Causes and treatment of ulcerative stomatitis. General information and the cause of the disease. What is this symptom

Most often, the appearance of Vincent's stomatitis occurs in people with low level immunity, especially against the background chronic diseases. Necrotizing stomatitis is one of the varieties bacterial stomatitis with pronounced necrotizing ulcers affecting soft tissues and oral mucosa. To a greater extent, young people under the age of thirty are susceptible to this disease, however, this does not mean at all that ulcerative necrotic stomatitis does not manifest itself in other age categories.

isolated leak this disease happens extremely rarely, since in most cases it is a complication of long-term illnesses gastrointestinal tract or a logical continuation of untreated catarrhal stomatitis. In this ulcerative form of the disease, damage to the mucous membrane is inherent in the entire depth of its layer with the possible formation of ulcers on the lips, the inside of the cheeks, on the gums, soft and hard palate and on the tongue.

Causes

The most important and obvious reason for the development of any form of stomatitis is poor oral care. In the absence of proper sanitation and timely treatment of diseased teeth and gums, the risk of pathogenic spirochetes of Vincent and spindle-shaped bacteria getting into the resulting microcracks and damage to the mucosa increases. As a result of the symbiosis of these bacteria and their active reproduction, ulcers form in the mouth, and soft tissues undergo necrosis and decomposition.

Often the cause of the development of Vincent's gingivostomatitis is the complications of such serious illnesses such as agranulocytosis, infectious mononucleosis, leukemia, poisoning of the body by prolonged exposure to salts of heavy metals, immunodeficiencies. IN this case fertile ground for development ulcerative stomatitis are periodontal disease, gingivitis, periodontitis, dental trauma, untreated deep caries, tartar and even wisdom teeth.

In addition, frequent smoking, drinking too hot drinks and food, stress and depression contribute to the development of inflammatory processes. favorable conditions work.

Symptoms

One of the most unpleasant signs of ulcerative stomatitis, in addition to severe pain — horrible smell from the mouth, formed due to rotting of soft tissues. In some cases, ulcerative stomatitis is not limited to the oral mucosa and spreads deep inside, affecting many vital organs. In this case, the following symptoms appear on the face:

• a sharp increase in body temperature, chills, fever;
• loss of strength, apathy, aching muscles and joints;
• gums swell, become loose and red;
• severe pain when eating, drinking and when trying to speak, because of which the patient is more often silent and sometimes completely refuses to eat;
• Enlargement and soreness of the cervical and submandibular lymph nodes;
• migraine-type headaches;
• increased salivation;
• an increase in leukocytes in the blood according to the results of the analysis;
• the number of ulcers is constantly increasing, the older ones are covered with a gray film, when removed, a deep bleeding and non-healing wound is exposed;
• there is constant bleeding of the gums;
• in rare cases, if left untreated, necrosis can affect not only soft tissues, but also the alveolar process, as a result of which teeth can be severely damaged and even fall out;
• if treatment is neglected, pathogenic bacteria can go to the palatine tonsils, resulting in both adults and children can become Simanovsky-Vincent's angina.

Treatment

Bacterial causes of this disease involve treatment with antibiotics, anti-inflammatory and disinfectant drugs. The most commonly prescribed medications are:

1. Rinsing and processing with a weak solution hydrogen peroxide, furatsilina or potassium permanganate;
2. Solutions of trypsin, pancreatin, chemotripsin and other proteolytic enzymes to remove tissues prone to necrosis;
3. Trichopolum, flagyl, metrogil, dioxidin or klion for a week;
4. Fortifying agents, immunomodulators, vitamin-mineral complexes for raising immunity;
5. Antibiotics: ampioks, gentamicin, lincomycin, penicillin, kanamycin;
6. Antihistamines to relieve possible adverse reactions from antibiotics;
7. Keratoplasty: metacil, solcoseryl, retinol acetate, aloe and kalanchoe juice, sea buckthorn oil.

How to treat sores on the tongue and soft tissues oral cavity, your attending physician will tell you in detail at the appointment in dentistry. Proper treatment contributes to the removal of the main symptoms within one to two days and the healing of ulcers within a week.

Prevention

The main rule is the observance of oral hygiene! If you're vigilant about your gums and teeth, brush them at least twice a day. medicinal pastes and visit your dentist regularly for check-ups, removal of plaque and tartar your chance of getting this disease is extremely low. And, of course, serious illness that lead to necrotizing stomatitis should not be left untreated. Eliminate the cause and complications will bypass you.

There are many pathologies of the oral mucosa, often their diagnosis and treatment become big problem even for experienced professionals. One of the exceptions is Vincent's ulcerative necrotic gingivostomatitis. It is enough to encounter it only once, then to confidently recognize this disease in any of its manifestations.

Ulcerative necrotic stomatitis - infection oral cavity caused by specific pathogens. It was very common during the First World War and was called "trench mouth" or "trench disease".

Video: stomatitis

Causes

Pathogen

The immediate cause of the disease is the symbiosis of opportunistic microorganisms - fusiform bacillus and Vincent's spirochete.

Normally, they are natural inhabitants of periodontal pockets, and are also found in abundance under hoods - gum folds over incompletely erupted lower third molars. Under adverse conditions, they multiply rapidly, acquiring pathogenic properties.

Provoking factors

Provoking factors should include such as:

• lack of high-quality hygienic care for the oral cavity;
• hypothermia of the body;
• prolonged stress;
• unbalanced diet, especially lack of vitamins;
• abundance of tartar;
• advanced form of catarrhal gingivitis;
• decrease in body resistance due to infectious and viral diseases;
• suppression of the activity of other microflora of the oral cavity with the irrational use of antibacterial drugs.

The mechanism of the development of the disease

Ulcerative necrotic stomatitis of Vincent begins acutely against the background of a significant decrease in the body's resistance and in the presence of adverse factors in the oral cavity (lack of hygienic care, abundant dental deposits, etc.).

The activated anaerobic symbiosis of the fusiform bacillus and Vincent's spirochete practically displaces most representatives of the microflora of the oral cavity.

There is a sharp soreness, swelling and bleeding of the gums, accompanied by the formation of abundant necrotic plaque. Multiple dense necrotic layers appear, which are very difficult to separate from the mucosa, and an ulcerated, hyperemic surface is exposed.

In the future, suppuration from pathological periodontal pockets is observed. All this is accompanied by general weakness and fever.

In case of inadequate treatment acute form disease can become chronic. Often there is chronic ulcerative stomatitis in children, especially of school age, who neglect oral care. It manifests itself in the form of swelling of the gums with small ulcerations in the region of some gingival papillae.

It is also possible to exacerbate chronic stomatitis. It usually occurs as a consequence of the transferred colds and also after severe stress.

Symptoms

Symptoms depend on the severity of the disease:

• Easy degree. The patient complains of pain and bleeding in the gums while eating, bad smell from the mouth, and increased salivation. An objective examination reveals diffuse swelling of the gums, the gingival papillae are edematous, bleed easily from touch and are very painful. The general condition of the body usually does not suffer.
• Average degree. The patient's complaints increase significantly. The contour of the gingival margin is distorted, covered with bleeding necrotic crusts of gray-green color with putrid fetid odor. Suppuration is observed from the periodontal pockets. Lymphatic nodes are enlarged, mobile and painful. The patient's condition worsens: general weakness, inactivity and apathy, the temperature rises to 38°C.
• Severe degree. The patient's condition is similar acute sepsis. Body temperature can change abruptly from an increase to 40°C to a decrease to 35°C, which indicates a significant decrease in the body's resistance. The patient is tormented by severe headaches, as well as pain in the oral cavity. Ulceration of the mucosa from the gums extends to the cheeks, palate and floor of the mouth. With significant progression, damage to the bone tissue of the jaws is possible.

Diagnostics

Diagnosis of ulcerative necrotic stomatitis does not cause difficulties. This takes into account the anamnesis, as well as an assessment of the general condition of the patient and the data of an objective examination.

At severe course diseases, as well as with a low effectiveness of the treatment, differential diagnostics should be carried out with such diseases and pathological conditions as:

• blood diseases accompanied by ulceration of the oral mucosa (leukemia, agranulocytosis);
• mercury poisoning;
• secondary syphilis;
• AIDS.

To clarify the diagnosis, a detailed blood test is performed, as well as the Wasserman reaction. Urine is tested for mercury content.

The most accurate answer is given by a study of a smear taken from the oral mucosa, the predominance of fusiform rods and spirochetes confirms the diagnosis of ulcerative necrotic stomatitis.

Treatment

Treatment of ulcerative necrotic stomatitis begins with anesthesia of the oral mucosa.

Preference should be given to application anesthesia, since when injections are carried out in conditions of extensive damage to the mucosa by anaerobic microflora, numerous complications are possible associated with their penetration into the deep tissues of the maxillofacial region.

Stages of treatment:

1. Softening and removal of necrotic tissue.
2. Antibacterial therapy.
3. Restorative and desensitizing therapy.

Preparations

For treatment, the use of non-irritating medicines. So for pain relief it is better to choose more gently active solution anesthesin in glycerin than the more powerful 10% lidocaine hydrochloride solution.

To remove necrotic tissue, mechanical methods should not be used, because. this will cause additional injury to the ulcerated mucosa.

First you need to put gauze swabs moistened with solutions of proteolytic enzymes such as chymotrypsin, trypsin or chymopsin. They soften non-viable tissues without affecting intact ones.

The areas of inflamed mucosa cleared of necrotic crusts should be carefully treated with antimicrobial and antiseptic drugs that are active against anaerobic microflora.

Most preferably, the use of a combination of metronidazole (trichopolum) with a solution of chlorhexidine bigluconate. However, it is also possible to use solutions of hydrogen peroxide and potassium permanganate.

From general treatment The following medications should be given:

• desensitizing drugs (tavegil, suprastin or fenkarol);
• vitamins (large doses ascorbic acid with routine)
• with a severe degree of the disease - antibiotics a wide range actions.

After removing the severity of inflammation, it is necessary to carry out an extended sanitation of the oral cavity - removal of supra- and subgingival dental deposits, elimination of traumatic dentures, treatment of caries and its complications.

If possible, it is better to postpone the extraction of teeth until the signs of inflammation are completely removed.

To improve the healing of ulcerative surfaces, ointments, such as Solcoseryl, help well, but other keratoplastic agents can also be used ( oil solutions vitamins A and E, etc.).

Treatment is practically no different from that of adults. However, it should be noted that the child may be capricious, afraid and interfere with the quality treatment of the oral cavity.

Diet

Since, with necrotizing ulcerative gingivitis, the oral mucosa is extremely sensitive to even the lightest influences, food should not be irritating - warm, not rough, and also not spicy.

Requires protein and fortified diet. It is desirable to exclude viscous and sticky products that make it difficult to treat with antiseptics and hygienic care.

Forecast and prevention

In the absence of treatment, as well as in case of its insufficiency, the disease usually progresses.

An increasing area of ​​the oral mucosa is involved in the inflammatory process, with the possibility of further damage to the skin of the face.

However, with the timely start of treatment, relief occurs after the first visit and the patient quickly recovers. In the future, such patients need regular monitoring at the dentist at least 2-3 times a year, and the next visit should be no later than two months after the end of treatment.

One of the most important measures for the prevention of necrotizing ulcerative gingivitis is careful oral care.

It is also important to timely professional removal of hard dental deposits and the elimination of other factors leading to injury to the mucosa. Emerging viral and infectious diseases should be avoided and promptly treated.

FAQ

Is it possible to treat folk remedies?

Ulcerative necrotic gingivitis does not come completely unexpectedly, it occurs where the body's resistance has already been significantly reduced and all conditions have been created in the oral cavity for the rapid progression of the disease.

Therapeutic dentistry. Textbook Evgeny Vlasovich Borovsky

11.3.2. Ulcerative necrotic stomatitis Vincent

Ulcerative necrotic stomatitis Vincent (stomatitis ulceronecroticans Vincenti) is an infectious disease caused by spindle-shaped sticks (Bacillus fusiformis) and Borellia vincentii.

Described under various names: ulcerative gingivitis and ulcerative stomatitis, ulcerative-membranous stomatitis, fusospirochetal stomatitis, Plaut-Vincent stomatitis, "trench mouth", ulcerative-membranous stomatitis, etc. modern classification the disease is called "Vincent's ulcerative necrotic stomatitis", or "Vincent's stomatitis". In the case of gum disease, the disease is defined as Vincent's gingivitis; with simultaneous damage to the gums and other parts of the mucous membrane - Vincent's stomatitis, and with the localization of the process in the area palatine tonsils- Simanovsky's angina - Plaut - Vincent.

Etiology. Ulcerative necrotic stomatitis of Vincent is caused by a symbiosis of the fusiform rod and Vincent's spirochete. Under normal conditions, these microorganisms are representatives of the resident microflora of the oral cavity and are detected in a small amount all people with teeth. They are found mainly in the gingival groove, periodontal pockets, carious cavities, crypts of the palatine tonsils. In an unsanitized oral cavity, with its poor hygienic condition, as well as with periodontitis, the number of fusobacteria and spirochetes increases sharply. The development of necrotizing ulcerative stomatitis Vincent is associated with sharp decline the body's resistance to infection, which can occur as a result of past viral diseases (acute respiratory infections, herpetic stomatitis, pneumonia, etc.). beriberi, stress, overwork, malnutrition. Ulcerative necrotic gingivitis often complicates the course of severe general diseases (leukemia, agranulocytosis, pneumonia, infectious mononucleosis). May occur as a complication of multiforme exudative erythema, erosive allergic stomatitis. Virulence of fusobacteria and spirochetes increases when specific and nonspecific defense mechanisms are violated in the body. Their number increases to such an extent that they become dominant compared to other microflora. The decrease in the overall resistance of the body negatively affects the resistance of the oral mucosa - it cannot play the role of a reliable barrier to the introduction of infection, and the violation of its integrity, which always occurs in an unsanitized oral cavity, due to the presence of local traumatic factors (sharp edges of teeth, prostheses, deposits of tartar, etc.) creates conditions for the introduction of fusobacteria and spirochetes. Therefore, Vincent's ulcerative necrotic stomatitis often develops in people with an unsanitized oral cavity and an unsatisfactory state of hygiene.

Despite the fact that cases of group morbidity with Vincent's stomatitis are known (in military units, schools, kindergartens), this disease is considered non-contagious, and such cases are explained by similar unfavorable living conditions (malnutrition, lack of vitamins, lack of hygienic measures for oral care, etc.).

Clinical picture. Affects predominantly individuals young age(17–30 years), mostly men.

The provoking factor in the development of Vincent's ulcerative necrotic stomatitis is often hypothermia, which explains the highest frequency of its occurrence in the autumn-spring period; The maximum cases of morbidity occur in the period from October to December.

Clinically, acute and chronic course of necrotizing ulcerative stomatitis of Vincent is distinguished, and according to severity - its mild, moderate and severe form.

The disease begins acutely with an increase in body temperature to 37.5-38 ° C. Regional The lymph nodes increase, thicken, become painful on palpation, retain mobility. Patients are worried about headache, general weakness, soreness of the oral mucosa, aggravated by eating, talking, bleeding gums, hypersalivation, putrid breath.

Catarrhal phenomena on the oral mucosa quickly turn into ulcers. The process most often begins on the gums, and then moves to other parts of the mucous membrane. Gums become swollen, hyperemic mi, sharply painful and bleed when touched. The epithelium of the gingival margin and interdental papillae becomes cloudy and then necrotic. As a result, the gingival margin looks as if cut off, with uneven notches, its surface is covered with an easily removable grayish-yellow coating. Subsequently, the affected gingival margin is not fully restored and remains deformed. Most often and to a greater extent, the area at the lower eighth teeth is affected, where necrosis with alveolar process quickly spreads to the buccal mucosa and the retromolar region, causing in some cases trismus and pain when swallowing. Ulcers on the mucous membrane of the cheeks can reach large sizes(up to 5–6 cm in diameter) and depth (Fig. 11. 1 5). Their edges are uneven, soft. The bottom is covered with a thick grayish-greenish necrotic coating, which has a putrid fetid odor, after the removal of which the bleeding bottom of the ulcer is exposed. There is no compaction in the area of ​​the base and edges of the ulcer. The mucous membrane around the ulcer is edematous, hyperemic. If there are local traumatic factors in the oral cavity (roots of destroyed teeth, sharp edges of teeth, prostheses), other parts of the oral mucosa (hard, soft palate, arches, tonsils, tongue) may also be affected. Ulcers in the oral cavity can be single or multiple, various sizes and depth. When the ulcer is localized on the hard palate, necrosis of all layers of the mucous membrane develops quite quickly and the bone is exposed. Isolated pharyngeal lesion(Simanovsky's angina - Plaut - Vincent), as a rule, is unilateral, in the practice of a dentist it is rare. 2–3 weeks after the onset of necrotizing ulcerative stomatitis, the process usually resolves with complete epithelialization of the ulcerative surfaces.

Rice. 11.15. Acute ulcerative necrotic stomatitis of Vincent. An extensive ulcer of the buccal mucosa along the line of teeth closure in the area of ​​large molars, covered with necrotic plaque.

In rare cases, when treatment is not carried out or it is ineffective, a chronic form of necrotizing ulcerative stomatitis of Vincent develops, in which general symptoms missing. Patients are concerned about constant bleeding and soreness of the gums, as well as bad breath. The clinical picture is blurred, the gum is stagnant-hyperemic, edematous, its ulcerated edge is often compacted, necrotic areas are located mainly in the interdental spaces and can be seen during a cursory examination. With careful examination and probing of the gingival margin, exposed bone tissue is determined. Affected areas are present only in some teeth. Lymph nodes (submandibular, submental) in patients with chronic ulcerative necrotic stomatitis of Vincent are compacted, slightly painful. With a disease duration of 4–8 months, the lymph nodes acquire a cartilage-like consistency.

Rice. 11.16. Histological picture in Vincent's ulcerative necrotic stomatitis. Area of ​​tissue necrosis in the superficial layers (1), maturing granulation tissue (2), edema and small cell infiltration (3).

When pathohistological examination of areas of the ulcerated edges of the gums, two zones are revealed: superficial - necrotic and deep - inflammatory (Fig. 11.16). In the surface layers of the necrotic gum tissue, a rich and diverse microflora (cocci, bacilli, fusobacteria, spirochetes, etc.) is revealed. Fusobacteria and spirochetes sharply predominate in the deeper layers (Fig. 11.17). Deep layers connective tissue inflamed: they are edematous, the vessels are dilated. In the perivascular inflammatory infiltrate, shaped elements blood. In the same zone of inflammation inside intact tissue, only spirochetes that have penetrated between epithelial cells are found.

The cytological picture of scrapings from the ulcerative surfaces of the mucous membrane in patients with Vincent's ulcerative necrotic stomatitis corresponds to a nonspecific inflammatory process. At the beginning of the disease, an abundance of structureless masses is determined, a sharp predominance of neutrophils, mainly in a state of decay, and erythrocytes (due to severe bleeding). In the second period of the disease, when healing begins, along with decayed neutrophils, full-fledged phagocytic cells and many macrophages appear. During the period of epithelialization, layers of young epithelial cells appear, the number of fusobacteria and spirochetes decreases.

Rice. 11.17, Acute ulcerative necrotic stomatitis. Fusospirochetosis. Scraping from an ulcer. Fusobacteria and spirochetes (1), neutrophils in the stage of deep decay (2). Cytogram. x 700.

In the chronic course of Vincent's ulcerative necrotic stomatitis, the relative number of fusobacteria and spirochetes decreases and the number of cocci increases, but fusospirochetes still prevail.

Vincent's ulcerative necrotic stomatitis is diagnosed on the basis of characteristic clinical picture and detection of an abundance of spindle-shaped fusobacteria and spirochetes in scrapings from the surface of ulcers.

Differential Diagnosis. Ulcerative necrotic stomatitis of Vincent must be differentiated primarily from ulcerative lesions with blood diseases (leukemia, agranulocytosis, infectious mononucleosis). Along with clinical differences (pallor of the oral mucosa, the presence of hemorrhages, leukemic infiltrates, severe and prolonged bleeding of the gums in blood diseases), the detected changes in the peripheral blood in leukemia, agranulocytosis, and infectious mononucleosis are of decisive importance in this case.

Vincent's ulcerative necrotic stomatitis is differentiated from allergic stomatitis on the basis of anamnesis data, features of clinical manifestations and results of bacterioscopic examination.

An ulcerative necrotic process in the oral cavity, similar to Vincent's stomatitis, can occur with mercury intoxication. If contact with mercury is detected, a urine test for mercury content is performed.

It should be remembered that ulcerative-necrotic lesions of the oral mucosa can complicate the course specific infections(syphilis, HIV infection) or malignant tumors (cancer, sarcoma). To avoid diagnostic errors in these cases, you should carefully collect an anamnesis, take into account not only local, but also general clinical manifestations diseases and conduct the necessary laboratory tests (clinical blood test, Wasserman serological tests or for the detection of HIV infection, cytological, bacterioscopic, pathohistological, etc.).

Treatment. Volume medical measures with ulcerative necrotic stomatitis, Vincent is determined mainly by the severity of its course. Since the disease often occurs in young people, most of them practically healthy, local treatment is of decisive importance. The earlier and more thoroughly the treatment of the oral cavity is carried out, the faster the patient's condition improves. High-quality processing of the oral mucosa, removal of traumatic factors are decisive in the further course and outcome of the disease.

Local treatment consists in removing local traumatic factors, necrotic tissues, affecting the microflora and stimulating the processes of regeneration of the oral mucosa. Treatment of the oral cavity should begin with anesthesia. For this purpose, application and injection anesthesia with solutions of pyromecaine, trimecaine, lidocaine is used. After that delete everything mechanical stimuli: grind sharp edges of teeth and prostheses, remove tartar and plaque. Carious cavities should be treated with antiseptic solutions. The removal of decayed teeth should be postponed until the ulcers are epithelialized, since the removal of teeth in the infected oral cavity of a patient with ulcerative necrotic stomatitis is fraught with serious complications (alveolitis, periostitis, abscess, phlegmon). Purification of ulcerative surfaces from necrotic tissues is carried out using proteolytic enzymes: trypsin, chymotrypsin, lysoamidase, deoxyribonuclease.

The entire oral cavity is treated with warm solutions of antiseptics (0.5% hydrogen peroxide solution, 1% chloramine solution, 0.06% chlorhexidine solution, 0.5% aethonium solution, potassium permanganate solution 1:5000, etc.). Gingival pockets, the surface of the ulcer, interdental spaces and undercapillary spaces are best washed with a jet under pressure. On the first visit, the entire oral cavity should be treated. Further processing is carried out daily. At home, the patient is prescribed warm antiseptic rinses: 3% hydrogen peroxide solution (2 tablespoons per glass of water), 0.25% chloramine solution, potassium permanganate solution (1:5000), 0.06% chlorhexidine solution or other antiseptic drugs every 3-4 hours

With a mild course of ulcerative necrotic stomatitis, Vincent is enough local treatment. In more severe cases, it is necessary to general therapy. For the purpose of antimicrobial action, metronidazole (trichopolum, flagyl, klion) is administered orally at a dose of 0.25 g 2 times a day for 7-10 days. Metronidazole is also used for local treatment (a liquid aqueous slurry is applied to ulcerative surfaces after removal of necrotic tissue). In severe cases, broad-spectrum antibiotics are sometimes used (bicillin-3, 300,000 IU once every 3 days or 600,000 IU once every 6 days; erythromycin, oletethrin, oxytetracycline in daily dose 800,000-1,000,000 IU for 5-10 days). For any degree of severity, it is recommended to prescribe B vitamins, ascorutin (0.1 g orally 2 times a day, for 10-14 days).

With proper treatment, improvement in the condition of patients with Vincent's ulcerative necrotic stomatitis occurs within 24-48 hours, pain decreases or disappears, patients can eat, sleep. Edema and hyperemia of the oral mucosa decrease, epithelialization of ulcers begins, which, when mild degree disease and a satisfactory condition of the oral cavity is completed by the 3-6th day. In an unsanitized oral cavity, epithelialization of ulcerative surfaces proceeds more slowly. After the improvement of the general condition of the patient and the disappearance of acute inflammatory phenomena it is necessary to carry out a thorough sanitation of the oral cavity with the removal of tartar, teeth roots, to carry out treatment carious teeth, periodontal disease.

Relapses of necrotizing ulcerative stomatitis can occur if foci remain in the oral cavity chronic infection(periodontal pockets, hoods over incompletely erupted third molars), or traumatic factors (overhanging fillings, carious cavities, roots of destroyed teeth, tartar, low-quality prostheses, etc.). The reason for recurrence may be unsatisfactory hygienic condition of the oral cavity.

Treatment of symptomatic ulcerative necrotic stomatitis with blood diseases allergic conditions, mercury intoxication is mainly in the general treatment of the underlying disease that causes these changes.

Forecast. With timely and proper treatment, the prognosis is favorable. Epithelialization of ulcerative surfaces in an acute process occurs after 3-6 days, in a chronic process it is somewhat slower. In an unsanitized oral cavity in the presence of many traumatic factors and untimely or improper treatment omission (retraction) or deformation of the gums, resorption of the bone tissue of the alveolar process may occur. These changes contribute to the further progression of periodontitis.

Patients who have had Vincent's stomatitis are subject to active observation during the year. The first examination is carried out after 1-2 months, subsequent - after 6 months.

Prevention. It consists in observing oral hygiene, regular sanitation, full and timely treatment of infectious and other diseases that lead to a decrease in immunity.