Aphthous stomatitis is an inflammatory process of the oral mucosa, accompanied by a violation of the surface layer of the mucosa and the formation of aphth (erosions). The formation of AFT is accompanied by sharp soreness, burning in the mouth, especially during meals, an increase in lymph nodes, and sometimes an increase in temperature. Aphthae heal without a trace after 7-10 days. With weakened immunity and the presence of concomitant diseases, aphthous stomatitis can occur with relapses.
Causes
The pathogenesis of AFT formation in chronic aphthous stomatitis has not been fully elucidated, however, in all patients there is a persistent link between the progression of the disease and the reaction of the immune system. To date, the generally accepted theory of the formation of aft on the oral mucosa is the theory that the human immune system cannot identify the molecules of the substance present in saliva. This causes activation of lymphocytes, as the immune system does not recognize the chemical agent, attacks it as a foreign one. As a result , aphthous ulcers are formed; the inferiority of the immune system and the constant presence of chemicals contributes to the chronization of the process and aphthous stomatitis takes a long sluggish course.
In patients who use oral care products containing sodium lauryl sulfate, aphthous stomatitis was diagnosed more often. The probable cause is the foaming component sodium lauryl sulfate, which has a drying effect, which can negatively affect the oral mucosa. And in the future, when the upper layer of the mucosa is damaged, the lower layers become more sensitive to irritants, especially to substances with high acidity.
The relationship between the occurrence of aphthous stomatitis and oral care products containing sodium lauryl sulfate is confirmed by the results of the study, when patients suffering from chronic aphthous stomatitis for a long time started using other toothpastes, noted that the manifestations either subside significantly, or a complete clinical recovery occurs. With long-formed ulcers, no recovery was observed, but in 81% of cases their soreness decreased.
Mechanical damage to the oral cavity is also a provoking factor, as the patients themselves note the connection between the trauma of the oral cavity and the onset of the disease. Chronic aphthous stomatitis can begin after biting the tissues of the oral cavity, after damage to the mucous membrane by the sharp edge of the tooth or solid food. Approximately 40% of patients with chronic aphthous stomatitis confirm the presence of trauma before the onset of the disease.
Neuropsychiatric overstrain itself rarely causes chronic aphthous stomatitis, but the appearance of AFT during exacerbations often coincides with periods of increased psychological stress. Most patients with chronic aphthous stomatitis have various nutritional disorders and nutritional deficiencies. The lack of vitamin C, B vitamins, iron, zinc, folic acid and selenium negatively affects the condition of the oral mucosa, which contributes to the occurrence of AFT.
An allergic reaction to food products can cause an outbreak of aphthous stomatitis, therefore, patients are recommended to keep a diary so that in the future it will be easier to find out the allergen that caused the appearance of aphth. Among the products that are the most likely allergens, cereals with a high content of gluten protein are noted: wheat, rye, barley, buckwheat. Citrus fruits, pineapples, apples, tomatoes, figs, strawberries, chocolate, seafood, spices, as well as dairy cheeses and food additives are the main causes of aphthous rashes in the oral cavity.
In women, the frequency of rashes is associated with the menstrual cycle, many of them experience clinical recovery or remission during pregnancy. However, the relationship between pregnancy and remissions of aphthous stomatitis has not yet been studied.
The genetic predisposition in the development of aphthous stomatitis is confirmed by the facts that in a third of patients, one or both parents also suffered from chronic aphthous stomatitis. Identical twins in 91% of cases suffer from aphthous stomatitis, while fraternal twins only in 57% – this also confirms the genetic conditionality of chronic aphthous stomatitis. Bacterial and viral agents were detected in the contents of the aft.
Often, with a full examination, systemic diseases of the blood, gastrointestinal tract and immunodeficiency are detected in patients with aphthous stomatitis. The relationship between them and the formation of aft is confirmed by the fact that after the correction of the underlying disease, clinical recovery from aphthous stomatitis or persistent remission occurs. Prolonged use of nonsteroidal anti-inflammatory drugs, antiarrhythmic and antihypertensive drugs as a side effect causes the development of chronic aphthous stomatitis.
Symptoms
In the fibrinous form of aphthous stomatitis, primary disorders of blood microcirculation in the epithelial layer come out in the first place. As a result of these changes, single aphthous rashes appear, covered with a fibrous coating. After 1-2 weeks, the aphthae are epithelized. Rashes are localized mainly on the mucous membrane of the lips, the lateral surfaces of the tongue and in the area of transitional folds. At the first stage of the disease, relapses occur 1-3 times a year. As the course of stomatitis progresses, it becomes permanent. At the same time, if at the beginning relapses are provoked by exacerbations of systemic pathology or trauma of the mucous membrane, then as the progression progresses, minor stress is sufficient for the appearance of aft.
With the necrotic form of aphthous stomatitis, the primary destruction of the epithelium occurs, while ulceration of the oral mucosa causes dystrophic disorders that occur against the background of necrosis and necrobiosis of epithelial tissue. Necrotic aphthous stomatitis is diagnosed in people with severe somatic diseases and with blood diseases. The aphthae that have appeared are practically painless, over time they turn into ulcers, the period of epithelization of which is from 2 weeks to a month.
Grandular aphthous stomatitis develops due to the primary lesion of the ducts of the small salivary glands. This causes hypofunction of the glands and provokes the appearance of afts, which are localized next to the salivary glands. Aphthae are painful and epithelize after 1-3 weeks, hypothermia, respiratory diseases and exacerbation in the foci of chronic infection can provoke their further appearance.
With scarring aphthous stomatitis, the acinuses of the small salivary glands are affected, a layer of connective tissue is involved in the pathological process, over time, elements of rashes are observed both in the location of the salivary glands and on the mucous membrane of the pharynx and anterior palatine arches. Mostly young people suffer. The primary element is aphthae, but they quickly transform into deep painful ulcers, reaching one and a half centimeters in diameter. Scarring stomatitis is not associated with somatic diseases, and genetic insufficiency of the secretory apparatus lies in the pathogenesis. The process of epithelization of ulcers is long, up to 3 months, after healing there are clearly visible scars.
The deforming form of aphthous stomatitis is considered the most severe, since the destructive changes in connective tissue are deep, and ulcers have a persistent character. Ulcers epithelize slowly, the healing process leads to deformation of the soft palate, anterior palatine arches and lips. If ulcers are localized in the corners of the mouth, then a microstoma may form during healing.
Diagnostics
Chronic aphthous stomatitis is diagnosed by a dentist based on the clinical picture and the patient’s survey, sometimes they resort to laboratory diagnostics. Differentiation should be carried out with recurrent herpetic stomatitis, with ulcerative-necrotic stomatitis and with ulceration of the oral mucosa with specific lesions and decubital ulcers.
Treatment
The goal of treatment is either persistent remission, or clinical or complete recovery. The complex of therapeutic measures includes general and local therapy, the choice of drugs depends on the severity of the manifestation and the dominance of individual symptoms.
Local treatment consists in treating the oral cavity with hydrogen peroxide, nitrofural and chlorhexidine. If there is a pain syndrome, then the aphthae are treated with 5-10% glycerin suspension with lidocaine or novocaine. If there is an allergic component in the pathogenesis of stomatitis, then a mixture containing trasylene, heparin, novocaine and hydrocortisone is used instead.
During exacerbations, enzymes are applied topically – trypsin, chymotrypsin and RNase. Solutions of citral, vitamin C and P, preparations with kalanchoe juice and propolis accelerate the process of epithelization. The use of corticosteroid ointments can interrupt the further development of AFT and accelerate the recovery process.
Oral administration of antihistamines – clemastine, loratadine, fexofenadine; and desensitizing drugs – hifenadine and histamine with immunoglobulin is indicated. If the sensitization of the organism to a specific microbial agent is detected, then specific desensitization is used. According to indications, antiviral drugs and an antiherpetic vaccine are prescribed.
All patients are recommended to undergo a course of vitamin therapy with an increased content of vitamins of groups B and C. Immunomodulators and immunoprotectors are indicated. If there are neurological disorders, sedatives and tranquilizers are used. It is recommended to include phonophoresis, electrophoresis and laser therapy in the treatment complex. During treatment and during remission, it is necessary to follow a hypoallergenic diet with the exception of coarse, traumatic food.
With timely treatment and compliance with the prescribed regimen, it is possible to achieve a stable and long-term remission, although complete recovery from chronic aphthous stomatitis is extremely rare.