Treatment of ulcerative necrotic stomatitis with drugs and folk remedies. Severe form of stomatitis. Treatment of Ulcerative necrotic stomatitis Vincent

Ulcerative necrotic stomatitis or ulcerative membranous stomatitis Vincent is a specific inflammatory disease oral cavity infectious nature caused by the association of anaerobic spindle-shaped rods (fusobacteria) Bacillusfusiformis and a strict anaerobe spirochete Borelliavincentii.

These bacteria can cause only damage to the gums, only the tonsils, or in combination with inflammation of the gums and other places in the oropharynx, therefore, there are respectively gingivitis, tonsillitis and Vincent's stomatitis. In the latter case, inflammation and destruction of the oral mucosa occurs, with ulcers and necrotic areas appearing on it. This process is called alternative inflammation, and this stomatitis itself is therefore also called an alternative inflammatory disease of the oral mucosa.

Vincent, French epidemiologist, described this infection in 1895. This stomatitis in the world medical literature has several names: “trench mouth”, Plaut-Vincent stomatitis, fusospirillosis, but official name- Ulcerative necrotic stomatitis Vincent. The age contingent of the diseased is children under 3 years old, men from 20 to 30 years old, the elderly over 60.

The disease has a seasonality: October - December. This is due to hypothermia of the body during this period, as one of the causes of this stomatitis. The onset of the disease is always associated with a decrease in immunity. Ulcerative necrotic stomatitis of Vincent is non-contagious, but can have a group character under general unfavorable living conditions (for example, in kindergartens, schools, the army).

Etiology of the phenomenon

These fusobacteria and spirochetes, being specific causative agents of this stomatitis, always live in the mouth, as opportunistic pathogens constantly. Their frequent localization is interdental spaces. Normally, there are few of them, they do not bother the owner. But with a decrease in immunity, they become pathogenic and begin to expand their colonies, causing inflammation. They begin to dominate over any other microflora.

A decrease in immunity also reduces the resistance of the ORM with all the ensuing consequences, it ceases to be a barrier to infection. In addition to reduced immunity, the following matters:

• advanced catarrhal gingivitis;
• lack of proper oral hygiene;
• profuse accumulation of tartar plaque;
• poisoning with lead, mercury and bismuth;
• the presence of leukemia, agranulocytosis;
• infectious mononucleosis, pathologies of the liver, kidneys, gastrointestinal tract, diabetes;
• transferred influenza, SARS;
• caries;
• hypovitaminosis B and C;
• microtrauma of the oral cavity (sharp edges of teeth, incorrect dentures, scratches of mucous solid food, etc.);
• in children, the main reason is the neglect of hygiene.

Classification of pathology

Ulcerative necrotic stomatitis of Vincent can be acute, subacute and chronic. According to the severity of the process, stomatitis is mild, moderate and severe. The majority of patients usually have a mild form. In stages, stomatitis, like any inflammation, goes through its initial phase, the height of inflammation and the stage of resolution. And, finally, the number of ulcers can be group or ulcers are single.

The most common localization of ulcers is the retromolar region of the mandible, especially behind the eighth teeth. In addition, the localization of ulcers is noted on the sides of the tongue and on the cheeks along the line of closing of the teeth. If there is an ulcer in the area hard palate, then all the overlying layers are quite quickly necrotic and this leads to the exposure of the bone. If the palatine tonsil (Vincent's angina) is affected, then usually on one side. This form of pathology is quite rare.

Symptomatic manifestations of the acute form

First, in prodromal period, there is a slight malaise with headache and subfebrile temperature. There are signs of gingivitis in the form of redness, gums are bleeding, mucous membranes are dry. This state, depending on the subsequent form, can last several days or hours. Weakness increases, efficiency decreases, lethargy, apathy appear, appetite is lost, the patient does not sleep well.

On the oral mucosa, ulcers are formed, covered with a yellow film. Over the next 3-4 days it becomes greenish gray; this indicates necrotic processes in the ulcer. This film is tightly soldered to the underlying layers, its violent removal reveals a bleeding surface. Be sure to increase the production of saliva (hypersalivation).

At mild form the zone of inflammation is limited, and so far has only a catarrhal character. Pain in the mouth on palpation is insignificant, the general condition is not disturbed, the temperature can be 37.5. Bleeding gums is clearly manifested during meals. The gums are swollen, there is a lot of saliva in the mouth, but the necrosis affects only the tips of the papillae between certain teeth. The patient remains quite active.

Medium severity

Catarrhal phenomena are replaced by the appearance of ulcerative surfaces, the temperature rises sharply to 38 degrees and above, it is accompanied by chills. Working capacity decreases, ulcers grow in breadth and depth, covered with a necrotic crust. The size of the ulcers can reach 5-6 cm. The edges are uneven, soft.

The papillae between the teeth become gray color and become cloudy, as well as the edges of the gums. Then necrosis develops. At the same time, the gingival margin becomes, as it were, jagged, with jagged and uneven. This unevenness persists even after treatment. The gums bleed constantly and strongly, a grayish-yellow coating appears on them, which is easily removed.

Appears from the mouth fetid odor perceptible even at a distance. Pus begins to ooze from the periodontal pockets. The head hurts, there is pain in the mouth, there is a grayish pallor of the face. The lymph nodes are enlarged and thickened. There is weakness and lack of appetite. It hurts to swallow and speak.

Complex degree

The state is disturbed, the ulcers reach the muscle layer, weakness is severe, the temperature is up to 40. There are pains in the abdomen, nausea and vomiting. If treatment is not carried out, the ulcer reaches deep into the bone and osteomyelitis of the lower jaw may develop. Trismus appears - limited opening of the mouth due to a lesion chewing muscles, it is impossible to eat.

Necrosis can also go to the tonsils. There is a lot of saliva and it flows out by itself, its consistency is viscous, viscous, with streaks of blood and bad smell. The inflammatory process is resolved after 2-3 weeks, and the ulcers are epithelialized.

Process timing

Vincent's chronic ulcerative necrotic stomatitis occurs in case of poor-quality sanitation and wrong therapy in the acute phase, due to which the acute process is replaced by a chronic one. It has a sluggish course, plaque remains on the surface of the ulcers, also gray in color, but insignificant. Systemic common manifestations no. There's further destruction bone tissue, ulcers are scarred.

If the acute period has passed into a chronic one, there is no severe degree of inflammation with it. The foul-smelling putrid odor from the mouth persists, and the bleeding and soreness of the gums also persists, although they become moderate. They are stagnantly hyperemic, the edges are thickened.

Between some teeth, mainly those where there are accumulations of old tartar and plaque, pockets of necrosis remain, but small. Interdental papillae collapse and go away, instead of them interdental pockets are formed. In the zone of ulcers alveolar ridge along the edges is subjected to slow resorption, due to which teeth fall out. Ulcers gradually scar. Lymph nodes with a long course of the process continue to hurt slightly, in 4-8 months they are compacted to a cartilage-like hardness.

Diagnostic measures

The diagnosis is first made after examination of the oral cavity. On the mucosa there are areas of necrosis, ulcers with uneven scalloped edges, the bottom of the ulcers is hyperemic, it is constantly present gray coating. Regional lymph nodes (submandibular) are hypertrophied and painful when pressed.

Then a scraping is taken from the damaged tissues and examined for histology. Since superficial and deep layers are distinguished in the affected tissues, various pathogens are found in the superficial layer during microscopy, but the association number remains leading. In the underlying deep layers, areas of inflammation are visible. In the final stage, the number of anaerobic pathogens decreases. In the blood test, all signs of inflammation: accelerated ESR, shift of the formula to the left, leukocytosis.

Principles of treatment

Treatment should be complex, and it is prescribed and carried out only under the supervision of a dentist. Treatment can always successfully cure a person from stomatitis, since its etiology, pathogenesis and clinic are well studied. In concept complex therapy includes local and general treatment.

General treatment involves etiotropic therapy, pathogenetic treatment and reception symptomatic remedies. Local treatment is a complex of all measures for cleaning the wound, its surgical treatment and treatment of ulcers and oral cavity with antiseptics.

The treatment sequence includes a phase of hydration and dehydration. These phases are mandatory for any wound process. The hydration phase includes hyperemia, exudative process, leukocyte infiltration, i.e. acute phase of inflammation. In the same phase, preparations for restoration are underway. To do this, the wounds are cleaned and freed from necrotic tissues, the removal of toxins and metabolites occurs due to proteolytics, etc.

The dehydration phase begins after the acute period subsides and consists in healing processes - regeneration, epithelialization, etc. Inflammation at the same time subsides, hyperemia and edema decrease, develops granulation tissue. Granulations have one useful quality - they push out microorganisms, which reduces their virulence.

Therapy in the hydration phase is as follows:

Signs of improvement as a result of treatment appear as early as 2-3 days: areas of necrosis disappear, gum bleeding and pain disappear. The patient can sleep peacefully and eat. Treatment for healed ulcers carious teeth and removal of the affected. On the 4-5th day, the restoration of the epithelium begins. Such treatment is carried out with the first degree of fusospirillosis. At 2 and 3 degrees of severity, a general treatment is prescribed. It includes broad-spectrum antibiotics to kill or slow down the reproduction of Fusobacteria and spirochetes. These pathogens are anaerobes and antibiotics are selected for them selectively, for example, Augmentin, Ampiox, Bicillin-3, Cephaloridine, the tetracycline group, aminoglycosides, macrolides, lincomycins (among them Erythromycin, Gentamicin, Levomycetin, Oletetrin, Lincomycin, etc.). They are used for the vastness of ulcers and the neglect of the process. In addition to them, antiprotozoal and antimicrobial agents are prescribed - Klion, Metrogil, Flagyl, Fazizhin.

If left untreated, Vincent's necrotizing ulcerative stomatitis can lead to complications: bone destruction, gum subsidence, development of periodontitis and osteomyelitis, bone exposure, and tooth loss. With irrational treatment, inflammation can drag on for several months. Relapses are also possible. They are possible if after the treatment in the mouth remained carious teeth, due to the accumulation of plaque or sharp edges of dental debris, after poor-quality cleansing of periodontal pockets.

Another common reason is the patient's careless reluctance to regularly care for their teeth. After the treatment, patients are under the supervision of a dentist for the whole year. The first visit should be done 2 months after the completion of treatment, then after six months.

Fusospirillosis is prevented by regular sanitation of foci of infection of the teeth, gums, throat, sufficient and proper brushing teeth and gums, as well as the tongue. It is necessary to maintain immunity at the proper level and fully treat viruses and infections. Microtrauma to the oral cavity should also be avoided whenever possible.

– specific infection oral mucosa, caused by the association of fusobacteria and spirochetes. Patients indicate the appearance in the mouth painful ulcers, deterioration general condition, temperature rise, headache, muscle ache. The diagnosis is based on the collected history, the results of a physical examination, bacterioscopic and cytological research scrapings from ulcerative surfaces. The basis of treatment is local etiotropic therapy. At severe course shows the use of antibiotics, antiprotozoal drugs in tablet form.

General information

Treatment of ulcerative necrotic stomatitis Vincent

The basis of the treatment of Vincent's ulcerative necrotic stomatitis is local therapy. During the hydration phase, the use is indicated local anesthetics(lidocaine, anesthesin). A prolonged analgesic effect is also achieved through the use of gel applications containing choline salicylate and cetalkonium chloride. For antiseptic treatment for Vincent's ulcerative necrotic stomatitis, drugs are prescribed that have antiprotozoal (metronidazole, dioxidine), antimicrobial (gentamicin) and proteolytic (terrilitin) actions.

Cleansing of ulcerative areas is carried out with the help of surgical instruments under constant irrigation of the mucosa with antiseptic and necrolytic agents. Also, with Vincent's ulcerative necrotic stomatitis, sorbents are widely used. In the resolution phase, keratoplasty is shown, the action of which is aimed at accelerating the recovery processes (for example, sea buckthorn oil). At the stage of epithelialization, the oral cavity is sanitized.

The general etiotropic treatment of Vincent's ulcerative necrotic stomatitis includes the use of antibiotics (semi-synthetic penicillins, cephalosporins), antiprotozoal drugs. As pathogenetic therapy use non-steroidal anti-inflammatory drugs (ibuprofen), antihistamines. For symptomatic treatment, analgesics, antipyretics and rehydration drugs are prescribed.

At timely detection and complex treatment Ulcerative necrotic stomatitis Vincent manages to completely stop the inflammatory process. The lack of qualified therapy leads to grave consequences: bone destruction, gum retraction, development of osteomyelitis.

Description:

Ulcerative-necrotic gingivostomatitis Vincent - inflammation of the gums and mucous membrane, characterized by the predominance of the alternative component, violation of the integrity of tissues, their necrosis and ulceration

Symptoms:

During the course of the disease, five periods are distinguished (incubation, prodromal, peak, extinction and recovery).

After a short incubation period prodromal develops. There is a malaise, the body temperature rises. On the gums (in the marginal part, gingival papillae), the phenomena of catarrhal inflammation are observed. Patients feel itching, burning. Then it increases, the body temperature rises to 39 ° C. The gums are cyanotic, loosened, the tops of the gingival papillae are ulcerated. Necrotic lesions often spread to nearby areas of the buccal mucosa, hard palate, pharynx, tonsils, sometimes capturing the entire oral mucosa. Lymphatic submandibular nodes enlarged, painful.

Causes of occurrence:

Development pathological process due to a decrease in the immunological status of the body, hypovitaminosis C and infection (fusospirillary symbiosis). The causative agents of the disease are anaerobic microflora (Vincent's spirochete, Spirocheta buccal is, fusobacteria and small treponemas). They are found in carious cavities, periodontal pockets, crypts palatine tonsils and are saprophytic microflora. Ulcerative necrotic gingivostomatitis Vincent can join the flu, tonsillitis, diseases of the upper respiratory tract, as well as to blood diseases (leukemia,), heavy metal poisoning, syphilis, tuberculosis, AIDS, tumors in the decay stage.

Faces get sick more often young age. Epidemic bursts of ulcerative necrotic ("trench disease") may occur.

Treatment:

For treatment appoint:

First aid for patients with ulcerative necrotic gingivostomatitis Vincent should be aimed at relieving pain, reducing the effects of intoxication. In order to influence anaerobic infection inside designate metronidazole - 0.25 g 3-4 times a day, tinidazole - 4 tablets of 0.5 g in 1 dose. Desensitizing agents are shown (diazolin - 0.1 g 2 times a day, diphenhydramine - 0.1 g 2 times a day), analgesics and a complex of vitamins.

Antiseptics and painkillers are applied locally. Soft coating remove with 3% hydrogen peroxide solution, 0.1% potassium permanganate solution, solutions of furacilin (1:5000) and ethacridine lactate, 0.5% ethonium solution, 0.2% chlorhexidine solution. Necrotized areas of the mucous membrane are treated with proteolytic enzymes (trypsin, chymotrypsin, terrilitin) diluted in isotonic sodium chloride solution, or with emulsions containing enzymes, trihonol, and ointments (iruksol). In the reparative stage, vitamin and keratoplastic agents are used.

Ulcerative necrotic stomatitis of Vincent is a pathology that develops as a result of infection of the oral cavity with fusiform rods.

The disease is accompanied acute currents inflammatory process, which affects all mucous membranes, as well as the formation of necrotic tissues. Most often, ulcerative stomatitis with necrotic foci is detected in children against the background.

Characteristics of the disease

The pathological process develops against the background of infection of the oral cavity with fusiform rods. These microorganisms are present in the body of almost all people. Pathogenic microflora is activated under the influence of certain factors.

Activation of pathogenic microflora leads to the formation of foci of inflammation in the oral mucosa. Depending on the course of the disease, it takes the following forms:

• acute;
• subacute;
• chronic.

Initially, a person manifests an acute form of pathology, characterized by intense clinical picture. Vincent's stomatitis develops under the influence of the following factors:

The above factors lead to a decrease in local and general immunity, which creates favorable conditions for the development of pathogenic microflora in the oral cavity.

Clinical picture

The main symptom of Vincent's stomatitis are ulcers that form on the surface of the mucous membrane. They may be single or multiple in distribution. Other symptoms of pathology depend on the severity of the disease.

On the initial stage (mild degree) stomatitis manifests itself in the form of:

• pain syndrome localized in the mouth;
• , aggravated by chewing food;
• active work of the salivary glands.

On palpation of the gum tissue, there are also pain. On their surface, areas with hyperemia and edema are formed. In addition to pain, patients also experience burning in the gums, as well as drying out of the mucous membrane.

Moderate severity ulcerative stomatitis characterized by the following symptoms:

On the late stage(severe degree) the disease is accompanied by the appearance of:

• severe weakness;
• high temperature reaching 40 degrees;
• bouts of nausea and vomiting;
• pain in the abdomen.

A characteristic sign of stomatitis is a gray-white plaque, which forms on the second or third day of the development of the disease on the mucous membrane. In some cases, the inflammatory process penetrates deep into the tissues, affecting the bone structure.

Ulcerative stomatitis in children is accompanied by the following symptoms:

• increased tearfulness;
• sleep disturbance.

The clinical picture in the chronic form of the disease is characterized by the absence of characteristic symptoms. The patient has bleeding gums and bad breath.

Diagnosis and treatment

Diagnosis is based on an external examination of the oral cavity and the collection of information about the current state of the patient.

Additionally assigned histological examination fabrics. In the superficial layer of the gums are found a variety of bacteria such as cocci, fusobacteria, spirochetes and others. AT deep tissues dilated blood vessels and foci of inflammation are detected.

Ulcerative necrotic stomatitis is one of the dangerous diseases treated under the supervision of a dentist. Pathology therapy is carried out in a complex.

To suppress the pain syndrome are prescribed:

• Anestezin (the most common drug);
• lidocaine hydrochloride, which is used in extreme cases.

After suppression primary symptoms an operation to remove necrotic tissue is prescribed. The procedure is carried out in several stages:

1. Swabs soaked in a solution of proteolytic enzymes are applied to the affected area. These substances soften necrotic tissues.
2. Then the affected area is treated with antiseptic and antimicrobials. If there are appropriate indications, hydrogen peroxide is used to remove necrotic tissues. The treatment of the oral cavity is carried out under local anesthesia. It is important that during the procedure medicinal substances entered the interdental space. For this, a syringe with a blunt needle is used.

The first results of treatment become noticeable on about 2-3 days of therapy. By this time, the gums stop bleeding and the necrotic tissue disappears. The epithelium begins to recover for 4-5 days.

Treatment of the disease is supplemented by the following procedures:

1. Reception antihistamines. They relieve puffiness and suppress the inflammatory process.
2. Taking broad-spectrum antibiotics. These include Augmentin, Penicillin, Ampiox and others. Antibiotics are prescribed for extensive lesions of the oral cavity and in advanced cases.
3. Reception vitamin complexes. They are necessary to strengthen immune protection and speed up the recovery process.
4. Treatment .
5. Extraction of teeth if indicated.
6. The use of ointments and keratoplastic preparations to accelerate the healing of ulcerated tissues.

Treatment of ulcerative stomatitis in children is carried out according to the same scheme that is used in the treatment of the disease in adults.

In the period of acute pathology, bed rest is indicated.

Nutrition Features

Successful recovery during and after necrotizing ulcerative stomatitis is impossible without a specialized diet. During treatment from daily diet should be excluded:

• sour and spicy foods(especially citrus fruits);
• berries;
• foods that cause an allergic reaction;
• pickled foods;
• sweet, bitter;
• dry foods.

It follows from the foregoing that the patient's diet for the recovery period should not contain products that irritate the mucous membrane. The diet includes:

Such a diet allows for relatively short term replenish the lack of trace elements and strengthen the immune system.

Possible consequences

If left untreated, ulcerative necrotic stomatitis causes the following complications:

• pathology of the genital tract;
• inflammation of the middle ear;
• rhinitis;
• endocarditis;
• pleurisy;
• gastroenteritis.

The long course of the disease contributes to the exposure of the roots and crowns of the tooth.

Prevention measures

Prevention of the disease consists in observing the following rules:

• timely implementation;
• normalization ;
• strengthening immune system, this is especially true during seasonal diseases;
• timely treatment of dental and other pathologies, elimination of microtraumas of the mucous membrane.

Ulcerative necrotic stomatitis of Vincent is serious illness which causes significant damage to the oral cavity.

Pathology develops against the background of a weakened immune defense and requires timely treatment. The lack of therapy leads to the exposure of the bone structure, tooth loss and the occurrence of a number of other diseases.

AT medical practice along with a description of the pathologies of the oral cavity, the concept of Vincent's symptom is often encountered. What is this condition, in what inflammatory process does Vincent's symptom occur and what is fertile ground for the occurrence similar pathology- we will deal with these issues in our article today.

What is this symptom?

Vincent's symptom is a condition in which a person loses sensitivity in the chin area, more precisely, in the zone lower lip.

The symptom is the result of various painful conditions organism, such as osteomyelitis of the jaw and acute apical periodontitis. This pathology also mentioned in ulcerative membranous angina, the second name of which is Simanovsky's angina - Vincent (the symptoms of the pathology are quite diverse).

Let us consider in more detail each of the pathologies leading to the manifestation of the above symptom.

Ulcerative membranous angina is a disease that leads to inflammation of the palatine tonsils. The cause of the pathology is the activity in the body of the spindle-shaped sticks of Plaut-Vincent together with Vincent's spirochete. With angina, ulcers form with a characteristic dirty green coating. The breath of the patient is accompanied by a putrid odor. I must say that such bacteria are constantly present in the oral cavity of a healthy person, however, under the influence various factors, for example, with caries of molars, in the presence of foci of necrosis in the oral cavity, as well as with a general weakening of immunity, microorganisms are activated, and their activity leads to the development of pathological conditions.

Angina Vincent. Symptoms and treatment

Ulcerative membranous angina is manifested by a whole complex of characteristic symptoms. These include:

• Enlargement of the affected tonsil. Mostly the disease affects one of the parties.
• Magnification and moderate soreness regional lymph nodes.

• The formation of a grayish-yellow plaque on the mucous membrane of the palatine tonsils, which can cause the formation of superficial, painless ulcers with a gray bottom. If the pathology progresses, ulcers occur in other parts of the pharynx, as well as on the mucous membrane of the cheeks or gums. Sometimes ulcers can heal without forming any defects.
• When eating food (when swallowing), painful sensations occur, while patients note increased salivation, bad breath.
• Body temperature in pathology rare cases exceeds normal limits, although sometimes the disease may begin with high fever and chills.
• Numbness and loss of sensation in the chin area.

Treatment of pathology is aimed at eliminating inflammation of the mucous membrane of the throat. Often, otolaryngologists prescribe means for rinsing or lubricating the affected area. In the case of a protracted course of the disease, antibiotic therapy is used. Patients with ulcerative membranous angina are always isolated, with severe forms pathology - hospitalized. The main principle of disease prevention is to strengthen protective functions body and enhance immunity.

Symptom of Vincent in dentistry. Periodontitis

Periodontitis is a pathology caused by infection from carious cavity into the bone tissue through the apex of the root. The disease causes inflammation of the shell of the tooth root. In the absence, it manifests itself with various signs, including Vincent's symptom. The reversibility of the disease depends on many factors: medical care, the general state of the human body, etc. Consider the mechanism of the occurrence of pathology.

Deep caries leads to pulpitis - inflammation of the pulp, as a result of which microorganisms enter the periodontium through the root canal.

There are also other ways of penetration of bacteria into bone tissues, for example, due to injuries, with sepsis, however, pulpitis is the most common cause inflammatory processes in the bone. Inflammation causes sweating of fluid, and the periodontium, a tissue saturated with receptors, reacts to an increase in pressure. In this case, inflammation causes pain.

A characteristic feature of periodontitis is the growing throbbing pain, which is strictly localized. Sometimes, when teeth are closed, pain is difficult to endure, patients cannot eat. It hurts a person just to touch the edge of the tooth, which also becomes mobile, the gums around the tooth, as well as the lip and cheek, swell, the body temperature rises sharply. A concomitant sign of periodontitis may be a symptom of Vincent. Signs of it have already been noted earlier: numbness and loss of tissue sensitivity in the chin area.

Forms of periodontitis

Distinguish between acute and chronic form periodontitis. If, during inflammation, the resulting fluid leaves through the root canal of the tooth, periodontitis becomes chronic. Pain syndrome at the same time, it is not very pronounced, and the pathological processes in the apex of the tooth flow slowly. Bacteria, multiplying in the area of ​​the affected bone, release toxins that "poison" the human body and lead to the development of diseases of various organs and systems (joints, heart, kidneys).

Otherwise, an acute form of periodontitis develops, which over time, if not properly treated, can go into a purulent stage.

The above forms of periodontitis require a long and highly qualified treatment. The main goal of therapy is to ensure the outflow of pus from the site of inflammation. In the course of treatment, the inflammatory process is first stopped, then antiseptic treatment pulp, then a temporary filling is placed. During the period therapeutic measures the condition of the bone tissue is monitored by radiography.

Treatment

In therapy chronic periodontitis use medical preparations that stimulate periodontal restoration. Related ways treatment can be physiotherapy: electrophoresis, UHF, microwave, laser therapy, magnetotherapy. In some cases, antibiotic treatment is used.

Antibiotics may be used topically if deep periodontal pockets form. filling root canal performed with materials that are selected individually in each case.

If the inflammation affects large areas of tissue, or conservative therapy does not lead to the desired result surgical intervention. The purpose of the manipulation is resection of the apex of the tooth root. A small incision is made in the gum in order to gain access to the bone tissue. Next, the affected structure is removed, the top of the canal is sealed. Bone regeneration is a long process. If the treatment does not lead to positive dynamics, the tooth may be removed.

To avoid development similar disease, it is necessary to carefully monitor oral hygiene.

This implies a mandatory daily brushing twice a day. Wherein toothbrush should be changed periodically, scrupulously approach the choice of toothpaste. At least once a year, contact your dentist for a professional tartar removal procedure.

Voids in the dentition lead to the fact that the remaining teeth in the mouth lie increased load. The molars become vulnerable, an inflammatory process can develop in the oral cavity, which in the future will lead to periodontitis.

Periodontitis is a rather insidious disease, because it causes many complications, among which - acute sepsis, inflammation of the soft tissues of the face, osteomyelitis of the jaw.

What is osteomyelitis?

Another reason why Vincent's symptom occurs is osteomyelitis. This pathology, regardless of which part of the human skeleton manifests itself, belongs to the group infectious diseases inflammatory nature.

With osteomyelitis of the jaw, all tissues are affected: the periosteum, the brain. Pathology occurs mainly in people not older than forty years. However, there are cases of the development of the disease in children, as well as in the elderly. It all depends on how badly the person's teeth are affected by caries. Equally, osteomyelitis worries both men and women. Vincent's symptom with osteomyelitis affects the chin area, and this is due primarily to the fact that the pathology often affects lower jaw than the top one.

Previously, when oral hygiene was not given due attention, osteomyelitis of the jaw occupied about 40% of the pathology of other bones. Not so long ago, the situation changed for the better.

Today, thanks to the widespread planned both in children and in the adult population, the percentage of patients with osteomyelitis of the jaw has decreased, and the use of antibiotics has made the course of the disease less severe.

Classification of osteomyelitis

In most cases, osteomyelitis of the jaw is a consequence of caries, as well as a complication after periodontal disease.

This group of osteomyelitis is commonly called odontogenic (stomatogenic). The infection enters the bone structures through caries-affected molars. In the foci of inflammation there is a diverse microflora. These are streptococcus, and staphylococcus aureus (white and golden), pneumococcus and other bacteria.

Contact osteomyelitis is a pathology that occurs as a result of infection of the skin or mucous membrane (for example, with a boil on the face). Here, specific osteomyelitis is distinguished:

• tuberculosis,
• syphilitic,
• actinomycotic.

Sometimes damage to the bone marrow of the jaw occurs through the ingestion of bacteria with the blood stream. This condition is classified as hematogenous osteomyelitis, which occurs after infections such as influenza, typhoid fever, scarlet fever, measles.

A separate group consists of osteomyelitis resulting from trauma (fracture, bad bruise). Vincent's symptom in fractures, when sensitivity is disturbed in the area of ​​the mental nerve and patients notice numbness of the lower lip, occurs due to compression of the lower alveolar nerve, formed during inflammation by exudate.

Course of the disease

The course of the disease can be different, and most often it depends on the state of the body as a whole, on the magnitude of circulatory disorders in the affected area. In some cases, the scale of bone necrosis is small, due only to primary focus. In such cases we are talking about limited osteomyelitis. If the disease progresses, the inflammatory process is transferred to the surrounding jaw soft tissues. This condition can manifest itself in the form of periostitis or phlegmon. Phlegmon is an acute space (often soft tissue), which is diffuse and does not have clear boundaries, such as an abscess. By the way, Vincent's symptom can often be observed with phlegmon, patients note a loss of sensitivity in the affected area.

At the beginning of the pathological process Bone marrow at the point of inflammation acquires a brown, dark red color. Later, purulent foci are formed, which merge into entire cavities. Pus enters the periosteum, gums and causes necrosis of the jaw areas. Sequesters are formed. In small blood vessels blood clots are formed, which are subjected to melting. Areas of bone necrosis appear in the bone, its blood supply gradually decreases, which leads to an increase in the scale of necrosis of the bone structure. The size of sequesters is determined by the size of thrombosed vessels. In particularly difficult cases, necrosis of the entire jaw may occur. Similar states associated with diffuse (diffuse) osteomyelitis.

Symptoms

There are several forms of pathology. During the period of subacute osteomyelitis, there is a so-called shaft between healthy bone and dead. In some cases, resorption of the sequester is observed. Regeneration processes can occur - a new bone structure is formed around. In reverse cases, rejection of sequesters is observed. The subacute form is borderline between acute and chronic osteomyelitis.

During the period acute form osteomyelitis occurs active development inflammatory process. Patients note severe pain in the jaw (drilling, shooting), which develop against the background of high temperature, chills, rapid breathing and pulse. In addition to pain in the jaw, the sensitivity of the lower lip may disappear - this is how Vincent's symptom manifests itself in osteomyelitis. After a few days from the onset of the disease, the teeth adjacent to the diseased tooth become mobile.

Palpation of the jaw reveals swelling and is accompanied by painful sensations. There is inflammation and swelling of the gums, cheeks or other areas on the face. During the period of illness, an increase in lymph nodes occurs. Subsequently, all these symptoms may be accompanied by trismus - reduction jaw muscles, numbness (Vincent's symptom). The reversibility of the disease depends on the timeliness of diagnosis and further treatment.

The general condition of the patient is classified into conditionally mild, moderate and severe. Unfortunately, sometimes the disease ends lethal outcome within a few days from the onset of the pathological process.

It is reliably known that at first, patients may seem cheerful, but soon the state of euphoria is replaced by a breakdown with sharp drop blood pressure and increased heart rate. Appearance a person changes drastically.

In diffuse osteomyelitis, there is a gradual inflammation of new areas of the bone. The patient's condition can be characterized as unstable, with temporary improvements and deterioration of health, during which the body temperature may first return to normal, and then rise again and be accompanied by recurring chills.

The stage of acute diffuse osteomyelitis can last up to four weeks. At the same time, it is observed a sharp decline the content of lymphocytes in the blood (up to 15% -18%), protein is present in the urine.

Chronic form of the disease in the absence medical measures can last for months, and sometimes years, and lead to the occurrence various complications: the formation of suppuration in the cranial sinuses, acute and chronic lesions kidneys.

Diagnosis and treatment

Radiography is one of the methods in the diagnosis of osteomyelitis and helps to determine the extent of damage to bone structures. However initial changes in the bone it is possible to examine only on the 7-10th day from the moment of the onset of the disease.

The first thing that is determined using a snapshot is the areas of rarefaction in bone structures. Further, if the course of the disease can be stopped, the radiograph reveals the resulting boundaries between healthy and dead tissue. Based on the size of this border, conclusions can be drawn about the size and localization of sequesters. In addition to radiography, it helps to identify the disease overall picture state of the human body and analysis accompanying signs, including Vincent's symptom.

Treatment of osteomyelitis involves the complex use of antibiotics and surgery. Often used as a conservative treatment penicillin injections, taking streptomycin or biomycin. At antibiotic therapy However, it is important to be mindful of the bacteria's ability to become addicted to drugs.

It is important to continue drug treatment for 7-10 days even after the temperature drops to normal indicators. Otherwise, the disease will be hidden. Often, the fate of the tooth, due to the disease of which inflammation has arisen, is decided unambiguously - it must be removed. Although there are exceptions to the rule.

Neighboring teeth are trying to save, restoring their functionality. For this, wire tires are used, which are installed on the entire dentition. In addition, inflammation of the pulp in the teeth is also eliminated if possible. Movable sequesters are subject to surgical removal, which is carried out no earlier than 4-6 weeks after the onset of the disease. This is primarily due to the fact that only after the specified period, the boundaries of the sequestration are clearly distinguishable.

Thus, Vincent's symptom is one of the main signs of the development of serious inflammatory diseases in the human body, including osteomyelitis, periodontitis, Simanovsky-Vincent's tonsillitis (the symptoms of this particular form of the disease are distinguishable from general symptoms angina due to the manifestation of Vincent's symptom).