Erosion of the oral mucosa of various etiologies. Painful lesions of the oral mucosa. Acute atrophic candidiasis

Various diseases of the oral mucosa often plague the painful symptoms and ulcers. Since the course of the disease and its first manifestations have almost the same symptoms, determining an accurate diagnosis and further treatment requires special skills and abilities. Often the oral cavity suffers from various types of stomatitis, but we should not forget about more rare, but no less serious lesions of the oral mucosa, which bring a lot of inconvenience to the patient and possibility of complications.

Causes and types of stomatitis

What may be the causes of diseases of the oral mucosa:

• CVD diseases;
• problems with the gastrointestinal tract;
• any allergies;
• metabolic disease;
• disturbances in the functioning of the immune system;
• lack of hygiene;
• damage to teeth followed by long-term development of bacteria;
• poor quality dental care;
• external factors that affected the mucous membrane (chemical burn, puncture with a fish bone, etc.).

Often these reasons cause stomatitis, but in isolated cases they can become the beginning of another series of diseases.

Allergic stomatitis

Such stomatitis, as a rule, cannot be considered a separate type of disease. It is caused by an allergy to external irritants of any origin. Its main characteristic is redness of the mucous membrane or white spots, which subsequently turn into blisters and bleeding scars.

Aphthous stomatitis

The disease is characterized by superficial damage to the lining of the mouth with erosions and ulcers that acquire a clear outline and round shape. Their diameter is usually small, but without an immediate reaction to the first symptoms of aphtha, they bring painful discomfort, increasing the patient’s body temperature. Traces of the disease on the oral mucosa may disappear on their own after a week, but later make themselves felt again. Treatment is prescribed by a doctor and, as a rule, consists of a complex of aseptic preparations, vitamin complexes for immunity and pain relief.

Vincent's stomatitis

This stomatitis manifests itself as passive form of infection: pathological microorganisms wait for the body to weaken, for example, with reduced immunity or vitamin deficiency. This gives the bacteria a significant advantage and they begin to attack. The disease most often affects men under 30 years of age.

This form of the disease is always accompanied by fever and bleeding ulcers on the gums. Temperature range and the depth of the ulcers depends on the stage and complexity of the disease. Treatment is carried out by a doctor and with the same drugs as aphthous stomatitis. In the later stages, when the temperature can rise to 40 degrees, antipyretics are also prescribed.

Traumatic or bacterial stomatitis

It appears as a result of various types of damage that affect the oral mucosa. Shell injury may occur due to mechanical impact, for example, a blow to the face, poor-quality dental surgery, a fall or careless or intensive teeth cleaning.

Herpetic stomatitis

It is caused by a common herpesvirus, so small children under three years of age usually suffer from the disease. Babies experience symptoms similar to those throughout the entire period. signs of intoxication:

• elevated temperature;
• general weakness;
• swollen lymph nodes;
• nausea;
• irritable bowel syndrome.

Thrush or fungal stomatitis

The disease occurs when there is insufficient oral hygiene or when it is injured. Most often they get sick children with weakened immune systems.

Catarrhal stomatitis

Much more widespread than all other varieties. The most common causes of its occurrence:

Disease develops quite quickly and begins with increased swelling of the mucous membrane, then it becomes covered with a yellowish or whitish coating, causing salivation, bleeding gums and a strong smell of rot from the mouth.

Ulcerative stomatitis

It can develop as a continuation of the catarrhal form, or as a separate disease. As a rule, people with enteritis, ulcers, cardiovascular diseases, poisoning or infectious diseases suffer from it. Ulcers reach incredible proportions in breadth and depth.

Signs of ulcerative stomatitis:

• feeling of weakness;
• increased body temperature;
• headache;
• enlarged lymph nodes;
• severe aching pain when eating.

Ulcerative stomatitis requires immediate medical attention.

Often stomatitis is an external warning about diseases present inside the body. To a greater extent this endocrine system problems, gastrointestinal tract, hematopoiesis.

Problem ratio with symptoms of the disease:

Since in such cases the problem is not only the pain of oral ulcers, but also serious dysfunction of body systems, these ailments should be treated exclusively through a doctor’s office, and under no circumstances at home. At home, the most that can be done is to suppress the symptoms of the disease, but not the disease itself.

Stomatitis and medications

Depending on the form of stomatitis, medications are usually prescribed. Several groups of drugs prescribed by doctors have been identified, depending on the etiology of the disease of the oral cavity:

• antiseptic;
• antibacterial;
• anesthetics;
• antiviral;
• wound healing (usually prescribed for healing ulcers after the main treatment);
• restoring immunity.

Medicines are prescribed by a doctor in combination, since single agent will not give the necessary results and will not relieve the symptoms.

Prevention of stomatitis

At the first signs of stomatitis, it is best to immediately seek help from a clinic that uses modern methods and has the appropriate equipment. Specialist will restore balance mucous membrane, will eliminate unpleasant symptoms and destroy the bacteria that caused the disease. This will, of course, not happen in one visit, so the patient should be patient.

If the patient does not abuse sweets and flour, and also leads a correct lifestyle, he will not be afraid of stomatitis. Timely and constant cleaning of the teeth and oral cavity, both at home daily and professionally, will help get rid of harmful bacteria without giving them a chance to develop. Alcohol and smoking reduce the body’s defense mechanisms, so giving up such bad habits will undoubtedly help disease prevention oral mucosa.

Less common oral diseases

If most often it is stomatitis that is the culprit of unpleasant and painful sensations on the mucous membrane, in some cases it is possible that diseases of a different etiology are present, respectively, with other treatment methods.

Glossitis

Inflammation of the mucous membrane of the tongue. Usually the disease affects only the mucous membrane, not reaching the muscle tissue of the tongue, but under certain conditions, for example, ignoring treatment or greater trauma, swelling and abscess may develop. In severe cases of the disease, the patient's temperature rises and it becomes difficult to swallow food. If you visit the dentist on time, the disease will not reach this state. Self-medication of glossitis most often does not produce results, but leads to complications and further development of the disease.

Gingivitis

Inflammation of the gums is chronic, acute or recurrent.

Causes of gingivitis:

• malocclusion;
• violation of oral hygiene rules;
• old fillings;
• tartar.

Gingivitis in pregnant women and adolescents can develop due to hormonal imbalances. Gingivitis may also indicate malfunctions in the functioning of any internal systems of the body.

Main symptoms of gingivitis:

• swelling;
• redness of the gums;
• bleeding;
• expressiveness of the contour;
• soreness;
• difficulty chewing and swallowing;
• sensitivity.

If the first signs occur, you should immediately seek help from a specialist.

Cheilitis

Cracks in the skin of the lips or oral mucosa. It develops, as a rule, with preliminary tissue injury due to hypothermia (during severe frost) or with prolonged exposure to UV rays.

Types of cheilitis:

• angular infectious. Often affects in childhood under the influence of fungi and staphylococcus. The causes of the disease are infections of the nasopharynx, lack of riboflavin in the body and malocclusion. Patient complaints with this form of the disease, the disease consists of painful sensations when opening the mouth, as cracks form in its corners, often with suppuration. Cracks can grow up to the chin and affect the entire skin around the mouth;
• actinic cheilitis expressed by the formation of a red border on the lips with prolonged exposure to sunlight. This form of cheilitis comes in two forms: exudative (hyperemia, swelling, cracks, erosion and ulcerative blisters) and dry (bright red border with white scales). Even after treatment possible spring-summer relapse;
• apostematous cheilitis affects only the lower lip. The disease is expressed by swelling, inflammation of the salivary glands, hyperemia, purulent discharge from the salivary glands. The inflammation is easily palpable;
• riboflaviosis cheilitis affects in the absence of the required amount of riboflavin (vitamin B). This form can be identified by the pale mucous membrane, but the bright red border of the lips. The tissues of the lips crack, exudate and bleed. The shell becomes covered with scales and peels off. The corners of the mouth are characterized by erosion with yellowish crusts. The patient feels pain when closing the jaws and burning in the mouth;
• fungal cheilitis occurs mainly in older people and is manifested by peeling of the lips, redness, cracking and swelling. This type of cheilitis can easily be confused with eczema;
• catarrhal cheilitis manifested by inflammation of the lip border and occurs under the influence of the external environment. Catarrhal cheilitis is characterized by frequent complications in the form of ulcers and inflammation, as well as peeling and swelling of the skin;
• Beltz-Uin cheilitis or purulent granular cheilitis affects the salivary glands and occurs most often with relapses. The salivary glands become covered with erosions and growths, the lips become covered with ulcers of infectious etiology;
• penicillin cheilitis appears when overusing medications containing penicillin. After the first stage of the disease, swelling, the labial border may begin to separate from the lips. In the absence of treatment, damage to the oral mucosa is typical, disturbing the patient with a burning sensation on the inside of the cheeks, tongue and palate;
• exfoliative cheilitis initially determined by swelling of the lips. Due to pain, the patient cannot close his mouth completely. The lesion occurs not only on the surface of the lips, but also on the mucous membrane. As the disease progresses, large scales appear on the lips, which, when removed, reveal red, inflamed tissue. This form is usually chronic and complicated by problems with the thyroid gland;
• eczematous form of cheilitis is the result of various allergies and can even be caused by lipstick or powder. In this case, the lips and mucous membranes swell greatly, dry skin flakes separate, revealing ulcers and erosions, which subsequently form crusts and cracks.

How to treat cheilitis

Cheilitis is not recommended to be treated at home, so at the first symptoms you should contact a multidisciplinary clinic. Since the main cause of the disease is inability to close lips completely and breathe only through the nose, the doctor must first eliminate this problem. The upper and lower lips should meet completely along the border line.

What should the dentist do:

• help the patient correct malocclusions;
• normalize nasal breathing by stopping oral breathing, which leads to dryness of the oral mucosa;
• restoration of the orbicularis oris muscle using myotherapy.

The problem usually lies in the type of breathing. That is why, first of all, the patient himself must monitor his breathing and try to breathe only through his nose. You can get rid of cheilitis on your own only with such careful self-control and exclusively in the initial stages.

Prevention of diseases of the oral mucosa

According to dentists, the following rules will undoubtedly help avoid problems with the oral mucosa:

1. a consultation with a dentist should be carried out at least 2 times a year, even if there is no cause for concern;
2. Oral hygiene should not be ignored;
3. it is important to avoid injury to the mucous membrane by hot and cold foods, as well as external factors such as frost or dry heat;
4. It is advisable to adhere to proper nutrition and do not forget to control the intake of vitamins to maintain the functions of the immune system;
5. Allergy sufferers should avoid contact with prohibited foods.

Nowadays, dental clinics offer a wide range of services and are able to cure any known dental diseases. With the help of tests and other diagnostic methods, you can find out in detail about your illness and, together with your doctor, find suitable treatment methods. When choosing a clinic, you need to pay attention to

DISEASES OF THE ORAL MUCOSA

According to their manifestations, diseases of the mucous membranes of the oral cavity can mainly be divided into three groups: 1) inflammatory lesions - stomatitis; 2) lesions similar to a number of dermatoses, dermatostomatitis, or stomatosis; 3) diseases of a tumor nature. Recognition of all these diseases requires, first of all, knowledge of the normal anatomy and physiology of the oral mucosa, the ability to examine it taking into account the state of the entire organism, which is directly related in its existence to the external environment.

RESEARCH METHODS. GENERAL SYMPTOMATOLOGY

The structure of the oral mucosa. The oral mucosa consists of three layers: 1) epithelium (epithelium); 2) the mucous membrane itself (mucosa propria); 3) submucosa (submucosa).

Epithelial layer formed by stratified squamous epithelium. The epithelial layer contains cells of various shapes - from a cylindrical, cubic layer to a completely flat surface epithelium. As in the skin, the epithelial cover can be divided depending on the characteristics and function of its individual rows into four layers: 1) horny (stratum corneum), 2) transparent (stratum lucidum), 3) granular (stratum granulosum), 4) germinative (srtatum germinativum).

The germinal layer makes up a significant part of the epithelium of the mucous membrane. Its lower row consists of cylindrical, densely colored cells, with their narrow side facing their own membrane. These cells are considered to be the germinal layer of the germinal layer. It is followed by several rows of flatter cells, which are also well painted and connected to each other by jumpers. Then there are layers of cells that are in various stages of keratinization: 1) granular layer - the initial degree of keratinization, 2) transparent layer - a more pronounced degree of keratinization, which is the transition to the last, clearly defined stratum corneum. The transparent layer of epithelium on the oral mucosa is mainly observed in those places where keratinization manifests itself with greater intensity.

Actually mucous membrane formed by dense connective tissue with a fibrillar structure. The connective tissue of the membrane itself contains small blood vessels such as capillaries and nerves. The membrane at the border with the epithelium forms papillary outgrowths. These papillae come in different sizes. Each papilla has its own feeding vessel.

Submucosa also of a connective tissue structure, but it is looser than the shell itself and contains fat and glands; it contains larger vascular and nerve branches.

The mucous membrane of the oral cavity is supplied with nerve fibers - sensory and motor. The innervation of the mouth involves the cranial and spinal nerves, as well as the cervical sympathetic nerve. The following cranial nerves approach the walls of the oral cavity: trigeminal, facial, glossopharyngeal, sublingual, and partly vagus.

To study the oral mucosa, we use a number of techniques, which, depending on the characteristics of the case, are used in varying numbers and combinations. The main examination of the oral cavity consists of the following points: 1) survey, 2) examination, 3) palpation, 4) microscopic examination. In addition, a study is carried out of the general condition of the body and individual systems and organs, and often additional serological, hematological and other laboratory tests.

Onpoс. As always, in case of diseases of the mouth, general indicative questions are asked first, and then questions of a specific nature. When interviewing patients suffering from oral lesions, the doctor often immediately detects a number of objective symptoms that are associated with speech disorder (dyslalia). They appear as a result of damage to oral tissues by inflammatory processes or the presence of congenital or acquired defects of the oral cavity. Disorders manifest themselves in changes in the sonority of speech and the nature of the pronunciation of individual sounds - letters.

Inflammatory processes on the lips, which reduce mobility or swelling of the latter due to pain, often distort the pronunciation of most of the labial sounds: “m”, “f”, “b”, “p”, “v” (dyslalia labialis).

Inflammatory processes in the tongue, especially ulcerative or other diseases leading to limited mobility of this organ, make it difficult to pronounce almost all consonant sounds, which leads to a lisp (dyslalia labialis). When the posterior part of the tongue is affected, the pronunciation of the sounds “g” and “k” is especially affected.

When the integrity of the hard palate is damaged (syphilis, congenital cleft defects, trauma) and when the soft palate is damaged, even slightly, speech takes on a nasal tone: all consonants are pronounced through the nose. The pronunciation of the so-called closed consonants is especially impaired: “p”, “b”, “t”, “d”, “s”. This speech disorder is called rhinolalia aperta in contrast to rhinolalia clausa (dull sound). The latter disorder is observed during infiltrating processes of the palatine velum.

The doctor pays attention to all these disorders at the beginning of the conversation with the patient, thus introducing elements of a functional study of the mouth into the survey.

Particular attention should be paid to complaints of difficulty and pain during eating, mainly when the soft palate is affected. Swelling of the palate and pain interfere with the normal act of active swallowing. If the integrity of the palatine vault is damaged, liquid food flows into the nose. Small abrasions on the hard palate often cause severe pain when eating solid food. Painful lesions of the tongue also cause difficulty in eating solid food; liquid food passes more easily. Complaints of painful eating may also occur if the vestibule of the oral cavity is affected. With stomatitis and ulcerative processes in the mouth, patients complain of bad breath (foetor ex ore).

It is important to establish a connection between mucosal lesions and some other diseases. In the presence of stomatitis and stomatosis, it is necessary to pay special attention to general infectious diseases, diseases of the digestive system, and metabolism.

In acute cases, it is important to determine the presence of any acute general infection, such as influenza. Often, influenza infection can precede stomatitis. In some acute diseases, damage to the mucous membrane provides very valuable diagnostic signs, for example, Filatov's spots in measles. Often stomatitis complicates some general debilitating disease or follows a disease, especially often after the flu. Acute as well as chronic lesions of the mucous membrane can be associated with skin diseases, general poisoning (drug, occupational, etc.), diseases of the gastrointestinal tract (anid and anacid gastritis, membranous colitis, etc.), helminthic infestation, nutritional disorders ( vitamin deficiencies - scurvy, pellagra, etc.), blood diseases (anemia, leukemia, etc.). Specific infections - tuberculosis and syphilis - should be highlighted. Diseases of the endocrine glands, such as thyroid dysfunction, should also be noted during the interview.

Examination of the oral mucosa. The most valuable method of examining the mouth is examination. Regardless of the intended diagnosis, all parts of the mouth should be examined. It is necessary to examine the mouth in very good lighting, preferably daylight. Not only the affected area is subject to examination, but the entire mucous membrane of the oral cavity and the affected areas of the mucous membrane of the pharynx, skin, perioral area and face.

Lips and cheeks. The oral mucosa mainly differs from the skin in the presence of a thin epithelial layer, very slight keratinization of the surface layers, abundant blood supply due to the presence of a dense vascular network, the absence of hair follicles and sweat glands, a small number of sebaceous glands, which are mainly located in the area of ​​the mucous membrane of the lips from the corners of the mouth to the free edge of the teeth. The skin, located at the junction with the mucous membrane in the area of ​​the red border of the lips, is also similar in structure to the mucous membrane. These features of the latter, as well as the presence of bacteria and a moist, warm environment in the form of oral fluid, cause different manifestations of the same origin of lesions on the mucous membrane and skin.

The examination begins from the vestibule of the mouth. Using a mirror, spatula or hook, first pull back the lip, then the cheek. On the inner surface of the lip, thin superficial veins are visible from under the mucous membrane and intertwined strands of loose connective tissue and the orbicularis oris muscle protrude. Upon closer examination, sparsely scattered small yellowish-white nodules can be seen. These are the sebaceous glands. In people suffering from seborrhea, the number of sebaceous glands in the oral cavity is often increased. On the lateral parts of the lips, especially the upper, small nodular protrusions are visible - mucous glands. On the mucous membrane of the cheek, sebaceous glands are sometimes found in significant numbers in the form of a scattering of yellowish-white or grayish tubercles, which are usually located along the bite line in the area of ​​molars and premolars. Acinous glands are also found on the mucous membrane of the cheeks. There are fewer of them here than on the lip, but they are larger in size. A particularly large gland is located opposite the third upper molar (gianduia molaris). It should not be confused with a pathological formation. During inflammatory processes of the mucous membrane, the number of visible glands usually increases.

On the buccal mucosa at the level of the second upper molar, if you pull back the cheek, you can see a small protrusion like a papilla, at the top of which the stenon duct opens - the excretory duct of the parotid gland. To determine the patency of the Stenon's duct, the examination can be supplemented with probing. The direction of the Stenon's duct in the thickness of the cheek is determined by a line drawn from the earlobe to the red border of the upper lip. Probing is done using a thin, blunt probe; the cheek should be pulled outward as much as possible. The probe, however, cannot be passed into the gland. Usually the probe gets stuck in the place where the stenope duct passes through m. buccinator. Unless absolutely necessary, probing is not recommended to avoid infection and injury. Is it easier and safer to examine gland function through massage? massage the area of ​​the parotid gland from the outside; the doctor observes the opening of the duct; saliva flows normally. When the gland becomes inflamed or the duct is blocked, saliva is not released, but pus appears.

In the transitional fold, mainly at the point of transition of the mucous membrane of the cheek to the gum, in the area of ​​the upper molars, blood vessels, especially veins, are sometimes clearly visible. They should not be mistaken for pathological formations.

The normal mucous membrane of the lips and cheeks is mobile, especially on the lower lip; it is less mobile on the cheeks, where it is fixed by fibers of the buccal muscle (m. buccinator). In the presence of inflammatory processes, deeply penetrating ulcers, the mucous membrane takes on an edematous, swollen appearance, sometimes tooth marks are visible on it, and its mobility is sharply limited.

In addition to inflammatory processes, swelling of the mucous membrane is observed in heart and kidney suffering, in some diseases associated with dysfunction of the endocrine glands (myxedema, acromegaly).

After examining the vestibule of the mouth (lips and cheeks), the oral cavity is examined (Fig. 175).

Mucous membrane of the hard palate in appearance it differs significantly from that on the cheeks. It is paler, denser, motionless and has a different relief. In the anterior part there are symmetrical, transverse elevations of the mucous membrane (plicae palatinae transversae), which smooth out with age. The relief of the mucous membrane of the palate is significantly distorted under the influence of wearing plastic prostheses. In the midline of the central incisors there is a pear-shaped prominence called the palatine papilla (papilla palatina). In some subjects it may be pronounced, but it should not be mistaken for a pathological formation. The area of ​​the palatine papilla corresponds to the location of the incisive canal of the upper jaw (sapalis incivus). Sometimes in the middle of the hard palate there is a rather sharply protruding longitudinally located elevation (torus palatinus). This formation represents a thickening of the palatine suture (raphe palatini), and it also cannot be considered pathological. Numerous glands are embedded in the thickness of the mucous membrane covering the palate. They are located mainly in the mucous membrane of the posterior third of the hard palate, closer to the soft palate. The excretory ducts of these glands open in the form of pinholes - depressions on the mucous membrane of the palate (foveae palatinae, fossae eribrosae).

The glands located under the mucous membrane of the hard palate extend to the soft palate. The mucous membrane of the palate rarely looks like a uniformly colored cover. In smokers, it is almost always inflamed and colored deep red. With lesions of the liver and biliary tract, the color of the soft palate sometimes takes on a yellowish tint, and with heart defects - bluish.

Language. When examining the tongue, a very complex picture is revealed. Its surface has a villous appearance due to the presence of various papillae. Usually the back of the tongue is colored pink with a matte tint. However, the tongue is often coated or coated, most often gray-brown in color. Any plaque should be regarded as a pathological phenomenon. Sometimes the tongue, even in its normal state, may appear coated with a white coating, which depends on the length of the filiform papillae (papillae filiformes) scattered along its upper surface - the back and root. This plaque may disappear with age, and sometimes change during the day (more pronounced in the morning, less pronounced by the middle of the day, after meals).

The tongue, as a rule, becomes coated in cases where, due to inflammatory processes and pain in the oral cavity or other reasons, its normal mobility is disrupted or speech, chewing, swallowing is difficult, or there is a disease of the stomach or intestines. In such cases, plaque appears not only on the back and root of the tongue, but also on the tip and side surfaces. Plaque can also cover the palate and gums. Plaque, or deposits, is usually formed due to increased desquamation of the epithelium and mixing of desquamation products with bacteria, leukocytes, food debris and oral mucus. The presence of plaque on only one side of the tongue depends, for the most part, on the limitation of the activity of this side of the tongue, which is observed with hemiplegia, trigeminal neuralgia, hysterical anesthesia, and unilateral localization of ulcers. I.P. Pavlov believes that the basis for the occurrence of plaque is the neuroreflex mechanism.

Around the angle formed by the large papillae, at the apex of which there is a blind opening (foramen coecum), the posterior part of the tongue begins, devoid of papillae. The follicular apparatus of the tongue is located here and, due to the presence of a large number of crypts (bays), this part resembles the tonsil in appearance. Some people call it the “lingual tonsil.” The follicular apparatus often enlarges during inflammatory processes in the oral cavity and pharynx. An increase can also be observed in the normal state of these departments, with changes in the lymphatic system of the body.

When examining the lateral surface of the tongue at the root, rather thick venous plexuses are visible, which can sometimes mistakenly appear abnormally enlarged (Fig. 176).

In the lower part of the tongue, the mucous membrane becomes more mobile in the middle, passes into the frenulum of the tongue and into the covering of the floor of the oral cavity on the sides. Two sublingual folds (plicae sublinguales) extend from the frenulum on both sides, under which the sublingual glands are located. Closer to the middle, lateral to the intersection of the sublingual fold and the frenulum of the tongue, there is the so-called sublingual caruncle (caruncula sublingualis), in which the excretory openings of the sublingual and submandibular salivary glands are located. Inward from the sublingual fold, closer to the tip of the tongue, a thin, uneven, fringed process of the mucous membrane (plica fimbriata) is usually visible. In this fold there is an opening for the anterior lingual gland of Blandin-Nun (gl. Iingualis anterior), which is located at the tip of the tongue or at the site of the transition of the mucous membrane from the bottom to the lower surface of the tongue. During inflammatory processes that move to the bottom of the mouth, the caruncle swells, rises, the mobility of the tongue is limited, and the tongue itself moves upward.

Symptoms of inflammation. When examining the mucous membranes of the oral cavity, you should pay attention to a number of symptoms and take into account the degree and nature of their deviation from the normal appearance. The following features should be fixed first.

Firstly, type of mucous membrane: a) color, b) shine, c) surface character.

Inflammatory processes cause a change in color a. In acute inflammation due to hyperemia, the mucous membrane takes on a bright pink color (gingivitis and stomatitis). The intensity of the color depends not only on the degree of congestion of the superficial vessels, but also on the tenderness of the mucous membrane. For example, on the lips, cheeks and soft palate the color is brighter than on the tongue and gums. With chronic inflammation (congestive hyperemia), the mucous membrane takes on a dark red color, a bluish tint, and a purplish color.

Changes in the normal luster of the mucous membrane depend on damage to the epithelial cover: keratinization or disruption of integrity (inflammatory and blastomatous processes), or the appearance of fibrinous or other layers (aphtha).

Surface character may vary depending on changes in the level of the mucous membrane. Based on the depth of destruction of the latter, one should distinguish: 1) abrasions (erosions) - violation of the integrity of the surface layer of the epithelium (there is no scar during healing); 2) excoriation - violation of the integrity of the papillary layer (during healing, a scar is formed); 3) ulcers - a violation of the integrity of all layers of the mucous membrane (deep scars form during healing). Violation of the integrity of the mucous membrane during abrasions and ulcers causes changes in the level of the mucous membrane - a decrease in it. Scars, on the contrary, for the most part produce a limited increase in levels on the mucosal surface. However, atrophic scars are known (with lupus), causing a decrease in the level of the mucous membrane. A decrease is also observed in retracted scars after deep destruction of the mucous membrane.

Hypertrophic productive forms of inflammation of the mucous membrane also noticeably change its appearance.

Changes the surface relief of the mucous membranes and the presence of nodular and tuberculate rashes. A nodule, or papule, is a small (from a pinhead to a pea) elevation of the mucous membrane in a limited area. The color of the mucous membrane over the papule is usually changed, since the papule is based on the proliferation of cellular elements in the papillary and subpapillary layers, accompanied by dilation of the superficial vessels. Papular rashes on the mucous membrane are observed mainly during inflammatory processes [syphilis, lichen ruber planus]. Large papules (plaques) are observed with aphthous stomatitis, and sometimes with syphilis.

Tubercle in appearance it resembles a papule, differing from it only anatomically. It covers all layers of the mucous membrane. Due to this, the tubercle, unlike the papule, leaves a mark in the form of an atrophic scar during reverse development. Typical manifestations of tubercular lesions on the mucous membrane are lupus and tubercular syphilide. The difference between the tubercular rashes in these two diseases is that with syphilis the tubercle is sharply limited, and with lupus, on the contrary, the tubercle does not have a clear outline. Sometimes, as, for example, happens with lupus, the presence of tubercular lesions of the mucous membrane is masked by secondary inflammatory phenomena. In this case, to identify the tubercles, it is necessary to squeeze out blood from the hyperemic tissue. This is achieved using diascopy: a glass slide is pressed onto the area of ​​mucosa being examined until it turns pale, then the lupus tubercle, if present, is indicated as a small yellowish-brown formation.

A gross change in the surface level of the mucous membrane is caused by the presence of neoplasms (tumors).

Thus, studying the appearance of the mucosa can be valuable for diagnosis. Determination of color, gloss, level must also be supplemented with data on the extent of the lesion and the location of its elements.

Banal stomatitis and gingivitis usually give diffuse lesions, some specific gingivitis, such as lupus, are mostly limited and strictly localized in the area of ​​the upper front teeth. Lupus erythematodes has a favorite localization on the oral mucosa - mainly the red border of the lips and the inner surface of the cheek in the area of ​​the molars. Lichen planus is located mainly on the mucous membrane of the cheek according to the bite line.

Next, one should distinguish a confluent lesion from a focal one, when the elements are located separately. In the oral cavity, the focal arrangement of elements produces predominantly syphilis. In tuberculous and common inflammatory processes, a confluent arrangement of elements is observed. Almost always, when examining the oral cavity, the outer coverings should also be examined.

Below is an inspection diagram.

Inspection scheme

1. Statement of damage to the mucous membrane.

2. Nature of appearance and course.

3. The main elements of the lesion.

4. Grouping elements

5. Growth of elements.

6. Stages of development of elements.

For a spot

1. Size.

3. Coloring.

4. Durability.

5. Topography.

6. Current.

7. Availability of other elements.

For papule and tubercle

1. Size.

3. Coloring.

4 Stages of development.

5. Topography.

For ulcers

1. Size.

5. Depth.

6. Secret.

7. Density.

8. Soreness.

9. Surrounding tissue

10. Development.

11. Current.

12. Topography.

For scars

1. Size.

4. Depth.

5. Coloring.

Having completed the morphological analysis of the lesion, the doctor supplements it, if necessary, with palpation and palpation. This cannot be neglected.

Examination of the outer integument is aimed mainly at establishing changes in the color and appearance of the skin, and the presence of swelling. Such an examination usually does not provide solid indicative signs, since the appearance of the swelling often says little about its nature and origin. Swelling of the cheek and chin can be caused by the presence of collateral edema, which is very often caused by either phlegmonous inflammation of the subcutaneous tissue, or a tumor process. To establish the nature of the swelling, it is necessary to perform a palpation examination.

TO palpation examination mouth lesions have to be resorted to quite often. Palpation must be performed when examining oral tumors, some ulcers, and in all cases of lesions of an unknown nature.

When palpating a tumor, in addition to its consistency, one should determine the depth of its location, the mobility of the tumor itself and the mucous membrane above it, and its connection with surrounding tissues and organs. When palpating an ulcer, the doctor should be interested in its density, edges and the nature of infiltration around the ulcer. These data often provide valuable auxiliary information in the differential diagnosis between cancer, tuberculosis, syphilis and nonspecific ulcers on the tongue, cheek, and lip.

A cancerous ulcer is characterized by the presence of a very dense cartilage rim around the ulceration. Feeling a cancerous ulcer is painless. On the contrary, palpation of a tuberculous ulcer often causes pain. The edges of a tuberculous ulcer are slightly compacted and do not give the sensation of a cartilaginous ring when palpated, which is so characteristic of cancer. Sometimes a hard chancre or syphilitic ulcer on the lip or tongue, cheek, due to the presence of a dense painless infiltrate, can be difficult to distinguish by touch from a cancerous ulcer.

Nonspecific ulcers of the oral mucosa, when palpated, for the most part differ significantly from those described above due to their superficial location. Here, however, one should keep in mind chronic ulcers of traumatic origin, especially those located on the lateral surface of the tongue, at its root. These ulcers, due to trauma constantly caused by a carious tooth or poorly fitted prosthesis, are surrounded by a rather dense infiltrate. And yet they remain more superficial and less dense than with cancer.

Often, in order to examine dental patients, it is necessary to use palpation of the external tissues of the face and neck. This study is carried out in search of inflammatory infiltrates, neoplasms, and when examining the lymphatic system. It is recommended to feel the soft tissues of the face with the head well fixed.

Visible diffuse swelling of the soft tissues of the face, which is observed during inflammatory processes in the jaws, mostly occurs due to collateral edema. Palpation examination usually reveals in the doughy mass of edematous tissue the presence (or absence) of a compacted area, infiltrated tissue or a fluctuating area of ​​abscess.

The lymph nodes. Especially often it is necessary to examine the lymph nodes. As is known, the study of nodes is of great importance for the clinical assessment of inflammatory and blastomatous processes. Lymph from the soft and hard tissues of the mouth is drained through the following system of nodes. The first stage is the submandibular, chin, lingual and facial lymph nodes; second - superficial and upper deep cervical nodes; third - lower deep cervical nodes. From the lower deep cervical nodes, lymph enters the truncus lymphaticus jugularis.

Individual areas of the mouth and dental system are connected to the first stage lymph nodes as follows. All teeth, with the exception of the lower incisors, give lymph directly to the group of submandibular nodes, the lower incisors - to the chin and then to the submandibular nodes. The floor of the mouth, cheeks (directly and through the superficial facial nodes), as well as the lips are connected to the submandibular lymph nodes, with the exception of the middle part of the lower lip, which gives lymph first to the mental nodes. The back part of the gums of the lower jaw gives lymph to the submandibular nodes and deep cervical nodes, and the front part - to the mental nodes; the gums of the upper jaw - only in the deep buccal, the tongue - in the lingual and directly in the upper deep cervical. The palate is connected directly to the deep facial lymph nodes (Fig. 177, 178).

Palpation of the chin and submandibular lymph nodes is carried out as follows. The doctor stands to the side and slightly behind the patient. The patient relaxes the neck muscles by slightly tilting his head forward. Using the tips of the three-middle fingers of both hands, the doctor penetrates from the right and left into the submandibular region, pressing the soft tissues. The thumbs rest on the lower jaw, fixing the head. The submandibular nodes are located inward from the edge of the lower jaw in the following order. In front of the submandibular salivary gland there are two groups of lymph nodes: 1) in front of the external maxillary artery and 2) behind the artery; behind the salivary gland is the third group of submandibular lymph nodes. The mental nodes are located along the midline of the chin between the geniohyoid muscles (Fig. 177).

To palpate the facial lymph nodes, it is more convenient to use a two-handed examination: one hand fixes and lifts the cheek from the inside, the other palpates the glands from the outside. Sometimes it is useful to use a two-handed examination when palpating the submandibular and mental lymph nodes, for example, in very obese subjects with inflammatory infiltration of soft tissues, etc. The facial lymph nodes are located mainly on the buccal muscle in the space between the masseter and orbicularis oris muscles. The cervical nodes run along the internal jugular vein.

When palpating the lymph nodes, it is important to determine their size, consistency, mobility and pain. Normally, the lymph nodes are not palpable at all or are vaguely palpable. Acute inflammatory processes in the mouth cause an increase in the corresponding nodes; the lymph nodes become painful when touched. In these cases, acute perilymphadenitis may also appear; the nodes are palpated in a continuous package. In banal chronic inflammatory processes, the nodes are usually enlarged, mobile and slightly painful. The glands are especially dense in cancer and syphilis; they can also be palpated in separate packets. With cancer in further stages of its existence, limited mobility of nodes may be observed due to metastases. Chronic perilymphadenitis is considered characteristic of tuberculous lesions of the lymph nodes.

Inflammatory diseases. The oral mucosa is highly resistant to a variety of local microbial flora. Among the many protective mechanisms implemented in the oral cavity, one should mention the selective competitive suppression of potential pathogenic pathogens by a mass of representatives of the autoflora; production of secretory immunoglobulin (IgA) and other immunoglobulins by accumulations of lymphocytes and plasma cells present in the mucous membrane; antibacterial properties of saliva; liquefying and flushing effect of food and drinks. Nevertheless, the weakening of any of the listed mechanisms, which occurs, for example, in immunodeficiency states or an imbalance in microbial balance during massive antibiotic therapy, contributes to the development of infection in the oral cavity. The following describes local, nosologically distinct forms of inflammatory lesions of the oral cavity, but will not touch upon systemic diseases, in which changes in the oral cavity are considered simultaneously with other data on these diseases in other chapters.

Herpes simplex virus (HSV) infections. In most cases, orofacial herpetic lesions are caused by type 1 virus (HSV-1); Type 2 - HSV-2 - most often affects the genitals (see Chapter 14). In addition, the herpes virus can cause keratoconjunctivitis, and in newborns and people with unstable immunity, it can cause severe keratitis or fatal encephalitis. Most primary oral infections with HSV-1 result in a trivial herpetic eruption. In children aged 2-4 years, such lesions can be severe, becoming diffuse, involving the mucous membrane of the mouth, tongue, gums and pharynx. Fiery red hyperemia and edema appear, followed by accumulations of vesicles. Acute herpetic gingivostomatitis develops. It is usually accompanied by systemic lesions.

Vesicles vary in diameter from a few millimeters to centimeters. They persist for some time, being filled with a light serous fluid, then rupture, and in their place very painful, superficial ulcers appear, surrounded by a red rim or cushion. Under a microscope, acantholysis is visible in the spinous layer of the epithelium, i.e. intra- and intercellular edema, destruction of intercellular bridges and the formation of blisters. In individual epithelial cells located at the edges of the vesicles or floating in their serous fluid, oxyphilic intranuclear viral inclusions are visible. Multinucleate giant cells are found. Superficial ulcers clear spontaneously and heal within 3-4 weeks. However, the virus migrates along the regional nerve trunks and enters a latent state in the regional ganglia, in particular the trigeminal ganglia. In the vast majority of adults, HSV-1 remains latent, but in some (especially young) individuals it can be activated and cause herpetic sores. The factors that trigger activation are not entirely clear. These include the influence of allergens, upper respiratory tract infections, being in a state of cooling, in a draft, in direct sunlight.

In contrast to acute gingivostomatitis, recurrent herpetic stomatitis manifests itself in lesions of the skin of the lips, less often the nasal openings or the mucous membrane of the cheeks in the form of groups of small (1-3 mm) vesicles. The acute stage of the process, in this case a milder stage, lasts for 4-6 days, and healing is noted after 8-10 days.

Aphthous stomatitis (“aphthous” - grayish-white plaque). It is an erosive lesion of the oral mucosa and is very common. In the United States, it affects about 40% of the population. The disease most often occurs during the first 20 years of life and is characterized by pain, a tendency to relapse and predominance in members of the same family, and can be single or multiple. The main manifestation of aphthous stomatitis is superficial, hyperemic ulcerations, covered with a thin layer of exudate and limited by a narrow strip of erythema. The inflammatory infiltrate in the bottom and edges of the erosive defect is represented predominantly by mononuclear elements. A secondary microbial infection that occurs later is accompanied by abundant leukocyte infiltration. The lesions may heal spontaneously within 1 week or persist for several weeks. The causes of aphthous stomatitis are unclear. Sometimes it is associated with the presence of enteritis or Behcet's syndrome (N. Behcet; chronic recurrent septic-allergic condition with rheumatoid lesions, hemorrhages, in particular in the brain tissue, as well as aphthous-ulcerous lesions of the genitals and oral cavity). Etiological factors may include hypersensitivity, stress, pregnancy, autoimmune cellular and humoral reactivity, and Streptococcus sanguis infections.

Candidal stomatitis (thrush). Various variants of candidiasis are described in Chapter 14. Suffice it to recall that oral lesions, as a rule, appear in the form of grayish-white filmy deposits, sometimes plaques. Under a microscope, fungal hyphae can be seen in the masses of fibrinous-purulent exudate. The latter is part of the normal flora of the oral cavity and can manifest its pathogenic effect only in severe predisposing conditions: diabetes mellitus, neutropenia of various origins, impaired microbial cooperation during antibacterial therapy, AIDS.

Glossitis (inflammation of the tongue). This name is used in relation to various processes in the tissue of the tongue. Atrophic glossitis is characterized by a decrease and even disappearance of the papillae and thinning of the mucous membrane and some reduction of the tongue. In some cases, atrophic changes are accompanied by inflammation and superficial ulcerations. Atrophic glossitis occurs with a deficiency of vitamin B12 (pernicious anemia, see Chapter 12), riboflavin (vitamin B2) / niacin (vitamin PP) or pyridoxine (vitamin B6) (see Chapter 9). Similar changes occur in malabsorption syndromes or iron deficiency anemia, especially complicated by a deficiency of one of the mentioned B vitamins. The combination of iron deficiency anemia, glossitis, esophageal dysphagia, skin hyperkeratosis, conjunctivitis, etc., occurring mainly in women, is known as Plummer-Vinson syndrome (H.S.Plummer, P.P.Vinson). Glossitis, characterized by ulcerative changes that usually occur along the lateral edges of the tongue, may be associated with carious, decaying teeth or poorly fitting dentures. It is much less common with syphilis, inhalation burns and ingestion of caustic chemicals.

Xerostomia (dry mouth). It is one of the main signs of the autoimmune disease - Sjögren's syndrome (H.C. Sjoegren) - a chronic systemic disease with insufficiency of the endocrine glands (see Chapter 5). Lack of salivary secretion may be a consequence of radiation therapy or drug treatment with various anticholinergic agents. With xerostomia, primarily dry mucous membrane or atrophy of the papillae of the tongue is detected. In addition, there may be fissures, erosions or - in Sjögren's syndrome - a concomitant enlargement of inflamed salivary glands.

Reflection of systemic diseases on the oral mucosa. Many diseases of the digestive and other systems affect the condition of the mucous membrane of the tongue and the oral cavity in general.

Pathological changes in the oral cavity in systemic diseases

Villous leukoplakia is a rare oral lesion found only in HIV-infected individuals. Sometimes recognition of an immunodeficiency state begins with the detection of this lesion. Externally, villous leukoplakia appears in the form of white confluent spots or plaques with a fluffy (hairy) surface, localized anywhere in the oral cavity. Under a microscope, one can see how the superficial layers of keratinocytes are raised and form piles, while acanthosis is observed in the basal layers of the epithelium. In some cases, in surface epithelial cells that have not yet keratinized and therefore contain nuclei, koilocytosis (perinuclear vacuolization) is observed, indicating the presence of human papillomavirus (HPV). At the same time, in situ hybridization studies, in addition to HPV, detected Epstein-Barr viruses (EBV) and sometimes HIV (HIV) in foci of villous leukoplakia. Finally, some patients sometimes experience a layer of candidal infection. If the plaques of villous leukoplakia are the “shelter” of HIV infection, then within 2-3 years the patients will certainly develop signs of AIDS.

Proliferates of a reactive nature. An irritation fibroma is a fibrous nodule, usually protruding in the gingivodental (marginal) area of ​​the gum, which is subject to chronic irritation. It is covered with hyperemic mucous membrane. Essentially, this is an overly pronounced focus of inflammatory fibrosis, occurs in both men and women, and often accompanies pregnancy. Therefore, such a fibroma is sometimes called a pregnancy tumor.

Epulis (supragingival; giant cell granuloma) is also an inflammatory lesion. This formation protrudes from the surface of the gums in the area of ​​chronic inflammation and reaches 1.5 cm in diameter. It can also be covered with a hyperemic mucous membrane, on which, however, erosions occur. Under the microscope, attention is drawn to clusters of multinucleated giant cells, such as foreign bodies, located in the fibrovascular stroma (Fig. 16.1). Epulis must be distinguished from true giant cell tumors of the maxilla and mandible, as well as from the histologically similar but usually multiple reparative giant cell “brown tumors” (osteoblastoclastomas) of hyperparathyroidism (see Chapter 23). Although not encapsulated, epulis is nevertheless easily removed surgically. In addition to giant cell epulis, there is angiomatous (vascular) epulis, whose structure resembles capillary hemangioma (Fig. 16.2).

Precancerous conditions and tumors. Very common pre-tumor conditions, as well as benign and malignant tumors, occur in the mucous membrane and soft tissues of the oral cavity. Many tumors - hemangiomas, granular cell myoblastomas, lymphomas, etc. - are also found in other organs, so they are described in other chapters. Let us dwell on some of the most important precancerous processes (leukoplakia, erythroplakia, papillomas) and squamous cell cancer of the oral cavity.

Rice. 16.1.

Giant cell epulis of the gums of one of the premolars

On the right is hyperplastic epithelium of the gums (preparation by M.G. Rybakova).

Rice. 16.2.

Vascular epulis

(preparation by M.G. Rybakova).

Leukoplakia and erythroplakia. Whitish spots and even plaques appear on the mucous membrane of the oral cavity with intense and long-term smoking or sniffing tobacco, chronic biting of the mucous membrane of the cheek, lichen planus (one of the dermatoses, see Chapter 25), inflammation of the mucous membrane of the palate in smokers, candidiasis, as well as for more rare conditions and exposures. According to modern concepts, true leukoplakia is characterized not just by hyperplasia and intense keratinization of the epithelium of the mucous membrane, it is an optional precancerous condition. The lesion occurs anywhere in the oral cavity, but more often on the mucous membrane of the cheeks, floor of the mouth, ventral surface of the tongue and hard palate; it can be single or multiple. The boundaries of soft or denser plaques are usually clear, less often blurred. Under the microscope, pronounced hyperkeratosis, a preserved zone structure of stratified squamous epithelium, and acanthosis are noted. Signs of mild to moderate dysplasia may occur. In this case, lymphomacrophage infiltration of the underlying connective tissue is more pronounced than in the absence of such signs.

Erythroplakia (leukoplakia with dysplasia) is a condition closely related to the previous one and is rarer and more threatening. This condition is characterized by the presence of red, velvety, sometimes eroded lesions on the oral mucosa. Compared with ordinary leukoplakia, malignancy is much more common. Under a microscope, as a rule, the disappearance of the zone structure of the epithelium, signs of ulceration, severe dysplasia, foci of carcinoma in situ and foci of incipient cancer invasion are observed. Inflammation and especially hyperemia are expressed in the underlying connective tissue. The latter, through zones of erosive thinning of the lining, gives the lesion a red color, hence the name “erythroplakia.”

Both leukoplakia and erythroplakia occur in adults of any age, but most often between 40 and 70 years. Men are affected 2 times more often than women. Smoking and chewing tobacco are strong predisposing factors for these lesions. Other factors include alcoholism, constant consumption of very hot drinks and very hot food. In more than 50% of patients, sequences of papillomavirus (HPV) serotype 16 were detected in lesions of leukoplakia and erythroplakia. The appearance of carcinoma in situ, as well as invasive cancer, is observed in 5-6% of patients. External signs of malignancy are a spotted surface and have a warty appearance. Malignancy most often occurs in plaques of the floor of the mouth or the ventral surface of the tongue. Erythroplakia is characterized by malignancy in at least 50% of cases.

Squamous cell papilloma and condyloma acuminata. These relatively harmless, benign growths occur on the skin and genitals of men and women (see Chapters 7 and 21). They are of not only clinical, but also theoretical interest due to the presence of HPV serotypes 6 and 11, which, however, are not typical for lesions of the oral cavity.

Squamous cell carcinoma. At least 95% of all oral carcinomas (including tonsils) are squamous cell carcinomas. The remainder includes adenocarcinomas of the mucous glands, melanomas and other rarer tumors. Squamous cell carcinoma of the oral cavity is a rare tumor, accounting for about 4% in men and approximately 2% of all malignant neoplasms in women [according to Cotran R.S., Kumar V., Collins T., 1998]. It occurs in the age range of 50-70 years. In approximately 50% of cases, this tumor leads to death.

It is believed that smoking and alcoholism play the largest role in the origin of squamous cell carcinoma of the oral cavity. Compared with non-smokers and non-drinkers, people who smoke but are not alcoholics have a 2-4 times higher risk of developing this type of cancer, and 6-15 times higher risk for people who abuse both. It has been proven that the amount of tobacco and alcohol consumed corresponds to the level of risk. Other etiological factors include chewing tobacco, betel nut (a mixture used for arousal and consisting of spicy leaves of the betel pepper bush with pieces of areca palm seeds and a small amount of lime), and marijuana use. Prolonged irritation or a source of infection are no longer considered predisposing carcinogenic factors, but they can lead to leukoplakia, which can become malignant. In approximately 50% of patients with squamous cell carcinoma of the tongue and floor of the mouth, HPV serotype 16 and closely related serotypes were identified in the tumor tissue. In terms of risk factors for cancer of the lower lip, the role of intense ultraviolet radiation (excessive sunbathing) and pipe smoking are also known. Perhaps all these and other factors influence the genetic apparatus of the oral epithelium, in which, during malignancy, various changes are determined at the level of genes and karyotype. In particular, divisions were detected in regions of chromosomes 18q, Jr, 8p and Zp. Mutations of p53 and overexpression of mutant p53 protein, amplification of oncogenes int-2 and bcl-/ were also detected. A large number of these changes indicate the multistage nature of carcinogenesis in the oral cavity.

According to the decreasing frequency of findings, the localization of squamous cell carcinoma of the oral cavity is distributed as follows: floor of the mouth - tip of the tongue - base of the tongue - mucous membrane of the hard palate - mucous membrane of the lips. In the early stages, this cancer appears as a slightly raised, dense plaque or as an area of ​​uneven and uneven warty thickening of the mucosa. The picture may resemble leukoplakia (see above). Sometimes malignancy occurs on the basis of leukoplakia or erythroplakia. As the tumor tissue progresses, it tends to grow exophytically, but quickly becomes necrotic, forming bizarre ulcers with a rough bottom and raised, dense and rounded edges. Invasive oral cancer progresses from foci of carcinoma in situ or areas of severe dysplasia. The period of such progression ranges from several months to several years. Histological variants of the tumor include all the diversity of differentiation, ranging from the most common well-differentiated (epidermoid) forms to the more rare anaplastic forms. All of them are distinguished by a tendency to local invasive growth, and then to lymphogenous or hematogenous metastasis. The time of occurrence and localization of metastases are largely determined by the localization of the primary tumor node in the oral cavity. Metastases are most often found in the mediastinal lymph nodes, lungs, liver and bones. Early recognition of oral cancer is the most important prognostic factor. The best prognosis after complex treatment is observed for lip cancer. Within 5 years, 90% of patients do not have a relapse. The worst indicators are for carcinoma of the floor of the mouth and base of the tongue. Only 20-30% of such patients do not experience relapses within 5 years.

Each of us dreams of beautiful snow-white teeth, but, unfortunately, not everyone can boast of a Hollywood smile. Today, dentists are increasingly diagnosing various diseases in adults. The most common types of ailments, as well as their causes and methods of treatment, will be discussed in the article.

Causes

The human oral cavity performs a variety of specific functions. Almost all pathological processes in it are closely interrelated with diseases of various human systems and organs.

And oral cavities can develop due to:

uncontrolled treatment with antibiotics;

consuming too spicy and hot food, alcoholic beverages, smoking;

various infections;

dehydration of the body;

vitamin deficiencies of various types;

pathologies of internal organs and systems;

hormonal fluctuations;

genetic predisposition.

The picture below shows an example of an oral disease (the photo shows what stomatitis looks like).

In a normal state, the oral cavity is populated by microorganisms that are classified as opportunistic. Under the influence of negative factors, certain types of microflora increase their virulence and become pathogenic.

Oral diseases: classification and treatment

Diseases that occur in the human mouth can be divided into infectious-inflammatory, viral and fungal. Let us consider in more detail each type of pathology and the main methods of therapy.

Infectious and inflammatory diseases

Oral infections in adults are the most common problem today that brings us to the dentist, otolaryngologist or primary care physician. Pathologies related to this type are:

Pharyngitis is an inflammation of the mucous membrane of the throat. Basically, the disease manifests itself with symptoms such as discomfort, sore throat and severe sore throat. Pharyngitis can develop due to inhalation of cold or dirty air, various chemicals, and tobacco smoke. Also, the cause of the disease is often an infection (pneumococcus). Often the disease is accompanied by general malaise and increased body temperature.
The disease is diagnosed through a general examination and a throat swab. Antibiotics are used in rare cases to treat pharyngitis. As a rule, it is enough to follow a special diet, do hot foot baths, apply to the neck, inhalation, rinsing, drink warm milk with honey.

Glossitis is an inflammatory process that changes the structure and color of the tongue. The cause of the disease is infections of the oral cavity. Glossitis can develop as a result of a burn of the tongue, trauma to the tongue and oral cavity; all this is a “pass” for infection. Also at risk are lovers of alcoholic beverages, spicy foods, and mouth fresheners. Of course, the risk of glossitis is higher for those who neglect the rules of hygiene and do not care for their oral cavity carefully enough. At the first stage, the disease manifests itself as a burning sensation and discomfort, later the tongue becomes bright red, salivation increases, and taste sensations are dulled.
must be prescribed by a dentist. Therapy consists of taking medications, the main ones being drugs such as Chlorhexidine, Chlorophyllipt, Actovegin, Furacilin, and Fluconazole.



Gingivitis is manifested by inflammation of the gum mucosa. This disease is quite common among teenagers and pregnant women. Gingivitis is divided into catarrhal, atrophic, hypertrophic, ulcerative-necrotic. Catarrhal gingivitis is manifested by redness and swelling of the gums, itching and bleeding. With atrophic gingivitis, a person reacts sharply to cold and hot foods, the level of the gums decreases, and the tooth becomes exposed. Hypertrophic gingivitis is characterized by an increase in gingival papillae, which begin to cover part of the tooth; in addition, the gums are painful and bleed slightly. A sign of ulcerative-necrotic gingivitis is the appearance of ulcers and necrotic areas, the disease is also manifested by bad breath, severe pain, general weakness, fever, and enlarged lymph nodes.
If you contact a medical facility in a timely manner, the doctor will prescribe effective treatment that will help you get rid of this problem in a short time. In addition, the specialist will give recommendations regarding oral hygiene, following which you can avoid the occurrence of such a disease in the future. For the treatment of catarrhal gingivitis, decoctions of medicinal plants are used (oak root, sage, chamomile flowers. For atrophic gingivitis, treatment involves the use of not only medications (vitamin C, B vitamins, hydrogen peroxide), but also physiotherapeutic procedures such as electrophoresis, darsonvalization , vibration massage. Therapy for hypertrophic gingivitis involves the use of non-steroidal anti-inflammatory drugs (Salvin, Galaskorbin) and antibacterial agents of natural origin (Tanin, Heparin, Novoimanin). In the treatment of ulcerative necrotic gingivitis, antihistamines are used and medications such as Pangexavit, Trypsin, Terrilitin, Iruksol and others.



Stomatitis is the most common infectious disease of the oral cavity. The reasons for infection entering the body can be different, for example, mechanical injury. Once the infection penetrates, it forms characteristic ulcers. They affect the inner surface of the lips and cheeks, the root of the tongue. The ulcers are single, shallow, round, with smooth edges, the center is covered with a film, the wounds are usually very painful.
Stomatitis in the throat often develops. The disease manifests itself as painful sensations when swallowing, itching, swelling, and soreness. The disease can occur due to a variety of reasons: burns to the mucous membrane, poor-quality filling treatment, taking certain medications (hypnotics, anticonvulsants, some types of antibiotics). Stomatitis in the throat can be confused with symptoms of a common cold. But upon examination, white-yellow ulcers formed on the tongue or tonsils are discovered.
Treatment of the disease involves the use of special toothpastes and mouth rinses that do not contain sodium lauryl sulfate. Anesthetics are used to relieve the pain of ulcers. To gargle, use a solution of hydrogen peroxide, an infusion of calendula or chamomile using medications such as Tantum Verde, Stomatidin, Givalex.

Drug treatment of diseases of the oral mucosa must be combined with a special diet, the basis of which is semi-liquid food; in addition, it is recommended to avoid eating spicy, too salty and hot foods.



Viral diseases

Viral diseases of the oral cavity in adults are caused by the human papillomavirus and the herpes virus.

• Herpes is one of the most common ailments. According to scientists, 90% of all inhabitants of our planet are infected with herpes. Quite often the virus in the body is located in a latent form. In a person with a strong immune system, it may appear as a small pimple on the lip, which dies off within 1-2 weeks without any outside help. If a person’s body’s defenses are weakened, herpes manifests itself much more significantly. The virus can be activated by stress, surgery, colds, lack of sleep, cold, wind, or menstruation.
  Herpes develops gradually. Initially, there is itching and a tingling sensation on the lips and adjacent tissues, after which the lips swell, become red, and pain appears, which makes it difficult to speak or eat. Then single bubbles or entire groups of them appear. After some time, these blisters begin to burst and turn into small ulcers; they are covered with a hard crust that cracks. Gradually the ulcers go away, the pain and redness subsides.
  At the first manifestations of herpes, it is recommended to moisturize your lips with special balms and apply ice to them. Any blisters that appear should be lubricated with a special ointment that can be purchased at a pharmacy, for example the drug Penciclovir.

Papillomas can occur in different parts of the body. A certain type of virus causes the development of papilloma in the oral cavity. White plaques appear in the mouth, looking like cauliflower. This disease can be localized in the throat and cause hoarseness and difficulty breathing. Unfortunately, it is impossible to completely get rid of the human papillomavirus; therapy is aimed only at eliminating the clinical manifestations of the disease.

Fungal diseases

Oral cavities are quite common. Half of the world's population are inactive carriers of Candida. It is activated when the body's defenses are weakened. There are several types of candidiasis (a disease caused by candida).

The disease manifests itself as dryness and a white coating on the inside of the cheeks and lips, on the back of the tongue and the palate. The patient also feels a burning sensation and severe discomfort. Children tolerate candidiasis in the mouth much easier than adults. The most painful type of candidiasis is atrophic. With this disease, the oral mucosa becomes bright red and becomes very dry. Hyperplastic candidiasis is characterized by the appearance of a thick layer of plaque; when trying to remove it, the surface begins to bleed. Atrophic candidiasis in the mouth develops as a result of prolonged wearing of lamellar dentures. The mucous membrane of the palate, tongue, and corners of the mouth dries out and becomes inflamed. Treatment of candidiasis in the mouth involves the use of antifungal drugs such as Nystatin, Levorin, Decamine, Amphoglucomin, Diflucan.



Diseases of teeth and gums

Dental diseases of the oral cavity are very diverse. Let's look at the most common dental pathologies.

Caries

This disease, to varying degrees of development, occurs in more than 75% of the total population. Only a specialist can accurately determine the causes of caries, since the development of the disease is influenced by many different factors: the patient’s age, his lifestyle, diet, habits, the presence of concomitant dental pathologies and other ailments.

Caries develops due to:

Insufficient oral hygiene. Persons who do not perform oral hygiene procedures after meals face the problem of caries in 90% of cases. With insufficient or irregular brushing of teeth, a persistent plaque forms on their surface, which over time turns into stone and leads to the loss of microelements from the enamel.

Poor nutrition. As a result of following strict diets with a reduced content of microelements and proteins, the absence of foods containing calcium in the daily diet, the qualitative balance of the microflora of the oral cavity changes and, as a result, the destruction of hard dental tissues can begin.

Enamel pathologies. If the tooth tissues are not fully developed, the enamel receives an insufficient amount of minerals from the saliva; as a result, the tooth is not able to form, develop and function normally.

When examining the oral cavity, the dentist will choose the most appropriate treatment method. If the caries is in the spot stage, remineralization (restoring the amount of mineral) will be enough. If a carious cavity forms, filling is required.

Periodontitis

Periodontitis is an inflammatory disease of the tissues surrounding the tooth. This disease is characterized by gradual destruction of the connection between the root and bone tissue, increased mobility of the tooth and its subsequent loss. Periodontitis is caused by an infection that, penetrating between the gum and tooth, gradually disrupts the connection between the bone and the tooth root. As a result, the area increases, but over time the connection between the bone and the root weakens.

Once an infection is identified, eliminating it will not be difficult. But in this case, the danger is the consequences of periodontitis. After the infection is eliminated, the soft tissues are restored faster, rather than the ligaments that hold the tooth root in the bone, which can cause its loss. Therefore, treatment of periodontitis consists not only of eliminating the infection, but also of restoring the bone tissue and ligaments that hold the tooth in the bone.



Periodontal disease

This disease is quite rare and occurs mainly in older people. What is periodontal disease, how to treat such pathology? Periodontal disease is which is characterized by:

bleeding and swelling of the gums, pain in the gums;

periodic swelling of the gums;

suppuration from periodontal pockets;

exposing the surface of the roots and necks of teeth;

fan-shaped divergence of teeth;

mobility of teeth.

If periodontal disease has developed, how to treat it and what methods are used, the dentist will tell you after examining the oral cavity. First of all, it is necessary to remove dental deposits and plaque, which cause inflammation in the gums and destruction of the dental-gingival attachment. Drug therapy consists of rinsing the mouth with Chlorhexidine, and applying Cholisal-gel to the gums.



Prevention of oral diseases

Hygiene is the basis for preventing oral diseases. It is imperative to brush your teeth not only in the morning, but also in the evening, before going to bed, using high-quality toothpastes and brushes; it is also recommended to use dental floss once a day.

A balanced diet and a healthy lifestyle. To maintain dental health, you should avoid eating foods that are too hot or cold. It is recommended to include foods rich in calcium and phosphorus in your daily diet: fish, dairy products, green tea. Yellow-brown plaque on the teeth is an unpleasant sight, so such a bad habit as smoking should be completely abandoned.

Regular visits to the dentist. The above measures are extremely important to maintain dental health. However, this is not enough. It is very difficult to independently detect a developing pathological process, especially at the initial stage. Therefore, examination by a dentist should be done regularly - once every six months.

Any diseases of the oral cavity in adults are always unpleasant, but, unfortunately, they occur quite often. To prevent the development of diseases, follow the above rules of prevention, and if pathology does occur, take appropriate measures.