Ulcerative stomatitis is an inflammatory disease of the oral cavity, accompanied by focal destruction of the mucous membrane. Pathology is manifested by edema and hyperemia of the oral mucosa, against which single or multiple bleeding and painful ulcers covered with plaque are formed. The ulcerative process is accompanied by halitosis, fever, regional lymphadenitis. Diagnosis includes a dental examination, examination of mucosal scraping. Treatment consists in the local treatment of ulcers and oral cavity with anesthetics, antimicrobials and proteolytic enzymes; if necessary, antibiotics, antihistamines, multivitamins are indicated.
K12.1 Other forms of stomatitis. Ulcerative stomatitis
Ulcerative stomatitis is an inflammatory process that occurs with a violation of the integrity of all layers of the oral mucosa and the formation of ulcerative defects. Disease is the most severe type of stomatitis, because it causes deep damage to the mucous membrane of the oral cavity and causes great suffering to the patient. Depending on the affected area (tongue, gums, cheeks, lips), ulcerative glossitis, ulcerative gingivitis, ulcerative palatinitis, ulcerative cheilitis are distinguished.
Ulcerative stomatitis most often develops in children from 6 months to 3 years old, as well as in elderly patients. Ulcerative necrotic stomatitis mainly affects young men.
Ulcerative stomatitis is more often an independent disease, but it can develop a second time, against the background of existing pathology of internal organs (symptomatic ulcerative stomatitis). The development of this disease is based on certain local reactions of the immune system to various stimuli. The cause of this pathology can be the following factors that directly affect the oral mucosa:
- Traumatic. The development of ulcerative stomatitis can be caused by microtrauma resulting from violation of the technique of dental manipulation during treatment and prosthetics, due to improper fitting of prostheses, the use of biologically incompatible materials.
- Infectious. In many cases, ulcerative stomatitis has an infectious nature. For example, Vincent’s ulcerative-necrotic stomatitis (“trench mouth”) is caused by a symbiosis of conditionally pathogenic bacteria – fusiform bacillus and Vincent’s spirochete, which occur in the oral cavity and, under special conditions, provoke an acute erosive-ulcerative process with soft tissue necrosis.
- Chemical. The use of toothpastes containing sodium lauryl sulfate leads to drying of the oral mucosa and increases its sensitivity to various irritants.
- Thermal. The use of too hot drinks, burns of the oral cavity damage the mucous membrane, causing the formation of ulcerative erosive defects.
Background local processes contribute to the development of ulcerative stomatitis:
- insufficient oral hygiene,
- the presence of abundant plaque and tartar, carious teeth,
- dysbiosis of the oral cavity.
- advanced forms of catarrhal stomatitis.
A significant role in etiopathogenesis is assigned to general diseases, the state of immune reactivity. The lack of formation of children’s immunity makes young children more susceptible to the development of ulcerative stomatitis than others. Pathology is more common in patients with:
- gastrointestinal diseases (peptic ulcer of the stomach and duodenum, chronic enteritis);
- cardiovascular pathology;
- blood diseases (leukemia);
- allergic and infectious diseases (scarlet fever, flu, measles);
- metabolic disorders;
- hypovitaminosis, especially lack of vitamins C, P and group B;
- inadequate and substandard nutrition;
- unfavorable sanitary and hygienic and social living conditions.
The initial symptoms of ulcerative stomatitis resemble manifestations of catarrhal form and are characterized by redness, swelling, burning in the gingival margin and interdental papillae with a gradual spread of the process to neighboring areas. After 2-3 days, single, rather painful rounded ulcers covered with a white-gray coating form on the gums, cheeks and under the tongue. Hypersalivation, halitosis, an increase in body temperature to subfebrile values, general malaise are observed. Sharp pain makes it difficult for the patient to eat and speak.
Ulcerative stomatitis can turn into a chronic form with mild symptoms and minor pain. Chronic ulcerative stomatitis can lead to various complications (rhinitis, otitis media, gastroenteritis, pleurisy, endocarditis) and cause tooth loss.
Vincent ‘s stomatitis
With ulcerative-necrotic stomatitis of Vincent, a more severe lesion of the entire oral mucosa develops with a rapid increase in the inflammatory process and necrotic changes. Multiple ulcers with uneven edges are formed, covered with a gray-green coating and surrounded by edematous, without seals, crimson-colored tissue. The ulcerative process can pass to the tongue and palate Ulcers are able to merge and penetrate deep into the tissue, forming extensive deep foci. When necrotic masses are removed, the ulcerated mucous membrane bleeds. Any movements of the tongue, lips and cheeks are very painful. A putrid smell from the mouth, fetid thick abundant saliva is characteristic. With a severe course of ulcerative stomatitis, swelling of the cheeks may occur.
Regional lymph nodes are compacted, enlarged and sharply painful; body temperature can rise to febrile. The patient’s condition worsens: he becomes restless, loses appetite, sleep. The duration of the acute period of ulcerative stomatitis ranges from 10 to 15 days. The necrotic process can deepen with the exposure of the palate and jaw bones, complicated by the development of osteomyelitis.
The diagnosis of ulcerative stomatitis is established by the dentist on the basis of patient complaints and visual examination of the oral cavity. During the dental examination, hygienic indices, the location and appearance of ulcers are evaluated, local irritating factors are identified. Cytological, microbiological, PCR examination of scraping from the mucous membrane plays an important diagnostic role.
Since ulcerative stomatitis can be a symptom of a number of other diseases, clinical, biochemical blood tests, determination of blood sugar, immune status can additionally be carried out. If necessary, patients with ulcerative stomatitis are recommended to consult a gastroenterologist, hematologist, cardiologist, endocrinologist, allergist-immunologist, etc.
In the treatment of ulcerative stomatitis, it is important not only to stop the symptoms of the disease, but also to eliminate the root cause that contributes to its development. It is recommended to drink plenty of water, sparing non-irritating food. With a mild form of ulcerative stomatitis, local treatment is sufficient, with severe – systemic therapy is added.
- Dental treatment. Under local application anesthesia, professional oral hygiene, removal of tartar and plaque, grinding of sharp edges of teeth is performed. After the acute inflammatory phenomena subside, systemic sanitation of the oral cavity, extraction of destroyed teeth, treatment of caries and periodontal diseases, repeated rational prosthetics are shown.
- Local processing. The oral cavity is irrigated with warm low-percentage solutions of hydrogen peroxide, furacilin, chlorhexidine, potassium permanganate and herbal decoctions; gel applications with metronidazole are prescribed for the affected areas. Proteolytic enzymes – trypsin, deoxyribonuclease – are used to cleanse the ulcerative surface from necrotic masses. The use of regenerating ointments, sea buckthorn oil and rosehip contributes to the acceleration of epithelialization.
- General drug therapy. It includes detoxification and antibacterial therapy, taking antihistamines, multivitamins.
- Physical therapy. The process of treatment of ulcerative stomatitis is beneficially influenced by physiotherapy – UFO, ultrasound.
With timely intensive treatment, ulcerative foci are closed in 6-8 days; in the case of a chronic form, longer therapy and follow-up by a periodontist for 1 year are required.
Prognosis and prevention
The prognosis of ulcerative stomatitis is favorable, but largely depends on the form and severity of the disease. Timely and competent treatment leads to recovery; in advanced cases, the process acquires a chronic recurrent course, provokes the development of periodontitis and periodontal disease. The outcome of ulcerative-necrotic stomatitis may be scarring of the gum with exposure of the neck and part of the root of the tooth.
Prevention of ulcerative stomatitis consists in observing oral hygiene; treatment of chronic infectious, gastrointestinal and cardiovascular diseases; proper fitting of dentures, quitting smoking and alcohol consumption, strengthening immunity.
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