Diseases of the oral mucosa, features of the course of the disease in childhood. Taking medications and lesions of the oral mucosa. What to do with inflammation of the oral cavity in children

Classification of diseases of the oral mucosa

(according to the etiological principle)

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

Diseases of the oral mucosa caused by a viral, bacterial and fungal infection (acute herpetic stomatitis, ulcerative necrotic gingivostomatitis of Vincent, candidomycosis);

Oral diseases 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, erythema multiforme exudative, Stevens-Johnson syndrome, chronic recurrent aphthous stomatitis).

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

7. Precancerous 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 threshold of irritability 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 injury of the oral mucosa may occur as a result of a blow, biting with teeth or injury by various sharp objects. A hematoma, abrasion, erosion, or deeper damage usually occurs at the site of exposure. As a result of secondary infection, these wounds can turn into chronic ulcers and fissures that do not heal for a long time.

Chronic mechanical injury – the most common cause of damage to the oral mucosa. Traumatic factors can be sharp edges of teeth, defects in fillings, poorly made or worn-out single crowns, fixed and removable dentures, orthodontic appliances. When exposed to mechanical trauma on the oral mucosa, hyperemia and edema occur first. Then erosion may appear at this place, and later on 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, with a long course they become denser. Regional The lymph nodes enlarged, painful on palpation. The ulcer may 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 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 mandible. The enamel or dentin of these teeth is underdeveloped, the cutting edge is thinned and, during suckling, injures the frenulum of the tongue, which leads to the formation of an ulcer. Under these conditions, an ulcer can also occur on the alveolar process of the upper jaw. A decubital ulcer of the cheek or lip may appear during the period of changing teeth, when the root of a milk tooth that has not resolved for any reason is pushed out permanent tooth, perforates the gum and, protruding above its surface, injures adjacent tissues for a long time. An ulcer can be in children who have decayed teeth with uneven, sharp edges, as well as in children with a bad habit of biting or sucking between the teeth of the tongue, mucous membrane of the cheeks or lips.

One of the manifestations of chronic trauma in debilitated children who are on artificial feeding is afta bednar (It is usually believed that aphthae is an erosion covered with fibrin; it is a surface 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 against which a slight traumatization of tissues by a long nipple or while wiping the child's mouth is sufficient to disrupt the epithelial cover. Erosions are more often symmetrically located on the border of the hard and soft palate, respectively, the projection onto the mucous membrane of the hook of the pterygoid process of the sphenoid bone. The defeat is also one-sided. The form of erosion is round, rarely oval, the boundaries are clear, the surrounding mucous membrane is slightly hyperemic, which indicates a state of hypergia. The surface of the erosions is covered with a loose fibrinous coating, sometimes clean, brighter in color than the surrounding mucous membrane of the palate. The size of erosions varies from a few millimeters to extensive lesions that merge with each other and form a butterfly-shaped lesion. When a secondary infection is attached, erosions 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 the midline of the sky or in the region of the alveolar processes of the upper and lower jaws. The child becomes restless. Starting to actively suck, after a few seconds, he stops sucking with crying, which is usually the reason for going to the doctor.

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

Prematurely erupted milk teeth should be removed, as their structure is defective. They are quickly erased and, in addition to trauma to the mucous membrane, can cause an odontogenic infection.

With Bednar's aphthae, first of all, it is necessary to establish feeding of the child: natural through the lining (with rough mother's nipples) or artificially 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 wiping of the mouth and the use of cauterizing substances are not allowed. The 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 oily solution of vitamin A and other keratoplasty. It should be borne in mind that Bednar's aphthae heal very slowly - within a few weeks.

Stomatitis in infectious diseases

Local changes in oral cavity in infectious diseases are predominantly inflammatory. 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 in scarlet fever are often early and characteristic symptoms of the disease.

The causative agent of the disease, according to most scientists, is hemolytic streptococcus. Infection occurs by drop and contact. The incubation period lasts from 3 to 7 days, but can be shortened to 1 day and extended 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 punctate 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 is covered with a grayish coating from the 1st day, in severe cases the coating has a brownish color, it is difficult to remove. From the 2-3rd day, cleansing of the tip and lateral surfaces of the tongue begins as a result of deep desquamation of the epithelium. On plaque-free areas, the mucous membrane of the tongue is bright red with a raspberry tint, the fungiform papillae are edematous, enlarged (crimson tongue). After a few days, the tongue is completely cleared of plaque, becomes smooth, “lacquered”, painful when eating. The filiform papillae are gradually restored, the tongue becomes normal. The lips swell, 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. It is necessary to differentiate scarlet fever from 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 aged 6 months to 4 years, but not uncommon at older ages. Clinical signs in the oral cavity appear in the prodromal period, when there are no other symptoms.

1-2 days before the appearance of a skin rash, red, irregularly shaped spots ranging in size from a pinhead to lentils appear on the mucous membrane of the soft and partially hard palate - measles enanthema, which in severe cases takes on a hemorrhagic character. After 1-2 days, these spots merge with the general background of the hyperemic mucosa. 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 are formed of various sizes, but not exceeding the size of a pinhead. They resemble splashes 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, never merge. Filatov-Koplik spots last 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 jawbone is possible. Complications often occur in debilitated children with non-sanitized oral cavity.

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

Spicy herpetic stomatitis(OGS)

Herpes infection is currently one of the most common human infections. ACS affects children of different ages, but most often in the period from 6 months to 3 years. This is because at this age, the antibodies obtained from the mother intraplacentally disappear, and their own methods of protection are in their infancy. OHS 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 or virus carrier by 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 the epidemiology of the disease. To clarify the diagnosis, it is recommended to perform a cytological examination of the 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 mild, moderate and severe degree of the course of ACS. Flowing according to the type of infectious disease, OGS has four main periods: prodromal, catarrhal, rashes and extinction of the disease.

Before the vesicles break out, fever, chills, headache, loss of appetite, sometimes vomiting, arthralgia, myalgia, etc. are often observed. From the initial stage of the disease, symptoms of lymphadenitis appear. varying degrees gravity. The catarrhal period is characterized by the 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 process, tongue, lips, cheeks, itching, burning or pain is felt, then hyperemia and rashes of vesicles 1-2 mm in diameter with transparent contents appear. The blisters break open very soon, forming superficial painful erosions with a bright pink bottom. Erosions are covered with fibrin, surrounded by a bright red rim (aphtha). Bubbles on the skin and the red border of the lips last longer; their content becomes cloudy, shrinks into crusts that last 8-10 days. Due to the fact that rashes continue to occur for several days, during examinations, you can see elements of the lesion that are at different stages of development. An obligatory symptom of acute herpetic stomatitis is hypersalivation, saliva becomes viscous and viscous, there is a smell from the mouth. 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, a stab shift to the left, eosinophilia, single plasma cells, and young forms of neutrophils are found. Sometimes there is protein in the urine.

Table. Clinical symptoms and treatment of acute hepatitis C at various degrees of severity of the disease:

Fungal stomatitis

Candidiasis(syn.: candidiasis) - a disease caused by exposure to yeast-like fungi of the genus Candida. They are widely distributed in the external environment, vegetate 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 epithelial cells and multiplying in them, fungi surrounded by a microcapsule are protected from drug exposure, 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 exogenous and endogenous influences. Among the latter, microtraumas, chemical damages leading to desquamation and maceration of the epithelium and subsequent fungal invasion are of great importance. Side effects of antibiotics are important not only in treatment, but also in the processes of their production and work with them. Candidiasis can be caused by cytostatics, corticosteroids, antidiabetic agents, oral contraceptives, alcohol and drug use, and radiation exposure. Endogenous background factors are immunodeficiency states, diabetes mellitus, gastrointestinal dysbacteriosis, hypovitaminosis, severe common diseases, HIV infection. Children younger age and elderly people are the most vulnerable due to age-related defects in the immune system.

In infants, candidiasis (thrush) can occur in the first weeks of life, mainly in debilitated individuals. 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 vegetations of mushrooms. They increase in size, forming films of white, grayish or yellowish hues, resembling curdled milk or whitish foam. The films are not tightly soldered to the underlying tissues, they are removed easily, without damage to the underlying mucous membrane, which retains a smooth surface and red color.

In adults, candidiasis often occurs as a chronic disease. At the same time, hyperemia and swelling of the mucous membrane decrease, and the raids become rough and fit tightly to the underlying base, leaving erosion when scraped. On the back of the tongue, deep transverse and longitudinal furrows appear, covered with a white coating, signs of macroglossia due to edema, hyposalivation, burning, which is aggravated by spicy food, are often observed. Filiform papillae flatten or atrophy.

There are several forms of candidiasis: pseudomembranous (false membranous), erythematous (atrophic) and hyperplastic. They can develop as independent forms of the lesion, or as transient ones, starting with erythematous (as an acute condition), and subsequently, as the process becomes more 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, and dotted white rashes appear on it, resembling curdled masses or whitish-gray, easily removable films. In severe, advanced cases, plaques become denser, are removed with difficulty, exposing an eroded bleeding surface.

Acute atrophic candidiasis may occur as a further transformation of the form described above or appear primarily during sensitization to the fungus. It is distinguished by dryness and bright hyperemia of the mucous membrane, severe pain is typical. There are very few raids, they are preserved only in deep folds.

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

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

Diagnosis of candidiasis presents no difficulty. Conduct a microscopic examination of scrapings from the oral mucosa on the mycelium of fungi.

Treatment. In mild forms, local treatment is prescribed: a diet with the exception of sugar, confectionery, bread, potatoes; rinsing the mouth with a solution of baking soda after eating; treatment of the oral cavity with a 5% solution of borax 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 the local application of dimexide; enzymes, potentiate their effect by 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 a developing pathology of the blood and hematopoietic system. Being one of the initial symptoms of the disease, changes in the oral cavity, detected in a timely manner by a dentist, with their correct interpretation, facilitate the early diagnosis of a blood disease.

Changes in the oral mucosa in acute leukemia

Leukemias are systemic diseases, the basis of which is a hyperplastic process in the hematopoietic tissue, combined with the phenomena of metaplasia. They can be acute and chronic. Acute leukemia is the most severe form. The disease occurs predominantly in individuals 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. The clinical picture of lesions of the oral cavity in the advanced phase of leukemia consists of 4 main syndromes: hyperplastic, hemorrhagic, anemic and intoxication. Tissue hyperplasia (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 small-pointed 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 nature of the 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 is determined, penetrating into the submucosal, and often into the muscle layer.

In some forms of leukemia, a kind of infiltration of the gums can develop. The infiltrates are relatively shallow. The mucous membrane above them is hyperemic, ulcerated in places, or its parts are torn away, 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. In the corners of the mouth develop "leukemic" seizures. Necrotic types of aphthous eruptions may be observed. When the tongue is affected, a dark brown coating is noted, often - ulceration of the back and lateral sections of the tongue (ulcerative glossitis); macroglossia may be observed, bad smell from mouth. Teeth are often mobile, with their removal, 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 can also be the therapy with cytostatic drugs used in the treatment of acute leukemia.

Chronic leukemias (myeloid leukemia, lymphocytic leukemia)

In chronic leukemia, clinical changes in the mucosa differ little from those 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. In chronic myeloid leukemia, the leading symptom of damage to the oral mucosa is hemorrhagic syndrome, but much less intense compared to 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, leukocyte migration 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 of a moderate nature, despite severe thrombocytopenia.

It should be noted that due to a sharp decrease in 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 risk of bleeding in leukemia after tooth extraction is so great that back in 1898, F. Cohn, among other causes of hemorrhagic diathesis in the oral cavity (along with hemophilia, Werlhof's disease), also considers leukemia. Sanitation of the oral cavity by patients with leukemia is carried out during the period of remission and is built according to general principles.

Lesions of the oral mucosa in iron deficiency anemia

This group combines anemic syndromes of various etiologies, 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.

Common symptoms are paresthesia of the oral cavity, inflammatory and atrophic changes, impaired taste sensitivity. In the diagnosis of iron deficiency anemia, great importance is attached to language changes. Appearing 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. Decreased and perverted 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 taking spicy and salty foods, paresthesia intensifies, and sometimes there are pains in the tongue. The latter is swollen, enlarged, 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 frequent symptom of the disease is a violation of the salivary and mucous glands of the oral cavity. Patients note dryness of the mucosa. 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 (jamming), gum bleeding, which is aggravated by brushing your teeth and eating. Atrophy of the epithelial cover is expressed in the thinning of the mucous membrane, it becomes less elastic and easily injured.

AT 12 - folic deficiency anemia

It develops with a deficiency of vitamin B12 or violations 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 what patients usually treat with. Mucous membranes are usually slightly subicteric, brown pigmentation in the form of a "butterfly" and puffiness are often noted on the face. In severe forms of the disease, minor petechiae and ecchymosis may appear. The mucous membrane of the oral cavity is pale, but, unlike iron deficiency anemia, it is well hydrated. Sometimes you can see areas of hyperpigmentation (especially the mucous membranes of the cheeks and palate).

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

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

Changes in the oral mucosa in diseases of cardio-vascular system

Changes in the oral mucosa in cardiovascular diseases are determined by the degree of circulatory disorders and changes in the vascular wall. With cardiovascular insufficiency, accompanied by circulatory disorders, cyanosis of the mucous membranes is usually observed, as well as cyanosis of the lips. There may be swelling of the mucous membrane, due to which the tongue enlarges, teeth marks 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 the filiform and fungiform papillae.

Against the background of a violation 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. Ulcers have uneven undermined edges, the bottom is covered with a grayish-white coating, there is no inflammatory reaction (areactive course). The ulcerative-necrotic process on the mucous membrane in case of circulatory disorders occurs against the background of a decrease in redox processes. The accumulation of metabolic products in the tissues leads to changes in the vessels and nerves, which disrupts tissue trophism. In such conditions, even with a slight injury to the mucous membrane, an ulcer is formed.

A.L. Mashkilleyson et al. (1972) described vesicovascular syndrome. It consists in the appearance after injury in patients with cardiovascular diseases on the oral mucosa of various sizes of blisters with hemorrhagic contents. Women aged 40-70 years are ill more often. Bubbles exist unchanged from several hours to several days. The reverse development occurs either by opening the bubble, or by resorption of its contents. When opening the bladder, the resulting erosion quickly epithelializes. Bubbles 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 blisters and underlying tissues are usually not observed. Nikolsky's symptom is negative. There are no acantholytic cells in smears-imprints from the surface of erosions of opened blisters. Most patients with vesicovascular syndrome have a history of arterial hypertension. The connection of hemorrhagic blisters with vascular changes as a result of cardiovascular diseases is not excluded. In the genesis of vesicovascular syndrome, the permeability of capillary-type 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, vesicovascular syndrome lacks its characteristic acantholysis and acantholytic cells.

Specific changes in the oral cavity with heart defects are called Parkes-Weber syndrome. At the same time, lesions of the mucous membrane, extensive telangiectatic hemorrhages are observed in the oral cavity; in the anterior third of the tongue - warty growths that may 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, pruritus, hyperglycemia.

Changes occur in the oral mucosa, the severity of which depends on the severity and duration of the disease. The earliest 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 injury, damage is observed in the form of hemorrhages, and sometimes erosions. At the same time, patients complain of burning in the oral cavity, pain that occurs during eating, especially when taking hot, spicy and dry food. The tongue is dry, its papillae are desquamated. A common form of pathology of the oral cavity in diabetes is candidiasis of the mucous membrane, including the tongue and lips.

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

In the decompensated form of diabetes, there is a violation of the analyzer function of the taste receptor apparatus, the development of decubitus ulceration 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 is often manifested in the mouth by a severe form of lichen planus (Grinszpan's syndrome).

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

Chronic recurrent aphthous stomatitis (CRAS)

Chronic recurrent aphthous stomatitis is a chronic disease of the oral mucosa, characterized by periodic remissions and exacerbations with rash of aphthae. A number of authors identified the disease with herpetic stomatitis, however, the polyetiological (not only viral) nature of the disease has now 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 injuries. CRAS is often the result of a wide variety of diseases and infections, as a result of which it is often referred to as a 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 threatening the life of the patient.

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

The most common primary element is "spot-hyperemia". Subsequently, necrosis of the mucous membrane, bordered by a rim of hyperemia, is observed at this place. Sometimes aphthae occur without previous 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 region of the transitional fold, on the mucous membrane of the tongue, lips; their central part is always covered fibrinous exudate with a dense film of yellow-gray color 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, followed by scarring. Aphthae are sharply painful, especially when localized on the tongue, along the transitional fold of the vestibule of the oral cavity, accompanied by increased salivation. Abundant salivation is reflex in nature. Regional lymph nodes are enlarged. The duration of the existence of aphtha is on average 8-10 days. Relapse is usually observed after 2-8 weeks, sometimes after several months.

Treatment. Removing the recurrence of the disease can be quite difficult. The best results are observed when establishing the etiological factor. 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 determine 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 "glossydynia". Some authors identify them, believing them to be synonyms. However, we agree with the opinion of V.I. Yakovleva (1995) on the distinction between these concepts; it is advisable to consider glossalgia as a lesion caused by diseases of the central or peripheral level of the central nervous system (due to infection, trauma, tumor, vascular disorder), and glossadynia as a symptom complex of pain and perception disorders in the language in functional neurotic conditions, diseases of internal organs, hormonal disorders and some other somatic pathology .

In general, to facilitate terminology, we propose to use the term "glossalgic syndrome" in the future.

Glossodynia develops with an increase in the tone of the sympathetic nervous system: with general autonomic dystonia, hyperthyroidism, endogenous hypovitaminosis B1, B2, B6, B12. Among patients, persons with anxious and suspicious character traits, prone to excessive painful fixation, suffering from phobias of various diseases predominate. In such patients, iatrogenics easily occur 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 bite, 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 menopause). Equally important are the condition of the teeth and periodontium, oral hygiene, the presence of dentures made of different metals, chronic injuries of the tongue due to malocclusion, sharp edges of the teeth, tartar, improperly applied fillings, etc. Isolated cases of the influence of odontogenic infection, allergies are described. Some authors associate the occurrence of glossalgia with the pathology of the dentoalveolar system, disorders of the temporomandibular joint. The latter often lead to chorda tympani injury when the articular head is displaced. 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, penicial anemia caused by vitamin B12 deficiency, gastrointestinal cancers. A common finding is glossodynia with 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); the 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 senestopathies. The connection of glossodynia with xerostomia of medicinal and autoimmune genesis is obvious.

Glossodynia often occurs after ongoing radiation and chemotherapy.

On the mucous membrane, as a rule, no pathological changes are observed.

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

The most common paresthesias such as burning, tingling, soreness, numbness. In about half of the patients, paresthesias are combined with pain in the tongue of a breaking, pressing nature (the pain is diffuse, without a clear localization, which indicates the neurogenic nature of the process). The pain syndrome usually recurs.

Paresthesias and pains are localized in both halves of the tongue, usually in the anterior 2/3 of it, less often in the entire tongue, and the posterior third of it is rarely affected in isolation. In about half of the 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 pharynx, esophagus, and neck. Unilateral localization of paresthesia and pain is noted in a quarter of patients.

Usually, the pains decrease or disappear during meals, in the morning after waking up, and intensify in the evening, with a long 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 are described.

Often there are sensory disturbances (a feeling 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 "tongue sparing". In the glossalgic syndrome, the tone of the sympathetic section often prevails over the parasympathetic, which is expressed by salivation disorders (more often - salivation disorders, sometimes alternating with periodic hypersalivation).

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

Usually, structural changes in the tongue are not observed in this disease, 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 (edematous), teeth marks are noted on its lateral surfaces.

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

Differential Diagnosis carried out with trigeminal neuralgia (it differs from glossalgia in sharp paroxysmal attacks of pain, which are almost always one-sided, there is usually no pain outside of attacks, pain is often accompanied by vasomotor disorders, convulsive twitches of the facial muscles, pain is provoked by eating or talking); with lingual nerve neuritis (simultaneously with unilateral pain in the anterior two-thirds of the tongue, there is also a partial loss of superficial sensitivity - pain, 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, talking)

Treatment is carried out taking into account the factors that caused the disease. Sanitation of the oral cavity and treatment of periodontal diseases, rational prosthetics are necessary. If necessary, they recommend consultations of somatic doctors and a psychiatrist, followed by the implementation of their recommendations for treatment internal diseases. Taking into account vegeto-neurotic manifestations, patients are prescribed sedative therapy, multivitamins are recommended. Positive results of reflexotherapy, laser therapy (helium-neon laser) are described.

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 sharp edges of teeth, removal of dental deposits, elimination of galvanism phenomena);

b) diet (avoid hot, spicy, hard foods);

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

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

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

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

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

Bath: the patient takes a solution of the drug into 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, the treatment of the oral mucosa is carried out by treating the oral cavity with cotton swabs. It is extremely important to keep the teat clean. Do not 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.

Diseases of the oral cavity in children are associated with pathological processes occurring in the internal organs, weakened immunity, adverse effects external factors. The reasons are dental pathology, lack of oral hygiene, unsystematic medication, trauma to the mucous membrane due to the use of spicy or too hot food, dehydration.

Hormonal disorders, deficiency of vitamins and minerals, infections of upper respiratory tract (whooping cough, scarlet fever, influenza, whooping cough, sinusitis), various viruses, fungi can also provoke the disease.

Types of inflammation of the oral mucosa in children

Diseases of the oral cavity, depending on the causes that caused their development, are divided into:

1. infectious;
2. viral or bacterial;
3. traumatic;
4. allergic;
5. fungal;
6. caused comorbidities Gastrointestinal tract, ENT organs, cardiovascular and endocrine systems;
7. hereditary.

Stomatitis

Stomatitis of the oral mucosa in children is common. The disease is accompanied by reddening of the oral cavity, a whitish coating on the tongue, inner surface cheeks, gums, bad breath, fever. The child experiences pain and discomfort, refuses to eat, becomes capricious and whiny.

General symptoms of diseases:

• bleeding ulcers yellow- white color on the mucous tissues of the tongue, lips, cheeks, on the gums;
• swelling and bleeding of the gums;
• increased secretion of salivary fluid;
• dry tongue;
• enlarged lymph nodes in the neck;
• painful sensations;
• loss of appetite;
• capriciousness and tearfulness.

To relieve the inflammatory process and disinfect the affected areas, you need to rinse your mouth with antiseptic agents - a warm decoction of chamomile or sage, a solution of furacilin, soda or hydrogen peroxide.

Herpetic stomatitis

The most common type of stomatitis is caused by the herpes virus. The acute form of herpetic stomatitis is a contagious disease. The disease is especially susceptible to babies from 6 months to 3 years with weak immunity. With age, the protective functions of the body are strengthened and the likelihood of infection decreases.

Symptoms of the disease in acute form:

1. body temperature often rises to 41ºС;
2. signs of general malaise - impotence, fatigue, headaches, pallor, increased painful sensitivity of muscles and skin;
3. lack of appetite;
4. nausea and vomiting;
5. swollen lymph nodes under the jaws and on the neck;
6. severe swelling and redness of the mucous tissues in the oral cavity;
7. a large number of ulcers inside lips, cheeks, gums and tongue;
8. with a moderate and severe form of the disease, rashes affect the outer skin around the mouth, ear lobes and eyelids;
9. increased salivation;
10. bad breath;
11. bleeding gums;
12. dry and chapped lips;
13. in rare cases - nose bleed due to a blood clotting disorder caused by herpesvirus.

For treatment, medication and local therapy are prescribed. Medicines are recommended to increase immunity (gamma globulin injections, Lysozyme, Prodigiosan, herpetic immunoglobulin, etc.); general therapy - Diphenhydramine, Suprastin, Pipolfen, calcium gluconate, etc.

Local therapy of the disease consists in the treatment of the oral cavity with agents that remove pain, preventing the spread of rashes, stimulating the processes of regeneration of damaged tissues.

For the destruction of viruses are prescribed various ointments(Oxolinic, Florenal, Heliomycin, Interferon, etc.). For antiseptic treatment use solutions of furatsilina, Etoniya, Etakridina, rosehip oil, Karatolin, Solcoseryl.

All meals for feeding a child should be liquid or mushy (soups, broths, mashed potatoes). Recommended for detoxification plentiful drink. Before eating, the oral cavity must be treated with an anesthetic (5% anesthetic emulsion), after eating, the mouth is rinsed.

Aphthous stomatitis

Aphthous stomatitis can be allergic or infectious nature, alternates between periods of remission and exacerbation. The first symptoms of the disease are fever (+39 ... + 40ºС), restlessness and capriciousness of the child, lethargy, dry mouth.

Gradually, the oral mucosa swells, turns red, hyperemia of the mucous tissues increases. Aphthae appear on the 3-4th day in the form of round or oval erosive formations ranging in size from 1 to 5 mm with yellow or gray coating surrounded by a red border. They affect the tongue, lips, cheeks, are single or multiple. The disease is accompanied by pain in the mouth, migraine, loss of appetite, impaired stool, swollen lymph nodes. The duration of the course of the disease is 2-3 weeks.

Candidal stomatitis

Candidal stomatitis is an inflammation of the oral mucosa caused by Candida fungi. The disease begins with redness and swelling of the tongue, then a white curdled coating appears on the mucous surface of the cheeks and lips. Under the plaque, ulcers and erosions form, which bleed and hurt.

The reason is the weakening of the immune system, and provoke the development of the disease and the spread of fungi milk nutrition babies. For treatment, immunomodulatory drugs are prescribed, the mouth is regularly treated soda solution. Good for Candida fungus removal 2% solution boric acid, which is treated with the oral mucosa 3 times a day.

Gingivitis or gingivostomatitis

Gingivitis is a disease associated with inflammation in the gums. It is a consequence of damage to the teeth (caries, plaque or calculus). Often the factors provoking gingivitis can be vitamin deficiency, weakened immunity, hormonal imbalance, infections (herpes).

The disease is accompanied by pain, aggravated during eating, brushing teeth. The gums turn red, swell, become loose and bleed. If the nature of the disease is infectious, then ulcerative or erosive formations on the gums may appear. Characteristic features- bad breath copious excretion salivary secretion. In the absence of proper treatment, the disease can be complicated by the development of periodontitis and tooth loss.

To prevent the disease, it is necessary to carefully care for the oral cavity (teeth, gums) - regular hygiene, timely removal of tartar. For treatment, mouth irrigation is prescribed with infusions of medicinal herbs - chamomile, sage, plantain. In order to exclude various pathologies internal organs, you should be examined by a pediatrician.

Thrush in children

Thrush is caused by pathogenic reproduction of fungi of the genus Candida, caused by weakened immunity due to various diseases, dysbacteriosis due to prolonged use of antibiotics. The disease is most common in infants and toddlers under 1 year of age. Pathology manifests itself in the form of a white cheesy plaque in the mouth and throat.

An infant can become infected with a fungus during childbirth, if the mother has vaginal candidiasis or due to poor hygiene during subsequent care, if the intestinal microflora is disturbed, which is often found in babies in the first six months of life.

Treatment of the disease consists in treating the oral cavity with a solution of baking soda. With the antibacterial nature of thrush, Nystatin or Levorin is prescribed. To increase the level of immunity and normalization intestinal flora the child is assigned good nutrition With great content vitamins (groups B, C, A, nicotinic acid).

Treatment and causes of cheilitis in children

Cheilitis is an inflammation of the lips caused by infection of a wound on the lips resulting from injury (cut, burn, mechanical damage upon impact, fall, etc.). Also, the causative agents of the pathology can be herpes viruses, erysipelas or eczema. The cause of the disease of the oral cavity may be vitamin B2 deficiency.

The disease is accompanied by swelling of the lips and a violation of its mobility, the mucous membrane of the oral cavity becomes red, painfully sensitive. Sometimes there are symptoms general intoxication- Weakness, headaches and muscle pain.

Zayeda or angular cheilitis is a subspecies of cheilitis. The causative agents of the disease are streptococci or fungi. When driving, the corners of the mouth are affected by small, but painful erosions, which crack and bleed when the mouth is opened, then crust over.

Antibiotics are prescribed to clear the infection. In case of formation of an abscess, it must be opened and treated with an antiseptic. With inflammation of the labial glands, opening, drainage and cleaning of infected areas is also shown.

For the treatment of fungal seizures, nystatin ointment is used, and the viral one is treated with an emulsion of synthomycin or penicillin ointment. Vitamin B2 deficiency is replenished by the use of riboflavin. It is necessary to carry out regular processing of the mouth, utensils and children's toys, use individual funds hygiene (towel, washcloth, toothbrush, dishes).

Traumatic lesions of the oral mucosa

Traumatic stomatitis can be caused by various one-time injuries or constant mechanical irritation of the mucous tissues of the mouth. In children, injury occurs due to toys, when falling or biting the tongue or cheek, due to wearing braces; in infants, gum disease can be caused by tooth growth. As a result, pustules, abscesses, sores or erosions form at the site of violation of the integrity of the mucosa. If an external infection has not entered the wound, it heals quickly without side effects.

Treatment consists in eliminating the cause of injury (a tooth fragment is removed or polished, tartar is removed, incorrect braces or dentures are corrected); wounds are treated with an antiseptic. If an infection is present, anti-inflammatory drugs are additionally prescribed.

Glossitis or inflammation of the tongue

Glossitis is an inflammatory lesion of the tongue, expressed in peeling of the skin layer and the formation of a whitish thickening in the form of a narrow strip. The affected surfaces are in the form of rings or semi-rings of a light red hue, sometimes merge into larger spots. This condition is called "geographical" language because of the loss of homogeneity of the surface of the organ and the similarity with a geographical map. Other signs in the form of pain or discomfort, redness and swelling are not observed, in rare cases, a slight burning sensation of the tongue is felt.

The causes of the disease are unknown, treatment is not prescribed. It is recommended to rinse the mouth with soda solution or Citral.

Other types of diseases

There are many diseases of the oral cavity, the most common of them are discussed above. Also in medicine, such pathologies of the oral mucosa as infectious mononucleosis and viral warts are described.

Infectious mononucleosis is viral disease. Manifested by an increase (up to size walnut) and soreness of the lymph nodes on the neck and under the jaw, the development of tonsillitis, stomatitis and changes in the composition of the blood.

Infection occurs through the pharynx or nasopharynx, quickly spreads through the lymphatic system and blood. The disease is accompanied by fever, headaches, drowsiness, lethargy and fatigue, nausea and vomiting. In young children, there may be an increase in the size of the liver, spleen. The analysis shows an increase in leukocytes, lymphocytes and monocytes, appear in the blood and atypical mononuclear cells (15-30%).

Treatment of mononucleosis is aimed at relieving symptoms - the appointment of painkillers and antipyretics, NSAIDs, vitamin and mineral complexes to boost immunity. As a local therapy for the disease, it is recommended to rinse the oral cavity with a solution of furacilin. The patient is prescribed bed rest, isolation, high-calorie meals and plenty of fluids.

Viral warts in the oral cavity are neoplasms of benign etiology. There are flat and pointed. Most often they affect the inner corners of the mouth and the side walls of the tongue, less often they can appear on the gums, lips or outside mouth. In most cases, they are associated with wart formations on the hands or genitals.

Treatment viral warts carried out with Oxolinic ointment (3%), Bonafton (0.5%), Florenal (0.5%) and others antiviral ointments. Before applying the product, it is necessary to thoroughly rinse the mouth and brush the teeth.

Prevention of oral diseases

In order to avoid the development of various diseases of the oral cavity, a child should be taught from early childhood to follow the rules of care and hygiene - brush your teeth regularly, limit the consumption of sweets. Subsequently, children can be taught to use dental floss and rinse it after each meal.

It is necessary to visit the dentist regularly, at least 2 times a year, together with the child, treat caries in time, remove plaque and stones. Children's immunity should be strengthened by hardening, exercise, swimming.

The child needs to provide good nutrition, rich in various vitamins and minerals. AT winter time according to the pediatrician's prescription, various vitamins should be given to the baby. It is important to remember that it is always easier to prevent the development of a disease than to treat its consequences.

Currently, the most common viral infection of childhood is herpetic, which is explained not only by the widespread prevalence of the herpes simplex virus, but also by the peculiarities of the formation of the immune system in the developing child's body.

One third of the world's population is affected by a herpes infection and more than half of these patients suffer several attacks of infections per year, including often with manifestations in the oral cavity.

It has been established that the infection of children with the herpes simplex virus at the age of 6 months to 5 years is 60%, and by the age of 15 - 90%. A similar problem is typical for pediatric dentistry, as the incidence of acute (primary) herpetic stomatitis in children increases every year.

For the first time, the role of the herpes simplex virus in diseases of the oral mucosa was pointed out at the beginning of the 20th century. N.F. Filatov (1902). He suggested the possible herpetic nature of the most common stomatitis in children - acute aphthous. This evidence was obtained later, when antigens of the herpes simplex virus began to be detected in the epithelial cells of the affected areas of the oral mucosa.

According to the international statistical classification of diseases and health problems, the last tenth revision (ICD-10, Geneva, 1995), this disease is classified as acute herpetic stomatitis (AHS). Acute herpetic stomatitis not only ranks first among all lesions of the oral mucosa, but is also included in the leading group among all childhood infectious diseases. At the same time, in every 7-10th child, acute herpetic stomatitis very early turns into a chronic form with fairly frequent relapses.

EPIDEMIOLOGY AND PATHOGENESIS.

The herpes simplex virus is very widespread in nature. It causes various diseases of the central and peripheral nervous system, liver, and other parenchymal organs, eyes, skin, mucous membrane of the gastrointestinal tract, genital organs, and also has a certain value in intrauterine fetal pathology. Often in the clinic there is a combination of various clinical forms herpetic infection. Acute herpetic stomatitis is characterized by high contagiousness among non-immune people.

The widespread occurrence of the disease between the ages of 6 months and 3 years is explained by the fact that at this age, antibodies received from the mother through the placenta disappear in children and there are no mature systems of specific immunity. Among older children, the incidence is much lower due to acquired immunity after a herpes infection in its various forms. clinical forms.

In the development of herpetic infection, which manifests itself mainly in the oral cavity, the structure of the oral mucosa in children is of great importance. different ages and activity of local tissue immunity. The highest prevalence of acute herpetic stomatitis in the period up to 3 years may be due to age-morphological features, manifested by high permeability during this period. histohematic barriers and a low level of cellular immunity reactions due to the thinness of the epithelial cover with a low level of glycogen and nucleic acids, looseness and weakness of differentiation of the basement membrane and fibrous structures of the connective tissue (abundant vascularization, high levels of mast cells with their low functional activity etc.).

The pathogenesis of acute herpetic stomatitis is currently not well understood. In all cases, viral infection begins with the adsorption of viral particles and the entry of the virus into the cell. Further ways of spreading the introduced virus throughout the body are complex and poorly understood. There is some evidence for the spread of the virus by hematogenous and neural pathways. In the acute period of stomatitis in children, viremia occurs.

Of great importance in the pathogenesis of the disease are the lymph nodes and elements of the reticuloendothelial system, which is consistent with the pathogenesis of sequential development clinical signs stomatitis. The appearance of lesions on the oral mucosa is preceded by lymphadenitis of varying severity. In moderate and severe clinical forms, more often develops bilateral inflammation submandibular lymph nodes, but I and all groups of cervical lymph nodes can be involved in the process. Lymphadenitis in acute herpetic stomatitis precedes rashes of lesions in the oral cavity, accompanies the entire course of the disease and remains for 7-10 days after complete epithelialization of the elements.

Both specific and non-specific factors immune protection. Studies of non-specific immunological reactivity in acute hepatitis C revealed violations of the body's protective barriers, reflecting the severity of the disease and periods of its development. Moderate and severe forms of stomatitis led to a sharp suppression of natural immunity, which was restored 7-14 days after the clinical recovery of the child.

CLINICAL PICTURE.

Acute herpetic stomatitis, like many other infectious diseases, occurs in mild, moderate and severe forms. The development of the disease goes through five periods: incubation, prodrome, the period of development of the disease, extinction and clinical recovery. In the period of development of the disease, 2 phases can be distinguished - catarrhal and rashes of the elements of the lesion.

During this period, symptoms of lesions of the oral mucosa appear. Initially, intense hyperemia of the entire mucous membrane of the oral cavity appears, and after a day, less often two, elements of the lesion are usually found in the oral cavity. The severity of acute herpetic stomatitis is assessed by the severity of manifestations of toxicosis and the nature of the lesion of the oral mucosa.

A mild form of acute herpetic stomatitis is characterized by an external absence of symptoms of intoxication of the body, the prodromal period is not clinically manifested (see figure.).

Figure 1. - Herpetic stomatitis, mild form.

The disease begins suddenly with an increase in temperature to 37-37.5 ° C. The general condition of the child is quite satisfactory. Sometimes minor phenomena of inflammation of the nasal mucosa, upper respiratory tract are found in the oral cavity. Also in the oral cavity there are phenomena of hyperemia, slight edema, mainly in the area of ​​the gingival margin (catarrhal gingivitis). The duration of the period is 1-2 days. The vesicle stage is usually viewed by the parents and the physician as the bubble quickly bursts and passes into an aphtha. Aphtha - erosion of a rounded or oval shape with smooth edges and a smooth bottom with a rim of hyperemia around.

In most cases, against the background of increased hyperemia, single or grouped lesions appear in the oral cavity, the number of which usually does not exceed 6. Rashes are single. The duration of the period of development of the disease is 1-2 days. The period of extinction of the disease is longer. Within 1-2 days, the elements acquire a kind of marble color, their edges and center are blurred. They are already less painful. After epithelialization of the elements, the phenomena of catarrhal gingivitis persist for 2-3 days, especially in the area of ​​the anterior teeth of the upper and lower jaws. In children suffering from this form of the disease, as a rule, there are no changes in the blood, sometimes a slight lymphocytosis appears only towards the end of the disease. With this form of the disease are well expressed defense mechanisms saliva: pH 7.4 ± 0.04, which corresponds to the optimal state. During the peak of the disease, the antiviral factor interferon appears in saliva (from 8 to 12 units / ml). The decrease in lysozyme in saliva is not expressed.

Natural immunity with a mild form of stomatitis suffers slightly, and during the period of clinical recovery, the defenses of the child's body are almost at the level of healthy children, that is, with a mild form of acute herpetic stomatitis, clinical recovery means a complete restoration of impaired body defenses.

The moderate form of acute herpetic stomatitis is characterized quite clearly severe symptoms toxicosis and lesions of the oral mucosa during all periods of the disease. Already in the prodromal period, the child's well-being worsens, weakness, whims, loss of appetite appear, maybe catarrhal angina or symptoms of an acute respiratory infection. Submandibular lymph nodes enlarge, become painful. The temperature rises to 37-37.5°C.

As the disease progresses during the development of the disease (phase of catarrhal inflammation), the temperature reaches 38-39 ° C, headache, nausea, and pallor of the skin appear. At the peak of the rise in temperature, increased hyperemia and severe swelling of the mucosa, elements of the lesion pour out, both in the oral cavity and often on the skin of the face near the mouth. There are usually 10 to 25 lesions in the oral cavity. During this period, salivation intensifies, saliva becomes viscous, viscous. Pronounced inflammation and bleeding of the gums are noted. Rashes often recur, which is why when examining the oral cavity, you can see elements of the lesion that are at different stages of clinical and cytological development. After the first rash of elements of the lesion, the body temperature usually drops to 37-37.5 ° C. However, subsequent rashes, as a rule, are accompanied by a rise in temperature to the previous figures. The child does not eat, sleeps poorly, symptoms of secondary toxicosis increase.

In the blood, ESR up to 20 mm / h is noted, more often leukopenia, sometimes slight leukocytosis. Band leukocytes and monocytes are within the upper limits of normal, lymphocytosis and plasmacytosis are also noted. An increase in the titer of herpetic complement-fixing antibodies is detected more often than after suffering a mild form of stomatitis.

The duration of the period of extinction of the disease depends on the resistance of the child's body, the presence of carious and decayed teeth, the rationality of therapy. At adverse conditions there is a fusion of the elements of the lesion, their subsequent ulceration, the appearance ulcerative gingivitis. Epithelialization of the elements of the lesion is delayed up to 4-5 days. Gingivitis, severe bleeding and lymphadenitis persist the longest.

In the moderate course of the disease, saliva pH becomes more acidic, reaching 6.96 ± 0.07 during rashes. The amount of interferon is lower than in children with easy flow disease, does not exceed 8 units / ml and is not found in all children. The content of lysozyme in saliva decreases more than with a mild form of stomatitis. The temperature of the externally unchanged oral mucosa corresponds to the temperature of the child's body, while the temperature of the elements of the lesion in the stage of degeneration is 1.0-1.2 ° lower than the temperature of the unchanged mucosa. With the beginning of regeneration and during the period of epithelialization, the temperature of the elements of the lesion rises by about 1.8 ° and remains at a higher level until the complete epithelialization of the affected mucosa.

The severe form of acute herpetic stomatitis is much less common than moderate and mild. In the prodromal period, the child has all the signs of an incipient acute infectious disease: apathy, weakness, headache, musculoskeletal hyperesthesia and arthralgia, etc. Often there are symptoms of damage to the cardiovascular system: bradycardia and tachycardia, muffled heart sounds, arterial hypotension . Some children have nosebleeds, nausea, vomiting, and pronounced lymphadenitis not only of the submandibular, but also of the cervical lymph nodes.

During the development of the disease, the temperature rises to 39-40 ° C. The child has a mournful expression of lips, suffering sunken eyes. There may be a not pronounced runny nose, coughing, somewhat edematous and hyperemic conjunctiva of the eyes. Lips dry, bright, parched. In the oral cavity, the mucosa is edematous, brightly hyperemic, pronounced gingivitis.

After 1-2 days, elements of the lesion, up to 20-25 in number, begin to appear in the oral cavity. Often rashes in the form of typical herpetic vesicles appear on the skin perioral region, eyelids, conjunctiva of the eyes, earlobes, on the fingers like panaritium. Rashes in the oral cavity recur, therefore, at the height of the disease in a seriously ill child, there are about 100 of them. The elements merge, forming extensive areas of mucosal necrosis. Not only lips, cheeks, tongue, soft and hard palate are affected, but also the gingival margin. Catarrhal gingivitis turns into ulcerative necrotic. There is a sharp putrid smell from the mouth, profuse salivation with an admixture of blood. Inflammatory phenomena on the mucous membrane of the nose, respiratory tract, and eyes are aggravated. In the secret from the nose and larynx, streaks of blood are also found, and sometimes nosebleeds are noted. In this state, children need active treatment by a pediatrician and a dentist, and therefore it is advisable to hospitalize the child in an isolation ward of a pediatric or infectious diseases hospital.

In the blood of children with severe stomatitis, leukopenia, a stab shift to the left, eosinophilia, single plasma cells, and young forms of neutrophils are found. In the latter, toxic granularity is very rarely observed. During the period of convalescence, as a rule, herpetic complement-fixing antibodies are determined.

In saliva, an acidic environment is noted (pH 6.55 ± 0.2), which can then be replaced by a more pronounced alkaline reaction (8.1-8.4). Interferon is usually absent, the content of lysozyme is sharply reduced.

The period of extinction of the disease depends on the timely and correct prescription of treatment and on the presence of concomitant diseases in the child's history.

Despite the clinical recovery of a patient with a severe form of acute herpetic stomatitis during the convalescence period, there are profound changes in homeostasis.

DIAGNOSTICS.

The diagnosis of acute herpetic stomatitis is made on the basis of the clinical picture of the disease. The use of virological and serological methods diagnostics in practical public health is difficult. This is primarily due to the complexity of special research methods. In addition, these methods can be used to obtain results in best case towards the end of the disease or some time after recovery. Such a retrospective diagnosis cannot satisfy the clinician.

AT last years In medicine, the method of immunofluorescence has found great application. High percent coincidences (79.0 ± 0.6%) of the diagnosis of acute herpetic stomatitis according to immunofluorescence data and according to the results of virological and serological studies make this method the leading one in the diagnosis of the disease. The essence of the immunofluorescence method lies in the detection of a specific luminescence of squamous epithelial cells obtained from the elements of the lesion by scraping and stained with fluorescent antiherpetic serum. The ability to get an answer within 2.5-3 hours from the moment of material sampling makes the method of etiological rapid diagnosis of stomatitis very promising. The percentage of positive results increases if the material for immunofluorescent studies is obtained in the first days of the rash of lesions in the oral cavity.

TREATMENT.

The tactics of treating patients with acute herpetic stomatitis should be determined by the severity of the disease and the period of its development. Complex therapy in acute herpetic stomatitis includes general and local treatment. In case of moderate and severe course of the disease, it is advisable to carry out general treatment together with a pediatrician.

Due to the peculiarities of the clinical course of acute herpetic stomatitis in the complex of therapeutic measures, an important place is occupied by balanced diet and proper organization feeding the patient. Food should be complete, i.e. contain all the necessary nutrients as well as vitamins. Therefore, it is necessary to include in the diet fresh vegetables, fruits, berries, juices. Before feeding, it is necessary to anesthetize the oral mucosa with a 2-5% solution of anesthesin or lidochlorgel.

The child is fed mainly liquid or semi-liquid food that does not irritate the inflamed mucous membrane. Much attention should be paid to the introduction enough liquids. This is especially important for intoxication. Natural food should be given with meals. gastric juice or its substitutes, since with pain in the oral cavity, it reflexively falls enzymatic activity glands of the stomach.

In the prodromal period, apply: interferon - 3-4 drops in the nose and under the tongue every 4 hours.

local treatment.

Local therapy for acute herpetic stomatitis has the following tasks:

• remove or loosen painful symptoms in the oral cavity;
• prevent repeated rashes of elements of the lesion (reinfection);
• contribute to the acceleration of epithelialization of the elements of the lesion.

From the first day of the development of the disease of acute herpetic stomatitis, given the etiology of the disease, an important place should be occupied by local antiviral therapy. For this purpose, it is recommended to use 25% oxolinic, 0.5% tebrofen, 0.5% bonafton, interferon ointment, acyclovir ointment. These drugs are recommended to be used repeatedly (3-4 times a day) not only when visiting a dentist, but also at home. affect both the affected areas of the mucosa and the area without pathological changes, since they have a more prophylactic effect than a therapeutic one.

Painkillers before meals:

• 5-10% solution of anesthesin in peach oil;
• lidochlor gel.

Means for the treatment of the oral cavity after each meal:

• potassium permanganate solution 1:5000;
• furacilin solution 1:5000;
• a strong solution of freshly brewed tea;
• solutions of enzymes - trypsin or chymotrypsin.

During the period of rashes, antiviral drugs are prescribed (Florenal, Tebrofen, Bonafton, acyclovir) in combination with bacterial lysates. They are applied to the oral mucosa after its hygienic treatment 3-4 times a day. The preparation of a mixture of bacterial lysates is prescribed up to 8 tablets per day. Solutions of neoferon, interferon are also used.

During the period of extinction of the disease, keratoplastic agents are used - rosehip oil, carotene, sea buckthorn oil, in combination with a preparation of a mixture of bacterial lysates.

It should be noted that ACS in any form is an acute infectious disease and in all cases requires attention from the pediatrician and dentist in order to provide comprehensive treatment, exclude contact of a sick child with healthy children, and take preventive measures in children's groups.

V.M. Elizarova, S.Yu. Strakhova, E.E. Kolodinskaya,

Moscow State University of Medicine and Dentistry,

Scientific Center for Children's Health, Russian Academy of Medical Sciences, Moscow

state budgetary educational institution higher professional education "Tyumen State Medical Academy"

Ministry of Health of the Russian Federation

(GBOU VPO Tyumen State Medical Academy of the Ministry of Health of Russia)

Department of Orthopedic and Surgical Dentistry

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

Completed by: Politova A.P.

Tyumen, 2014

Introduction

The collective name "stomatitis" combines a large group of diseases of the oral mucosa, diverse in etiology and clinical manifestations.

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

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

Moreover, the nature of the elements of damage to the oral mucosa depends on the anatomical and physiological features of the structure of a particular area. This can explain why, in some cases, pathological elements appear and develop immediately, while in other patients they appear after a while or are dimly expressed.

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

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

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

Different authors classify these diseases on the basis of different principles: by process localization, clinical course, pathoanatomical picture, etiology, etc. It seems to us the most appropriate to group diseases of the oral mucosa in children according to etiological grounds, although a number of factors act simultaneously on the child's body (trauma, infection, allergies, disorders of various systems and organs, etc.) .

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

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

Acute aphthous stomatitis

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

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

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

Clinic

Acute aphthous stomatitis, as a rule, affects children of nursery and younger children up to school age. The onset of the disease is acute, often with a rise in temperature to 39-40 ° C, intoxication phenomena: the child is lethargic, refuses to eat, sleeps poorly. Older children complain of a burning sensation, itching, pain in the mouth.

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

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

The mucous membrane of the oral cavity becomes edematous, in 64% of cases catarrhal gingivitis is expressed. 35% of children have facial skin lesions in the form of individual small vesicular elements (N. A. Antonova). Lips swell, sometimes covered with crusts. Salivation increases, but the saliva is viscous, with an unpleasant odor. Regional lymph nodes are enlarged and painful.

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

Differentiation of acute aphthous stomatitis should be with drug-induced stomatitis, erythema multiforme exudative and similar syndromes, diphtheria and other stomatitis in acute infectious diseases.

Afta Bednara

In children of the first months of life, traumatic erosions in the sky, known as Bednar's aft, are observed. Bednar's aphthae are more common in weakened children who are bottle-fed, suffering from birth defects hearts that have suffered any disease in the first months of life.

Hypotrophy is the background against which a slight traumatization of tissues with a long horn or while wiping the child's mouth is sufficient to disrupt the epithelial cover.

Clinic

Erosions are located more often symmetrically on the border of the hard and soft palate. The defeat is also one-sided. The shape of erosions is round, less often oval, the boundaries are clear, the surrounding mucous membrane is slightly hyperemic, which indicates a state of hypergia. The surface of the erosions is covered with a loose fibrinous coating, sometimes clean, brighter in color than the surrounding mucous membrane of the palate.

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

The child becomes restless. Starting to actively suck, after a few seconds he stops sucking with crying, which is usually the reason for going to the doctor. Treatment traumatic lesions is to remove the cause. Prematurely erupted milk teeth should be removed, as their structure is defective. They are quickly erased and, in addition to trauma to the mucous membrane, can cause an odontogenic infection. When removing such teeth, one should be aware of the possibility of heavy bleeding.

With Bednar's aphthae, first of all, it is necessary to adjust the feeding of the child: natural through the lining (with rough mother's nipples) or artificially through a short hard rubber horn that would not stretch when sucking and would not reach the eroded surface.

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

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

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

Lesions of the oral mucosa of traumatic origin

Depending on the nature of the traumatic agent, mechanical, thermal, chemical and radiation injuries are distinguished. In childhood, mechanical injuries are more often observed.

With prolonged mechanical irritation of the mucosal area, a deep lesion develops - the so-called decubital ulcer.

Decubital ulcer

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

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

A decubital ulcer of the cheek or lip may occur during the period of tooth change, when the root that has not resolved for any reason milk tooth is pushed out by a permanent tooth, perforates the gum and protrudes above its surface, permanently injures the adjacent tissues. Decubital erosions and ulcers can occur in children who have uneven, sharp, or decayed teeth and a bad habit of biting or sucking between the teeth of the tongue, buccal mucosa, or lips.

Clinic

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

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

Lesions of the oral mucosa in infectious diseases

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

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

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

On the mucous membrane of the cheeks and along the edges of the tongue there are imprints of teeth. Sometimes, in the area of ​​transitional folds, a whitish-gray, easily removable plaque is visible, the epithelium under it is not damaged. Catarrhal inflammation with successful treatment of the underlying disease and proper care behind the oral cavity quickly ends with a complete recovery.

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

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

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

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

Ulcerative lesions can also be provoked by difficult eruption of the third or less often second molars of the lower jaw.

Clinic

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

In the area of ​​ulceration, the interdental papillae are as if cut off due to the decay of the tissue at their top and are covered with a dirty, easily soiled coating with a putrid odor. Ulcerative lesions can also occur in other parts of the mucosa.

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

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

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

Thrush

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

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

Weakened children of the first weeks and months of life are more likely to suffer from thrush, but often thrush occurs in practically healthy children if the hygiene of the newborn is violated, since fungi can be transmitted from adults through nipples, underwear and other child care items.

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

Thrush affects the mucous membrane of the mouth and in older children who are seriously and long-term ill, treated with antibiotics and corticosteroids.

The disease begins asymptomatically. Later, children become restless, do not sleep well, suckle sluggishly at the breast. Older children complain of an unpleasant taste in the mouth, a burning sensation, then pain appears during meals, especially spicy and hot. Regional submandibular and submental lymph nodes may be somewhat enlarged and painful.

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

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

The fungus first develops on the surface of the mucous membrane and therefore is easily removed with a swab, but soon penetrates into the superficial and then deep layers of the epithelium. Such a plaque is already removed with difficulty, and with the forcible rejection of the film, a bleeding eroded surface is exposed.

Penetration of the fungus into the underlying connective tissue is possible and even the germination of the walls by the fungus blood vessels followed by hematogenous dissemination of candidiasis. The fungus can spread from the mouth to Airways and the digestive tract.

It is not uncommon for small children to have yeast skin lesions in the genital area, cervical, interdigital folds, feet, etc., which is important to consider as a source of re-infection of the oral cavity.

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

Lesions of the oral mucosa associated with the intake of drugs

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

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

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

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

Clinic

In addition to diffuse hyperemia and edema of the mucous membrane, vesicles and blisters appear, after opening of which erosions remain, covered with fibrinous films, and the picture of the lesion may resemble exudative erythema multiforme. The tongue is edematous, furred, or due to desquamation of the epithelium, it becomes smooth, as if polished, sharply sensitive to external stimuli. In addition to changes in the oral cavity, urticaria, pain in muscles, joints, dyspepsia, and in severe cases, a general reaction such as anaphylactic shock are possible.

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

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

Differentiate drug stomatitis it is necessary with erythema multiforme exudative, acute herpetic stomatitis, epidermolysis bullosa.

Erythema multiforme exudative

A recurrent disease that occurs with lesions of the oral mucosa and skin. The etiology of the disease is unclear.

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

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

Clinic

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

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

In adults and children, only the oral mucosa may be affected. Patients feel severe pain and burning of the mucous membrane, lips, cheeks, tongue, which prevent food intake, impede speech. When viewed on the reddened and edematous mucous membrane of the lips, cheeks, transitional folds, tongue, sublingual region in initial stage diseases, you can see single or grouped papules, vesicles and blisters of different sizes.

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

The period of eruptions usually lasts 5-8 days, therefore, with late treatment, even greater polymorphism of elements can be seen. The lips are often affected, especially the lower ones. Injury to the blisters on the red border leads to the formation of massive dark brown crusts. With secondary infection, ulceration of eroded areas is possible.

Rashes on the skin are localized on the back surface of the hands, forearms, shins, face and look like bluish-red spots of rounded outlines. In the center of the spot is an infiltrate, which turns into a bubble. Blisters may immediately appear on the skin, surrounded by a bright red or bluish-red rim. The disease lasts 2-4 weeks and is very difficult to tolerate by children. After healing of erosions in uncomplicated cases, no scars remain.

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

Bibliography

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

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

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

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

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The nature of diseases of the oral mucosa in children is largely determined by age characteristics mucosal structure.

Thrush (acute candidiasis)

In infancy, the epithelium of the oral mucosa is very thin, so a fungal infection, with a decrease in saliva immunity, is very easily fixed on the surface of the mucosa. Therefore, it is in newborns that acute candidiasis (thrush) is very common.

Stomatitis in children

Stomatitis in children: chronic recurrent aphthous

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

Treatment regimen includes a diet with the exclusion of irritating food, the appointment of immunocorrectors and immunomodulators (after consultation with an immunologist), vitamins B and C, desensitizing therapy. Local treatment of the oral cavity of the child antiseptic solutions, apply applications of proteolytic enzymes (trypsin, chymotrypsin), lubricate with oil solutions of vitamin A, sea buckthorn, rosehip.

Stomatitis in children: acute herpetic stomatitis

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

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

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

Stomatitis in children: acute herpetic stomatitis, treatment

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

For epithelialization of affected areas, ointments based on proteolytic enzymes of animal origin (trypsin and chymotrypsin) are used, as well as oil solutions vitamin A, carotolin, Vitaon oil, rosehip oil, dental paste Solcoseryl. Recent studies have shown high efficiency drug "Super Lysine +" (ointment, tablets, USA) and laser therapy. Super Lysine + accelerates the healing of herpetic ulcers, speeds up epithelialization, cleansing the ulcer from fibrin plaque, and has a high analgesic effect.

Antiviral drugs must be combined with immunomodulators (Imudon, Likopid, Immunal, etc. - as prescribed by a doctor).

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

Pyoderma in children

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

Taking medications and lesions of the oral mucosa

Oral mucosal lesions caused by medications. When taking many drugs, lesions of the oral mucosa can occur, which can be combined under the general name "catarrhal stomatitis". An allergic reaction to medications also belongs to the same group of diseases of the oral mucosa in children.

Diseases of the oral mucosa of traumatic origin

In a special group, diseases of the oral mucosa in children of traumatic origin can be distinguished. With mechanical damage to the mucous membrane, dangerous pathogens can easily enter the wound, which will lead to its inflammation. A child can get injuries of the oral mucosa when brushing his teeth, when eating solid food, during dental interventions, etc. A newborn, with careless wiping of the mouth, can be injured, which causes the so-called aphthae of newborns.

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

Catarrhal stomatitis in children

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

An allergic reaction to medications also belongs to the same group of diseases of the oral mucosa in children. The mucous membrane is hyperemic, edematous, covered with multiple vesicles, after opening of which erosion may remain. The tongue and lips are also swollen. At the same time, the child may develop urticaria, muscle and joint pain, dyspepsia, and even anaphylactic shock.

Treatment is aimed primarily at identifying the cause of stomatitis. If taking, for example, antibiotics is necessary in the future, it must be combined with antifungal treatment and with antihistamines. Locally used rinses, painkillers, ointments that promote healing and epithelialization of the mucosa.

Diseases of traumatic origin

In a special group should be allocated diseases of the oral mucosa in children tratian origin. The mucous membrane, due to its physiological characteristics, has a high regenerative capacity. However, if it is mechanically damaged, dangerous pathogens can easily enter the wound, which will lead to its inflammation. A child can get injuries of the oral mucosa when brushing his teeth, when taking solid food, and during dental interventions. This may be an injury from sharp destroyed teeth, orthodontic appliances in the oral cavity. The child can bite the tongue, lips, cheek. A newborn, with careless wiping of the mouth, can be injured, which causes the so-called aphthae of newborns.

Treatment of traumatic lesions of the oral mucosa begin with the elimination of the causes of injury. Then locally administered antiseptics that relieve inflammation, and means that promote healing (oils, solcoseryl-gel, etc.).

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