease develops as a result of disruption of barrier mechanisms and a decrease in the body's defenses as a result of various exo- and endogenous influences. Among the latter, microtraumas and chemical damage leading to desquamation and maceration of the epithelium and subsequent fungal invasion are of great importance. Side effects of antibiotics are important not only in treatment, but also in the processes of their production and work with them. Candidiasis can be caused by cytostatics, corticosteroids, antidiabetic drugs, oral contraceptives, alcohol and drug use, and radiation exposure. Endogenous background factors are immunodeficiency states, diabetes mellitus, gastrointestinal dysbiosis, hypovitaminosis, severe general diseases, and HIV infection. Young children and the elderly are the most vulnerable due to age-related defects in the immune system.

In infants, candidiasis (thrush) may occur in the first weeks of life, mainly in weakened individuals. The initial signs of the disease are hyperemia and swelling of the gums, oral mucosa and tongue. Subsequently, against this background, white deposits appear, consisting of mushroom vegetation. They increase in size, forming films of white, grayish or yellowish shades, reminiscent of curdled milk or whitish foam. The films are loosely fused to the underlying tissues and are easily removed without damaging the underlying mucous membrane, which retains a smooth surface and red color.

In adults, candidiasis often occurs as a chronic disease. At the same time, hyperemia and swelling of the mucous membrane decrease, and the plaque becomes rough and adheres tightly to the underlying base, leaving erosion when scraped. Deep transverse and longitudinal grooves appear on the back of the tongue, covered with a white coating; signs of macroglossia due to swelling, hyposalivation, and burning are often observed, which intensifies when eating spicy food. The filiform papillae smooth out or atrophy.

There are several forms of candidiasis: pseudomembranous (false-membranous), erythematous (atrophic) and hyperplastic. They can develop as independent forms of damage, or as transitional ones, starting with erythematous (as an acute condition), and subsequently, as the process becomes chronic, transform into the above options.

Acute pseudomembranous candidiasis. In the prodromal period, the mucous membrane of the tongue (often other parts of the oral cavity) becomes hyperemic, dryish, and pinpoint white rashes appear on it, resembling cheesy masses or whitish-gray films that are easily removable. In severe, advanced cases, plaque becomes denser and is difficult to remove, exposing an eroded bleeding surface.

Acute atrophic candidiasis may occur as a further transformation of the form described above or appear primarily during sensitization to the fungus. It is distinguished by dryness and bright hyperemia of the mucous membrane, and severe pain is typical. There are very few plaques; they are preserved only in deep folds.

Acute pseudomembranous candidiasis characterized by the appearance of large white papules on the hyperemic mucous membrane, which can merge into plaques. When scraped, the plaque is only partially removed.

Chronic atrophic candidiasis, in contrast to a similar acute form found on the tongue, it is almost always localized on the prosthetic bed (repeating its shape). Clinically manifested by hyperemia and dryness of the mucous membrane, single white spots of plaque.

Diagnosis of candidiasis presents no difficulties. A microscopic examination of scrapings from the oral mucosa is carried out for fungal mycelium.

Treatment. For mild forms, local treatment is prescribed: a diet excluding sugar, confectionery, bread, potatoes; rinsing the mouth with a baking soda solution after eating; treatment of the oral cavity with a 5% solution of borax in glycerin or Candide. For severe forms of the disease, Diflucan, Orungal, amphotericin B, clotrimazole and other antimycotics are used. Dimexide enhances the effect of antimycotics when applied topically; enzymes potentiate their effect by 2-16 times.

Changes in the oral cavity in diseases of the blood and hematopoietic organs

With most blood diseases, changes occur in the oral mucosa, often signaling a developing pathology of the blood and hematopoietic system. Being one of the initial symptoms of the disease, changes in the oral cavity, promptly identified by a dentist, and if interpreted correctly, facilitate an early diagnosis of a blood disease.

Changes in the oral mucosa in acute leukemia

Leukemia is a systemic disease, the basis of which is a hyperplastic process in hematopoietic tissue, combined with the phenomena of metaplasia. They can be acute or chronic. Acute leukemia is the most severe form. Mostly people get sick young. Cases of acute leukemia also occur in children. The clinical picture is determined by anemia, signs of hemorrhagic syndrome and secondary septic-necrotic processes. Large fluctuations in the number of leukocytes are characteristic: along with mature leukocytes, blast forms are present. The diagnosis of the disease is based on studying the composition of the peripheral blood of the bone marrow. Clinical picture lesions of the oral cavity in the advanced phase of leukemia consists of 4 main syndromes: hyperplastic, hemorrhagic, anemic and intoxication. Tissue hyperplasia (painless plaques and growths on the gums, dorsum of the tongue, and palate) is often combined with necrosis and ulcerative changes. The hemorrhagic syndrome is based on severe thrombocytopenia and anemia. Clinical manifestations vary: from pinpoint and small-spotted rashes to extensive submucosal and subcutaneous hemorrhages (ecchymosis). Hematomas are often found on the tongue.

In acute leukemia, in 55% of cases, ulcerative-necrotic lesions of the oral mucosa are observed, especially in the area of ​​the soft palate, back and tip of the tongue. Histologically, numerous necrosis of the mucous membrane is determined, penetrating into the submucosal and often into the muscular layer.

In some forms of leukemia, a kind of infiltration of the gums may develop. Infiltrates are located relatively shallowly. The mucous membrane over them is hyperemic, sometimes ulcerated, or parts of it are rejected, which is often accompanied by sequestration of the alveolar ridge. The specificity of hypertrophic ulcerative gingivitis is confirmed by cytological and histological analysis.

Lip damage in acute leukemia is characterized by thinning of the epithelium, dryness or hyperplastic changes. “Leukemic” spots develop in the corners of the mouth. Necrotic types of aphthous eruptions may occur. When the tongue is affected, a dark brown coating is observed, often ulceration of the back and sides of the tongue (ulcerative glossitis); Macroglossia and bad breath may occur. The teeth are often mobile, and when they are removed, prolonged bleeding is observed.

The development of ulcerative processes in the oral cavity is associated with a decrease in the body's resistance, which is caused by a decrease in the phagocytic activity of leukocytes and the immune properties of blood serum. The cause of ulcerative-necrotic changes in the oral mucosa can also be the therapy with cytostatic drugs used in the treatment of acute leukemia.

Chronic leukemia (myeloid leukemia, lymphocytic leukemia)

In chronic leukemia, clinical changes in the mucous membrane differ little from changes in acute leukemia. Hyperplasia of the lymphoid apparatus of the oral cavity (tonsils, tongue, salivary glands) and slight hyperkeratosis of the mucous membrane are observed. Necrotic changes in the oral mucosa are rare and are mainly recorded histologically. In chronic myeloid leukemia, the leading sign of damage to the oral mucosa is hemorrhagic syndrome, but of significantly less intensity compared to acute leukemia. Bleeding does not occur spontaneously, but only due to injury or biting. In 1/3 of patients with myeloid leukemia, erosive and ulcerative lesions oral mucosa.

Lymphocytic leukemia is characterized by more benign lesions of the oral cavity. Ulcers heal faster than with other leukemias: this is due to the fact that in patients with lymphocytic leukemia, the migration of leukocytes does not differ significantly from that in healthy people, and the decrease in phagocytic activity is less pronounced than in all other forms of leukemia. Manifestations of hemorrhagic diathesis also occur less frequently and are moderate in nature, despite severe thrombocytopenia.

It should be noted that due to sharp decline resistance of the body in leukemia, candidiasis often develops in the oral cavity (25% of patients) due to a specific leukemic process and the action of drugs (antibiotics, cytostatics, corticosteroids).

When providing dental care, great importance is attached to the elimination of post-extraction bleeding. The danger of bleeding in leukemia after tooth extraction is so great that back in 1898, F. Kohn considered leukemia among other causes of hemorrhagic diathesis in the oral cavity (along with hemophilia, Werlhof's disease). Sanitation of the oral cavity in patients with leukemia is carried out during the period of remission and is based on general principles.

Lesions of the oral mucosa in iron deficiency anemia

This group includes anemic syndromes of various etiologies, which are based on a lack of iron in the body. Depletion of iron reserves in tissues leads to a disorder of redox processes and is accompanied by trophic disorders of the epidermis, nails, hair and mucous membranes, including the oral mucosa.

Frequent symptoms are paresthesia of the oral cavity, inflammatory and atrophic changes, and disturbances in taste sensitivity. In the diagnosis of iron deficiency anemia, great importance is attached to changes in the language. The appearing bright red spots localized on the lateral surfaces and tip of the tongue are accompanied by a burning sensation, and often pain due to mechanical irritation. The decrease and distortion of olfactory and taste sensitivity is accompanied by loss of appetite. Paresthesia is noted in the form of a burning sensation, tingling, tingling, or “bloating”, which manifests itself especially at the tip of the tongue. When eating spicy and salty foods, paresthesia intensifies, and sometimes pain appears in the tongue. The latter is swollen, increased in size, the papillae are sharply atrophied, especially at the tip of the tongue, its back becomes bright red. In patients with late chlorosis, in addition, there is a perversion taste sensations(need to eat chalk, raw cereal, etc.). A frequent sign of the disease is disruption of the salivary and mucous glands of the oral cavity. Patients note dry mucous membranes. There are frequent violations of the integrity of the epithelial covering of the oral mucosa, painful, long-lasting cracks in the corners of the mouth (jams), bleeding gums, which worsens when brushing teeth and eating. Atrophy of the epithelial cover is expressed in thinning of the mucous membrane, it becomes less elastic and is easily injured.

IN 12 - folate deficiency anemia

Develops with a deficiency of vitamin B12 or impaired absorption. A triad of pathological symptoms is characteristic: dysfunction of the digestive tract, hematopoietic and nervous systems.

Often the initial signs of the disease are pain and burning in the tongue, which is what patients usually present with. The mucous membranes are usually slightly subicteric; brown pigmentation in the form of a “butterfly” and puffiness are often noted on the face. In severe forms of the disease, minor petechiae and ecchymoses may appear. The mucous membrane of the oral cavity is pale, but, unlike iron deficiency anemia, it is well moisturized. Sometimes you can see areas of hyperpigmentation (especially the mucous membrane of the cheeks and palate).

The classic symptom is Hunter's (Gunther's) glossitis, which is expressed in the appearance on the dorsal surface of the tongue of painful, bright red areas of inflammation, spreading along the edges and tip of the tongue, often subsequently involving the entire tongue. The disease is manifested by atrophy of the epithelium of the mucous membrane and the formation of an inflammatory infiltrate of lymphoid and plasma cells in the submucosal tissue. Clinically, in the initial stages of the process, areas of atrophy can be seen in the form of red spots of irregular round or oblong shape, up to 10 mm in diameter, sharply delimited from other areas of the unchanged mucous membrane. The process begins with the tip and sides of the tongue, where a brighter redness is noted, while the rest of the surface remains normal. At the same time, pain and a burning sensation occurs not only when eating spicy and irritating food, but also when moving the tongue during a conversation. Subsequently, the inflammatory changes subside, the papillae atrophy, the tongue becomes smooth and shiny (“varnished” tongue). Atrophy also extends to the circumvallate papillae, which is accompanied by a distortion of taste sensitivity. According to Hunter, similar changes develop in the mucous membrane of the entire gastrointestinal tract.

On palpation, the tongue is soft, flabby, its surface is covered with deep folds, and there are tooth marks on the lateral surfaces. In the area of ​​the frenulum of the tongue, its tip and lateral surfaces, miliary vesicles and erosions often appear.

Changes in the oral mucosa in diseases of the cardiovascular system

Changes in the oral mucosa in cardiovascular diseases are determined by the degree of circulatory impairment and changes in the vascular wall. In case of cardiovascular failure, accompanied by circulatory disorders, cyanosis of the mucous membranes, as well as cyanosis of the lips, are usually observed. Swelling of the mucous membrane may occur, which causes the tongue to enlarge, and tooth marks appear on the mucous membrane of the cheeks and tongue.

With myocardial infarction, especially in the first days of the disease, changes in the tongue are noted: desquamative glossitis, deep fissures, hyperplasia of filiform and mushroom-shaped papillae.

Against the background of impairment of cardiovascular and cardiopulmonary activity of degrees II–III, trophic changes in the oral mucosa may occur, including the formation of ulcers. The ulcers have uneven, undermined edges, the bottom is covered with a grayish-white coating, there is no inflammatory reaction (unresponsive). An ulcerative-necrotic process on the mucous membrane in circulatory disorders occurs against the background of a decrease in redox processes. The accumulation of metabolic products in tissues leads to changes in blood vessels and nerves, which disrupts tissue trophism. Under such conditions, even with minor trauma to the mucous membrane, an ulcer forms.

A.L. Mashkilleyson et al. (1972) described vesical vascular syndrome. It consists of the appearance after injury in patients with cardiovascular diseases on the oral mucosa of blisters of varying sizes with hemorrhagic contents. Women aged 40-70 years are most often affected. Bubbles exist unchanged from several hours to several days. Reverse development occurs by either opening the bladder or by resolving its contents. When the bladder is opened, the resulting erosion quickly epithelializes. Bubbles occur more often in the area of ​​the soft palate, tongue, and less often on the mucous membrane of the gums and cheeks. Signs of inflammation in the surrounding blisters and underlying tissues are usually not observed. Nikolsky's symptom is negative. There are no acantholytic cells in the impression smears from the surface of the erosions of the opened blisters. Most patients suffering from vesicovascular syndrome have a history of arterial hypertension. A connection between hemorrhagic blisters and changes in blood vessels as a result of cardiovascular diseases cannot be ruled out. In the genesis of vesical-vascular syndrome, the permeability of capillary-type vessels and the strength of contact of the epithelium with the connective tissue layer of the mucous membrane (the condition of the basement membrane) are important. In this regard, with increased permeability of the vascular wall, as well as with its damage, hemorrhages are formed. In areas of destruction of the basement membrane, they peel off the epithelium from the underlying connective tissue, forming a bubble with hemorrhagic contents. Unlike true pemphigus, vesicovascular syndrome does not have its characteristic acantholysis and acantholytic cells.

Specific changes in the oral cavity due to heart defects are called Parkes-Weber syndrome. In this case, lesions of the mucous membrane and extensive telangiectatic hemorrhages are observed in the oral cavity; in the anterior third of the tongue there are warty growths that can ulcerate ( warty tongue)

Changes in the oral mucosa in diabetes mellitus

Diabetes mellitus is a disease caused by a deficiency in the body of the hormone (insulin) produced by the B cells of the insular apparatus of the pancreas. Clinical symptoms: increased thirst, excessive urination, muscle weakness, itchy skin, hyperglycemia.

Changes occur in the oral mucosa, the severity of which depends on the severity and duration of the disease. Most early symptom is dry mouth. A decrease in salivation leads to catarrhal inflammation of the mucous membrane: it becomes swollen, hyperemic, and shiny. In places of minor mechanical trauma, damage in the form of hemorrhages and sometimes erosions is observed. In this case, patients complain of a burning sensation in the mouth, pain that occurs while eating, especially when eating hot, spicy and dry foods. The tongue is dry, its papillae are desquamated. A common form of oral pathology in diabetes is candidiasis of the mucous membrane, including the tongue and lips.

In diabetes mellitus, inflammation of the marginal periodontium often occurs. Initially, catarrhal changes and swelling of the gingival papillae are observed, then pathological periodontal pockets are formed, proliferation of granulation tissue, and destruction of the alveolar bone are observed. Patients complain of bleeding gums, mobility of teeth, and, in a neglected state, their loss.

In the decompensated form of diabetes, there is a violation of the analyzer function of the taste receptor apparatus, and the development of decubital ulcerations of the oral mucosa in areas of its injury is possible. The ulcers are characterized by a long course, at their base there is a dense infiltrate, epithelization is slow. Combination diabetes mellitus with hypertension, it often manifests itself in the mouth as a severe form of lichen planus (Grinshpan syndrome).

Treatment is carried out by an endocrinologist. The dentist provides symptomatic therapy depending on the signs of pathology of the oral mucosa, including antifungal, keratoplasty agents, and herbal medicine. All patients need sanitation of the oral cavity, treatment of periodontitis

Chronic recurrent aphthous stomatitis (CRAS)

Chronic recurrent aphthous stomatitis is a chronic disease of the oral mucosa, characterized by periodic remissions and exacerbations with aphthous rash. A number of authors identified the disease with herpetic stomatitis, however, the polyetiological (not only viral) nature of the disease has now been proven.

Causes of the disease: 1) allergic conditions accompanied by hypersensitivity to medicinal, food, microbial and viral allergens, 2) dysfunction of the gastrointestinal tract, 3) respiratory infections, 4) trauma to the mucous membrane. HRAS is often a consequence of a wide variety of diseases and infections, as a result of which it is often classified as a group of symptomatic stomatitis. HRAS occurs primarily in adults, but can also occur in children. One of the reasons for the development of the disease in children may be helminthic infestation. The disease can last for decades without threatening the patient's life.

Clinic. Typically, the initial symptoms of CRAS are difficult to detect due to their transience. In the prodromal period, which lasts several hours, patients note paresthesia, a burning sensation, tingling, and soreness of the mucous membrane in the absence of any visible changes on it.

The most common primary element is “hyperemia spot.” Subsequently, necrosis of the mucous membrane, bordered by a rim of hyperemia, is observed at this site. Sometimes aphthae occur without previous prodromal phenomena. Most often, aphthae appear in single elements and are usually scattered in different places mucous membrane (as opposed to herpetic rashes), most often in the area of ​​the transitional fold, on the mucous membrane of the tongue, lips; their central part is always covered fibrinous exudate with a dense film of yellow-gray color due to superficial necrosis. Aphthae, unlike erosions and ulcers, never have undermined edges. Along the periphery of the element, on the somewhat swollen mucous membrane, there is a narrow inflammatory rim of bright red color. Less commonly, necrosis involves deeper layers and leads to the formation of ulcers with subsequent scarring. Aphthae are sharply painful, especially when localized on the tongue, along the transitional fold of the vestibule of the oral cavity, and are accompanied by increased salivation. Profuse salivation is a reflex. Regional lymph nodes enlarge. The duration of aphthae is on average 8-10 days. Relapse is usually observed after 2-8 weeks, sometimes after several months.

Treatment. Removing relapses of the disease can be quite difficult. top scores observed when establishing the etiological factor. Treatment is carried out in two directions: treatment of the underlying disease and local therapy aimed at eliminating pathological changes in the oral cavity.

Glossalgias

This term is used to define a symptom complex of pain or discomfort in the tongue. It should be noted that in modern literature there is confusion regarding the confusion of the concepts of “glossalgia” and “glossadynia”. Some authors identify them, considering them to be synonyms. However, we agree with the opinion of V.I. Yakovleva (1995) on the distinction between these concepts; It is advisable to consider glossalgia as a lesion caused by diseases of the central or peripheral part of the central nervous system (due to infection, trauma, tumor, vascular disorder), and glossadynia as a symptom complex of pain and perception disorders in the language in functional neurotic conditions, diseases of internal organs, hormonal disorders and some other somatic pathology .

In general, to simplify terminology, we propose to use the term “glossalgic syndrome” in future.

Glossodynia develops with increased tone of the sympathetic nervous system: with general autonomic dystonia, hyperthyroidism, endogenous hypovitaminosis B1, B2, B6, B12. Among the patients, people with anxious and suspicious character traits predominate, prone to excessive painful fixation, suffering from phobias of various diseases. In such patients, iatrogenism easily occurs due to careless statements by the doctor. Glossalgia is observed with organic lesions of the central nervous system in the clinical picture of residual effects of arachnoencephalitis, cerebrovascular accidents, neurosyphilis, etc., with pathological occlusion, cervical osteochondrosis, deforming cervical spondylosis. In addition, glossodynia can develop against the background of disorders of the gastrointestinal tract, endocrine pathology (it is not uncommon during menopause). Also important are the condition of the teeth and periodontal tissue, oral hygiene, the presence of dentures made of different metals, chronic tongue injuries due to malocclusion, sharp edges of teeth, tartar, incorrectly applied fillings, etc. Isolated cases of the influence of odontogenic infections and allergies are described. Some authors associate the occurrence of glossalgia with pathology of the dental system and disorders of the temporomandibular joint. The latter often lead to injury to the chorda tympani when the articular head is displaced. There is information about the relationship between the manifestations of glossalgia and hepatocholecystitis.

Quite often, glossalgic syndrome can be a symptom of various diseases: iron deficiency anemia, penicious anemia caused by vitamin B12 deficiency, gastrointestinal cancer. A common finding is glossodynia due to errors in the diet: lack of proteins, fats and vitamins. Glossodynia is observed in almost 70% of patients with chronic glossitis and enterocolitis. Glossalgic syndrome is characteristic of liver diseases (hepatitis, cholecystitis); the tongue and soft palate become yellowish in color. A number of authors note the development of this disease in psychiatric practice; Glossodynia in such cases has a distinct form of senestopathies. The connection between glossodynia and xerostomia of drug and autoimmune origin is obvious.

Glossodynia often occurs after radiation and chemotherapy.

As a rule, no pathological changes are observed on the mucous membrane.

Clinical features of glossalgic syndrome. The disease usually begins gradually, with minor pain, the exact time of onset of which the patient cannot determine. However, the vast majority of patients associate the onset of the disease with chronic trauma, the beginning or end of prosthetics, after the removal of damaged teeth, or any surgical interventions in the oral cavity. Other patients indicate the development of the disease after completion or during drug therapy.

The most common paresthesias are burning, tingling, rawness, and numbness. In approximately half of the patients, paresthesia is combined with pain in the tongue of an aching, pressing nature (diffused pain, without clear localization, which indicates the neurogenic nature of the process). The pain syndrome usually recurs.

Paresthesia and pain are localized in both halves of the tongue, usually in the anterior 2/3 of it, less often in the entire tongue, and very rarely the posterior third of it is affected in isolation. In approximately half of the patients, pain spreads from the tongue to other parts of the oral cavity, and can radiate to the temporal region, back of the head, pharynx, esophagus, and neck. Unilateral localization of paresthesia and pain is observed in a quarter of patients.

Typically, the pain decreases or disappears during meals, in the morning after waking up, and intensifies in the evening, during a long conversation, or in situations of nervous excitement. The disease occurs from several weeks to several years, with varying intensity, subsiding during periods of rest. Cases of spontaneous disappearance of burning symptoms have been described.

Sensory disturbances often occur (feelings of awkwardness, swelling, heaviness in the tongue). In this regard, patients spare their tongue from unnecessary movements when speaking. As a result, speech becomes slurred, similar to dysarthria. This peculiar phenomenon is described as a symptom of “sparing the tongue.” With glossalgic syndrome, the tone of the sympathetic department often prevails over the parasympathetic, which is expressed by disturbances in salivation (more often - disturbances in salivation, sometimes followed by periodic hypersalivation).

Almost all patients suffering from glossalgic syndrome also suffer from cancerophobia. These patients often examine the tongue in a mirror and fixate on the normal anatomical structures of the tongue (its papillae, ducts of the minor salivary glands, lingual tonsil), mistaking them for neoplasms.

Typically, structural changes in the tongue are not observed in this disease, but in some cases, areas of epithelial desquamation and signs of desquamative glossitis or “geographical” tongue are identified. In some cases, the tongue is enlarged (swollen), and tooth marks are noted on its lateral surfaces.

Sensations of burning and dryness can also be observed as a sign of the action of galvanism in the presence of metal prostheses in the oral cavity made of dissimilar metals. Patients complain of a burning sensation and a metallic taste in the mouth.

Differential diagnosis carried out with neuralgia trigeminal nerve(differs from glossalgia by sharp paroxysmal attacks of pain, which are almost always one-sided, there is usually no pain outside of attacks, pain is often accompanied by vasomotor disturbances, convulsive twitching of the facial muscles, pain is provoked by eating or talking); with neuritis of the lingual nerve (characterized simultaneously with unilateral pain in the anterior two-thirds of the tongue, there is also a partial loss of superficial sensitivity - pain, tactile, temperature, which manifests itself in numbness and paresthesia, sometimes a decrease or perversion of taste in the same area; pain in the tongue intensifies during food, while talking)

Treatment carried out taking into account the factors that caused the disease. Sanitation of the oral cavity and treatment of periodontal diseases, rational prosthetics are necessary. If necessary, consultations with somatic doctors and a psychiatrist are recommended, followed by implementation of their treatment recommendations. internal diseases. Taking into account vegetative-neurotic manifestations, patients are prescribed sedative therapy and multivitamins are recommended. Positive results of reflexology and laser therapy (helium-neon laser) are described.

Principles of treatment of diseases of the oral mucosa

Etiotropic treatment;

Pathogenetic treatment;

Symptomatic treatment.

Symptomatic treatment includes:

a) elimination of local irritating factors (grinding down sharp edges of teeth, removing dental plaque, eliminating galvanism);

b) diet (exclude hot, spicy, hard foods);

c) anesthesia of the mucous membrane before eating (baths and applications of a 2% solution of novocaine or lidocaine, a mixture of anesthesin and glycerin);

d) antiseptic treatment (rinses, baths and applications of solutions of furatsilin 1:5000, hydrogen peroxide 3%, 0.02% aqueous solution of chlorhexidine, infusion of herbs: chamomile, calendula, sage);

e) strengthening the mucous membrane with rinses, baths and applications of astringents (decoction of oak bark, tea)

f) stimulation of epithelization processes (application of an oil solution of vitamin A, sea ​​buckthorn oil, caratolin, rosehip oil, solcoseryl)

Rinsing: the patient takes a solution of the drug into his mouth and, using the muscles of the cheeks, floor of the mouth, and tongue, rinses the mucous membrane.

Bath: the patient takes the drug solution into his mouth and holds it over the lesion for 2-3 minutes.

Application: the affected area is dried with a gauze pad, and then a cotton swab or gauze swab moistened with a medicinal substance is applied to it for 2-3 minutes.

In early childhood, treatment of the oral mucosa is carried out by treating the oral cavity cotton swabs. It is extremely important to keep the pacifier clean. You should not lick the pacifier before giving it to your baby. Treatment of the oral mucosa should be extremely careful, without pressure. It is preferable to use blotting movements.

An inflammatory disease of the oral mucosa, often of infectious or allergic origin. Stomatitis in children is manifested by local symptoms (hyperemia, swelling, rashes, plaque, ulcers on the mucous membrane) and a violation of the general condition (fever, refusal to eat, weakness, adynamia, etc.). Recognition of stomatitis in children and its etiology is carried out by a pediatric dentist based on an examination of the oral cavity and additional laboratory tests. Treatment of stomatitis in children includes local treatment of the oral cavity and systemic etiotropic therapy.

General information

Causes of stomatitis in children

The condition of the oral mucosa depends on the effects of external (infectious, mechanical, chemical, physical agents) and internal factors (genetic and age-related characteristics, immune status, concomitant diseases).

Viral stomatitis ranks first in terms of frequency of spread; of these, at least 80% of cases are herpetic stomatitis in children. Less commonly, stomatitis viral etiology develop in children against the background of chickenpox, measles, influenza, rubella, infectious mononucleosis, adenovirus, papillomavirus, enterovirus, HIV infection, etc.

Stomatitis bacterial etiology in children they can be caused by staphylococcus, streptococcus, as well as pathogens of specific infections - diphtheria, gonorrhea, tuberculosis, syphilis. Symptomatic stomatitis in children develops against the background of diseases of the gastrointestinal tract (gastritis, duodenitis, enteritis, colitis, intestinal dysbiosis), blood system, endocrine, nervous system, helminthic infestations.

Traumatic stomatitis in children occurs due to mechanical trauma to the oral mucosa with a pacifier or toy; teething or biting lips, cheeks, tongue; brushing teeth; burns to the oral cavity from hot food (tea, soup, jelly, milk), damage to the mucous membrane during dental procedures.

Allergic stomatitis in children can develop as a reaction to local impact allergen (ingredients of toothpaste, lollipops or chewing gum with artificial colors and flavors, medications, etc.).

Prematurity, poor oral hygiene, accumulation of plaque, caries, wearing braces, frequent general morbidity, deficiency of vitamins and microelements (B vitamins, folic acid, zinc, selenium, etc.), application medicines, changing the microflora of the oral cavity and intestines (antibiotics, hormones, chemotherapy drugs).

The mucous membrane of the oral cavity in children is thin and easily injured, so it can be injured even with a slight impact on it. The microflora of the oral cavity is very heterogeneous and is subject to significant fluctuations depending on nutritional habits, the state of the immune system and concomitant diseases. When the defenses are weakened, even representatives of the normal microflora of the oral cavity (fusobacteria, bacteroides, streptococci, etc.) can cause inflammation. The barrier properties of saliva in children are poorly expressed due to the insufficient functioning of local immune factors (enzymes, immunoglobulins, T-lymphocytes and other physiologically active substances). All these circumstances determine the frequent incidence of stomatitis in children.

Symptoms of stomatitis in children

Viral stomatitis in children

The course and features of herpetic stomatitis in children are discussed in detail in the corresponding article, so in this review we will focus on the general symptoms viral infection oral cavity, characteristic of various infections.

The main symptom of viral stomatitis in children is the appearance of quickly opening blisters on the oral mucosa, in place of which small round or oval erosions, covered with fibrinous plaque, then form. Vesicles and erosions can appear as separate elements or have the character of defects merging with each other.

They are extremely painful and, as a rule, are located against the background of a brightly hyperemic mucous membrane of the palate, tongue, cheeks, lips, and larynx. Local manifestations viral stomatitis in children are combined with other signs of infection caused by this virus (skin rash, fever, intoxication, lymphadenitis, conjunctivitis, runny nose, diarrhea, vomiting, etc.) Erosion epithelializes without a scar.

Candidal stomatitis in children

The development of specific local symptoms of candidal stomatitis in children is preceded by excessive dryness of the mucous membrane, a burning sensation and bad taste in the mouth, bad breath. Infants are capricious while eating, refuse the breast or bottle, behave restlessly, and sleep poorly. Soon on inside Small white dots appear on the cheeks, lips, tongue and gums, which, merging, form a rich white plaque of a cheesy consistency.

In severe forms of candidal stomatitis in children, the plaque acquires a dirty gray tint and is difficult to remove from the mucous membrane, revealing a swollen surface that bleeds at the slightest touch.

In addition to pseudomembranous candidal stomatitis described above, atrophic candidal stomatitis occurs in children. It usually develops in children wearing orthodontic appliances and occurs with scant symptoms: redness, burning, dryness of the mucous membrane. Plaque is found only in the folds of the cheeks and lips.

Repeated episodes of candidal stomatitis in children may indicate the presence of other serious diseases - diabetes, leukemia, HIV. Complications of fungal stomatitis in children may include genital candidiasis (vulvitis in girls, balanoposthitis in boys), visceral candidiasis (esophagitis, enterocolitis, pneumonia, cystitis, arthritis, osteomyelitis, meningitis, ventriculitis, encephalitis, brain microabscesses), candidosepsis.

Bacterial stomatitis in children

The most common type of bacterial stomatitis in childhood is impetiginous stomatitis. It is indicated by a combination of the following local and common features: dark red color of the oral mucosa with merging superficial erosions; the formation of yellow crusts that stick together the lips; increased salivation; unpleasant putrid smell from mouth; low-grade or febrile temperature.

With diphtheria stomatitis in children, fibrinous films form in the oral cavity, after removal of which an inflamed, bleeding surface is exposed. With scarlet fever, the tongue is covered with a dense whitish coating; after its removal, the tongue becomes bright crimson in color.

Gonorrheal stomatitis in children is usually combined with gonorrheal conjunctivitis, in rare cases - with arthritis of the temporomandibular joint. The child becomes infected when passing through the infected genital tract of the mother during childbirth. The mucous membrane of the palate, back of the tongue, lips is bright red, sometimes lilac-red, with limited erosions, from which yellowish exudate is released.

Aphthous stomatitis in children

Prevention of stomatitis in children

Prevention of stomatitis in children consists of eliminating any microtraumas, careful hygienic care of the oral cavity, and treatment of concomitant pathologies. To reduce the risk of stomatitis in infants, it is important to regularly disinfect pacifiers, bottles, and toys; treat the mother's breasts before each feeding. Adults should not lick a baby's pacifier or spoon.

Starting from the moment the first teeth erupt, regular visits to the dentist are necessary for preventive measures. To clean children's teeth, it is recommended to use special toothpastes that help increase local immunity of the oral mucosa.

Stomatitis is one of the diseases that is more often diagnosed in children than in adults. This is explained by the fact that babies often taste inappropriate objects, introducing infection or pathogenic bacteria into their mouths. Added to this is an incompletely formed immune system, which is unable to withstand the powerful onslaught of pathogenic microflora. How to recognize stomatitis on early stage so that the disease does not develop into chronic form, - we will consider in our material. We will also talk about possible complications of the disease and methods of its prevention.

What is stomatitis?

Stomatitis is an inflammation of the oral mucosa, accompanied by painful sensations when swallowing and speaking. Since the disease has many varieties, its manifestations may vary. As a rule, a plaque appears in the mouth that looks quite dense, and swelling, ulcers, blisters with liquid, or small cracks may also form. Let's look at how the disease progresses and what are the routes of infection.

Course of the disease

Stomatitis in children usually begins with mild discomfort in the mouth. At first, the patient thinks that he simply bit his tongue or the inside of his cheek, or tasted too hot tea. However, instead of gradual improvement, he notices that the number of areas in the mouth in which soreness is felt becomes more numerous.

The first symptoms of stomatitis may be accompanied by elevated temperature– up to 38°C, and also general weakness. Viral stomatitis causes fever up to 40°C. As a rule, these signs gradually disappear, giving way to painful sores and plaque in the mouth. If stomatitis in a child is not treated, it can degenerate into an ulcerative-necrotic, purulent or chronic form. Symptoms, as shown in the photo below, may occur several times a year.

Is stomatitis contagious?

The contagiousness of the disease depends on its causative agent, and we will talk about the types of stomatitis below. Viral, bacterial and fungal diseases can be contagious. Stomatitis caused by injury or a reaction to any allergen is not covered. Infectious species stomatitis is transmitted by airborne droplets, and fungal stomatitis is transmitted from mother to child during childbirth or from an infected baby to a healthy one through toys and pacifiers.

Causes of stomatitis in a child

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Most often, stomatitis occurs in children due to bacteria entering the mucous membranes of the oral cavity or infection yeast-like fungi. Unwashed hands and dirty toys that get into the baby's mouth can cause painful rashes. Also, the offspring can become infected in kindergarten from one of his friends.

It is worth understanding that children early age their immunity is weaker than that of adults, so they get sick (including stomatitis) more often. At the same time, a healthy baby who regularly walks in the fresh air, eats rationally and sleeps enough has less chance of getting sick.

What do different types of stomatitis look like in the photo?

Stomatitis can have a different nature, and the choice of therapy depends on the diagnosis. In children, the disease is most often provoked by a bacterial infection, as well as fungi of the genus Candida. This does not mean that the baby cannot be diagnosed with viral or allergic stomatitis. Let's look at the types of the disease and the symptoms that accompany each of them.

Viral stomatitis

Viral stomatitis refers to a condition caused by the herpes virus. It manifests itself in the same way as a herpes cold on the lips, only the localization of the bubbles is found on the mucous membranes of the mouth. Fluid blisters appear on the tongue, inner cheeks and lips, and rarely on the gums or palate. Over time, the blisters burst, forming ulcers that are difficult to treat.

Viral stomatitis has several features that distinguish it from other types of disease:

• The onset of the disease is usually accompanied by a high temperature (39-40°C), which gradually decreases over several days.
• Herpetic stomatitis can recur over time. As a rule, the appearance of bubbles with liquid is observed in the same place that they occupied previously.
• This type of disease is particularly characterized unpleasant symptoms– the pain is quite pronounced, the baby has difficulty eating, and experiences pain when swallowing.

Bacterial damage

The bacterial form is one of the most common in children. Signs of stomatitis in a child:

• Swelling and redness of the mucous membrane of the cheeks, tongue, inner surface of the lips and palate. Cracks and ulcers may form on it.
• Bad breath appears, the temperature may rise slightly, and weakness may occur (see also:).

It is difficult to diagnose the bacterial type on your own; a doctor can do this based on clinical manifestations or laboratory results. A baby can become infected from a playmate, since his local mucosal immunity is not yet sufficiently developed. If one of the parents has damage and cracks on the tongue, palate and gums, the baby has a high probability of contracting an infection.

Traumatic form

Traumatic stomatitis - not so much a rare event. It is not difficult to injure the oral mucosa - you can easily get a burn when tasting a hot dish, bite your tongue while eating, scratch your cheek with a splintered tooth, etc. Usually such injuries heal quickly, but when immunity is reduced for some reason, the wound can become the beginning of the development of inflammation. The disease also starts from permanent injuries resulting from wearing braces, dentures or a broken tooth.

Why does the disease occur in children? This condition can be triggered by a fall or hitting the lips with a toy. This type of stomatitis is not transmitted to others, but requires treatment.

Inflammation due to allergies

It happens that the patient is allergic to some product, but the parents have no idea about it. The allergen accumulates in the blood and tissues, resulting in a reaction in the body in the form of stomatitis. However, more often this type of disease develops as a result of an allergy to dentures. According to statistics, the majority of patients with such stomatitis are women over 50 years of age.

Symptoms of allergic stomatitis:

• burning sensation, dry mouth;
• saliva often becomes viscous;
• Clinically, the disease is expressed by redness of certain areas of the mucosa.

Candidal stomatitis

The candidal form of stomatitis occurs more often in infants. It is caused by fungi of the genus Candida, which are normally present on the mucous membrane of a healthy person. Active growth microorganisms are provoked by a decrease in the body’s defenses due to taking antibiotics, long-term illness, vitamin deficiency, etc. For adults, this type of stomatitis is practically not contagious if they do not share the same utensils with the sick person. Babies have weaker immunity, so children are often exposed to infection.

How to determine that a baby has thrush (the popular name for candidal stomatitis):

• This condition manifests itself as a white coating on the tongue, inner surface of the cheeks, and palate.
• Under the plaque, reddened tissue and the appearance of blood are found. There may be slight swelling and soreness of the mucous membrane.
• If stomatitis is not treated, cracks and ulcers appear, the plaque becomes denser, and the top turns a little yellow.

General symptoms of the disease

You can tell if a child has stomatitis by various symptoms. If the baby is an infant, he may refuse the breast or pacifier, experiencing pain during feeding. You should evaluate the color of the mucous membrane, check whether there is swelling or white coating on the cheeks and tongue.

An older child can explain to his parents what is bothering him. The initial symptoms of stomatitis may be mild (the exception is the herpetic form), and may be accompanied by fever, tearfulness of the child, and refusal to eat.

To make sure that your baby has stomatitis, you should carefully examine his oral cavity. Redness of certain areas of the mucous membrane and a white coating may indicate the development of the disease. In this case, it is advisable to show the child to a pediatrician or dentist.

How can stomatitis be cured?

Stomatitis can be cured, and today there are a lot of drugs for this. We will tell you how to deal with the manifestations of the disease - help your child get rid of discomfort and severe pain and also relieve inflammation. Let's consider traditional methods treatment of illness and folk remedies. In addition, we will tell you how to feed your baby during illness.

Use of painkillers

Is stomatitis accompanied by pain and the child refuses to eat? You should try to reduce the discomfort. For this, it is advisable to use painkillers. Paracetamol and Ibuprofen show excellent results. However, these drugs should not be abused; they are given only at the beginning of treatment in case of significant pain accompanied by elevated temperature.

For local anesthesia, you can treat the affected areas with special gels, including: Kamistad Baby, Cholisal, Lidochlor, Metrogyl Denta, etc.

The use of medications depending on the form of stomatitis

Before prescribing medications for treatment, you should find out the nature of the disease. Let's consider the main methods of therapy depending on the pathogen. Treatment of any type of stomatitis in children should be comprehensive - use both drugs for local anesthesia and for internal use.

Folk remedies

There are a lot folk remedies for the treatment of stomatitis. The most commonly used are tinctures of herbs that have antiseptic, anti-inflammatory and healing properties. Chamomile, sage, yarrow, and oak bark are used separately or in equal proportions. You should rinse your mouth several times a day with herbal infusion.

Other treatments:

• Stomatitis is fought with garlic. To do this, chop the clove and mix with yogurt or yogurt, then apply to the affected areas of the mucous membrane. This method is only suitable for adults and children over 12 years old.
• Raw potatoes have good pain-relieving properties. The gruel grated on a fine grater is applied to ulcers and wounds.
• Traditional recipes recommend using honey. To anesthetize the oral cavity and remove symptoms of inflammation, just put it under your tongue. small portion honey and keep it on your tongue until it gradually dissolves. The method is not suitable for small children and those who are allergic to this product.
• Rinse your mouth carrot juice. You can also make juice from cabbage leaves and dilute it half with water.
• Aloe juice helps remove swelling and inflammation - a cut leaf of the plant is applied to the affected areas of the mucous membrane.

Nutrition and diet

Despite the fact that during stomatitis a child cannot eat many foods, the diet must be balanced. It is important to ensure that your baby’s diet includes carbohydrates, proteins and fats. Dishes should not be hot, but not cold, and in a processed form (without large solid particles).

Carbohydrates on the menu can be presented:

• mashed potatoes;
• boiled porridge with milk;
• puree soups.

Meat and fish should also be present on the child’s table. It is advisable to cook him meatballs, steam cutlets, and not chops or steaks. Steam the fish or stew it with vegetables. At first, you should avoid sour fruits, try to salt your dishes less, and do not use spices. Do not buy your baby crackers, bagels, or hard cookies.

Fermented milk products can cause pain while eating, so they can be offered after pain relief.

The baby's nutrition remains unchanged. You just have to try to treat the oral mucosa after feeding and periodically offer him water.

Features of therapy for children of different ages

Therapy for a child is selected according to age. Many drugs are not recommended for children under one or two years of age. Special attention Parents of infants should pay attention to the treatment of stomatitis, since a small child may react inadequately to a particular drug. Let's consider what to do with an infant or an older child who has a coating on the tongue and sores.

Treatment of infants

It is better to use for the treatment of infants natural remedies, familiar to our grandmothers:

• Candidal stomatitis responds well to treatment soda solution. You need to stir a teaspoon baking soda in a glass of water and, moistening a piece of bandage in the liquid, treat the mucous membranes. Among the approved medications are Candide and Nystatin.
• Herpetic stomatitis can be treated with oxolinic ointment. Lubricate the wounds, trying not to go beyond their boundaries.
• Shostakovsky ointment can be used as a healing agent - it is applied up to 5 times a day. Solcoseryl is applied once, after which the wounds are periodically moistened with water.

Treatment of children 1-2 years old and older

Therapy for children over a year old may be the same as for infants. Cholisal gel and Fluconazole are added to the list of approved drugs.

Older children who can rinse their mouths on their own can prepare such solutions.