Oral diseases in children. Oral diseases in children. The use of medications depending on the form of stomatitis

Oral diseases of various origins are very common among children. Some of them are almost harmless, and some are not necessary treatment can greatly harm a fragile body. The article will discuss stomatitis, its causes, symptoms, types, methods of treatment, as well as Dr. Komarovsky’s opinion on stomatitis.

What is stomatitis?

Stomatitis is irritation or damage to the mucous membranes of the oral cavity. It appears in the form of ulcers and so-called “pimples” filled with liquid. It is useful to study medical photographs to know exactly what they look like and contact the hospital in time. Stomatitis can appear in both adults and children, but it is children who are most predisposed to it. The disease equally affects children both at 4 - 5 months of age and at 4 - 5 years of age.

Stomatitis in children is explained by the underdevelopment of the mucous membranes, from which they are easily damaged by the slightest influence of any factor. Do not forget that children constantly put dirty hands, toys and various items. The development of bacteria and microorganisms is a powerful impetus for the occurrence of stomatitis. Children also experience frequent disruptions in the gastrointestinal tract, which increase acidity and change the composition of saliva. Such changes lead to problems.

Depending on what caused the disease, stomatitis is divided into many subspecies. The most common ones are:

1. viral;
2. candidiasis (fungal);
3. aphthous (allergic);
4. traumatic;
5. bacterial.

Symptoms of the disease

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Stomatitis in children manifests itself with characteristic symptoms, which are difficult to confuse with other similar diseases, especially if you compare photos of a healthy and affected oral cavity:

• ulcers on the mucous membranes of the mouth, filled with white liquid (after 2–3 days they burst, and inflamed wounds appear in their place);
• severe redness around the rash;
• the light pink color of the mucous membrane changes to red or dark purple;
• increased body temperature (with the progression of stomatitis, the temperature can reach 41 degrees);
• intoxication of the body;
• decreased or complete lack of appetite;
• sleep disorders;
• mouth pain;
• inflammation and swelling of the gums and tongue;
• the appearance of a painful plaque on the tongue, gums, palate;
• available bad smell from mouth;
• increased salivation or vice versa, which is characterized by sticking of the lips.

Diagnostic methods

For parents, the first warning signs are characteristic changes in the mouth. Older children may complain of pain and bad feeling. If you notice a rash or severe redness, you should not examine it yourself, especially with dirty hands and no gloves.

It is better to first show a child under 1 year of age to the attending pediatrician, who, after an initial examination, will refer him for tests and an appointment with a specialist. Children after 3 years of age can be immediately taken to see a pediatric dentist; this is his specialization. To confirm the diagnosis, several types of diagnostics are used:

• detailed analysis of blood, urine and, if necessary, stool;
• mouth swab;
• cytological examination;
• testing for viruses and bacteria;
• checking the state of immunity.

It is important to carry out a full list of tests and undergo a comprehensive examination. This will make it possible not only to make a diagnosis, but also to accurately determine the type of stomatitis. The specialist will prescribe correct therapy and will be able to quickly cure the patient.

Treatment of stomatitis in the mouth in children

Treatment depends entirely on the cause of the disease. It is prescribed by a doctor based on the results of the examination. The therapy includes medications (antiseptics, antifungals, healing), diet, hygiene rules and some home or folk remedies. On average, the illness period lasts up to 14 days, after which all symptoms disappear.

Viral stomatitis

Viral stomatitis in children occurs under the influence of various viruses on the oral mucosa. Most often it is a herpes virus, which is why it is also called herpes stomatitis. The disease is serious, as there is a possibility of infection spreading throughout the body. It can appear in a child as early as 2-3 months.

• past infectious diseases (measles, influenza, chickenpox, etc.);
• contact with a patient with viral stomatitis (it is transmitted not only by airborne droplets, but also through toys and other objects);
• weakened immunity, which allows viruses to attack the child’s body.

The signs of viral stomatitis are practically no different from the general symptoms. The child experiences an increase in temperature, swelling and redness of the oral cavity, a profuse rash of ulcers in which pus forms over time, a lethargic state, severe pain, and swelling of the lymph nodes.

Candidal stomatitis

Candidal stomatitis is caused by fungi that enter the body. Absolutely everyone is susceptible to it, but more often children of the first year of life. Such stomatitis one year old child may appear for a number of reasons:

Symptoms:

• poor health, lethargy, moodiness;
• refusal to eat;
• the appearance of ulcers on the mucous membranes of the lips and cheeks;
• plaque in the mouth with a cheesy consistency;
• sour breath;
• inflammation of the mucous membranes;
• temperature increase;
• pain.

Treatment is prescribed by a doctor and is comprehensive. First of all, it is necessary to take care of careful hygiene, maintaining cleanliness and sterilization of objects that the child uses. You need to regularly treat your mouth with solutions that increase acidity. This helps kill the fungus on early stage. You can use a soda solution (take a tablespoon of soda per glass of water) or a 2% boric acid solution. It should be applied with a clean cotton swab or sterile bandage.

In addition, doctors prescribe local antifungal drugs, such as Candide or Fucis DT. Furacilin is suitable for disinfection, and Solcoseryl gel is suitable for rapid healing of canker sores.

Aphthous stomatitis

Aphthous stomatitis can be caused by infections, previous diseases, as well as allergic reactions, which is why it is often called allergic stomatitis. Its symptoms are identical to the standard symptoms of all types of disease (ulcers or aphthae, inflammation of the oral cavity, fever, pain).

Aphthous stomatitis can only be confirmed by a doctor. You may need to consult an allergist. He will be able to identify the allergen that negatively affects the body and provokes stomatitis. After eliminating prohibited foods, the child’s well-being improves and the illness goes away.

1. rinsing (chlorhexidine or hydrogen peroxide solution) (more details in the article:);
2. smear the affected areas with anti-inflammatory and healing topical preparations;
3. inhalation;
4. diet;
5. proper hygiene;
6. antipyretic medications if necessary.

Traumatic stomatitis

One of the most common causes of childhood stomatitis is mechanical damage to the oral cavity:

1. wounds caused active games or foreign objects in the mouth;
2. exposure to too hot foods;
3. chemical damage;
4. the child biting his cheeks and lips, as well as scratches from sharp teeth;
5. incorrectly installed bracket systems or careless manipulations by the dentist.

Traumatic stomatitis is absolutely not contagious. Treatment is aimed at relieving symptoms and fast healing. It includes antiseptic, anti-inflammatory and healing effects, antipyretic drugs, pain relief, proper daily routine, healthy nutrition and compliance with all hygiene rules.

Bacterial stomatitis

In most cases, bacterial stomatitis affects children who often suffer from colds, ARVI, flu, bronchitis or sore throat (more details in the article:). Against the background of reduced immunity, bacteria enter the oral cavity and infect existing minor injuries, for example, scratches from teething or toys.

As the disease progresses, the blisters in the mouth (on the gums and cheeks) enlarge and fill with pus, the entire oral cavity becomes inflamed, a coating appears on the tongue, bad breath is felt, and the temperature may rise. The child feels general malaise, refuses to eat, and is capricious.

Treatment bacterial stomatitis includes the use of antiseptics, antibacterial solutions (furatsilin) ​​or gels, healing agents (solcoseryl), and drugs to lower the temperature. Rinsing with a soda solution is useful. Small children need to irrigate their mouth with it. It is also allowed to treat the mouth with diluted hydrogen peroxide or chlorhexidine.

Main principles of nutrition:

Sample list of products:

1. dairy and fermented milk products without dyes and flavoring additives;
2. non-acidic fruits (bananas, melon, watermelon);
3. vegetables and juices from them;
4. liquid porridge;
5. homemade milk ice cream (cold relieves swelling and pain);
6. teas and herbal infusions;
7. ground lean meat or fish.

Prevention of disease according to Dr. Komarovsky

To prevent the appearance of stomatitis in early childhood, simple preventive work can be carried out. Pediatrician Evgeny Komarovsky gives useful recommendations for the prevention of stomatitis. In his video lesson, Komarovsky reveals this topic in detail. Main recommendations:

Possible complications

In case of untimely or incorrect treatment, as well as chronic form The disease may develop some complications. After an illness, especially when the child has already suffered stomatitis several times, the the immune system. An unprotected body can easily catch a cold, ARVI, flu or other infection.

Chronic stomatitis destroys tooth enamel under the influence of fungi, viruses and unhealthy oral microflora. In this case, you need to regularly visit the pediatric dentist. Don't forget about the risk of infection and spread of infection or fungus. Always treat ulcers or canker sores carefully and correctly. It is necessary to consult a doctor in a timely manner and treat the child responsibly.

Each disease will be reflected in physiological processes body.

It has long been proven that the symptoms of many diseases, especially infectious ones, can manifest themselves in the oral cavity, and this will be precisely the first signals of illness.

The manifestation of infections can be seen in both the oral cavity of an adult and a child. Young children most often encounter respiratory, herpetic infections and many others. So how do they manifest themselves in the oral cavity? And what should you pay attention to?

Childhood infections

ARVI in the oral cavity

In pediatric practice, acute respiratory diseases are widespread. ARVI is a general name that unites many infections with completely different pathogens, which include influenza, parainfluenza, adenoviral infections, etc.

In the oral cavity, ARVI will have one common symptom - increased vascular pattern of the mucous membrane, its redness, swelling, the tongue becomes coated - covered with a coating of various shades.

When examining the mucous membrane, its granularity is noted. A few days before the appearance of the first pronounced signs of a cold, the child’s regional The lymph nodes. Against the background of infection, stomatitis often develops, mainly candidiasis.

Enterovirus infection

Susceptibility to enteroviruses in children is quite high; children in age group from one to 10 years. And the occurrence of pathology is characterized by seasonality - spring-summer.

Viruses themselves can cause the development of many diseases - meningitis, enterovirus, herpangina.

With herpangina, from the very first days of the disease, the first manifestations appear in the oral cavity - small papules, literally a couple of millimeters.

Papules quickly turn into vesicles, surrounded in diameter by a red halo.

In just a couple of days, the bubbles open, forming surface erosions covered with a gray-white coating. Sometimes, the elements of the rash can merge with each other, which contributes to the formation of larger erosion.

Initially, the elements of the rash are extremely sensitive, but after that the pain goes away.

Herpangina and herpangina are two different nosological units, although they have somewhat similar symptoms.

Herpes infection

The causative agent of chickenpox is one of the herpes viruses. Chickenpox manifests itself with a clear clinical picture in the oral cavity.

A finely blistered rash appears on the mucous membrane, on the cheeks, gums, even the palate, which brings a lot of inconvenience to the child due to constant itching and a painful reaction to thermal irritants.

Itching, scratching, cause frequent attachment secondary infection on the formed skin erosions, even minor injuries - pockmarks - may subsequently remain.

The mucous membrane is swollen and red. The papules quickly open, revealing erosions covered with plaque.

Elements of the rash also form on the red border of the lips with the formation of crusts. Has the same symptoms herpetic stomatitis.

In its course, three forms are distinguished - mild, moderate and severe, which directly reflect the severity of symptoms, the number of rashes and the patient’s well-being.

A severe form of herpetic stomatitis is treated within the walls of a hospital, due to the serious condition of the child.

Having gone through all stages of development, papules form erosions that are difficult to treat and are often contaminated with secondary microflora, followed by inflammation.

Another manifestation of herpes zoster is herpes zoster, which manifests itself when the body encounters the virus a second time. Rash and vesicles appear along the sensory nerve fibers.

The disease most often manifests itself in adults, less often in adolescents who had chickenpox in childhood.

Shingles is characterized by an acute onset, a strong pain reaction, and rashes can appear along the sensitive branches of the trigeminal nerve.

Manifestation of scarlet fever in the oral cavity

The causative agent of this acute infection is hemolytic streptococcus type A, which has a toxic, septic and allergic effect on the child’s body.

The first symptoms of infection occur at the site of entry of the pathogen - the mucous membrane of the pharynx and pharynx.

Specific symptoms are recorded precisely on the tongue. At the beginning of the disease, the tongue becomes covered with a white coating.

After a couple of days, usually 3 - 4, it turns bright red. Due to the desquamation of the epithelium of the tongue and the smoothing of the papillae, dentists will talk about a varnished tongue. Against the background of smoothed threadlike ones, the mushroom-shaped papillae of the tongue become clearly visible, due to which the tongue acquires a visual resemblance to a raspberry.

"Raspberry Tongue" - specific symptom scarlet fever.

Measles

The maximum number of cases is recorded in the autumn-winter period, and the source of infection will be a sick child.

The first symptoms of the disease: sharp increase body temperature, dry barking cough, rhinitis and conjunctivitis. Examination of the oral cavity shows hyperemia of the mucous membrane, its looseness and roughness.

A few days before the rash appears on the skin, in the mouth, on the hard palate, you can notice a small pink-red rash.

At the site of the projection of the chewing group of teeth, small gray-whitish dots, framed by a red rim, appear on the cheek mucosa.

Diphtheria in the mouth

Initially, diphtheria affects the pharynx, tonsils, and only then the mucous membrane of the gums.

During the examination, you may notice swelling, hyperemia, and in the area of ​​the tonsils and pharynx, the mucous membrane is covered with a dirty gray film.

After the film comes off, the erosive mucosa is exposed, which bleeds even with minor trauma. In addition to erosions, ulcers also form on the mucous membrane.

Fortunately, cases of diphtheria in our time are a casuistry; thanks to vaccinations, it was practically defeated.

How does rubella manifest?

First of all, the rash appears on the face, in the area of ​​the nasolabial triangle, and only then spreads to the whole body.

The development of rubella is associated with a special type of stomatitis - catarrhal.

When examining the oral cavity, spots of small diameter, about the size of a match head, pale, become noticeable. Pink colour.

The tongue is coated, but only for a couple of days, after which it is cleaned and becomes varnished.

The red border of the child’s lips is swollen and brightly colored, and after 4–5 days from the onset of symptoms, cracks may appear on the lips.

Adult infections

HIV infection

HIV infection is typical for people of any age, and can even be congenital.

All symptoms characteristic of infection are usually divided into three groups:

1. Symptoms directly associated with infection: persistent and difficult to treat oral candidiasis, leukoplakia, necrotizing ulcerative gingivitis, Kaposi's sarcoma;
2. Diseases salivary glands, bacterial infections that develop against the background of reduced immune defense;
3. Symptoms not related to infection.

All symptoms will resemble the manifestation of individual nosological diseases. And most importantly diagnostic criterion there will be no effect from treatment. And when making a diagnosis, it is important to consider nonspecific symptoms– increased body temperature, enlarged lymph nodes, loss of body weight.

Tuberculosis

In the oral cavity, secondary tuberculosis can manifest itself in two different forms - tuberculous lupus or miliary ulcerative tuberculosis.

Most often, tuberculous lupus is located on upper lip, gum or palate. A specific manifestation of the infection will be lupoma - the primary element of the lesion is red in color and small in size. The tubercles are located in groups and are destroyed with the formation of erosions.

Patients with tuberculosis often complain of tooth mobility, and even their loss, due to destructive processes in the body of the jaw.

Due to swelling, the lips may be enlarged and covered with crusts. With a long-term process, scars may form at the site of the lesion.

Scars will contribute to the occurrence of deformities, most often the lips are subject to deformation, therefore, the function of proper speech production and eating is impaired.

Syphilis

Manifestations of primary syphilis in the oral cavity are localized at the site of entry of the pathogen. Total number elements do not exceed 2 - 3, and are mainly located on the lips, less often on the mucous membrane.

The formation of syphilitic chancre begins with redness of the mucous membrane and thickening of the area, followed by an increase in size.

At secondary syphilis, symptoms in the mouth and skin appear simultaneously, but there are exceptions to their rules.

Secondary syphilis manifests itself in two forms of syphilides - macular and papular.

Papular syphilide is a dense elevation above the mucous membrane, pale gray in color, with a velvety surface and noticeable fine granularity.

Papules are characterized by growth or, conversely, merging with each other. Spotted syphilide has a round shape, a smooth surface, and when they merge, limited erythemas are formed.

As a rule, tertiary syphilis does not have any manifestations in the oral cavity, but syphilides can be recorded with localization on the soft or hard palate, which grow deep into the periosteum and bone.

Gonorrhea

In the oral cavity, gonorrhea can manifest itself in completely different ways. In newborns who have received an infection from their mother, a special type of stomatitis, gonococcal, may be registered in the oral cavity.

The same symptoms are typical for homosexual men.

In the oral cavity, the mucous membrane is brightly colored, swollen, erosions and superficial ulcers are noticeable, and there is an abundant plaque of a purulent nature.

The soft palate, dorsum of the tongue, lips and gums are most often affected. Simultaneously with symptoms in the oral cavity, symptoms from the genitourinary system appear.

The body is a perfect system, and all processes in it are interconnected. Even before the onset of pronounced clinical manifestations, the body signals problems in its functioning.

The task of every person is to be able to recognize these signals and respond to them in a timely manner. Timely dental examinations will help achieve these goals.

Other information on the topic

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  Jaundice in newborns
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  Umbilical hernia in newborns

state budgetary educational institution of higher education vocational education"Tyumen State Medical Academy"

Ministry of Health of the Russian Federation

(GBOU VPO TyumGMA of the Ministry of Health of Russia)

Department of Orthopedic and Surgical Dentistry

Diseases of the oral mucosa, features of the course of the disease in childhood

Completed by: Politova A.P.

Tyumen, 2014

Introduction

The collective name “stomatitis” unites a large group of diseases of the oral mucosa, varied in etiology and clinical manifestations.

The oral mucosa as the initial site digestive tract from the first hours after the birth of a child and throughout his life, he is exposed to a variety of local influences related to the function of the oral organs, and also, to a greater or lesser extent, reflects all the physiological and pathological processes occurring in the human body.

Experimental studies by A. I. Rybakov established that lesions of the central nervous system, hematopoietic organs, as well as trauma and infectious diseases often accompanied by dysfunction of the gastrointestinal tract. This, in turn, leads to the occurrence of certain dystrophic or inflammatory changes in the oral mucosa.

Moreover, the nature of the elements of damage to the oral mucosa depends on the anatomical and physiological characteristics structures of a particular site. This can explain why in some cases pathological elements arise and develop immediately, while in other patients they appear after some time or are not clearly expressed.

To understand the etiology, pathogenesis, and, consequently, carry out successful treatment of a particular disease of the oral mucosa, pediatric dentist must take into account the variety of local and general factors simultaneously acting on the mucous membrane.

It is necessary to carefully collect anamnesis, conduct a comprehensive clinical examination of the child together with a pediatrician, neurologist and other specialists, use additional methods studies: cytology, biopsy, biological tests, etc. A number of diseases of the oral mucosa are observed at any age, but in children, most stomatitis occurs more acutely, with significant disturbances in the general condition of the body.

Some diseases occur only in children (Bernard's aphthae) or mainly in children (acute aphthous stomatitis, stomatitis with measles, scarlet fever, diphtheria). At the same time, children practically do not have such diseases as leukoplakia, lichen planus, true pemphigus etc. Classification of diseases of the oral mucosa is very difficult.

Different authors classify these diseases based on different principles: according to the localization of the process, clinical course, pathological picture, etiology, etc. It seems to us most appropriate to group diseases of the oral mucosa in children according to etiology, although a number of factors simultaneously affect the child’s body (trauma, infection, allergy, disorders various systems and organs, etc.).

This grouping guides the doctor to determine the leading pathogenetic factor, the influence of which contributes to successful treatment.

Grouping of lesions of the oral mucosa, tongue and lips in children. Lesions of the oral mucosa traumatic origin.. Lesions of the oral mucosa due to infectious diseases.. Lesions of the oral mucosa caused by a specific infection.. Lesions of the oral mucosa caused by allergies.. Lesions of the oral mucosa associated with intake medicinal substances.. Changes in the oral mucosa during disease various organs and body systems.. Diseases of the tongue.. Diseases of the lips.

Acute aphthous stomatitis

The most common disease of the oral mucosa in children. Most modern domestic and foreign authors consider it a manifestation of a primary infection of the body with the herpes simplex virus.

The virus is widespread in nature, its carriers are many healthy people. The contagiousness of the virus is low, but the disease often occurs in the form of small epidemic outbreaks in nurseries and kindergartens.

Infection occurs by airborne droplets, through toys. It is possible for a child to become infected from an adult suffering from recurrent herpes (N.A. Antonova). Incubation period from 2 to 6 days.

Clinic

Acute aphthous stomatitis, as a rule, affects children of toddler and primary preschool age. The onset of the disease is acute, often with an increase in temperature to 39-40°, symptoms of intoxication: the child is lethargic, refuses food, sleeps poorly. Older children complain of a burning sensation, itching, and pain in the mouth.

On the 2nd day of the disease, rashes appear in the oral cavity in the form of quickly opening vesicles or erosions of a round or oval shape, from 1 to 5 mm in diameter. The erosions are sharply painful, have a slightly concave bottom, are covered with a yellowish-gray fibrinous coating and are surrounded by a bright red rim.

Aphthae are localized on the tongue, mucous membrane of the lips, cheeks, and less often on the palate and gums. With a massive rash, aphthae in individual areas merge with each other, forming extensive erosions of various shapes.

The oral mucosa becomes swollen, and in 64% of cases catarrhal gingivitis is expressed. 35% of children have facial skin lesions in the form of individual small vesicular elements (N. A. Antonova). The lips swell and sometimes become crusty. Salivation increases, but the saliva is viscous and has an unpleasant odor. Regional lymph nodes are enlarged and painful.

With secondary infection, ulceration of the affected areas is possible. The duration of the disease is 7-10 days. Aphthae heal without scarring. The disease does not recur, as strong immunity remains.

Acute aphthous stomatitis should be differentiated from drug-induced stomatitis, erythema multiforme and similar syndromes, diphtheria and other stomatitis in acute infectious diseases.

Afta Bednara

In children in the first months of life, traumatic erosions on the palate are observed, known as Bednar's aft. Bednar's aphthae often occur in weakened children who are on artificial feeding, suffering birth defects hearts that have suffered any diseases in the first months of life.

Hypotrophy is the background against which minor tissue trauma by a long horn or while wiping the child’s mouth is sufficient to disrupt the epithelial cover.

Clinic

Erosion is often located symmetrically at the boundary between solid and soft palate. The defeat can also be one-sided. The shape of the erosions is round, less often oval, the boundaries are clear, the surrounding mucous membrane is slightly hyperemic, which indicates a state of hypergia. The surface of the erosions is covered with a loose fibrinous coating, sometimes clear, brighter in color than the surrounding mucous membrane of the palate.

The size of erosions ranges from a few millimeters to extensive lesions merging with each other and forming a butterfly-shaped lesion. When a secondary infection occurs, erosions can turn into ulcers and even cause perforation of the palate. Bednar's aphthae can occur in children and breastfeeding, if the mother's nipple is very rough, for example after irradiation with quartz. Erosion in this case is located along midline sky.

The child becomes restless. Having started to actively suck, he stops sucking after a few seconds with crying, which is usually the reason for contacting a doctor. Treatment traumatic injuries comes down to eliminating the cause. Prematurely erupted baby teeth should be removed because their structure is defective. They quickly wear off and, in addition to trauma to the mucous membrane, can cause odontogenic infection. When removing such teeth, you should be aware of the possibility of heavy bleeding.

With Bednar's aphthae, it is necessary, first of all, to establish feeding of the child: natural through a pad (if the mother's nipples are rough) or artificial through a short horn made of hard rubber, which would not stretch when sucking and would not reach the eroded surface.

To treat the oral cavity of a child suffering from canker sores, weak antiseptic solutions (0.25% chloramine solution, 3% hydrogen peroxide solution) should be used; vigorous wiping of the mouth and the use of cauterizing substances are unacceptable.

It should be borne in mind that Bednar's aphthae heal very slowly - over several weeks or even months. Thermal injuries in children are rare, but are possible when eating hot food, especially milk and broth.

The mucous membrane of the lips, the tip of the tongue, and the anterior part of the hard palate is mainly affected. It becomes swollen, hyperemic, and painful when touched. Less commonly, superficial intraepithelial vesicles form, which immediately burst. Upon examination in this case, fragments of white epithelium are visible on a hyperemic base.

Lesions of the oral mucosa of traumatic origin

Depending on the nature of the traumatic agent, injuries are distinguished between mechanical, thermal, chemical and radiation. Mechanical injuries are more common in childhood.

With prolonged mechanical irritation of an area of ​​the mucous membrane, a deep lesion develops - the so-called decubital ulcer.

Decubital ulcer

One of the causes of decubital ulcers in children in the first weeks or months of life is trauma to the teeth or one tooth that erupted before the birth of the child or in the first days and weeks after birth. Usually one or two central incisors erupt prematurely, mainly on the lower jaw.

The enamel and dentin of these teeth are underdeveloped, the cutting edge is worn away and during sucking the breast injures the frenulum of the tongue, which leads to the formation of a decubital ulcer. A similar ulcer on the frenulum of the tongue can also occur in older children during whooping cough or chronic bronchitis, since prolonged bouts of coughing are accompanied by protrusion of the tongue and the frenulum of the tongue is injured by the cutting edge of the front teeth (Rigi's disease).

Decubital ulcer of the cheek or lip can occur during the period of changing teeth, when the root has not resolved for any reason baby tooth is pushed out by a permanent tooth, perforates the gum and protrudes above its surface, causing long-term injury to adjacent tissues. Decubital erosions and ulcers can occur in children who have uneven, sharp or damaged teeth and a bad habit of biting or sucking the tongue, mucous membrane of the cheeks or lips between the teeth.

Clinic

Decubital ulcer has uneven, scalloped edges, dense on palpation, the bottom is covered with a whitish-gray or yellowish coating. The mucous membrane around the ulcer is swollen and hyperemic. At first the ulcer has small sizes, later increases and deepens. A young child becomes restless, sucks poorly at the breast or refuses it altogether.

In children of preschool and school age, especially with bad habits, the ulcerated area is not painful, since with prolonged irritation they are destroyed nerve receptors mucous membrane. A doctor is often consulted only when the process worsens, caused by secondary infection and an inflammatory reaction of the surrounding tissue, which is accompanied by swelling, lymphadenitis, etc.

Lesions of the oral mucosa in infectious diseases

On the mucous membrane of the oral cavity, certain changes are detected in various acute infectious diseases accompanied by intoxication and increased body temperature, including the so-called respiratory infections that are widespread in childhood.

Sick children refuse to eat, self-cleaning of the oral cavity is disrupted, the mucous membrane becomes dry, plaque appears, especially on the tongue, due to the accumulation of desquamated epithelium, leukocytes, mucus, food debris and a large number of bacteria.

A decrease in the body's resistance helps to increase the virulence of the oral microflora; a number of saprophytes acquire the properties of pathogenic microbes. More often, catarrhal inflammation of the oral mucosa is observed, in which there is diffuse hyperemia and swelling of the mucous membrane. The gingival margin is raised like a roller, covering part of the crowns of the teeth.

There are tooth marks on the mucous membrane of the cheeks and along the edges of the tongue. Sometimes a whitish-gray plaque that can be easily removed is visible in the area of ​​transitional folds; the epithelium underneath is not damaged. Catarrh with successful treatment of the underlying disease and proper care for the oral cavity quickly ends with complete recovery.

However, with a severe general condition of the child, a decrease in the reactivity of the body and local tissue immunity and the presence of virulent microflora in certain areas of the inflamed tissue, necrosis most often occurs along the edge of the gums, followed by tissue disintegration and the formation of areas of ulceration.

A certain role in the development of ulcerative stomatitis is played by saprophytes of the oral cavity - fusiform bacillus and spirochetes, which become pathogenic and are found in large quantities in the discharge from the surface of ulcers. With the rapid progression of the ulcerative-necrotic process in the oral cavity, they speak of gangrenous stomatitis, in which anaerobic infection comes to the fore.

The most severe form of gangrenous stomatitis is noma. In recent decades, noma has become a rare disease in our country, which should be explained by the general rise in prosperity and the availability of qualified medical care.

Banal ulcerative stomatitis is also observed relatively rarely, more often in older children and adolescents who have a large number of carious teeth, in the absence of oral care, periodontopathies, i.e. in cases where an infectious disease is preceded by a long chronic inflammation oral mucosa, gums or dental disease.

Ulcerative lesions can also be caused by difficult eruption of the third or, less commonly, second molars of the mandible.

Clinic

The general condition of the child is serious, since the absorption of tissue breakdown products causes significant intoxication of the body. Body temperature is elevated, regional lymph nodes are enlarged and painful, salivation is increased. The gums are swollen and dark red in color.

In the area of ​​ulceration, the interdental papillae seem to be cut off due to the disintegration of tissue at their apex and are covered with a dirty, soiled coating with putrid smell. Ulcerative lesions can also occur in other areas of the mucous membrane.

Their edges are usually uneven, the bottom is covered with a dirty coating of yellowish-gray or brown (from blood). After healing, scars may remain at the site of ulceration; the tops of the interdental papillae of the gums are not restored.

Most important differential diagnosis with necrosis in the oral cavity with systemic blood diseases (leukemia, aplastic anemia, etc.), therefore, all patients with oral ulcers should have clinical tests blood. In some acute infectious diseases, changes in the oral mucosa occur, which are mainly characteristic of this disease.

The lesions in these diseases can serve as an important diagnostic sign, as they appear earlier than the skin rash. However, under the influence of banal microflora of the oral cavity, these characteristic changes in the mucous membrane are sometimes detected with great difficulty.

Thrush

Thrush (candidiasis, superficial blastomycosis) is caused by the yeast-like fungus Oidium albicans and other similar fungi from the genus Candida.

Yeast-like fungi are widespread in nature and, being saprophytes of the oral cavity, are found in 40% of healthy people.

Thrush most often affects weakened children in the first weeks and months of life, but thrush often occurs in practically healthy children when the hygiene of the newborn is poor, since fungi can be transmitted from adults through nipples, underwear and other baby care items.

IN early age the child has not yet developed a protective reaction of the mucous membrane, is poorly developed local immunity, the oral flora has not stabilized. Under these conditions, fungi such as Candida can become pathogenic.

Thrush also affects the oral mucosa in older children who are seriously ill for a long time and treated with antibiotics and corticosteroids.

The disease begins asymptomatically. Later, children become restless, sleep poorly, and suck the breast sluggishly. Older children complain of an unpleasant taste in the mouth, a burning sensation, and then pain appears when eating, especially spicy and hot food. Regional submandibular and mental lymph nodes may be slightly enlarged and painful.

The temperature is within normal limits or low-grade. When examined, groups of pearly-white spots ranging in size from fractions of a millimeter to 1 - 1.5 mm, round in shape, are found on the unchanged or hyperemic mucous membrane of the tongue, lips, cheeks, and palate.

As the fungus multiplies, the affected areas slowly increase in size and, merging with each other, form white film, rising above the level of the mucous membrane and resembling curdled milk. Sometimes the coating is coarser, curdled, crumbly or foamy. The plaque contains filaments of pseudomycelium, budding fungal cells, desquamated epithelium, leukocytes, and food debris. The plaque can become yellowish, dirty gray, and when blood gets in, brown.

The fungus first develops on the surface of the mucous membrane and is therefore easily removed with a swab, but soon penetrates into the superficial and then deep layers of the epithelium. Such plaque is difficult to remove, and when the film is forcibly removed, a bleeding, eroded surface is exposed.

It is possible for the fungus to penetrate into the underlying connective tissue and even for the fungus to grow into the walls blood vessels with subsequent hematogenous dissemination of candidiasis. The fungus can spread from the mouth to the respiratory tract and digestive tract.

Common in young children yeast lesions skin in the genital area, cervical, interdigital folds, feet, etc., which is important to consider as a source of re-infection of the oral cavity.

Thrush is differentiated from coated tongue in various diseases, acute aphthous stomatitis, diphtheria. Laboratory confirmation of the diagnosis is desirable. With candidiasis, scrapings reveal a large amount of mycelium and budding cells. The detection of individual yeast cells in the material does not provide grounds for a diagnosis of thrush.

Lesions of the oral mucosa associated with taking drugs

Many medicinal substances, including antibiotics, sulfonamides, pyramidone, salts heavy metals, novocaine, iodine, phenol, etc. can cause side effects, which are collectively called “drug disease”. In 17% of patients, it also manifests itself in the oral cavity.

The pathogenesis of such stomatitis can be different. Toxic effect drugs are determined by their chemical structure. Thus, streptomycin causes damage to the auditory and optic nerves, chloramphenicol has a toxic effect on the liver, the pyramidon group inhibits the circulatory system, etc.

Against this background, lesions of the oral mucosa can also develop, usually in the form of catarrhal stomatitis. Another mechanism of drug side effects in children suffering from allergic diseases or previously sensitized by the same medicinal substances or allergens of a different nature (food, microbial, viral, etc.).

The medication at its first or reuse plays the role of a resolving factor in this case. Especially often, such allergic reactions occur in connection with the use of antibiotics, since they themselves and their compounds with body proteins have pronounced antigenic properties. Damages to the mucous membrane are more severe.

Clinic

In addition to diffuse hyperemia and swelling of the mucous membrane, vesicles and blisters appear, after opening which erosions remain covered with fibrinous films, and the picture of the lesion may resemble exudative erythema multiforme. The tongue can be swollen, coated, or due to desquamation of the epithelium it becomes smooth, as if polished, sharply sensitive to external irritants. In addition to changes in the oral cavity, urticaria, pain in muscles, joints, dyspeptic symptoms, and in severe cases general reaction such as anaphylactic shock.

Side effects of medicinal substances may also be due to dysbacteriosis, which develops with long-term use of sulfonamides and antibiotics, especially wide range actions. Along with pathogenic flora Many saprophytes are also destroyed, and their resistant forms exhibit previously hidden pathogenic properties.

Lesions of the oral mucosa can be different: from mild catarrhal stages to severe conditions with ulcerative-necrotic manifestations. Dysbacteriosis also explains the development of candidiasis in patients who have been receiving antibiotics for a long time and steroid hormones. Besides typical picture thrush, sometimes chronic candidiasis in children manifests itself in the form of a so-called black or hairy tongue. Long-term use of antibiotics leads to vitamin deficiency, which also affects the condition of the oral mucosa.

It is necessary to differentiate drug stomatitis from exudative erythema multiforme, acute herpetic stomatitis, and epidermolysis bullosa.

Erythema multiforme exudative

A recurrent disease that occurs with damage to the mucous membrane of the oral cavity and skin. The etiology of the disease is unclear.

In the pathogenesis, various intoxications play an important role, as well as the action of a number of unfavorable factors: biological, physical, chemical, which are allergens for the body.

The allergic nature of the disease is confirmed by a significant increase in blood histamine to 13.6 mcg% (normal -5.2 mcg%) and a skin histamine test. Exudative erythema multiforme occurs in schoolchildren and children of senior preschool age.

Clinic

The disease often begins acutely, with a rise in body temperature to 38°, accompanied by severe intoxication. With frequent relapses, the overall reaction of the body is less pronounced.

The disease manifests itself in various morphological elements: erythematous spots, papules, vesicles, etc. Damage to the oral mucosa, according to the Central Dermatovenerological Institute, is observed in 25-60% of patients.

In adults and children, only the oral mucosa may be affected. Patients feel severe pain and burning of the mucous membrane, lips, cheeks, tongue, which interfere with food intake and make speech difficult. When examined on the reddened and swollen mucous membrane of the lips, cheeks, transitional folds, tongue, sublingual area V initial stage disease, you can see single or grouped papules, vesicles and blisters of different sizes.

The blisters quickly burst, and the mucous membrane eroded in this area is covered with a thin fibrinous film of whitish-yellow color, which is usually located in the plane of the surrounding mucous membrane. Sometimes fragments of a bubble are visible along the periphery of the lesion; Nikolsky’s symptom is negative.

The period of rash usually lasts 5-8 days, so with late treatment you can see even greater polymorphism of elements. The lips are very often affected, especially the lower one. Trauma to the blisters on the red border leads to the formation of massive dark brown crusts. With secondary infection, ulceration of eroded areas is possible.

Skin rashes are localized on the back of the hands, forearms, legs, face and have the appearance of bluish-red spots with round outlines. In the center of the spot there is an infiltrate, which turns into a vesicle. Blisters may immediately appear on the skin, surrounded by a bright red or bluish-red rim. The disease lasts 2-4 weeks and is very difficult for children to tolerate. After healing of erosions in uncomplicated cases, no scars remain.

Exudative erythema multiforme should be differentiated from acute aphthous stomatitis, severe forms of herpes simplex and herpes zoster, and in adolescents with true pemphigus.

Bibliography

1. Vinogradova T.F. Diseases of periodontal and oral mucosa in children. //M., 2007.

2. Elizarova V.M. Dentistry for children. Therapy: M., Medicine. - 2009.

3. National Guide to Pediatric Therapeutic Dentistry + CD. // Edited by Kiselnikova L.P., Leontyev V.K., M.: GEOTAR-Media, 2010.

4. Therapeutic dentistry. Ed. E.V. Borovsky. - M.: 2009.

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Methodological development

IN CHILDREN'S DENTISTRY

AND PREVENTION OF DENTAL DISEASES

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

Discussed at a department meeting

Protocol No. ________

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

Total lesson time – 6.0

academic hours

OBJECTIVE OF THE LESSON:

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

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

MATERIAL EQUIPMENT:

Tables, models, slides, radiographs, samples.

OBJECTIVES OF THE LESSON:

REQUIREMENTS FOR INITIAL LEVEL OF KNOWLEDGE

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

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

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

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

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

From pediatrics - clinical manifestations Gastrointestinal tract, kidneys, cardiovascular system, blood.

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

From prevention dental diseases- dental examination of the patient, state of oral hygiene, methods and means of individual prevention.

From pediatric therapeutic dentistry - caries of temporary and permanent teeth with unfinished root formation, non-carious lesions of hard dental tissues, pulpitis and apical periodontitis of temporary and permanent teeth with incomplete root formation.

CONTROL QUESTIONS

IN RELATED DISCIPLINES

1. Structure of the musculoskeletal system in adults.

2. Examination methods for diseases of the oral mucosa.

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

4. Signs and stages of inflammation.

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

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

CHECK QUESTIONS ON THE TOPIC OF THE CLASS

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

a) up to a year;

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

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

EDUCATIONAL MATERIAL

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Features of the structure of the oral mucosa in children

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Gums in children are characterized by a number of signs:

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

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

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

3. Differs in low density of connective tissue.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Pathological processes

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

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

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

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

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

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

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

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

The nature of diseases of the oral mucosa in children is largely determined by the age-related characteristics of the structure of the mucous membrane.

Thrush (acute candidiasis)

In infancy, the epithelium of the oral mucosa is very thin, so a fungal infection, when salivary immunity decreases, very easily attaches to the surface of the mucosa. Therefore, acute candidiasis (thrush) is very common in newborns.

Stomatitis in children

Stomatitis in children: chronic recurrent aphthous

Chronic recurrent aphthous stomatitis(HRAS) is one of the most common diseases that can be classified as infectious-allergic. HRAS is characterized by periods of remission and exacerbation and manifests itself in the form of aphthae - superficial painful defects of the mucous membrane. Aphthae have a round or oval shape, covered with fibrinous plaque, red hyperemic rims are visible around the afts. The appearance of aphthae is not preceded by the formation of blisters. HRAS can occur in a mild form (1-2 aphthae) and in a severe form, when recurrent deep scarring aphthae are formed, the period of epithelization of which lasts up to 2-3 weeks. At the same time, relapses of the disease are very frequent (can occur monthly).

Treatment regimen includes a diet with the exclusion of irritating foods, the prescription of immunocorrectors and immunomodulators (after consultation with an immunologist), vitamins B and C, and desensitizing therapy. Locally treat the child's oral cavity with antiseptic solutions, use applications of proteolytic enzymes (trypsin, chymotrypsin), lubricate with oil solutions of vitamin A, sea buckthorn, and rose hips.

Stomatitis in children: acute herpetic stomatitis

Much more dangerous and, unfortunately, widespread is another form of stomatitis - acute herpetic stomatitis. According to the World Health Organization, diseases caused by the herpes simplex virus rank second in the world after viral flu. The overall incidence of herpes ranges from 50 to 100%, so herpes infections are considered socially significant diseases. Infection of children with the herpes simplex virus is 60% under the age of 5 years, and 90% by the age of 15 years. This statement is also true for dentistry. In addition, acute herpetic stomatitis in children with reduced immunity is highly contagious, that is, very contagious. The disease spreads through airborne droplets and household contact. The older the child, the lower the likelihood of acquiring an acute form of herpetic stomatitis due to acquired immunity.

The disease occurs in mild, moderate and severe forms. The incubation period is up to 17 days (in newborns - up to 3 days). A child with acute herpetic stomatitis may have a fever (up to 37-39o C, depending on the severity of the disease). The mucous membrane of the oral cavity is hyperemic, then single or grouped lesions appear. In more severe forms, rashes can appear both in the oral cavity and on the skin in the perioral area. The disease is accompanied by symptoms of catarrhal gingivitis (inflammation and bleeding of the gums). Changes in the blood appear in moderate and severe forms of the disease (ESR up to 20 mmh, leukocytosis, lymphocytosis).

The most reliable diagnostic method herpetic infection is a method of polymerase chain reaction (PCR diagnostics). The material for research is smears and scrapings from the oral mucosa.

Stomatitis in children: acute herpetic stomatitis, treatment

The treatment is complex. First of all, it is necessary to provide the child with adequate nutrition, however, eliminating all traumatic factors from the food (food should not be hard, spicy, salty, hot, etc.). It is important to ensure you drink plenty of fluids. Before each feeding of the child, his mucous membrane must be anesthetized (2-5% oil solution of anesthesin or lidochlor gel). Antiviral therapy involves taking special antiviral drugs(as prescribed by a doctor). These include: interferon, ointments “Bonafton”, “Tebrofen”, “Oxolin”, drugs “Acyclovir”, “Alpizarin”, “Panavir”, etc.

For epithelization of affected areas, ointments based on proteolytic enzymes of animal origin (trypsin and chymotrypsin) are used, as well as oil solutions vitamin A, carotoline, Vitaon oil, rosehip oil, Solcoseryl dental paste. Latest Research showed the high effectiveness of the drug “Super Lysine +” (ointment, tablets, USA) and laser therapy. The drug "Super Lysine +" accelerates the healing of herpetic ulcers, the rate of epithelization, the cleansing of ulcers from fibrin plaque, and has a high analgesic effect.

Antiviral drugs must be combined with immunomodulators (imudon, lykopid, immunal, etc. - as prescribed by a doctor).

To prevent relapses, it is necessary to strengthen the child’s immunity naturally: hardening, swimming, good nutrition, etc. Thorough sanitation of the oral cavity is also important: removal of dental plaque, treatment of caries and its complications, periodontitis in order to remove all foci of infection.

Pyoderma in children

Pyoderma- these are streptostaphylococcal lesions of the mucous membrane of the oral cavity, lips (cracks), and skin of the perioral area. Occurs in weakened children with low immunity, as well as in children who do not receive balanced nutrition. Children suffering from pyoderma are extremely susceptible to diabetes mellitus, which creates a good breeding ground for bacteria. Provoking factors are: hypothermia, overwork, overheating of the body, systemic diseases other organs.

Taking medications and damage to the oral mucosa

Lesions of the oral mucosa caused by taking medications. When taking many medications, lesions of the oral mucosa can occur, which can be combined common name « catarrhal stomatitis" This same group of diseases of the oral mucosa in children also includes an allergic reaction to medications.

Diseases of the oral mucosa of traumatic origin

A special group includes diseases of the oral mucosa in children of traumatic origin. At mechanical damage of the mucous membrane, dangerous pathogens can easily enter the wound, which will lead to its inflammation. A child can get injuries to the oral mucosa when brushing teeth, eating solid food, during dental procedures, etc. Rubbing the mouth carelessly can cause injury to a newborn, causing so-called neonatal aphthae.

Treatment of pyoderma is determined the nature of the pathogen. Therefore, it is necessary to carry out bacteriological culture to determine the causative agent of infection and its sensitivity to certain antibacterial drugs, and only after that the doctor can prescribe adequate treatment. Self-medication without tests can only blur the picture without destroying the causative agent of the infection.

Catarrhal stomatitis in children

Lesions of the oral mucosa caused by taking medications. When taking many medications (antibiotics, serums, vaccines, sulfonamides, novocaine, iodine, phenol, etc.), lesions of the oral mucosa may occur, which can be combined under the general name “ catarrhal stomatitis."

This same group of diseases of the oral mucosa in children also includes an allergic reaction to medications. The mucous membrane is hyperemic, edematous, covered with multiple blisters, after opening of which erosions may remain. The tongue and lips are also swollen. At the same time, the child may experience hives, muscle and joint pain, dyspepsia, and even anaphylactic shock.

Treatment is aimed primarily at identifying the cause of stomatitis. If taking, for example, antibiotics is necessary in the future, it must be combined with antifungal treatment and with antihistamines. Rinses, painkillers, and ointments are used locally to promote healing and epithelization of the mucosa.

Diseases of traumatic origin

Diseases of the oral mucosa in children should be included in a special group. Tratic origin. The mucous membrane, due to its physiological characteristics, has a high regenerative ability. However, if it is mechanically damaged, dangerous pathogens can easily enter the wound, which will lead to its inflammation. A child can get injuries to the oral mucosa when brushing teeth, eating solid food, or during dental procedures. This may be trauma from sharp damaged teeth or orthodontic devices in the oral cavity. The child may bite his tongue, lips, or cheek. A newborn, if he carelessly wipes his mouth, can cause injury, which causes so-called aphthae of newborns.

Treatment of traumatic lesions of the oral mucosa begin with eliminating the causes of injury. Then antiseptics that relieve inflammation and agents that promote healing (oils, solcoseryl gel, etc.) are prescribed locally.

In case of chemical damage to the oral mucosa in a child (accidental ingestion of potent chemical substances) it is necessary to immediately rinse the child’s mouth with plenty of water and a neutralizing solution (for example, alkaline for an acid burn). In the future, painkillers, antidotes, and agents that stimulate epithelialization are used.