Primary elements of damage to the mucous membrane. Secondary morphological elements of damage to the oral mucosa

Chapter 5.

The development of each disease of the oral mucosa is characterized by the appearance of peculiar elements of damage on its surface. The rashes observed on the skin and SO consist of individual elements that can be combined into several groups: 1) changes in the color of the mucous membrane, 2) changes in surface relief, 3) limited accumulations of fluid, 4) layering on the surface, 5) SO defects. Elements of damage are conventionally divided into primary (which arise on unchanged CO) and secondary (which develop as a result of transformation or damage to existing elements). The formation of identical primary elements on CO is considered as monoform, and different ones - as polymorphic precipitation. Knowledge of the elements of the rash makes it possible to correctly navigate the numerous diseases of the mucous membranes and lips. And the comparison clinical picture local changes with the state of the whole organism, with factors external environment, which adversely affect both the affected area and the entire body as a whole, allows for a correct diagnosis.

TO primary elements rashes include a spot, a nodule (papule), a node, a tubercle, a vesicle, a vesicle, an abscess (pustule), a cyst. Secondary - scales, erosion, excoriation, aphthae, ulcers, cracks, crusts, scars, etc.

Primary elements of the lesion. Spot (macula) - limited color change of the mucous membrane(rice. 15). The color of the spot depends on the reasons for its formation. The spots never protrude above the CO level, that is, they do not change its relief. There are vascular spots, pigment spots and spots resulting from deposition in CO coloring matter.

Vascular spots can occur as a result of temporary vasodilation and inflammation. Inflammatory spots have different shades, usually red, less often bluish. When pressed, they disappear, and then, after the pressure stops, they appear again.

Erythema - unlimited redness without clear contours. Roseola - small erythema of a round shape, ranging in size from 1.5-2 to 10 mm in diameter with limited contours. Roseola observed

at infectious diseases(measles, scarlet fever, typhoid, syphilis). Hemorrhages are spots that arise as a result of a violation of the

flatness vascular wall. The color of such spots does not disappear when pressure is applied to them and, depending on the decomposition of the blood pigment, can be red, bluish-red, greenish, yellow, etc. These spots come in different sizes. Petechiae are point hemorrhages; large hemorrhages are called ecchymoses. The peculiarity of hemorrhagic spots is that they resolve and disappear without leaving a trace.

Telangiectasia- spots that arise due to persistent non-inflammatory dilation of blood vessels or their neoplasm. They are formed by thin tortuous vessels anastomosing among themselves. With diascopy, telangiectasias become slightly pale.

Dark spots arise due to the deposition of coloring substances of exogenous and endogenous origin in CO. They can be congenital or acquired. Congenital pigmentations are called nevi. Acquired pigmentations have an endocrine

a a

b b

An inflammatory spot on the gum (a), its schematic image (b).

1 - epithelium; 2- lamina propria of the mucous membrane; 3 - dilated vessels.

origin or develop during infectious diseases.

Exogenous pigmentation occurs when substances that color it penetrate from the external environment into CO. Such substances include industrial dust, smoke, medications and chemicals. Pigmentation when heavy metals and their salts enter the body has a clearly defined shape. The color of the spots depends on the type of metal. They are black from mercury, dark gray from lead and bismuth, bluish-black from tin compounds, gray from zinc, greenish

From copper, black or slate - from silver.

Nodule (papule) on the mucous membrane of the cheek (a), its schematic image

1 - epithelium, 2 - lamina propria; 3 - elevation of the epithelium.

A nodule, or papula (papula) is a non-cavitary element protruding above the surface of the mucous membrane, the infiltrate of which is located in the papillary layer of the lamina propria (Fig. 16). The shape of the papules can be pointed, semicircular, round, or pin-shaped. The diameter of the papules is 3-4 mm. When they merge, plaques are formed. With reverse development, the papule leaves no trace.

Node (nodus) - limited, significant size (from hazelnut to a chicken egg) compaction that reaches the submucosa (Fig. 17). The formation of nodes can be the result of an inflammatory process, benign

Elements of damage to the oral mucosa

a a

b b

A node on the mucous membrane of the lip (a), its schematic image (b).

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

natural and malignant tumor growth, as well as the result of deposition of calcium and cholesterol into the tissue.

Inflammatory nodes formed due to nonspecific or specific infiltration (with leprosy, scrofuloderma, syphilis, tuberculosis) are characterized by rapid increase. The reverse development of nodes depends on the nature of the disease. They can dissolve, necrotize, melt with the formation of ulcers, and subsequently deep scars.

Tuberculum (tuberculum) is an infiltrative cavityless element of a round shape, up to the size of a pea, protruding above the level

Tubercle on the mucous membrane of the upper lip (a), its schematic image

1 - epithelium; 2 - lamina propria of the mucous membrane; 3 - infiltration.

German CO (Fig. 18). The infiltrate covers all layers of the mucosa. A feature of the tubercle, which at first looks like a nodule, is that its central part, and sometimes the entire element, becomes necrotic, which leads to the formation of an ulcer, which scars or the tubercle resolves without violating the integrity of the epithelium with the formation of cicatricial atrophy. The tubercles tend to group or, being close to each other, merge. tubercles

Primary elements for tuberculous lupus, tertiary syphilis, leprosy, etc.

Bubble river (vesiculum) - a cavity element ranging in size from a pinhead to a city

b b

A bubble on the lower lip (a), its schematic image (b).

1 - epithelium; 2- lamina propria of the mucous membrane; 3- intraepithelial cavity.

tires filled with liquid. A vesicle is formed in the spinous layer of the epithelium; it often has serous, sometimes hemorrhagic contents (Fig. 19). Blistering rashes can be either unchanged or hyperemic and edematous. Due to the fact that the walls of the vesicle are formed by a thin layer of epithelium, its cover quickly ruptures, forming erosion, along the edges of which fragments of the vesicle remain. When the bubble develops back, it leaves no trace. Often the bubbles are located in groups. Bubbles are formed due to vacuolar or ballooning dystrophy, as a rule, with different vi-

Rice. 20.

A bubble on the mucous membrane of the tongue (a), its schematic image (b).

1 - epithelium; 2 - lamina propria of the mucous membrane; 3 - subepithelial cavity.

Russian diseases (herpes, etc.).

Bubble (bulla) is a cavity element of considerable size (up to a chicken egg), filled with liquid (Fig. 20). Formed intraepithelial or subepithelial. It distinguishes between the tire, the bottom and the contents. The exudate may be serous or hemorrhagic. The covering of the subepithelial bladder is thick, so it exists on the mucosa for a longer time than the intraepithelial bladder, the covering of which is thin and ruptures quickly. The erosion that forms at the site of the bubble heals without scar formation.

Pustula (pustula) - limited

Elements of damage to the oral mucosa

An abscess on the skin of the face (a), its schematic image (b).

1 - epithelium; 2 - lamina propria of the mucous membrane; 3 - cavity filled with purulent exudate.

accumulation of purulent exudate (Fig. 21). There are primary and secondary abscesses. Primary pustules develop on the unchanged mucosa and are immediately filled with purulent contents of a whitish-yellowish color. Secondary pustules arise from vesicles and blisters. Abscesses are formed as a result of the action of enzymes and toxins, the waste products of staphylococci and streptococci, on the epithelium. Pustules are located at different depths, that is, they can be superficial and deep.

Cyst (cystis) - cavity formation, which has a wall and contents (Fig. 22). Cysts are of epithelial origin and re-

Rice. 22.

Cyst of the oral mucosa (a), its schematic image (b).

1 - cavity; 2 - epithelial lining.

tensional. The latter are formed due to blockage of the exit ducts of small mucous membranes or salivary glands. Epithelial cysts have a connective tissue wall lined with epithelium. The contents of the cyst are serous, serous-purulent or bloody. Retention cysts are located on the lips, palate and buccal mucosa and are filled with transparent contents, which become purulent when infected.

Secondary elements of the lesion. Scales - to a (squama) - a plate consisting of desquamated keratinized epithelial cells(rice. 23). Scales arise as a result of hyper- and parakeratosis. They come in different colors

a a

b b

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

1 - epithelium; 2- lamina propria of the mucous membrane; 3- scales.

and size. Scales are formed, as a rule, in places of reverse development of spots, papules, tubercles, etc. Scales can also appear primarily: with mild leukoplakia, exfoliative cheilitis, ichthyosis. To diagnose lesions accompanied by the formation of scales, their location, thickness, color, size, and consistency are important.

Erosion (erosio) is a defect in the surface layer of the epithelium, therefore, after healing it does not leave a trace (Fig. 24). Erosion occurs from rupture of a bladder, vesicle, destruction of papules, or traumatic injury. When a bubble ruptures, erosion follows its contours. When merging

Erosion on the mucous membrane of the lateral surface of the tongue (a), its schematic representation (b).

1 - epithelium; 2- lamina propria of the mucous membrane; 3 - epithelial defect.

When erosion occurs, large erosive surfaces with varied contours are formed. On SB, erosive surfaces can form without a preceding bubble, for example, erosive papules in syphilis, erosive-ulcerative form of lichen planus and lupus erythematosus. The formation of such erosions is a consequence of injury to the easily vulnerable inflamed mucus. A superficial defect in the mucosa that occurs due to mechanical damage is called excoriation.

Aphtha (aphta) is a superficial defect of the epithelium of a round or oval shape, with a diameter of 5-10 mm, located on the inflamed

Elements of damage to the oral mucosa

a a

b b

Aphtha on the mucous membrane of the lower lip (a), its schematic image (b).

1 - epithelium; 2 - lamina propria of the mucous membrane; 3 - epithelial defect covered with fibrinous plaque.

nom area of ​​CO (Fig. 25). The aphtha is covered with fibrinous effusion, which gives the affected element a white or yellow tint. Along the periphery, the aphtha is surrounded by a bright red rim.

An ulcer (ulcus) is a defect of CO within the connective tissue layer (Fig. 26). Ulcer healing is accompanied by a scar. Since the formation of an ulcer is characterized by a number of pathological processes, to determine their nature it is necessary to evaluate all the features of the lesion: the condition of the edges, depth, shape, condition of the surrounding tissues. Knowledge of their features facilitates differential diagnosis.

An ulcer on the mucous membrane of the lateral surface of the tongue (a), its schematic representation (b).

1 - epithelium; 2- lamina propria of the mucous membrane; 3-defect of the epithelium and lamina propria of the mucous membrane.

The edges of the ulcer can be undermined and overhanging the bottom, vertical or saucer-shaped. The edges and bottom of the ulcer can be soft or hard. In addition, the bottom of the ulcer can be covered with purulent plaque, necrotic masses, papillary growths, and it can bleed easily when traumatized. Often, elements of damage to the main pathological process are preserved at the edges of the ulcer. Sometimes the ulcer spreads to the underlying tissues (muscles, bone) and even destroys them.

It should be noted that only one clinical assessment an ulcer is not enough to clarify

Rice. 27.

A crack in the red border of the lower lip (a), its schematic image (b).

1 - epithelium; 2 - lamina propria of the mucous membrane; 3 - linear defect of mucosal tissue.

lack of diagnosis of the disease. This requires a full range of laboratory tests, as well as mandatory general examination sick.

Crack (rhagas) is a linear tear of the CO, red border of the lips, which occurs with excessive dryness or loss of elasticity, with inflammatory infiltration (Fig. 27). Most often, cracks form in places of natural folds or in places that are susceptible to trauma and stretching. A deep crack extends to connective tissue lamina propria, heals with the formation of a scar.

There are superficial and deep cracks. The superficial crack is located within the epithelium and heals without scar formation.

Crust on the upper lip (a), its schematic image (b).

1 - epithelium; 2 - lamina propria of the mucous membrane; 3 - crust (dried exudate).

Crusta (crusta) is a dried exudate that forms after the opening of a bladder, vesicle, or pustule (Fig. 28). The crust is a combination of coagulated tissue fluid and blood plasma, broken blood cells and epithelial cells. The color of the crusts depends on the nature of the exudate. When drying out serous exudate grayish or honey-yellow crusts are formed, with purulent exudate - dirty gray or greenish-yellow crusts, with hemorrhagic exudate - bloody-brown. When the crusts are forcibly removed, the erosive or ulcerative surface is exposed, and after natural falling off, an area of ​​regeneration, a scar or cicatricial atrophy is exposed.

Elements of damage to the oral mucosa

a a

b b

Rice. 29.

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

1 - epithelium; 2- lamina propria of the mucous membrane; 3-fibrous formations.

A scar (cicatrix) is a section of connective tissue that replaces a defect in the tissue that occurs due to its damage or a pathological process. The scar consists mainly of collagen fibers, covered with a thin layer of epithelium, in which there are no epithelial projections.

There are hypertrophic and atrophic scars. Hypertrophic (keloid) scars (Fig. 29) occur after injury and surgical interventions. They have a linear shape, dense, and often limit the mobility of CO. Atrophic scars (Fig. 30) are formed after healing of elements of tuberculosis, syphilis, and lupus erythematosus. They are characterized by non-

Rice. thirty.

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

1 - thinned epithelium; 2 - lamina propria of the mucous membrane; 3 - fibrous formations.

correct shape and significant depth. Since scars formed in many diseases have a characteristic appearance for one or another disease, by looking at them, one can determine with sufficient accuracy what disease they are caused by. Thus, scars after tuberculous lupus are characterized by an irregular shape and considerable depth, after a tuberculous ulcer they are relatively shallow, after gumma they are smooth and retracted. With congenital syphilis, the scars are located around the mouth and have a ray-like character.

Chapter 6. General views about diseases of the oral mucosa and their taxonomy (classification)

Among dental diseases A special place is occupied by processes associated with damage to the oral mucosa. The increased interest of scientific researchers and practitioners in this pathology is explained by the frequent occurrence of diseases of the oral mucosa, the wide variety of their forms, wide range etiological factors, a rather complex, and in many cases insufficiently clear mechanism of the pathogenetic essence of the disease.

IN Over the past decade, a number of reports have appeared in domestic and foreign literature that indicate in-depth studies of this pathology (dissertations, monographs, atlases). They played a positive role in studying the problem. However, many aspects of oral mucositis diseases require further study, detail and specification, development and clarification of effective methods of treatment and prevention.

IN There are no statistical data in the literature showing the frequency and number of diseases occurring in lesions of the oral mucosa. Which of them are independent processes? What are the changes in CO that occur as symptoms of organ and general somatic pathology? What diseases of the oral mucosa are syndromes?

IN In this work, we tried to summarize information about diseases that are most often given in domestic and foreign manuals. Now, according to our data total The number of described diseases, including those that are rare, reaches about a thousand nosological units.

One of the reasons that makes it difficult to create full presentation about diseases of the oral mucosa, there is a wide variety of causative factors involved in the development of a particular disease. This is typical even for those observations when the clinical manifestations of diseases are naturally the same and the mechanism of their development is the same. Hence, an understanding of the essence of a particular disease of the oral mucosa and clear ideas about its development are possible only by analyzing the etiological, pathogenetic factors and clinical manifestations as a single cause-and-effect process. Based on this point of view, many researchers have tried to develop the most substantiated classifications of diseases of the oral mucosa. Considering this approach as the most rational and methodologically correct, let us briefly dwell on some of its provisions.

Etiology. At one time on early stages studying the causes of diseases of the oral mucosa and their pathogenesis, during a period that was associated with the accumulation of clinical facts, analysis of the features of their appearance, development, study of the course of individual clinical forms diseases, all pathological processes of the oral mucosa were combined under the general diagnosis of “stomatitis”. Later, as facts and clinical experience accumulated, attempts appeared to systematize diseases, to combine some of them into different

(Slide 1)

Lecture 1. Pathological processes in the mucous membrane: inflammation, tumors. Elements of damage (primary and secondary). The importance of general and local factors, conditions contributing to the development of the pathological process. Prevalence of the main nosological forms of diseases of the oral mucosa.
Pathology of the oral mucosa and red border of the lips makes up a small part of dental diseases. However, their diagnosis presents significant difficulties. This is due, on the one hand, to the variety of diseases that manifest themselves in the oral cavity, and on the other hand, to the similarity of the clinical manifestations of diseases that differ in etiology and pathogenesis.

Despite significant advances in studying the clinical picture, etiology and pathogenesis of diseases of the oral mucosa, the causes of many of them remain unclear.

Currently, diseases of the oral mucosa are considered from the perspective of the whole organism, since no one has any doubts about the connection of most pathological processes on the oral mucosa and the red border of the lips with changes in the organs and systems of the body, the nature of metabolic processes, immune status etc. Changes in the oral mucosa are often the first clinical symptom of metabolic disorders, diseases of the hematopoietic system, skin and sexually transmitted diseases, etc.

(Slide 2) Pathological processes in the mucous membrane: inflammation, tumors.

Diseases of the mucous membrane can be divided into two groups: 1) pure inflammatory lesions; 2) diseases of a tumor or blastomatous nature.

Inflammation- complex complex local vascular-tissue protective-adaptive reaction of the whole organism to the action of a pathogenic stimulus. (Slide 3) By morphological characteristics There are three forms of inflammation: alternative, exudative and productive (proliferative). The course of inflammation can be acute or chronic.

As a consequence of the impact various factors Both superficial and deep defects can occur in the oral mucosa.

(Slide 4) Surface defects, called erosion, are observed when the integrity of only surface layers epithelium with preservation of the basal layer. In this case it happens complete regeneration multilayered squamous epithelium of the mucous membrane. Deep defects in the form of ulcers are formed in cases where damage affects not only the epithelial, but also the connective tissue layer. As a rule, healing of ulcers occurs with the formation of a scar. (Slide 5)

(Slide 6) A number of changes are observed in the epithelium of the oral mucosa, which develop as a result of various pathological processes.

(Slide 7) Acanthosis. Thickening of the epithelial layer of the mucous membrane with elongation of the interpapillary processes. It is based on increased proliferation of basal and styloid cells of the epidermis. Acanthosis is characteristic of lichen planus and other diseases.

(Slide 8) Parakeratosis. Violation of the keratinization process, which is expressed in incomplete keratinization superficial cells awl-shaped layer and preservation of flattened, elongated nuclei in them.

(Slide 9) Dyskeratosis. A form of irregular keratinization, characterized by pathological keratinization of individual epidermal cells. They become larger and rounder; the nuclei are intensely stained, the cytoplasm is eosinophilic, slightly granular. Darier gave them the name “round bodies” (Darier corpuscles). The cells then turn into homogeneous acidophilic formations with small pyknotic nuclei, called granules, located in the stratum corneum. Malignant dyskeratosis is characteristic of Bowen's disease, squamous cell carcinoma.

(Slide 10) Hyperkeratosis. Excessive thickening of the stratum corneum of the epithelium. It may occur as a result of excess keratin formation, when the granular and styloid layers of the stratified squamous epithelium thicken, or due to delayed desquamation, when the granular and sometimes styloid layers are thinner than normal. Hyperkeratosis is based on intensive synthesis of keratin as a result of increased functional activity of epithelial cells. Depending on the thickness of the stratum corneum, various degrees of hyperkeratosis are distinguished: moderate, moderate and pronounced.

(Slide 11) Papillomatosis. Proliferation of the papillary layer of the mucous membrane itself and its ingrowth into the epithelial layer. Papillomatosis is observed with chronic trauma to the mucous membrane of the palate with a prosthesis.

(Slide 12) Vacuolar dystrophy. Intracellular edema of epithelial cells, characterized by the appearance of vacuoles in the protoplasm of cells. Vacuoles are formed in the circumference of the nuclei (the nucleus itself decreases in volume, is intensely stained, but retains its shape). Sometimes the vacuole occupies almost the entire cell, pushing the nucleus to the periphery.

(Slide 13) Spongiosis. Accumulation of fluid between the cells of the styloid layer. The intercellular spaces are widened, filled with fluid, and the cytoplasmic protrusions are greatly elongated. With abundant accumulation of fluid in the intercellular spaces, the stretched cytoplasmic processes rupture. In the cavity thus formed, serous contents and epithelial cells that have lost contact with the epithelium are found.

(Slide 14) Ballooning dystrophy. Disruption of communication between cells of the styloid layer. This is preceded by some thickening of the epithelium, the appearance of giant epithelial cells formed as a result of amitotic division of nuclei, not accompanied by division of the cell itself. Dystrophically altered epithelial cells float in the resulting vesicle. Melting of intercellular bridges - acantholysis - leads to loss of connections between epithelial cells and the formation of cracks, vesicles, and blisters in the epithelium.
(Slide 15) Elements of damage to the mucous membrane.
The development of pathological processes in the oral mucosa is accompanied by the appearance of lesions on its surface.

The formation of homogeneous lesion elements on the mucous membrane of the oral cavity and skin is considered monomorphic, and various kinds elements - like a polymorphic rash. There are primary elements of the lesion and secondary elements that develop from the primary ones. (Slide 16) The primary ones include: spot, nodule (papule), node, tubercle, vesicle, blister, pustule, cyst, blister, abscess. Secondary elements are erosion, aphthae, ulcer, fissure, scar, plaque, scales, crust, atrophy.
Primary elements of the lesion.

(Slide 17)Spot. Change in color of the mucous membrane. Spots of inflammatory origin are characterized by hyperemia of a limited area of ​​tissue.

(Slide 18)Roseola- an erythematous spot of a round shape, ranging in size from 1.5-2 to 10 mm in circumference with limited contours.

(Slide 19)Hemorrhages. Depending on the size, they are divided into petechiae - pinpoint and ecchymoses - extensive hemorrhages of a round or oval shape.

(Slide 20)Erythema. Diffuse redness of the mucous membrane.

(Slide 21)Dark spots. Formations resulting from the deposition of coloring substances of exogenous and endogenous origin. Pigmentation caused by lead, bismuth and mercury is predominantly located in the form of a border along the gingival margin. Silver stains or deposits in the gums are usually irregular in shape.

(Slide 22)Nodule (papule). A cavityless formation protruding above the surface of the mucous membrane and differing from it in color. The diameter of the papules does not exceed 3-4 mm. Their shape is different - pointed, semicircular, round, etc. Most often, changes are observed in both the epithelium and the mucous membrane. Papular rashes are predominantly inflammatory in nature. When the papule develops back, no trace remains. Fused papules often form plaques.

(Slide 23)Knot. A dense formation originating in the submucosal layer. It is detected upon palpation as a dense, slightly painful, round infiltrate. Possible suppuration of the node with the formation of fistulas (with actinomycosis) or ulceration (with syphilitic gumma).

(Slide 24)Tubercle. An infiltrative, cavity-free formation that covers all layers of the mucous membrane and rises above its surface. Its dimensions are 0.5-0.7 cm. The tubercles are crowded and, as a rule, quickly decay. As a result, an ulcer appears. After it heals, scars form.

(Slide 25)Bubble. A cavity element resulting from a limited accumulation of fluid (exudate, blood). Located in the styloid layer. Sizes from 1.5-2 to 3-4 mm. Due to the fact that the walls of the vesicle are formed by a thin layer of epithelium, they quickly open, forming erosion.

(Slide 26)Bubble. A dense formation that differs from a bubble in its larger size. The bladder can be located both intra- and subepithelial. Contains serous or hemorrhagic exudate. Sizes from 5 mm to several centimeters.

(Slide 27Pustule. Cavity formation filled with purulent exudate.

(Slide 28)Cyst. A cavity formation that has a connective tissue capsule (sheath) and an epithelial lining.

(Slide 29)Blister. A cavitary formation that occurs as a result of acute limited swelling of the papillary layer. A flat elevation above the level of the mucous membrane ranging in size from 0.2 to 1.5-2 cm.

(Slide 30)Abscess. Cavity formation of various sizes, filled with pus.
(Slide 31) Secondary elements of damage.

(Slide 32)Erosion. Violation of the integrity of the epithelium that occurs when opening cavity formations, after necrosis of the epithelium, destruction of papules, or traumatic exposure. Erosion of traumatic origin is called excoriation.

(Slide 33)Aphtha. A superficial defect of the epithelium of a round or oval shape with a diameter of 0.3-0.5 mm, located on the inflamed area of ​​the mucous membrane. Along the periphery, the aphtha is surrounded by a bright red rim and covered with fibrinous effusion. Aphtha heals without scars.

(Slide 34)Ulcer. It is characterized by a violation of the integrity of all layers of the mucous membrane, has a bottom and edges. Healing occurs with the formation of a scar.

(Slide 35)Crack. A linear defect within the epithelium alone or including in the layer of the mucous membrane itself occurs as a result of loss of tissue elasticity.

(Slide 36)Scar. Formation of a defect in the mucous membrane itself and the submucosal layer at the site of healing. There are hypertrophic (keloid) and atrophic scars. Atrophic scars form after healing of elements of tuberculosis, syphilis, and lupus erythematosus. They are distinguished by their irregular shape and significant depth.

(Slide 37)Raid. Formation on the mucous membrane, consisting of microorganisms, fibrinous film or layers of sloughed epithelium. Plaque can be white, gray, brown or dark in color.

(Slide 38)Scales. Falling off plates of keratinized epithelial cells formed during the process of pathological keratinization.

(Slide 39)Crust. Dried exudate of the contents of vesicles, pustules, cracks, ulcers.

(Slide 40)Tumor. Tissue proliferation due to excessive cell proliferation. Tumor cells, under the influence of a number of factors, acquire properties that distinguish them quantitatively and qualitatively from normal cells.

(Slide 41)Angiomatosis. Congenital excessive development of blood vessels or acquired dilatation of capillaries (telangiectasia). Angiomatosis is considered as a peculiar defect in the formation of mesenchyme and may be accompanied by dysfunction internal organs, changes in sensitivity, paralysis.

(Slide 42)Papillomatosis. The growth of the papillary layer of the mucous membrane itself, protruding above the level of the mucosa, disrupting its configuration. May be primary, often congenital, or secondary (after chronic injury).
^ The importance of general and local factors, conditions contributing to the development of the pathological process.
Dental diseases are the most common lesions of the human body. A special place among them is occupied by diseases of the oral mucosa (ODM). There is no organ or tissue where large quantity diseases than on the oral mucosa. But, despite the fact that the causes of occurrence, mechanisms of development and clinical course are quite diverse, many of these diseases are characterized by some common features, which makes it possible to combine them into separate related groups.

The most common group of diseases of the mucous membranes and lips that a dentist encounters in everyday work are the so-called independent stomatitis. Conventionally, these include diseases that primarily affect only the mucous membranes and lips. Stomatitis, which we attribute to this group, develops mainly under the influence of certain factors on the mucous membrane (MS). They are united by a characteristic development mechanism and a conditioned clinical course. Most often, independent stomatitis occurs under the influence of irritants such as mechanical, physical and chemical injuries. The cause of the disease may also be the action of fungi, viruses, microorganisms, various allergens, etc. It should be noted that the frequency of independent stomatitis in Lately has increased significantly. This trend is explained by the significant influence of negative external factors associated with urbanization, the influence of general environmental disturbances, and the action of various local irritants. All this leads to a significant decrease in the reactive reserves of the mucous membranes and contributes to the development of certain diseases.

The second group of stomatitis, regardless of their clinical manifestation in the oral mucosa, includes symptomatic stomatitis, the occurrence of which is associated with general human diseases. The most common among them are stomatitis with lesions of the gastrointestinal tract, blood diseases, endocrine system, hypovitaminosis, etc. Observations and research last decades showed that in the human body there is not a single systemic disorder, which to one degree or another would not affect the state of the oral mucosa and lips. It should be remembered that in many common diseases such changes appear on the mucous membranes long before the appearance of general clinical symptoms, and therefore it is understandable why the ability to correctly diagnose symptomatic stomatitis is very important. important not only for dentists, but also for general specialists, especially therapists, hematologists, and endocrinologists.

The third group includes changes in the mucous membranes and lips, which arise and develop as an obligatory sign and component of the syndromes. Currently in dental literature More than 300 of them have been described. Their occurrence and development are associated with damage individual organs or body systems and, in addition to general manifestations, they are accompanied by various changes in individual areas of CO. The most common changes that occur during the syndromes are aphthous-like formations, keratinization, changes in the tongue, etc. Most syndromes are rare, and some of them are even described by some authors as casuistic observations. Facilitates the diagnosis of syndromes by the development of a disease with the obligatory manifestation of all or several symptoms. For example, Behçet and Melkersson-Rosenthal syndromes are characterized by three symptoms, one of which manifests itself in the oral mucosa. Without its manifestation, the diagnosis of these diseases is highly doubtful. The nature of most of the described syndromes is unknown, so their treatment is symptomatic, associated with the impact on individual symptoms.

From the above, it is clear what difficulties the doctor encounters when recognizing diseases of the mucous membranes and lips.

(Slide 44) Despite the wide variety of diseases of the oral mucosa and lips, their development, like the development of diseases that occur in other tissues of human organs, is subject to uniform general biological laws. With the development of such processes, phenomena of inflammation, dystrophy or the appearance of tumors are observed. SO lesions are most often accompanied by exudative, alterative and proliferative forms inflammation. In some cases, dystrophic changes are observed, especially in cover epithelium. These include processes with keratinization disorders - parakeratosis, hyperkeratosis, dyskeratosis.

A relatively small group consists of benign and malignant neoplasms of the oral mucosa and lips. When diagnosing them, cytological and morphological studies are of great importance. Understanding the essence of diseases of the oral mucosa, explaining the reasons for their occurrence and revealing the mechanism of development is not only important, but also a necessary link both in assessing the development of the process and in choosing pathogenetic methods of treatment.

^ Prevalence of the main nosological forms of diseases of the oral mucosa.

Unlike dental caries and periodontal diseases, diseases of the oral mucosa (OMD) among the adult population, according to the criterion of the population seeking dental care, do not pose a big problem. In official medical statistics, data on the incidence of oral mucositis in the population, with the exception of malignant tumors, are not given, probably due to their low prevalence and insignificant impact on general health person. In support of the above, we can cite unpublished statistical data on the “share” of oral mucositis diseases in the structure of visits to the therapeutic department of the Republican Clinical Dental Clinic in Minsk: from 0.5 to 0.9% of all initial visits, depending on age.

However, in everyday clinical practice, patients seeking dental care with diseases of the oral mucosa represent one of the most difficult problems in dentistry due to difficulties in diagnosis and treatment. The problem is further complicated by the fact that to date no measures have been developed for the community prevention of diseases of the mucous membranes. The prevalence of many of the existing diseases of the oral mucosa increases as people age. This especially applies to life-threatening diseases that tend to transform into malignant tumors. According to the Ministry of Health of the Republic of Belarus in 2000, out of 328 cases of malignant tumors, cancer of the oral cavity and lips was 8.7 and 2.8 cases per 100 thousand population, respectively. Fortunately, this is a relatively low incidence when compared with data from some other countries: Denmark - 35, USA - 60, India -170 cases of oral cancer per 100 thousand population. But it should be taken into account that in our country the prevalence of risk factors for the occurrence of malignant tumors is increasing (smoking, etc.), which may contribute to an increase in the incidence of oral mucositis.

In a dental study of the elderly population age groups(55-75 years and older), a high incidence (from 41.2 to 48.4%) of oral mucositis was revealed with a tendency for a number of diseases to increase with age. The highest prevalence of candidiasis (17%) and leukoplakia (12%) has been established, which, taking into account the potential danger of these diseases to life, requires urgent measures treatment and prevention. Smoking and unhygienic maintenance of dentures are predisposing factors to diseases of the oral mucosa.

Pathological processes in the oral mucosa can be divided into two groups: inflammatory lesions and tumors.

Inflammation- protective vascular-tissue reaction of the body to the action of an irritant. According to morphology, three phases of inflammation are distinguished: alterative, exudative and proliferative. According to the flow, inflammation can be acute, subacute and chronic. In acute cases, alterative and exudative changes, and in chronic cases - proliferative.

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

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

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

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

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

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

With an exacerbation of the chronic process, it joins acute disorder vascular permeability with the release of polymorphonuclear leukocytes and erythrocytes into the connective tissue layer of the mucous membrane.

Pathological processes lead to changes in the oral mucosa, in particular to disturbances in the processes of keratinization in the epithelium.

Acanthosis- thickening of the epithelial layer of the mucous membrane due to the proliferation of basal and spinous cells. The result of acanthosis is the appearance of a nodule, nodule, and lichenification.

• red lichen planus;
• leukoplakia;
• soft leukoplakia;
• hypo- and vitamin deficiencies;
• lupus erythematosus;
• precancerous cheilitis Manganotti;
• atopic cheilitis;
• actinomycosis;
• changes in the mucosa due to endocrine disorders.

Parakeratosis- incomplete keratinization of the superficial cells of the spinous layer while maintaining flattened elongated nuclei in them. In this process, the formation phase of keratohyalin and eleidin is eliminated, so the granular and lucid layers are absent. The adhesive substance, keratin, disappears from the cells of the stratum corneum, resulting in pronounced peeling of the epidermis. The resulting scales are easily torn off.

Diseases that accompany this pathological process:

• leukoplakia;
• hypo- and avitaminosis A, C, B;
• lichen planus;
• dry form of exfoliative cheilitis;
• atopic cheilitis;
• lupus erythematosus.

The result of parakeratosis is the appearance of a spot, lichenification, vegetation, node, nodule. Areas of parakeratosis are whitish in color and cannot be scraped off.

Dyskeratosis- a form of irregular keratinization, characterized by pathological keratinization of individual epithelial cells.

The cells become larger, rounder, with granularity in the cytoplasm - “Darier bodies”, then turn into homogeneous acidophilic formations with small pictonic nuclei, called grains, located in the stratum corneum. Dyskeratosis occurs with aging. Malignant dyskeratosis is characteristic of Bowen's disease, squamous cell carcinoma.

Hyperkeratosis- excessive thickening of the stratum corneum of the epithelium. It can develop as a result of excessive keratin formation or due to delayed desquamation of the epithelium. Hyperkeratosis is based on intensive synthesis of keratin as a result of increased functional activity of epithelial cells (chronic irritation or metabolic disorders).

This process accompanies the following diseases:

1. dry form of exfoliative cheilitis;
2. leukoplakia;
3. lichen planus;
4. intoxication with mercury, lead, bismuth, aluminum, zinc, etc.;
5. lupus erythematosus;
6. actinomycosis.

Papillomatosis- proliferation of the papillary layer of the lamina propria of the mucous membrane and its ingrowth into the epithelium. This process is observed in chronic trauma to the mucous membrane of the palate with a plate prosthesis and other chronic injuries.

Vacuolar dystrophy- intracellular swelling of epithelial cells with the appearance of vacuoles in the cytoplasm that destroy cells. Sometimes the vacuole occupies almost the entire cell, pushing the nucleus to the periphery. In this case, the core takes on a saddle shape.

• pemphigus vulgaris;
• herpes simplex;
• lupus erythematosus;
• changes in the mucosa due to endocrine diseases (gingivitis in pregnant women, Itsenko-Cushing syndrome, etc.).

Spongiosis- accumulation of fluid between the cells of the spinous layer. The intercellular spaces are expanded, filled with fluid, and the cytoplasmic protrusions are elongated. The process begins with the expansion of intercellular tubules, which are filled with exudate coming from the connective tissue. This exudate stretches and then breaks intercellular connections, forming a cavity. In the resulting cavity, serous contents and epithelial cells that have lost contact with the epithelium are found. The result of this process can be a blister, blister, or bubble.

Spongiosis accompanies the following diseases:

• herpes simplex;
• pemphigus vulgaris;
• lichen planus (bullous form);
• exudative erythema multiforme;
• chronic recurrent aphthous stomatitis; eczema.

Ballooning dystrophy- disruption of connections between the cells of the spinous layer, which leads to the free arrangement of individual cells or their groups in the exudate of the resulting vesicles in the form of balloons. This is preceded by some thickening of the epithelium, the appearance of giant epithelial cells formed as a result of amitotic nuclear division, but the cell itself does not divide. The cell increases in size (ball, balloon) and floats in the liquid. This pathological process manifests itself in herpes simplex, eczema, erythema multiforme exudative, and lichen planus.

Acantholysis- melting of intercellular bridges in the spinous layer, which leads to loss of connections between epithelial cells. Clefts and intraepithelial blisters and vesicles form in the epithelium. This process is based on immune mechanisms. In this case, the spiny cells become rounded, slightly decrease in size, and the nucleus becomes larger. These cells are called Tzanka cells. The cells float freely in the contents of the bladder and also line its bottom. This process occurs in pemphigus vulgaris and herpes simplex.

Tumors (blastomas)- pathological tissue proliferation as a result of potentially unlimited cell division. Blastomas are divided into benign (mature) and malignant (immature). Based on their origin, they are classified as follows: tumors from epithelial, connective, vascular, glandular, muscle and nervous tissue, as well as mixed tumors.

Benign tumors of the oral mucosa consist of differentiated cells similar in structure to the original tissue. Tissue atypia is observed. These tumors grow slowly, are clearly limited, never grow into surrounding tissues, and do not metastasize.

Malignant tumors- built from poorly and undifferentiated cells and bear little resemblance to maternal tissue. Not only tissue but also cellular atypia is characteristic: changes in cell shape, enlargement of the nucleus, polymorphism, the appearance of giant cells. Malignant tumors grow rapidly and are prone to metastasis and relapse. The criterion for malignancy is the classic triad: atypia, polymorphism, invasive growth.

Elements of defeat

Distinguish primary elements of the lesion and secondary, developing from the primary ones.

TO primary include spot, nodule (papule), node, tubercle, vesicle, bubble, abscess, cyst, blister, abscess.

Secondary elements are erosion, aphthae, ulcer, crack, scar, plaque, scale, crust.

Spot- change in color of the mucous membrane in a limited area. There are inflammatory and non-inflammatory spots. Roseola- limited hyperemia up to 1.5 cm in diameter. Erythema- diffuse redness of the mucous membrane. Non-inflammatory spots include hemorrhagic spots: petechiae(point hemorrhages) and ecchymoses(extensive round hemorrhages). Pigment spots are formations resulting from the deposition of coloring substances of exogenous and endogenous origin (melanin deposits, intake medicines containing bismuth or lead).

Nodule (papule)- a cavityless formation of inflammatory origin up to 5 mm in size, protruding above the level of the mucous membrane and involving the epithelium and the surface layer of the mucous membrane itself. Morphologically, small cell infiltration, hyperkeratosis and acanthosis are determined. Lichen planus is a typical example of the manifestation of papules on the oral mucosa. When the papule develops back, no trace remains. Plaque- merged papules.

Knot- dense, slightly painful, rounded infiltrate originating in the submucosa. Much larger than a nodule. With actinomycosis, it may suppurate with the formation of a fistula. With syphilitic gumma, the node may ulcerate. The node is formed as a result of the inflammatory process, tumor growth, etc.

Tubercle- infiltrative cavity-free formation 5-7 mm, covers all layers of the oral mucosa and rises above its surface. The tubercles are formed during tuberculosis, tertiary syphilis, and leprosy. They quickly decay with the formation of ulcers. After they heal, a scar forms.

Bubble- this is a cavity element up to 5 mm in diameter, resulting from a limited accumulation of fluid (exudate, blood). It is located in the spinous layer (intraepithelial) and quickly opens, forming erosion. Bubbles occur due to viral infections.

Bubble- formation that differs more from a bubble large sizes(more than 5 mm), with serous or hemorrhagic exudate. It can be located intraepithelially (with acantholytic pemphigus as a result of acantholysis) and subepithelially (with exudative erythema multiforme, allergies, etc.).

Pustule- cavity formation with purulent exudate; found on the skin and red border of the lips.

Cyst- a cavity formation having a connective tissue capsule with an epithelial lining.

Blister- acavitary formation up to 2 cm due to acute limited swelling of the papillary layer. An example is Quincke's edema.

Abscess- limited cavity formation filled with pus; occurs due to the decomposition of pathologically altered tissue or the fusion of pustules.

Erosion- a violation of the integrity of the epithelium that occurs at the site of the papule, after the opening of the vesicle, as a result of injury. Heals without a scar. Excoriation- erosion of traumatic origin.

Aphtha- a superficial defect of the epithelium of a round shape of 3-5 mm, located on a hyperemic area of ​​the mucous membrane, covered with fibrous plaque and surrounded by a bright red rim. Heals without a scar. An example is chronic recurrent aphthous stomatitis.

Ulcer- a defect that involves all layers of the mucous membrane. In an ulcer, the bottom and edges are distinguished. Healing occurs with the formation of a scar. Ulcers occur due to injury, tuberculosis, syphilis, or tumor decay.

Crack is a linear defect resulting from loss of tissue elasticity. Superficial cracks are localized within the epithelium, deep cracks penetrate into the lamina propria and heal without a scar.

Scar- replacement of the defect with connective tissue with a high content of fibrous structures. Hypertrophic (keloid) scars occur after injury or surgical interventions. Atrophic scars form after healing of elements of tuberculosis, syphilis, and lupus erythematosus. They are characterized by irregular shape and great depth.

Raid- a formation consisting of microorganisms, fibrinous film or layers of rejected epithelium.

Flake- a falling thin plate of keratinized epithelial cells, resulting from pathological keratinization, in particular, with some cheilitis.

Crust- dried exudate at the site of a bubble, crack, erosion. The color of the crust depends on the nature of the exudate (serous, purulent, hemorrhagic).

Sit the patient so that the light source is in front of him. Determine the area of ​​damage to the mucous membrane. If the damage element is located on the unchanged surface of the mucous membrane, then it will be classified as primary elements:

Spot(Macula) – change in the color of the mucous membrane in a limited area. It can be inflammatory or non-inflammatory in nature (vascular, pigmentary, keratinization).

Nevus– congenital pigment spot;

Vitiligo– acquired pigment spot.

Erythema– diffuse hyperemia of CO.

Roseola– erythema of a round shape, with a diameter of 1.5-2-10 mm, with limited contours.

Telangiectasia– persistent vasodilation of a non-inflammatory nature.

Hemorrhage– hemorrhage in the mucous membranes (pitechiae - small, ecchymosis - large).

Nodule(Papula) – bandless infiltrate. Papule – merged nodules.

Knot(Nodus) – limited compaction of significant size.

Tubercle(Tuberculum) is an infiltrative bandless element of a rounded shape, up to the size of a pea, protruding above the level of the mucous membrane. The central part of the tubercle becomes necrotic.

Bubble(Veeesicula) – a cavity element ranging in size from a millet grain to a pea, filled with liquid. The lining of the bladder quickly opens and erosion forms.

Bubble(Bulla) is a cavity element of considerable size (up to a chicken egg), filled with liquid. The exudate is serous or hemorrhagic. The tire is thick, if it is opened, erosion occurs.

Pustule, pustula (Pustula) – a cavity formation filled with purulent contents, yellowish or yellow-green in color. It only happens on the skin.

Blister(Urtica) - a bandless cushion-shaped element of a round or oval shape, the result of limited swelling of the papillary layer. Accompanied by severe itching or burning, appears quickly, exists for a short time.

Cyst- a cavity formation that has a connective tissue or epithelial lining, with transparent, purulent or hemorrhagic contents.

Abscess- a cavity formation filled with pus. It occurs as a result of pathologically altered tissue and the fusion of small pustules into one focus of inflammation.

If an element is a consequence of transformation or damage to existing ones, then it will be classified as secondary elements of defeat:

Flake(Sguama) - an accumulation of sloughed keratinizing epithelial cells, usually tightly held to the underlying tissue. Various colors and sizes. Does not occur in the oral cavity.

Erosion(Erosio) – a defect in the surface layer of the epithelium. The lesion is shallow, without penetration into the connective tissue, and heals without scarring.

Aphtha– superficial limited defect of the epithelium of a round or oval shape with a diameter of 0.3-0.5 cm, covered with a fibrinous coating of white or yellow color. There is a bright red rim along the periphery.

Ulcer(Ulcus) – a defect of the mucous membrane within the boundaries of the connective tissue layer. The edges of the ulcer may be undermined, overhanging, saucer-shaped. At the bottom of the ulcer there may be purulent plaque, necrotic masses, and granulation growths.

Crack(Ragas) - a linear defect of the mucous membrane or red border of the lips. They can be superficial or deep.

Crust(Crusta) - formed when serous, purulent, hemorrhagic exudate or lymph dries, rises above the surrounding surface. Color ranges from transparent, grayish to bloody brown.

Scar(Cicatrix) - connective tissue that replaces the defect of the mucous membrane, has a different shape and depth. There are atrophic and hypertrophic scars.

Raid– superficial formation on the teeth, consisting of microorganisms, food debris, fibrinous films, rejected epithelium; white, brown, dark color.

Atrophy– thinning of the mucous membrane, which becomes smooth, shiny, and easily folds. Translucent vessels are visible.

Pigmentation– change in color of the skin or mucous membrane, usually in place of morphological elements. May be primary (freckles, birthmarks, change in the color of the oral mucosa in certain races) and secondary, as a consequence of the deposition of melanin pigment after the resolution of primary or secondary morphological elements, after interstitial hemorrhage.

Vegetation(Vegetatio) – villous growth of epithelial papillae on the surface of papules, erosions, inflammatory infiltrates, lumpy appearance.

Tumor(Tumor) – tissue proliferation due to excessive cell proliferation (angiomatosis, lymphomatosis, papilomatosis, etc.).

Lichinization, lichenification(Licheniticatio) is the result of long-term inflammatory infiltration of the red border of the lips, skin, due to massive infiltration of the papillary layer and acanthosis. Elasticity is lost, they thicken, become denser, dryness and flaking appear, they are difficult to form into folds, and the pattern is enhanced.

Disturbance of keratinization:

Hyperkeratosis– a significant increase in the stratum corneum compared to its thickness with keratosis. In this case, hyperkeratosis, from a histological point of view, should be considered pathological only due to its abnormal location and too large volume. Clinically, hyperkeratosis manifests itself in changes in the color and relief of the mucous membrane. These are whitish formations that rise above the level of the normal mucous membrane, regarded as papules or plaques (according to the classification of elements of mucosal lesions).

In the literature the term “ leukokeratosis", used to designate an area of ​​white hyperkeratosis.

Dyskeratosis– this is a peculiar violation of the normal physiological process of keratinization of the epithelium, in which dyskeratinization and degeneration of the cells of the spinous layer occur. In this case, dysplasia occurs, the cells fall out of the common connection, the connection between them is disrupted, and in all subsequent layers they appear as independent elements. The arrangement of cells is chaotic. Large round cells appear with a sharply limited and well-stained nucleus, basophilic granular cytoplasm and doubly contoured membranes that strongly refract light - these are the so-called round bodies. Dyskeratosis can be benign or malignant. Benign dyskeratosis is an independent type of disorder of the keratinization process, clinically manifested in the form of areas of fine-scaly peeling. Maybe with Daria's illness. Malignant dyskeratoses occur in Paget's and Bowen's diseases. Focal, or limited, dyskeratosis can manifest itself in the form of excessive growth of the integument, and in this case it is called productive. In other cases, it has the appearance of a defect, a flaw in the cover and is therefore called destructive. More often, there is a simultaneous manifestation of productive and destructive changes, that is, a mixed form of dyskeratosis. Productive focal dyskeratosis is characterized by the appearance in the area of ​​the red border, often at its border with the skin, of a flat or spine-like protrusion above the surface. The horny layer on it periodically disappears. As it grows, it may look like cutaneous horn. A distinctive feature of focal destructive dyskeratosis is a sharp thinning of the red border in a limited area, as a result of which it takes on the appearance of a superficial ulceration. In other cases, a slit-like flaw or crack forms.

Parakeratosis– this is a histological concept - a violation of the keratinization process associated with the loss of the ability of epithelial cells to produce keratohyalin. Histologically, with parakeratosis, loosening of the stratum corneum and partial or complete disappearance of the granular layer are noted. The cells of the stratum corneum have rod-shaped nuclei. The connection between the individual cells of this layer is lost. Parakeratosis occurs when papular syphilides, psoriasis, stomatitis. Parakeratosis can be combined with hyperkeratosis in psoriasis, exfoliative pemphigus and other long-term hyperkeratosis.

Acanthosis- a histological term characterizing the thickening of the epithelium due to increased proliferation of the basal and spinous layers - proliferative acanthosis or slower maturation of epithelial cells with a decrease in metabolism - retention acanthosis. Clinically, acanthosis is characterized by thickening of the mucous membrane, especially the interpapillary processes.

Considering that the use of the above terms as clinical and morphological at the same time introduces a certain confusion, the terms “hyperkeratosis”, “dyskeratosis”, parakeratosis”, “acanthosis” should be used as morphological concepts. They actually reflect structural changes in a number of diseases that are not related to each other or etiological factors, nor clinical manifestations that have different outcomes and often require diametrically opposed treatment methods.

Exudative changes in the epithelium:

Vacuolar dystrophy – accumulation of fluid inside the cells of the spinous and basal layers. The size of the cells increases, the nucleus moves to the periphery, changes shape and size, and may completely disappear.

Spongiosis– accumulation of fluid inside the cells of the spinous layer, effusion of exudate into the intercellular space of the epithelium, connective tissue of the oral mucosa, intercellular connections are broken.

Ballooning dystrophy – focal change cells of the spinous layer, which enlarge, acquire a rounded shape (balloon). As a result of liquefaction necrosis of such a section of the epithelium, cavities are formed filled with exudate, in which homogeneous “balloons” float.

Acantholysis– melting of intercellular connections, the appearance of gaps between individual cells, and then bubbles. Individual epithelial cells are rounded, have a large nucleus, and float freely - these are acantholytic cells, or Tzanck cells.

Epithelial hypertrophy- this is a thickening of the epithelial layer of the mucous membrane.

Papillomatosis– proliferation of interepithelial connective tissue papillae and their ingrowth into the epithelial layer.

It is advisable to adhere to the following scheme for assessing the elements of damage to the oral mucosa:

1. Nature of appearance and course.

2. The main elements of the lesion.

3. Grouping of lesion elements.

4. Growth of lesion elements.

5. Stages of development of elements.

6. Localization of elements.

Then the elements of the lesion are characterized in detail, for example.

III. Primary and secondary skin lesions

Pathological phenomena on the skin lead to the formation of changes, which are most often expressed in the appearance of skin rashes or morphological elements.

There are primary and secondary morphological elements.

Primary- these are skin changes that are the immediate, first consequence of exposure to a pathogenic agent.

Secondary– appear after the primary ones due to their further development.

The primary morphological elements include: spot, blister, vesicle, bladder, abscess, nodule, node, tubercle (8 elements).

1) Spot (macnea) – organic, located at the skin level, of various shapes with changes in the color of the skin or mucous membrane. Spots are divided into:

a) vascular – found in syphilis, measles, typhus, liver diseases, vasculitis.

b) hemorrhagic spots are formed due to the release of blood into the tissue.

c) pigment spots occur due to an increase or decrease in the content of melanin (leucoderma).

2) Blister (irtica) - is a cavity-free formation that rises above the surface of the skin, resulting from limited acute inflammatory edema of the papillary dermis. This is an element of urticaria.

3) Bubble (vesicle) - a cavity formation, slightly elevated above the skin level, filled with transparent serous, less often bloody, contents. Occurs as a result of inflammation of the epidermis.

4) Bubble (bulla) is a cavity formation that appears above the skin level, the size of a pea to the palm, filled with cloudy serous or hemorrhagic contents, where epithelial cells are microscopically found, ₤ are a manifestation of pemphigus, Dnoring's dermatitis.

5) Pustule (pustula) - a cavity formation filled with purulent contents, in which many ₤, albumins, and globulins are found. Pustule located around hair follicle called folliculitis . Abscesses located around the sebaceous glands are called acne with pyodermatitis.

6) Nodule (papula) - a cavity-free formation that rises above the surface of the skin. This is a manifestation of many skin and veins. diseases.

7) Knot (nodus) is a cavityless infiltrated formation, located deep in the dermis or subcutaneous fatty tissue and is determined by palpation. An example is morplit. gumma.

8) Tubercle (tuberculum) - is a cavityless formation that rises above the level of healthy skin or is located at its level and is sharply demarcated. The tubercle heals with a scar. The tubercles are typical for leprosy, leishmaniasis, tuberculosis, and tertiary syphilis.

Secondary morphological elements: pigmentation and depigmentation, scale, crust, erosion, crack, abrasion, ulcer, cicatricial atrophy, vegetation.

1) Pigmentation and depigmentation . Hyperpigmented spots appear in places of greatest deposition of melanin and imosiderin, appear in places of primary or secondary elements. Hypopigment spots are located in areas where macular-flaky elements and papules resolve.

2) Flake (squama) are loosened horny plates that have lost their connection with each other, ready to be torn off or already torn away from the surface of the skin. The separation of scales is called peeling .

3) Crust (crusta) – occurs due to the drying out of the contents of vesicles, blisters, ulcers and discharge from erosions and ulcers.

4) Erosion (erosion) is a superficial skin defect that most often occurs at the site of a rupture: the covering of the primary cavity morphological element, repeating its shape and size. After the erosion heals, there is no scar left.

5) Cracks (rhagudes) - are linear damage to the skin in the form of a tear resulting from loss of skin elasticity during inflammatory process or when it is overstretched. Cracks usually appear where the skin bends. The cracks are located within the epidermis and dermis. There are superficial and deep.

6) Abrasion (excoriation) – violation of the integrity of the skin due to scratching or scratching. The abrasions are superficial and deep. Prone to infection.

7) Ulcer (ulous) is a deep skin defect, subcutaneous tissue, muscles, fascia of bones. Occurs as a result of the breakdown of tissue of nerve elements. They heal by forming a scar.

8) Scar (cicatrix) - is a newly formed fibrous connective tissue that replaces the lost property of the skin.

9) Scar atrophy – a regressive process that occurs as a result of the depletion of all layers of the skin. It develops without previous ulceration by converting the infiltrate into connective tissue.

10) Lichenification - a focus of increased skin pattern, accompanied by thickening and compaction, hyperpigmentation, and dryness.

11) Vegetation – papillary thickening of the skin, resulting from the proliferation of the spinous layer of the epidermis and papillomatosis of the dermis during a long-term inflammatory process. Most often they form in the area of ​​papules and ulcers.