How is the problem reflected in the oral cavity. Treatment of the oral mucosa. Preventive measures and possible complications

Diagnosis of infectious diseases of the oral cavity usually does not require any special dental procedures other than examination of the affected areas.

Despite similar external manifestations, infections of the oral cavity still have pronounced distinctive features.

For what reasons does the infection "settle" in the mouth?

The most common reason infectious infections is the lack of basic but regular. However, dentists advise their patients to convert Special attention the possibility of infection in such cases:

Infectious diseases of the oral cavity, their characteristics

Any infectious and inflammatory process that occurs in dental practice, can cause damage to the periodontal tissues and enamel adjacent to them. The rapid course of the disease leads to partial decay or loss of teeth.

Experts identify several common types of oral infections, each of which must be neutralized as soon as possible:

HIV infection settled in the mouth

The human immunodeficiency virus attacks the immune system and, unfortunately, no country in the world has yet developed drugs for its treatment.

However, with a timely visit to a doctor, the symptoms of this disease can be relieved quite successfully. In most cases, the mucous membrane of an HIV-infected person is affected, which spreads throughout the mouth. White bloom can be located not only on the inside of the cheeks, but also on the tongue.

During an external examination of the patient, wounds are often observed, which eventually transform into ulcers and erosive depressions. Herpes simplex and herpes zoster causes considerable discomfort when eating.

The defeat of the skin by the papillomavirus also does not go away asymptomatically. Nodules formed in oral cavity, cover not only the palate, but also the gums.

Candidal stomatitis - the main manifestation of HIV infection in the oral cavity

Preventive measures and possible complications

Having entrusted your health to professionals, it is enough to rely on their experience and follow all the recommendations prescribed by them. High-quality performance, regular visits to the dental office, including not only examination, but also with the use of various modern technologies, as well as an individual selection of drugs that maintain an optimal balance of vitamins in the body, will help to cope with an infection in the mouth for initial stage its manifestations.

Untreated inflammatory processes from the oral cavity can spread throughout the body, affecting the respiratory system and the digestive system. It is not easy to recover from such complications, so full recovery occurs only after all the provoking factors have been identified.

Diseases of the oral cavity are largely determined by lifestyle, nutrition, the influence of the external environment and everyday habits. At all times, the problem was reasonably associated with hygiene and the general condition of the body, as well as the absence of pathologies of the teeth and gums. It is known that the oral mucosa is closely connected with a number of internal organs. That is why her health is a guarantee wellness, high performance and active lifestyle.

Each of us has at least once encountered a similar pathology and probably tried to independently establish how serious it is and whether it is worth going to a doctor. This article will help you determine the type of disease, find out which ailment can be cured on your own, and when you should visit a doctor.

Types of diseases

To date, the lesions of the oral cavity do not have any clear structure. The classification of diseases is quite extensive and in different scientific works generalized by mismatched features. This situation greatly complicates the understanding of the material. Therefore, we will try to systematize the information and consider the most common pathologies.

By their nature, oral lesions can be infectious, fungal, viral, inflammatory, or oncological. For this reason, it is not worth doing self-diagnosis and treatment. It is prudent to seek professional medical attention.

The infectious nature of the disease

This group includes all pathological conditions that have arisen as a result of bacterial lesions and are accompanied by a necrotic process in the tissues.

Stomatitis begins with the appearance of erosive ulceration on the mucous membrane.

Infectious and inflammatory lesions of the oral cavity traditionally include:

all kinds of stomatitis (catarrhal, ulcerative, erosive, traumatic;
diseases of the teeth and gums;
damage to the tongue (glossitis);
sore throat.

All of them are the result of non-observance of hygiene measures or illiterate care of teeth and gums. Often, inflammation of the mucous membrane occurs against the background of certain diseases of the gastrointestinal tract - gastritis, enterocolitis, duodenitis, helminthic invasions.

Stomatitis

The lion's share among the pathologies of the oral cavity are infectious stomatitis. They are diagnosed in adults and children equally often. In some cases, the ailment goes away on its own after a few days, but more often the patient needs health care... The type of inflammation should be determined by the therapist or the doctor of the dental clinic.

At mild lesions of the oral cavity in adults of any specific treatment not required. In general, it is enough to rinse your mouth with pharmacy antiseptics or herbal infusions several times a day and follow a sparing diet. To reduce unpleasant sensations apply Kamistad ointment, baking soda.

Diseases of the teeth and gums

Very often, dental problems are to blame for the defeat of the oral cavity. In this case, not only the mucous membrane suffers. The gums begin to bleed and ulcerate, the shape of the teeth changes, the roots become bare.

Often the cause of damage to the mucous membrane of the mouth and gums is bad teeth.

The following diseases cause such manifestations:

periodontal disease;
periodontitis;
gingivitis.

In terms of lesions of the oral cavity, dentistry is in second place after stomatitis. This disease requires the help of a specialist and careful treatment. With late or illiterate therapy, the patient runs the risk of being left without teeth.

Often, the cause of a pathological condition is surgical operations(implantation) on the upper or lower jaw. This complex procedure requires a highly qualified specialist and long-term treatment in the future.

Diseases of the larynx

Lesions of the oral cavity and pharynx are the most common reasons for treatment medical professionals... Most often, people of working age and children suffer from the disease.

Among the diseases of this group are pharyngitis and acute pharyngitis, sore throat, chronic tonsillitis and laryngitis. Ailments are manifested by dryness of the oral mucosa, sore throat and sore throat, fever.

An inflammatory process that disrupts the structure and color of the tongue. It develops under the influence of infections that have penetrated the oral cavity. Activate pathological condition may burn or other mucosal injury.

The risk group includes people who neglect the rules of oral hygiene, lovers of hot drinks and spicy foods.

Diseases of the oral cavity include glossitis.

The fight against the inflammatory process consists in rinsing the mouth with antiseptic drugs.

The virus is to blame

The main difference between viral diseases and infectious and inflammatory diseases is their ability to be transmitted by air, sex or contact. These ailments are united by a similar symptomatology - the appearance of a small bubble, gradually turning into an erosive expression.

Viral diseases of the oral mucosa include:

candidiasis;
herpes lesions;
ulcerative necrotic stomatitis;
papillomas;
venereal manifestations;
vesicular pharyngitis ().

In some cases, other viral pathologies may develop on the oral mucosa. Such a process is most often of a short-term nature and does not cause any particular trouble for the patient.

Herpes

Medical statistics show that more than 90% of the entire population of the planet is infected with the herpes virus. In most cases, he is in a dormant state, occasionally reminding of himself with a pimple on his lip. After 8-10 days, the vial dries up safely.

A severe form of herpes manifests itself multiple foci inflammation

In immunocompromised patients, the virus is much more aggressive and manifests itself in many formations on the surface of the lips and inside the mouth. With damage to the gums, catarrhal gingivitis develops.

Bursting, pimples merge into an extensive ulcer that does not heal for a long time. The disease is recurrent in nature, exacerbating at the slightest disruption in the body. At the first sign of herpes on the lips, it is recommended to use moisturizing gels and ointments. Fenistil Pencivir cream will remove inflammation and accelerate recovery.

Candidal lesions

Fungal diseases of the oral cavity occur just as often as herpes. In the normal state, mycoses are passive and do not bother the owner. They are activated only under the influence of unfavorable factors:

hypothermia of the body;
inflammatory processes;
decreased immunity;
frequent stressful situations, physical strain.

In medical practice, the most common the following types mycoses:

atrophic candidiasis. It is manifested by drying out and redness of the mucous membrane;
pseudomembrane candidiasis. Most frequently registered. It flows sharply, the oral cavity is covered with a curdled bloom, itching and burning are felt;
hyperplastic candidiasis. It is characterized by the appearance of many plaques and the appearance of a white rash on the tongue. At self-treatment quickly turns into chronic form.

A fungal infection of the mucous membrane is characterized by a white coating on the tongue.

To choose correct scheme treatment, it is necessary to accurately establish the type of candidiasis. This can only be done by a specialist after a visual examination and obtaining analysis data.

Other viral diseases

Majority sexually transmitted infections able to penetrate into the body through oral contact. At the site of the introduction of the pathogen, for example, syphilis, a superficial ulcer is formed on a dense base, the so-called chancre... He does not respond to stimuli and does not cause discomfort.

Diseases of the oral cavity of a sexually transmitted nature easily spread to other parts of the body and are transmitted to others through close contact.

The papillomas caused by the virus are also very contagious. They are localized in the mouth and throat, resembling cauliflower... It is impossible to completely get rid of this disease. Specific therapy can only eliminate the signs of pathology.

Neoplasms

Separately, we should talk about cancer alertness. Oncological diseases today they are diagnosed very often and acquire the character of an epidemic. The mucous membrane of the mouth is especially vulnerable. She is regularly exposed to all kinds of irritants - cigarette smoke, spicy, salty and hot food, mechanical stress from uncomfortable dentures.

Unfavorable factors provoke the appearance of non-healing microtraumas, which, with constant irritation, turn into oncology.

The appearance of signs of cancer requires immediate referral to a therapist or a narrow specialist

Precancerous conditions require special attention. Despite the fact that this is not yet a cancerous process, but only a background for its development, it is necessary to take a very responsible attitude to the situation. With proper treatment and timely diagnosis, it is possible to localize the pathological condition and achieve complete recovery.

Childhood diseases

The lesions of the oral cavity in children are in many ways similar to the pathologies of adults. They are also systematized by common reasons and featured. Below is a look at what pediatricians and pediatric dentists are most likely to encounter.

Stomatitis

Babies often develop all kinds of diseases of the oral mucosa. This is explained by imperfection immune system and childish restlessness. Children early age they pull into their mouths everything that attracts their attention, and the thing may turn out to be far from harmless in terms of transferring a bacterial and viral infection.

With aphthous (erosive) stomatitis, which is diagnosed especially often, ulcers with a white coating appear in the mouth. They are very painful and very disturbing to the child.

Herpes stomatitis is found no less often. Herpes itself is very contagious and is easily transmitted from a sick adult by kissing, through toys and other things that end up in the baby's mouth. In childhood, the infection develops against a background of fever, irritation and inflammation of the oral mucosa, and the appearance of bubbles.

With weakened immunity and excessive intake antibacterial drugs catarrhal stomatitis often develops.

Pyoderma

A similar ailment, as a rule, occurs in weakened and often ill children. It manifests itself as cracks in the corners of the lips and on the mucous membrane. It can occur as a result of vitamin deficiency or the entry of dirt into the oral cavity.

Trauma

Highly common reason diseases in childhood. Toys, cutlery, toothbrushes and many other items that children do not know how to use become traumatic factors.

Thrush

The disease most often occurs in children infancy... The causative agent is fungal infection, which a weak immunity is not yet able to resist.

Sometimes diseases of the teeth and gums become the cause of damage to the oral cavity, but this happens much less often than in adults. Babies are more likely to suffer from infectious and traumatic diseases than dental ones.

Thrush is a common occurrence in infants

General manifestations of pathologies

Diseases of the oral mucosa do not go unnoticed. They make themselves felt with a mass of unpleasant sensations and significantly reduce the patient's quality of life.

In general, when the mucous membrane is affected, the following symptoms develop:

soreness and dry mouth;
discomfort while eating, talking, drinking;
localization of irritation in the area of infection, the appearance of cracks, wounds, erosion;
loss of working capacity;
weakness, lethargy.

Complex inflammation of the mouth and tongue often leads to loss of taste, swelling and dryness of tissues, a feeling of swelling and numbness of the organ.

With stomatitis, the pains are quite strong. The patient's sleep and daily routine are disturbed. The mucous membrane becomes loose, bleeds and is easily damaged by hot drinks, a toothbrush, and dentures.

Some diseases are accompanied by the appearance of a cheesy plaque or a whitish film on the mucous membrane, the inside of the cheeks, pharynx and tongue. Often there is increased salivation, the submandibular lymph nodes swell and become inflamed. May appear unpleasant aftertaste or bad breath.

Treatment tactics

Pathological processes in the oral cavity imply complex therapy... Treatment is selected individually in each case and depends on the nature of the pathogen, the severity of symptoms and the presence of concomitant pathologies. The age of the patient also matters.

Local assistance

Diseases of the oral mucosa require regular treatment of foci of inflammation - ulcers, erosions, cracks, wounds and herpetic vesicles. For this purpose, pharmacy antiseptics or herbal infusions are used:

Furacilin;
Miramistin;
Stomatidin;
Chlorhexidine;
Malavit;
Octenisept
hydrogen peroxide solution;
boric alcohol;
sage, calendula, chamomile.

Pharmacy antiseptics used for mouthwash

Pathological ulcerations can be washed with ordinary soda dissolved in a glass of water. For spot treatment of foci of inflammation, blue or brilliant green is used. True, this one, in general, effective way there is a drawback - the mouth and tongue will be painted in a bright color.

For contact with ulcers and erosions, a gauze swab is used. In this case, cotton wool cannot be used. The slightest villi stuck on the surface of the expression will cause an exacerbation.

After disinfection, ulcers and wounds are lubricated with Solcoseryl, sea buckthorn or almond oil. With severe pain, drugs with anesthetics are prescribed - Kamistad gel, Lidocaine or Novocaine solution. With the viral nature of the disease, the patient is prescribed Acyclovir, Valtrex, Famvir, Valacyclovir.

The local treatment of diseases of the oral cavity also includes dental debridement of foci of inflammation. Diseased teeth are removed or filled, lost teeth are restored.

Diet

Diseases of the oral cavity require adherence to a special diet. Dishes should not be hot, spicy or sour. In order not to aggravate the pathological condition, patients are advised to abandon the following products:

tomato, apple and other juices;
marinades, spices;
spicy and sour dressings, sauces;
alcohol;
citrus;
biscuits, crackers, chips;
seeds.

Food should be pleasantly warm, soft and gentle. The patient is shown cereals, slimy soups, dairy products, boiled vegetables. After eating, it is recommended to thoroughly rinse your mouth with an antiseptic or infusion of anti-inflammatory herbs. If this is not done, food particles will cause bacteria to proliferate.

If the mucous membrane is severely damaged, when any food causes discomfort, the use of dry nutritional mixtures can be recommended.

Medicines

With the pathological development of the disease, patients are prescribed general therapy, aimed at destroying the pathogen and eliminating the symptoms of the disease. For this purpose, the following groups of medicines are used:

antibiotics - Amoxiclav, Sumamed, Metronidazole, Flemoklav Solutab, Augmentin, Ciprofloxacin;
drugs that improve microcirculation - Agapurin, Vazonit, Latren, Pentilin, Pentoxpharm, Pentoxifylline NAS, Trental;
vitamin and mineral complexes in capsules and injections;
antihistamines- Suprastin, Tavegil, Claritin;
immunostimulants - Viferon, Echinacea tincture, Amixil, Viferon, Neovir, Arbidol.

For moderate and severe mucosal lesions, drugs are prescribed

Oncologists are involved in the treatment of cancerous growths. In this case, in addition to medications, the patient is prescribed chemotherapy.

How to protect yourself

The prevention of mucosal diseases is based on hygiene. Brush your teeth and rinse your mouth twice a day after every meal. In addition, dentists advise using dental floss every day.

For the prevention of diseases of the oral cavity, it is necessary to undergo an examination with a dentist every six months.

It is very important to visit regularly dental office and not only for treatment. Play a huge role preventive examinations... From identified in early dates it will be much easier to get rid of the disease than from a neglected ailment that has already caused a lot of complications.

Immunity plays a huge role in the prevention of diseases of the oral cavity. In most cases, mucosal lesions occur precisely at the time of weakening of the body's defenses.

Of course, it is very difficult to get sick. Unfortunately, it is not always possible to protect yourself from an illness. If the trouble has already occurred, and you feel that the infection has already entered the body, do not delay contacting a doctor.

The oral cavity of an adult is associated with the performance of many functions, due to which it reflects the state of the body. In particular, the mucous membrane demonstrates various pathological and systemic phenomena occurring in the body, characterizes the strength of immunity, the health of internal organs, etc. As a rule, diseases of the oral cavity in adults (you can see the photos and symptoms below) are divided into 3 types: diseases of the gums, teeth and mucous membranes.

First, let's find out what factors affect the state of the human mucous membrane:

haphazard, independent intake of antibiotics and potent drugs;
weak defenses, the presence of HIV, AIDS;
inflammation of the teeth and gums;
dysfunction and damage to internal systems;
the influence of sharp temperatures;
illiterately composed diet (predominance of too spicy or acidic foods);
the presence of bad habits (alcoholism, smoking);
the presence of inflammation, infections;
general dehydration;
avitaminosis;
unstable hormonal background;
hereditary predisposition.

Inflammatory processes of the teeth and gums provoke diseases of the oral mucosa

In a healthy state, the oral cavity contains bacteria and other organisms that are conditionally pathogenic. But under the influence of the above conditions, they provoke diseases of the mucous membrane: infectious, inflammatory, viral, fungal, lichen, as well as dysbiosis.

Infectious and inflammatory processes

TO infectious diseases oral cavity and tongue (photo below) include stomatitis. They are caused mainly by irregular and illiterate oral hygiene, and sometimes are the result of gastrointestinal diseases and some others (angina).

Viral diseases

These include infectious diseases, ulcerative necrotic stomatitis, as well as the consequences of sexually transmitted diseases.

But the most common viral "guest" in the mouth is herpes. Inflamed, it settles in the area around the mouth, but often spreads to the mucous membrane. Symptoms of such a lesion are erosive aphthae on the inside of the cheeks and lips, tongue, palate.

Sometimes herpes also affects the periodontal tissues, the gums, as a consequence of acute catarrhal gingivitis.

Fungal lesions

Fungal disease of the oral cavity in adults (photo below) is caused by the activity of yeast-like microorganisms of the Candida group.

Such fungi live in an inactive state in most of the population. But any external and internal factors ( pathological processes, weakening of immunity, hypothermia, etc.) activate them. As a result, the fungus forms on various mucous areas, including in the oral cavity, which indicates the development of candidiasis.

Types of disease:

Lichen disease

As a rule, the mucous membrane is affected by lichen planus. At the same time, it can appear on the skin. It is a consequence of a weakened immune system, as well as systemic diseases of the gastrointestinal tract, liver, diabetes mellitus, hereditary predisposition to pathology.

The disease occurs in acute form(month), subacute (up to six months) and long-term (more than 6 months).

The main symptoms: redness of the mucous membrane, the appearance of blistering rashes, erosions and ulcers, plaques.

Dysbacteriosis

This ailment is just a consequence of the illiterate use of antibiotics, as well as the use antiseptic local impact in the treatment of colds.

Symptoms of the disease on early stage practically invisible: bad breath, cracks in the corners of the lips. The development of the disease is accompanied by loosening of the teeth, the appearance of concomitant ailments such as periodontal disease. Also, plaque is intensively formed on the teeth, corroding the enamel.

The appearance of cracks in the corners of the lips is a sign of dysbiosis

With an untimely restoration of the microflora of the oral mucosa, dysbiosis can cause damage to the receptors of the tongue, affect the vocal cords and the function of the glands.

Above, we examined diseases of the oral cavity in adults. We turn to diseases and pathologies of teeth and gums.

Major diseases of the tooth and gums

Let's get acquainted with the common reasons:

weakened immunity;
improper diet;
bad habits;
diseases of the mucous membrane itself;
injuries and microcracks, including those obtained as a result of dental manipulations;
lack of trace elements (fluoride, calcium, etc.), vitamins in the body;
allergies to dentures, types of food, oral solutions and drugs, etc.;
the presence of infections, viruses, inflammatory processes;
increased deposition of plaque and stone, which leads to the occurrence of caries;
poor oral hygiene.

We present diseases of the oral cavity in adults (photo below), which are affected by the above conditions.

Periodontal disease... A rare and complex disease leading to the depletion and destruction of periodontal tissues. It can be asymptomatic without causing discomfort or pain. It is often detected already at the stage of overflowing into a more complex form - periodontitis.

Symptoms can be seen on visual inspection of the oral cavity. As a rule, exposed necks or roots of the tooth are visible due to the change in the shape of the gums. The papillae between the teeth atrophy, which also leads to a change in the position of the teeth.

Paradontitis... It is a consequence of periodontal disease and is caused by additional factors: metabolic disorders, weakening of the body's defenses, lack of proteins and vitamins, concomitant neuro-somatic pathologies, illiterate regular oral hygiene, environmental factors, improper diet (too little hard and rough food). Also, the disease can be a consequence of gingivitis.

Paradontitis

Symptoms of the disease are different: gums bleed, bad breath appears, plaque quickly appears. In advanced stages, soft tissue edema, abscesses, pain and loosening of the teeth.

Gingivitis... It occurs against the background of diseases of the gastrointestinal tract, the endocrine and cardiovascular system, the introduction of infections, allergic reactions, or is the result of a disorderly diet, exposure to adverse environmental factors, hormonal changes.

Symptoms: bleeding gums, burning and itching in them, bad breath, and ulcers and necrotic areas are possible.

Xerostomia... Often appears in diabetics, it is a consequence of an allergic reaction, other pathologies.

Symptoms are as follows: dry mucous membrane, inflammation, itching, burning, decreased salivary secretion, inflammation of nearby glands.

Heilit... It is an ailment characteristic of the red area of the lips, which has inflammatory or trophic processes. The reasons for its appearance are as follows: hormonal imbalance, the action of viruses or fungi, prolonged exposure to the sun, allergies, lack of B vitamins, neurogenic factors.

The main symptoms are: inflamed and painful seizures in the corners of the lips, hyperemia of soft tissues and their edema.

All of the above ailments are treated exclusively by systemic doctors and dentists.

Stomatitis Is an inflammatory disease of the mucous membrane in the oral cavity. The disease is a consequence of a defense reaction on the action of a variety of stimuli. Inflammation of the oral cavity often manifests itself in children, however, at present, such inflammation is also typical for adult patients, since an unfavorable environmental situation affects people's health, as well as a massive deterioration in the function of the immune system.

The causes, symptoms and features of the treatment of stomatitis, as well as what types of this disease are determined by specialists, will be discussed in this article.

What is stomatitis?

Nowadays, this is a common problem among the population. At the same time, many patients who develop stomatitis for the first time, what it is, find out only after consulting a doctor. It is important that inflammation of the oral cavity is detected in a timely manner so that adequate treatment... Therefore, if a person has White spot on the inside of the lip, soreness and discomfort is noted, you need to quickly seek the advice of a specialist.

Causes of stomatitis

Wikipedia indicates that often the causes of stomatitis in adults are associated with negative impact a number of bacteria, viruses, pathogens of infectious diseases leading to the appearance mouth ulcers ... Nevertheless, answering the question of what causes this disease, it should be borne in mind that for the reproduction of pathogenic microflora, the presence of additional factors that provoke the development of the disease is necessary. After all, when normal condition health in humans, bacteria are constantly present on the oral mucosa and do not cause negative processes.

Therefore, determining what causes stomatitis, experts identify a number of reasons:

An unbalanced diet is an irrational diet, in which the body does not enter enough B vitamins , iron , zinc and etc.

Trauma - if an injury of thermal, mechanical, chemical origin occurs in the oral cavity (irritation, burns and blisters, a person has bitten the skin from the inside, other damage to the mucous membrane has occurred). In particular, the cause of stomatitis is often a cheek bite, a wound left by a sharp fragment of a tooth, a wound from solid food. Most often, such an injury passes without a trace, but sometimes, in the presence of others negative factors a sore develops.
Ignoring the principles of personal hygiene, consumption of dirty fruits and vegetables, untimely hand washing.
Substandard dentures (incorrectly selected prosthetic material, poorly installed prostheses).
Excessive obsession with dental hygiene, in particular if applied Toothpaste, which includes sodium lauryl sulfate ... Under its influence, salivation decreases, which ultimately leads to dehydration of the oral cavity. Such abuse leads to the fact that the mucous membrane becomes susceptible to the influence of acids, etc.
Taking certain medications - if the person is taking medications that reduce the production of saliva, as well as diuretic pills.
Mouth ulcers often appear if a person is accustomed to constantly smoking, regularly consuming alcohol.
The disease develops after , radiation, application of other methods of treatment of malignant diseases.
The disease occurs against the background of concomitant ailments. If the functions of a certain system are disrupted in the body, the appearance of a sore may be an indication that a person's health is impaired. For example, sometimes it turns out that patients have formed malignant tumors pharynx, neck, nose, etc.
For diseases of the digestive system, infection the appearance of ulcers on the tongue and in the mouth may be noted.
May be due to dehydration after prolonged vomiting, diarrhea, significant blood loss, (long elevated temperature body).
HIV-infected people are at increased risk of developing this disease.
During the period , sores can appear as a result of hormonal surges.
People who get sick often develop aphthous stomatitis.
Those who suffer and, accordingly, use hormones in the inhaler, manifest the candidal type of the disease.
Frequent manifestations are noted with anemia .
The development of the disease is possible after.

Stomatitis in the mouth, classification

Mouth ulcers, causes and treatment are determined, first of all, depending on the causative agent of the disease. There is a certain classification of the disease depending on which pathogen caused the white spots to appear. What stomatitis looks like in the mouth also depends to a certain extent on the pathogen.

Type of disease	Description
Bacterial	It manifests itself as a result of the action staphylococci or streptococci ... With this form of the disease, a purulent rash appears (it is easy to see in the photo), which subsequently quickly opens up. As a result, mouth ulcers and erosion are formed.
Viral	Consequence of defeat by the herpes simplex virus (herpes stomatitis) Epstein-Barr (herpetic stomatitis). Such pathogens provoke the appearance blistering eruptions containing clear liquid... Later, the accession of the secondary bacterial infection... Further, they are opened, and erosion appears. Similar mouth ulcers also appear with. How to treat wounds, the doctor determines, finding out the cause of the development of the disease.
Gribkova(candidal stomatitis)	As a rule, it manifests itself after a course with which the patient is trying to cure other diseases. Fungal stomatitis in the mouth, the photo of which clearly demonstrates dense, appears due to the action that the Candida fungus has. After deleting white bloom in the mouth, on the tonsils, painful erosion is observed.
Ray	The consequence of radiation sickness also develops after chemotherapy. In the patient, erosions appear in the oral cavity, in certain areas the mucous membrane thickens.
Chemical	As a result of burns caused by acid or alkali. Later, scarring and deformation of the mucous membrane occurs.
Erosive	It manifests itself after the transferred diseases and is characterized by the occurrence of erosion.

Also, depending on concomitant diseases, allocate syphilitic , streptococcal stomatitis.

Stomatitis symptoms

As a rule, the signs of stomatitis are the same for any of the types of disease described above. Most often, symptoms in adults are mild. There are no signs of degenerate intoxication - heat etc. As a rule, the onset of the disease occurs after the appearance of a slight redness - these are the first signs of the disease. Further, the area near the lesion becomes edematous, it swells, pain and burning appear.

With the bacterial form of the disease, the next day, a round or oval sore with smooth edges appears at the site of the focus, and a red spot is a halo around. In the center of the ulcer there is a thin white film.

In addition, the patient is worried about the strong secretion of saliva, bleeding gums , noted bad smell from mouth. The pain is constantly disturbing and is so severe that it interferes with normal chewing, moving lips and tongue.

At acute current disease, body temperature rises sharply, may increase lymph node or multiple lymph nodes. Pimples with stomatitis are mainly localized on the inner side of the lips - upper and lower, on the tonsils, in the palate. Pimples can also appear on the tongue, underneath.

Stomatitis in adults

Before starting the treatment of stomatitis in adults, the doctor must establish a diagnosis and determine which diseases of the oral cavity occur in a particular case.

Symptoms of all types of stomatitis in adults ( herpetic , aphthous , herpes , ulcerative ) appear gradually. Initially, slight redness and swelling appear on the mucous membrane. Then an ulcer occurs, the main signs of which are as follows:

single, round or oval, shallow;
a thin, loose white or gray film in the center of the ulcer;
smooth edges, reddish halo;
the ulcer is painful and creates noticeable discomfort.

Such diseases of the oral cavity, as a rule, last 4-14 days. The causes of frequent stomatitis in adults are described above, but if a person has had this ailment once, then the probability re-development disease is high. Sometimes symptoms in the mouth in adults and other types of stomatitis appear periodically, acquiring a virtually chronic form. In this case, only a doctor should determine the symptoms and treatment of this disease in adults, prescribing medications only after careful research.

There is currently no evidence that stomatitis is contagious. However, the latter does not apply to some of its forms.

Stomatitis treatment

If on the mucous membrane or on the tongue appears catarrhal stomatitis associated with a violation of the rules of hygiene, then, subject to its mild course, you can treat the disease yourself, first, having found out how to treat stomatitis with a specialist.

It is advisable to treat the affected surfaces and dentures soda solution, Lugol spray .

It is equally important to stick to a diet, since nutrition affects the patient's condition. To restore microflora, there should be no easily digestible carbohydrates in the menu of children and adults.

Treatment of aphthous stomatitis

How to treat this form of the disease depends on the degree of damage. Sometimes, after the appointment of a therapy regimen, aphthous stomatitis in adults is treated at home.

In the aphthous form, the appearance of lesions occurs against the background of a decrease in immunity. Only specialists can determine why sores appeared in the mouth, the causes and treatment, since some of them believe that the causes of this type of disease are associated with mucosal herpes infection. In the chronic form of the disease, white sores in the mouth of an adult appear periodically and appear on the cheeks, on the inner side of the lip, and sometimes in the throat.

With aphthous stomatitis, a person can note both single manifestations (for example, a white sore appeared on the gum), and multiple. In contrast to herpetic stomatitis, with aphthous, rounded white plaques appear, that is, aphthae with a red rim, which is noticeable in the photo. If a white sore appears in the mouth again, how to treat it depends on whether the stomatitis has turned into a chronic form. The disease can last for years, so it is important to immediately determine how to treat mouth ulcers.

With the aphthous form of the disease, treatment is carried out in stages. Initially, aft processing is carried out, for which a solution is used boric acid and a decoction of chamomile. An antiseptic rinse with a solution recommended by a specialist is also carried out. For example, the throat and mouth can be gargled with a mild solution. potassium permanganate or . You can also do other rinses. Intravenous use is practiced sodium thiosulfate for the purpose of desensitization and detoxification. Those who have been diagnosed with this disease of the oral mucosa are prescribed funds Prodigiosan , Lysozyme , Pyrogenal ... Means Lidocaine Asept contains local anesthetic and effectively acts in the aphthous form of the disease.

Also prescribed multivitamins, antihistamines, sedatives.

Since aphthous stomatitis develops in people suffering from diseases of the nervous, endocrine, digestive systems, recurrent stomatitis can be prevented by curing these diseases.

Catarrhal stomatitis treatment

The clinic of this form is such that for successful treatment it is necessary to eliminate the cause of its manifestation. If affected areas appear on the mucous membrane, they must be carefully treated with antiseptic solutions, Chlorhexidine ... The use of applications with lidocaine or benzocaine is practiced with severe pain.

A remedy, etc., is widely used, with which the lesions can be anointed after the appointment of this remedy. If after taking these funds the condition does not improve, it is advisable to go to the hospital. For the period of treatment, it is worth giving up the toothbrush so as not to irritate the gums. The use of folk remedies is also practiced: sea buckthorn oil, honey, etc. help from stomatitis.

Treatment of herpetic stomatitis

This type of disease manifests itself most often, because the carrier of the virus is the vast majority of the population. However, stomatitis on the lip or in other areas of the mucous membrane appears when a person has a deterioration in immunity.

antiviral drugs :

Oxolin .

So that the disease does not turn into chronic stomatitis, shows the use of immunostimulants, vitamin complexes.

Consider the fact that this type of sore mouth is contagious and can be transmitted through close contact, such as kissing. Therefore, if a person has a bubble on the gum, or in the mouth white sore how to treat and what its nature is, should be determined by a specialist. You should not fight such manifestations on your own - smear with brilliant green, drink antibiotics and practice other unconfirmed methods.

Treatment of allergic stomatitis

About a third of the population has a variety of allergic reactions associated with the action of certain allergens. It is with them that stomatitis in the tongue or in other places of the mucous membrane can be associated.

In this case, the causes of the sore are contact with dentures, medications, etc. Since this manifestation is not considered a separate disease, how to treat a sore on the tongue, as well as how to treat a wound, depends on the nature of the allergic reaction.

Treatment in adults is reduced to the use of antihistamines -,. Prevention comes down to eliminating the allergen.

The so-called prosthetic stomatitis , which is usually subdivided into the following types: allergic and bacterial ... When bacterial form stomatitis on the gums is manifested by reddening of the mucous membrane of the prosthetic bed. At allergic form redness can spread further, for example, stomatitis in the throat, etc.

Ulcerative stomatitis, treatment

What to do with stomatitis depends on its form. The ulcerative form manifests itself, like a number of others, against the background of deterioration of immunity, poor oral hygiene, etc., while a number of unpleasant symptoms are noted - the appearance of ulcers, bad breath, fever. If such stomatitis manifests itself in the palate or the place where the pimple was previously, in another place of the mucous membrane, is inflamed and sore, it is necessary to initially determine why sores appeared in the palate in the mouth, and then - how to treat the ailment.

The mild form of the disease can be cured with local remedies. It will be enough to practice a gentle diet and plentiful drink, Sand the sharp edges of the teeth and remove the tartar. For rinsing, the use of solutions is practiced hydrogen peroxide , chlorhexidine , furacilin , also herbal decoctions. To speed up the epithelialization process, regenerating agents are prescribed.

If the disease does not go away after a few days, but lasts a long time, detoxification and antibacterial treatment... Sometimes vitamins are also prescribed, general treatment, physiotherapy. If the focus, which has become inflamed, is treated in a timely manner, then the ulcers close after 6-8 days. If the disease persists long time, then its transition to a chronic form is likely.

Classification of diseases of the oral mucosa

(by etiological principle)

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

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

Diseases of the oral cavity caused by a specific infection (syphilis, tuberculosis);

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

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

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

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

Traumatic lesions of the oral mucosa

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

Acute mechanical trauma to the oral mucosa may occur as a result of impact, biting with teeth or injury from various sharp objects. At the site of exposure, hematoma, abrasion, erosion or deeper damage usually occur. As a result of secondary infection, these wounds can turn into chronic ulcers and cracks that do not heal for a long time.

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

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

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

Treatment traumatic injuries is reduced to the elimination of the cause, antiseptic treatment of the affected area, the use of keratoplastic agents.

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

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

To treat the child's oral cavity, weak antiseptic solutions should be used (3% hydrogen peroxide solution, herbal infusions with antiseptic action). Vigorous rubbing of the mouth and the use of cauterizing agents are not allowed. Treatment of the oral cavity should be carried out with cotton balls, making blotting movements. To accelerate epithelialization, the affected area is treated with an oil solution of vitamin A and other keratoplasty. It should be borne in mind that Bednar's aphthae heals very slowly - over several weeks.

Stomatitis for infectious diseases

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

Scarlet fever

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

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

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

Measles

The causative agent of the disease is a filterable virus. Infection occurs by airborne droplets. Incubation period 7-14 days. Measles is more common in children from 6 months to 4 years of age, but not infrequently at an older age. Clinical signs in the oral cavity appear in the prodromal period, when there are no other symptoms.

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

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

Spicy herpetic stomatitis(OGS)

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

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

Clinic OGS consists of symptoms of general toxicosis and local manifestations on the oral mucosa. The severity of the disease is assessed by the severity and nature of these 2 groups of symptoms. Allocate light, medium and severe OGS course. Flowing according to the type of infectious disease, OGS has four main periods: prodromal, catarrhal, rashes and extinction of the disease.

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

table... Clinical symptoms and treatment of OGS at various degrees of severity of the disease:

Severity of OGS
Severity of OGS	premonitory	catarrhal	eruptions	extinction of the disease
		Temperature 37.2-37.5 ° С.	The temperature is normal. Sleep and appetite are gradually restored. In the oral cavity - single aphthae.	The temperature is normal. The state of health is good. In the oral cavity, erosion at the stage of epithelialization
	Temperature 37.2 ° C. Symptoms of acute respiratory viral disease	Temperature 38-39 ° C. General state medium severity. Nausea, vomiting. Rash on the skin of the face. Lymphadenitis. Gingivitis.	Temperature 37-37.5 ° С. Sleep and appetite are bad. In the oral cavity, up to 20 aft, appearing in several stages (2-3). Gingivitis. Lymphadenitis.	The temperature is normal, the state of health is satisfactory. Sleep, appetite restored. Erosion at the stage of epithelialization.
	Temperature 38-39 ° C. Adynamia, nausea, vomiting, headache, runny nose, cough.	Temperature 39.5-40 ° С. The general condition is serious. Symptoms of intoxication are sharply expressed. Catarrhal ulcerative gingivitis. Lymphadenitis of the submandibular and cervical nodes.	Temperature 38 ° C. On the skin of the face and oral mucosa there are up to 100 elements that recur. The mucous membrane of the oral cavity turns into a continuous erosive surface. Necrotizing gingivitis. Lymphadenitis. Sleep disturbance, lack of appetite.	The temperature is normal. Sleep and appetite are restored slowly. Gingivitis. Lymphadenitis.
	Antiviral agents Pain relief of the mucous membrane. Removal of plaque from the surface of the teeth (daily with cotton balls). Hyposensitizing agents. Symptomatic treatment. At severe forms treatment is carried out in a hospital setting.			Keratoplastic funds

Fungal stomatitis

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

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

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

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

In adults, candidiasis often occurs as a chronic disease. In this case, the hyperemia and edema of the mucous membrane decrease, and the plaques become coarse and adhere tightly to the underlying base, leaving erosion when scraped. Deep transverse and longitudinal grooves, covered with a white coating, appear on the back of the tongue, signs of macroglossia due to edema, hyposalivation, burning sensation, aggravated by ingestion of spicy food, are often observed. The filiform papillae are smoothed or atrophied.

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

Acute pseudomembranous candidiasis. In the prodromal period, the mucous membrane of the tongue (often other parts of the oral cavity) becomes hyperemic, dryish, dotted white rashes appear on it, resembling curdled masses or whitish-gray easily removable films. In severe, advanced cases, plaque becomes denser, is removed with difficulty, exposing an eroded bleeding surface.

Acute atrophic candidiasis can arise as a further transformation of the above-described form or manifest itself primarily upon sensitization to the fungus. It is distinguished by dryness and bright hyperemia of the mucous membrane, severe soreness is typical. There are very few plaques, they persist only in deep folds.

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

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

Diagnosis of candidiasis is not difficult. A microscopic examination of scraping from the oral mucosa for the mycelium of fungi is carried out.

Treatment. In milder forms, local treatment is prescribed: a diet with the exception of sugar, confectionery, bread, potatoes; rinsing the mouth with a baking soda solution after a meal; oral cavity treatment with 5% borax solution in glycerin or Candide. In severe forms of the disease, diflucan, orungal, amphotericin B, clotrimazole, and other antimycotics are used. Enhance the action of antimycotics in local application of Dimexide; enzymes, potentiate their effect 2-16 times.

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

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

Changes in the oral mucosa in acute leukemia

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

In acute leukemia, in 55% of cases, there is an ulcerative-necrotic lesion of the oral mucosa, especially in the area of the soft palate, back and tip of the tongue. Histologically, numerous necrosis of the mucous membrane are determined, penetrating into the submucosa, and often into the muscle layer.

In some forms of leukemia, a kind of infiltration of the gums can develop. Infiltrates are located relatively shallow. The mucous membrane above them is hyperemic, ulcerated in places or its sections are rejected, which is often accompanied by sequestration of the alveolar ridge. The specificity of hypertrophic ulcerative gingivitis is confirmed by cytological and histological analysis.

The defeat of the lips in acute leukemia is characterized by thinning of the epithelium, dryness or hyperplastic changes. "Leukemic" seizures develop in the corners of the mouth. Necrotic types of aphthous eruptions may occur. With the defeat of the tongue, a dark brown bloom is noted, often ulceration of the back and lateral parts of the tongue (ulcerative glossitis); there may be macroglossia, bad breath. The teeth are often mobile, and when they are removed, prolonged bleeding is observed.

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

Chronic leukemia (myeloid leukemia, lymphocytic leukemia)

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

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

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

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

Lesions of the oral mucosa with iron deficiency anemia

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

Frequent symptoms are paresthesias of the oral cavity, inflammatory and atrophic changes, and disturbances in taste sensitivity. In the diagnosis of iron deficiency anemia, great importance is attached to changes in the language. The emerging spots of bright red color with localization on the lateral surfaces and the tip of the tongue are accompanied by a burning sensation, and often soreness with mechanical irritation. Decrease and perversion of olfactory and gustatory sensitivity is accompanied by loss of appetite. Paresthesias are noted in the form of a burning sensation, tingling, tingling, "bursting", manifested especially at the tip of the tongue. When spicy and salty food is taken, paresthesias intensify, and sometimes pain in the tongue appears. The latter is swollen, increased in size, the papillae are sharply atrophied, especially at the tip of the tongue, its back becomes bright red. In patients with late chlorosis, in addition, there is a perversion of taste sensations (the need to eat chalk, raw cereals, etc.). A common symptom of the disease is a violation of the salivary and mucous glands of the oral cavity. Patients note dryness of the mucous membrane. There are frequent violations of the integrity of the epithelial cover of the oral mucosa, painful, long-term healing cracks in the corners of the mouth (seizures), bleeding of the gums, which increases when brushing teeth and eating. Atrophy of the epithelial cover is expressed in thinning of the mucous membrane, it becomes less elastic and is easily injured.

V 12 folate deficiency anemia

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

Often the initial signs of the disease are pain and burning in the tongue, which is usually the case with patients. The mucous membranes are usually slightly subicteric, brown pigmentation in the form of a "butterfly" and puffiness are often noted on the face. With severe forms of the disease, minor petechiae and ecchymosis may appear. The mucous membrane of the oral cavity is pale, but, unlike iron deficiency anemias, it is well hydrated. Occasionally, areas of hyperpigmentation can be seen (especially the mucous membranes of the cheeks and palate).

The classic symptom is Hunter's (Gunther's) glossitis, which is expressed in the appearance on the dorsal surface of the tongue of painful, bright red patches of inflammation spreading along the edges and tip of the tongue, often further affecting the entire tongue. The disease is manifested by atrophy of the epithelium of the mucous membrane and the formation in the submucosa of an inflammatory infiltrate of lymphoid and plasma cells. Clinically, in the initial stages of the process, you can see areas of atrophy in the form of red spots of an irregular rounded or oblong shape, up to 10 mm in diameter, sharply delimited from other areas of the unchanged mucous membrane. The process begins at the tip and sides of the tongue, where a more intense redness is noted, while the rest of the surface is still normal. At the same time, there is soreness and a burning sensation not only when eating spicy and irritating food, but also when the tongue moves during a conversation. Subsequently, the inflammatory changes subside, the papillae atrophy, the tongue becomes smooth, shiny ("lacquered" tongue). Atrophy extends to the grooved papillae, which is accompanied by a perversion of taste sensitivity. According to Hunter, similar changes develop in the mucous membrane of the entire gastrointestinal tract.

On palpation, the tongue is soft, flabby, its surface is covered with deep folds, on the lateral surfaces there are imprints of teeth. In the area of the frenum of the tongue, its tip and lateral surfaces, miliary vesicles and erosion often appear.

Changes in the oral mucosa in diseases of the cardiovascular system

Changes in the oral mucosa in cardiovascular diseases are determined by the degree of circulatory disorders and changes in the vascular wall. In case of cardiovascular insufficiency, accompanied by impaired blood circulation, cyanosis of the mucous membranes is usually observed, as well as blueness of the lips. Swelling of the mucous membrane may occur, due to which the tongue enlarges, teeth imprints appear on the mucous membrane of the cheeks and tongue.

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

Against the background of violations of the cardiovascular and cardiopulmonary activity of the II-III degree, trophic changes in the oral mucosa may occur, up to the formation of ulcers. The ulcers have uneven undermined edges, the bottom is covered with a grayish-white bloom, there is no inflammatory reaction (non-reactive course). The ulcerative-necrotic process on the mucous membrane with circulatory disorders occurs against the background of a decrease in redox processes. The accumulation of metabolic products in tissues leads to changes in blood vessels and nerves, which disrupts tissue trophism. In such conditions, even with a minor injury to the mucous membrane, an ulcer is formed.

A.L. Mashkillayson et al. (1972) described vesicovascular syndrome... It consists in the appearance after trauma in patients with cardiovascular diseases on the oral mucosa of various sizes of bubbles with hemorrhagic contents. More often women aged 40-70 are ill. Bubbles exist unchanged from several hours to several days. The reverse development occurs by either opening the bladder, or by resorption of its contents. When the bladder is opened, the resulting erosion is rapidly epithelialized. Blisters occur more often in the soft palate, tongue, less often on the mucous membrane of the gums and cheeks. Signs of inflammation in the environment of the blisters and underlying tissues are usually not observed. Nikolsky's symptom is negative. Acantholytic cells in smears-prints from the surface of erosion of the opened bubbles are absent. Most patients with vesicovascular syndrome have a history of arterial hypertension. The connection of hemorrhagic bladders with changes in blood vessels as a result of cardiovascular diseases is not excluded. In the genesis of the vesicovascular syndrome, the permeability of capillary vessels and the strength of the contact of the epithelium with the connective tissue layer of the mucous membrane (the state of the basement membrane) are important. In this regard, with increased permeability of the vascular wall, as well as with its damage, hemorrhages are formed. In areas of destruction of the basement membrane, they exfoliate the epithelium from the underlying connective tissue, forming a bubble with hemorrhagic contents. Unlike true pemphigus, in the vesicovascular syndrome, the characteristic acantholysis and acantholytic cells are absent.

Specific changes in the oral cavity with heart defects are called Parks-Weber syndrome... At the same time, mucosal lesions, extensive telangiectatic hemorrhages are observed in the oral cavity; in the anterior third of the tongue - warty growths that can ulcerate ( warty tongue)

Changes in the oral mucosa in diabetes mellitus

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

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

In diabetes mellitus, inflammation of the marginal periodontium often occurs. At first, catarrhal changes and edema of the gingival papillae are noted, then pathological periodontal pockets are formed, the growth of granulation tissue is observed, and the destruction of the alveolar bone. Patients complain of bleeding gums, mobility of teeth, in a state of neglect - of their loss.

With the decompensated form of diabetes, there is a violation of the analyzer function of the taste receptor apparatus, the development of decubital ulcerations of the oral mucosa in the areas of its injury is possible. Ulcers are characterized by a long course, at the base of them there is a dense infiltrate, epithelialization is slowed down. The combination of diabetes mellitus with hypertension often manifests itself in the mouth as a severe form of lichen planus (Grinshpan's syndrome).

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

Chronic recurrent aphthous stomatitis (HRAS)

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

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

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

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

Treatment. It can be quite difficult to remove relapses of the disease. The best results are observed when the etiological factor is established. Treatment is carried out in two directions: treatment of the underlying disease and local therapy, aimed at eliminating pathological changes in the oral cavity.

Glossalgia

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

In general, to facilitate terminology, we propose to further use the term "glossalgic syndrome"

Glossodynia develops with an increase in the tone of the sympathetic part of the nervous system: with general vegetative dystonia, hyperthyroidism, endogenous hypovitaminosis B1, B2, B6, B12. Among the patients, persons with anxious and suspicious character traits, prone to excessive painful fixation, suffering from phobias of various diseases predominate. In such patients, iatrogenies easily arise due to the careless statements of the doctor. Glossalgia is observed with organic lesions of the central nervous system in the clinical picture of residual effects of arachnoencephalitis, cerebrovascular accidents, neurosyphilis, etc., with pathological occlusion, cervical osteochondrosis, deforming cervical spondylosis. In addition, glossodynia can develop against the background of disorders of the gastrointestinal tract, endocrine pathology (it is not uncommon in the climacteric period). The condition of teeth and periodontium, oral hygiene, the presence of dentures made of different metals, chronic trauma to the tongue due to malocclusion, sharp edges of teeth, tartar, improperly applied fillings, etc. are also of great importance. Some authors associate the occurrence of glossalgias with the pathology of the dentoalveolar system, disorders of the temporomandibular joint. The latter often lead to injury to the chorda tympani when displaced. articular head... There is information about the relationship between the manifestations of glossalgia and hepatocholecystitis.

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

Glossodynia often occurs after radiation and chemotherapy.

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

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

Most often, there are paresthesias such as burning, tingling, rawness, numbness. In about half of the patients, paresthesias are combined with pains in the tongue of a breaking, pressing character (the pain is diffuse, without clear localization, which indicates the neurogenic nature of the process). Pain syndrome usually recurs.

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

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

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

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

Usually, structural changes in the language in this disease are not observed, but in some cases areas of desquamation of the epithelium and signs of desquamative glossitis or "geographical" language are determined. In some cases, the tongue is enlarged (swollen), there are imprints of teeth on its lateral surfaces.

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

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

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

The principles of treatment of diseases of the oral mucosa

Etiotropic treatment;

Pathogenetic treatment;

Symptomatic treatment.

Symptomatic treatment includes:

a) elimination of local irritating factors (grinding of sharp edges of teeth, removal of dental plaque, elimination of the phenomena of galvanism);

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

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

d) antiseptic treatment (rinsing, baths and application of solutions of furacilin 1: 5000, hydrogen peroxide 3%, 0.02% aqueous solution chlorhexidine, herbal infusion: chamomile, calendula, sage);

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

f) stimulation of epithelialization processes (applications oil solution vitamin A, sea buckthorn oil, karatoline, rosehip oil, solcoseryl)

Rinsing: the patient draws a solution of the drug into his mouth and, with the help of the muscles of the cheeks, the floor of the mouth, the tongue, washes the mucous membrane.

Bath: the patient collects a solution of the drug in his mouth and holds it over the focus for 2-3 minutes.

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

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