- Causes of the disease
- Forms of aphthous stomatitis
- Differential diagnostics
- Treatment of aphthous stomatitis
Aphthous stomatitis is considered to be one of the most complex chronic diseases of the oral cavity. It is characterized by regular relapses and prolonged course. This kind of stomatitis is the most common. About 30% of the population suffers from its symptoms. And recently the number of patients with chronic aphthous stomatitis is gradually increasing.
Causes of the disease
The specialist agrees that the main role in the pathogenesis of recurrent aphthous stomatitis is played by a low degree of activity of the immune system. Aphthous type of stomatitis is accompanied by low reactivity of body's defenses and violation of nonspecific defense functions.
The causes of the primary onset of the disease can be foci of chronic infection:
As etiologic factors, unfavorable factors also appear:
- Frequent change of belts with different climates
- Professions that negatively affect the mental and physical health of a person
- Stressful situations that occur regularly.
You can make a long list of typical infectious foci and adverse situations, but the principle of etiology of aphthous stomatitis remains one - the inability of the body to resist infection due to exhaustion. Along with the violation of the general state of human immunity, local defense factors are also losing ground. The level of protection of the mucous membrane decreases, the composition of the microflora of the oral cavity changes. The number of microbial agents in the oral fluid increases, their ability to harm the body significantly increases.
On the mucous membrane can detect a large number of streptococci, which have some similarities with cells of the mucosa. Lining the oral cavity to some extent is able to deposit the antigen.
In persons suffering from aphthous stomatitis, the immune system is not always able to recognize the threat in harmful bacteria. This is due to the peculiarities of the genetic structure of man. But, in such people there is a diverse spectrum of antigens on the surface of the oral mucosa. In connection with this, the mechanism of cytotoxicity of antibody-dependent type is activated, which, according to experts, is the true cause of the development of recurrent aphthous stomatitis.
Forms of aphthous stomatitis
The features of the clinic depend on the form of the disease: mild, or severe.
Symptoms and features of the course
The process of formation of aphthae begins with a small speck. The spot has all the signs of the inflammatory process: it is hyperemic, painful, edematous and has clear boundaries. A few hours after the formation, erosion acquires a film of fibrinous tissue that fits snugly against the erosive surface. When touching the aphthae, the patient experiences pain, but the pathological focus itself, to the touch, is soft. At the base of the aphthae, an infiltrate is formed, as a result of which it rises above the level of the surrounding tissues.
The mucous membrane around the pathological formation becomes hyperemic and swells. When palpating submandibular lymph nodes, one can find their increase.
A few days later, necrotic tissue is rejected, after a couple of days, the aphthae itself heals. Perhaps, some time after the disappearance of signs of erosion, at this place there will be a slight reddening. But this is just a residual phenomenon of the disease. Before the appearance of pathological foci, the body gives a warning signal in the form of a burning sensation and pain in the place where erosion should occur. With constant relapses, patients begin to recognize such signs and know in advance about the approaching period of exacerbation.
A light form is characterized by the appearance of one aphtha or two. Localization - the inner surface of the cheeks and lips, the tip of the tongue or its lateral surfaces. Aphids can potentially be anywhere in the oral cavity, but these areas are most often captured by them. Relapses of mild form of the disease occur every few months or days. The frequency of exacerbations depends on the individual characteristics of the organism.
The mild form of aphthous stomatitis can occur without the knowledge of the patient, since a person may simply not pay attention to mild symptoms. But, with each aggravation, in most patients the severity of symptoms is aggravated, and they are forced to visit the doctor about 5-6 times within one year. But some report relapses no more than twice a year, and the course of the illness does not cause them any particular inconvenience.
Causes of exacerbation of the disease
- The provoking factors of exacerbation may be: various mechanical or thermal injuries of the oral mucosa
- Stressful situation
- Chronic overfatigue
- Viral infection
- Premenstrual period in women.
A variant of the onset of the exacerbation period is possible spontaneously, without a valid reason. According to the research, the disease has been mild for the first three years. Relapses occur rarely, the symptoms are of a smoothened nature. In young adults, aphthous stomatitis can quickly move from mild to severe, without waiting for the promised delay of three years.
Acceleration of the transition from one state to another happens under the influence of certain factors:
- Occupational hazards
- Frequent changes of place of residence (respectively, changes in the climatic belt)
- The presence in the patient's body of diseases with a chronic type of current (bronchitis, tonsillitis, etc.)
- Age younger than 25 years.
Differential diagnosis of mild form of aphthous stomatitis
The external similarity of aphthae have:
- Herpetic erosion
- Traumatic erosion
- Papules of syphilis, which are covered with fibrinous coating after some time after the formation.
Herpetic erosion, in contrast to aphthous, has large dimensions and fuzzy outlines due to the fact that it is formed by the fusion of many small erosions. Syphilitic papules are practically painless and are diagnosed by the identification of pale treponemes in the contents of the blisters. Traumatic erosions occur when the mucous membranes of the oral cavity are mechanically affected, so they do not have a fibrinous film and a hyperemic rim.
Severe form of aphthous stomatitis
The severe form of aphthous stomatitis is called "Setton's aphthae," or "recurrent deep aphthae prone to scarring."
Symptoms of severe form of aphthous stomatitis
- Afta, which appeared on the mucous membrane, is epithelialized not earlier than in 2-3 weeks.
- Exacerbations occur regularly, every month.
- On the oral mucosa, deep ulcers are formed in the form of craters, which are accompanied by severe pain syndrome.
- The ulcer heals not earlier than a month.
- Afts and ulcers can be found in the mouth simultaneously.
- The frequency of exacerbations is about six times a year.
- The disease has a chronic course.
A harbinger of exacerbation is the appearance of a small area of compaction, which is first transformed into a superficial, then deep ulcer.
After healing, on the site of ulceration and aphtha there are scars that are so coarse in their structure that they lead to deformation of the mucous membrane. If the scars are in the area of the corners of the mouth, they can narrow the mouth slit, resulting in microstoma formation.
The severe form of aphthous, recurrent stomatitis must be differentiated with:
- Traumatic ulcer
- Traumatic erosion
- Recurrent herpes
- Ulcerative necrotic stomatitis of Vincent
- Behcet's disease
- Specific ulcers (with syphilis, tuberculosis)
- Ulcers with a tendency to malignancy.
Symptomatic analysis may be inaccurate and there is a risk of making a mistake in diagnosis. Therefore, the final diagnosis is made only when conducting a laboratory study of biological material taken from the affected area.
Treatment of aphthous stomatitis
The treatment of aphthous, recurrent stomatitis can be effective only if the patient has been examined by all the relevant specialists for all systems and organs. Only a deep clinical and immunological study can provide enough information about the state of the body, which will allow the appointment of adequate, comprehensive, pathogenetic treatment.
General treatment measures are represented by a complex of three components:
- Appointment of immunocorrecting drugs
- Use of drugs to improve cellular metabolism
- Sanitation of all foci that are the source of chronic infection.
Correction of immunity is carried out by taking thymogen. Timogen regulates the responses of the humoral and cellular types of immunity. The drug is administered by intramuscular injection for ten consecutive days.
Normalization of lymphocyte metabolism at the cellular level is carried out with the help of drugs that stimulate metabolism in the mitochondria. Depending on the results of the cytochemical analysis of the enzymatic status of white blood cells, individual drugs are selected.
The first complex of drugs of metabolic action improves energy processes in lymphocytes. Its application fits within a time span of ten days.
The second set of drugs to improve metabolism is taken within the next ten days.
The purpose of such therapy is to achieve a state of persistent remission of aphthous stomatitis. For this it is necessary to conduct about 6 courses of correction of metabolism at intervals of six months.
It is especially recommended to carry out metabolic therapy in the spring period, since it is at this time of year that the body suffers from vitamin deficiency and the exacerbation of the disease occurs more often.
Treatment of all diseases of the patient's body is explained by the fact that any chronic focus of infection can cause aggravation of aphthous stomatitis, since such a state supports the constant sensitization of the bacterial agent.
Compliance with the diet plays an important role in the complex of general therapy. Patients with recurrent aphthous stomatitis are prohibited:
- Eat spicy seasonings
- Have spicy food
- Drinking alcoholic beverages
- To smoke.
Compliance with the rules of treatment and conscientious implementation of all the recommendations of a doctor-periodontist allows you to quickly stop the symptoms of exacerbation, normalize the state of immunity and lengthen the periods of remission.
Local treatment consists of fairly simple activities:
- Sanitation of teeth and oral cavity
- Elimination of traumatic factors
- Treatment of foci of chronic infection
- Use of anesthetics to eliminate pain.
The use of medicines and methods of physiotherapy gives a good therapeutic effect.
Removal of plaque from the surface of the aphid is carried out with the help of proteolytic enzymes.
Stimulation of healing processes is performed by local application of an oil solution of vitamin A and E, carotolin, actovegin and solcoseryl ointments.
The prognosis of the disease can be quite favorable if an early diagnosis is performed and the corresponding treatment is undergone in a mild form.
To prevent the development of recurrent aphthous stomatitis can be through the conduct of a healthy lifestyle, regular monitoring of their health and timely treatment of foci of chronic infection.
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