|Ministry of Health
Republic of Uzbekistan
Tashkent Medical Academy
Department of Therapeutic Dentistry
Lecture number 3
Changes in the mucous membranes of the mouth and red portion of the lips in allergic diseases vaniyah. Cheilitis.Anomalies language.
Lecturer: Prof.. H.P.Komilov
The text of the lecture
designed for students of the Faculty of Dentistry of the 5th year medical students
Tashkent - 201 3
Topic: Changes in the mucous membranes of the mouth and red portion of the lips for allergic diseases. Cheilitis. Anomalies language.
The purpose of the lecture: About acquaint students with the changes of the mucous membranes of the mouth and red portion of the lips in allergic diseases, and diseases of cheilitis language.
Tasks lecture: student should know about the changes of the mucous membranes of the mouth and red portion of the lips in allergic diseases, and diseases of cheilitis language.
Plan of the lecture:
1. Immediate type allergic reactions (angioedema, anafilakticheksky shock) in Dental practice. The symptoms and treatment.
2. Delayed hypersensitivity (allergic stomatitis, cheilitis, glossitis, gingivitis). The symptoms and treatment.
3. Bacterial allergies (Chronic recurrent aphthous stomatitis, erythema multiforme). The symptoms and treatment.
4. Cheilitis. The symptoms and treatment.
5. Anomalies language. The symptoms and treatment.
Currently, in many countries, including Uzbekistan, the large increase in allergic diseases. The significant increase of these diseases and their serious consequences determine the need for knowledge of a physician of any specialty of the basic theoretical and practical aspects of allergy, the ability to provide emergency assistance in case of allergic conditions.
In dental practice, the most common drug allergy, the immune mechanism which corresponds to the general laws of allergic reactions.
Allergic reactions of immediate type
(Angioedema, anaphylactic shock) in dental practice.
The symptoms and treatment.
With the increase of drug efficacy and increases the possibility of adverse effects to the human body. Therefore, the problem of complications from medications currently very topical and acquires medical - social value, as economic losses due to drug disorders are ord Romney excess of economic losses from communicable diseases.
In modern conditions, the doctor - dentist forced to engage in requested the prevention, early diagnosis and emergency treatment of patients who develop an immediate allergic reaction to the medication. Medication use among patients, unfortunate nately, not decreasing, but increasing. Virtually all drugs pre formulations can cause severe side effects, but some materials are used in dentistry are more likely than others, and therefore they should be addressed. These substances include antibacterial nye agents (antibiotics, sulfonamides), local anesthetic (lidocaine, ultrakain, etc.), pain (group protivovospalitel analgesics), and some other medicines (vitamins, hormones, enzymes, etc.).
As stated above, that the time of the onset of allergic symptoms to distinguish between reactions of immediate and delayed action interaction.
Immediate type allergic reactions develop in 5-20 minutes after the allergen. A.D.Ado (1978) suggested that the reaction takes place in three stages: first - an immunological reaction (antigen-antibody), the second-pathochemical (isolation of biologically active substances in the re result of antigen - antibody), the third - the pathophysiological (functional and degenerative disorders of the tissues and organs).
For immediate-type allergic reactions are angionevro-energy angioedema and anaphylactic shock.
Angioedema may occur as a result of food al lergenov, various medications used inside (sulfonamides, antibiotics, aspirin, etc.), local application (lidocaine, tincture of iodine, lipstick), and the presence of foci of chronic technical infection. Within a few minutes, sometimes slower, in different parts of the body develops significant swelling. Swelling may disappear show in a few hours or days. Most often it is located on the upper lip and the eyelids, at least - on the lower lip, tongue and throat. The patient noted a sense of embarrassment, the increase in volume lips, tongue or other parts of the body and face. Most opastnost life is swelling of the throat, which is one quarter of all cases of angioedema. Edema develops rapidly, the patient is restless and feels difficulty in breathing develops aphonia, the face becomes cyanotic. If there is inadequate care the patient may die. In such cases, a first aid until the tracheotomy.
Angioedema should be distinguished from swelling lips with syn drome Melkerssona - Rosenthal trofedeme Meyzha and other mahroheyln-ing.
Treatment. Important to stop contact with the allergen. Swelling of the lips, eyelids and other sites (except for laryngeal edema) take antihistamines by mouth (diphenhydramine, tavegil, etc.), 10% solution of calcium chloride, askorutin tablets 3-4 times a day. Local therapy is not required.
Drug anaphylactic shock develops within 5-20 minutes after the administration of allergen in sensitized body. By the nature of the clinical course of anaphylactic shock is divided into mild, moderate and severe. Mild is a small manifestation of vascular dystopia: dizziness, itching, unpleasant sensations tion in different parts of the body, flushing of the skin. Objectively fromsword quickly passing skin flushing, hypotension, tachycardia without loss of consciousness. Lasts from several minutes to several hours. At moderate shock in a patient develops severe weakness, head whirling, dark vision, hearing loss, cough, and vomiting. On observed rapid change geperemii skin pallor, cold sweat, pade tion of blood pressure, tachycardia, possible asthma, about Morochno state. Severe anaphylactic shock develops fast, fast: the collapse and coma, accompanied by a loss of knowledge, prostration, a violation of the respiratory rhythm, involuntary defects tion and urination. Death occurs within 5-40 minutes. To severe degree accounts for 10-15% of deaths from anifilakticheskogo shock.
Treatment. Medical care should be urgent. First of all, the patient should be put to warm, decrease of allergen in the blood. Intramuscularly at a site injected with 0.5 ml of 0.1% solution of adrenaline, the procedure must be repeated after 10-15 minutes. Additional tools to deal with the collapse of a kordiamin, caffeine, camphor. In severe bronchospasm additional picture slowly for 4-5 minutes, internally administered 10 ml of 2.4% solution euffillina with 10 ml of 40% of the races Express Yourself glucose. In addition, as intravenous or gidrokartizon prednizalon, 1% solution dimedrola intramuscularly, 10% solution of calcium chloride intravenously.
Eskie allergic reactions of delayed-type
(Allergic stomatitis, cheilitis, Glos, gingivitis).
The symptoms and treatment
The use of different drugs often leads to the tubular response to the oral mucosa. They are depending on the location is referred to as cheilitis (isolated lesion of lips), glossitis (loss of language), stomatitis (damage various parts of the mucous membrane of the mouth). On the severity of the inflammatory response are distinguished: catarrhal, erosive, yaznenno - necrotic stomatitis (cheilitis, glossitis), hypertrophic gingivitis.
Catarrhal stomatitis (Cheilitis, glossitis). Is the most mild form of medical injury. Patients experience itching, burning, slight pain when consuming hot, spicy write. Typically, these events occur after administration of a drug product. Oral mucosa rich red swelling. If the lesions are localized in the language, the back of his acquiring a bright red color. This kind of language is described as "pentsillinovy glossitis."
Catarrhal stomatitis (cheilitis, glossitis) medical origin should "differentiate from similar changes in gipovita-minozah, infections, gastro-intestinal diseases, fungal infections.
Treatment consists in the abolition of the drug or its replacement
others, the appointment of antihistamines, vitamins C and Group B. Topical therapy is not required, except for the application obezbali-down means.
Erosive and ulcerative stomatitis is a more severe form of drug destruction. Patients concerned about pain, difficult eating and speech. The degree of severity of pain depends on the propagation prevalence of pathological changes, localization of erosions and ulcers. Oprah divided localization elements are usually absent. Affected mucous hull cheeks, lips, tongue, etc. there is an increase in body temperature (37.5-38.5 C), weakness, loss of appetite.
Differential diagnosis of the disease should be made with erythema multiforme, pemphigus, acute gerpetiche Skim stomatitis, herpes zoster, foot and mouth disease, and changes of the oral mucosa in some systemic diseases.
Stomatitis medical treatment begins with a withdrawal of a new drug, given that they can cause allergies cal reaction. Topically administered painkillers, stimulated trolling epithelization.In the combined treatment impor chenie withdrawn diet. Food must be pureed, receiving fractional (4-5
a day). You must assign a higher amount of vitamin C and E (broth hips, etc.), vitamins A and B, as well as calcium and phosphorus.
Bacterial allergy (Chronic recurrent aphthous stomatitis, erythema much forme).
The symptoms and treatment
The development of this type of allergy associated with the presence of foci of chronic infection in the body: in the tonsils, sinuses, teeth with necrotic pulp, periodontium, or internal organs. According to temporary views, sensabilizatsiya body has a certain value tion in the development and progression of chronic recurrent aphthous stoma Titus and exudative erythema multiforme.
Chronic recurrent aphthous stomatitis occurs more frequently in patients with gastro - intestinal diseases and severe sensitization to microbial allergens to the damage of cellular immunity. In most patients, this stomatitis is characterized by the appearance of single (1-3) AFL round or oval in shape with a diameter of 2 to 8 mm, covered with fibrous or necrotic plaque.Aphthae are painful, difficult meal, localized mainly in the mucous membrane of the lips, cheeks, the sides of the tongue. There are not more than 10-14 days. Differentiate from traumatic erosion, secondary syphilis, chronic retsediviruyuschego herpes.
Treatment. For the targeted treatment of patients with chronic retsediviruyuschim aphthous stomatitis is necessary to:
1. examination of gastro - intestinal tract to detect inflammatory processes, dysbiosis, helminthiasis;
2. study of the functional state of the liver;
3. identify foci of chronic inflammation, including odontogepnyh;
4. allergic tests (intradermal tests with microbial allergens, leukocytosis response to microbial allergens);
5. mmunologicheskoe examination.
Treatment is aimed primarily at the elimination of associated diseases, sanitation foci of chronic infection of the mouth. When you phenomenon of increased sensitivity to microbial allergens prescribe a course of specific shposensibilizatsii.
Nonspecific desensitization is subcutaneous gistaglobulina (1 ml after 3 days, only 8-10 injection), intravenous 30% solution of sodium thiosulfate (10 ml every other day, 10 injections).
If indicated (lower body resistance, impaired cell exact immunity) and sodium administered pentoksil nukleinat tablets, prodipyuzan intramuscularly individual scheme (under steady nara), lysozyme intramuscularly at 75 mg 2 times a day, autohaemotherapy, hyperbaric oxygen therapy, vitamin therapy.
Local treatment begins with anesthesia (applications, bath), removal of necrotic plaque effect on aftu antiseptic or ulcer kami and keratoplasticheskie means. Necrotic plaque can be removed shed by proteolytic enzymes (himopsin, chymotrypsin). Good effect of irradiation have aphthae or ulcers of helium-neon laser, local UV irradiation using tube OH-7 or OKUF-5M.During eruptions AFL should exclude chit smoking, sour and salty food, alcohol.
Erythema multiforme. The disease is retstsiviruyuschy character, a marked seasonality (usually in the spring and fall). At the beginning of the disease are observed fever, malaise, muscle and joint pain, and headaches. Then there are sores on the skin and mucous membranes. If at first manifestations zistoy oral cavity are swelling and erythema, against which there are subepithelial blisters. Hull blistering fast breaks Xia, exposing a very painful, bleed easily eroded. Erosion may coalesce to form large areas of damage covered fibrioznym bloom. The red border of lips and corners of the mouth crusted erosions. Localization of erosion of the mucous membrane of the mouth can be very different: lips, cheeks, tongue, soft palate, floor of the mouth. Gingival margin and papilla are only slightly flushed, and very rarely affects the hard palate.
On the skin of the hands, forearms and lower legs formed bluish - red spots with zapadaniem center (badge), sometimes bubbles surrounded by hyperemia.
Generalizovanye skin and all mucous membranes (eyes, nose, gastro - intestinal tract, urogenital system) are described in the literature tour under the name Stevens - Johnson. This syndrome is accompanied accompanied by severe intoxication, fever, sometimes le perimental outcome.
Diagnosis of exudative erythema multiforme is not difficult. In the case of localization of elements of defeat only to mucous membrane of the mouth of the disease should be differentiated from acute gerpe cally stomatitis, drug allergy, true pemphigus.
Treatment. During the acute period of symptomatic treatment. Prescribe anti-inflammatory drugs, intravenous injections of 8.10 30% solution of sodium thiosulfate in 10 ml intramuscular antihistamines, calcium supplements, ascorbic acid, vitamin group nN B. In severe cases, shows broad-spectrum antibiotics, corticosteroids, intravenous drip - reopolyglukine, gemodez etc.
Local treatment is aimed at eliminating inflammation, swelling, acceleration, epithelization erosions. For baths and rinses with this, you can primenyatO various antiseptic and anti-inflammatory drugs (chloramine, chlorhexidine, furatsilin, rivanol, aerosols - oksm court and oksitsiklozol), 5% metiluratsiolovuyu ointment, liniment aloe, rosehip oil and sea buckthorn.
Cheilitis. The symptoms and treatment
Inflammation of the red portion, mucous membranes and skin lips called cheilitis.
It occurs as a distinct disease, and as a symptom of various diseases of the mouth.
Distinguish exfoliative, glandular, eczematous, angular cheilitis, chronic crack lips. The same can be abrasive and prekantserozny cheilitis Manganotti makroheylit Melkersson-Rosenthal, but they will be discussed in the section "Precancerous diseases of the mouth."
Exfoliative cheilitis. Esfoliativnogo Two forms of cheilitis, dry and exudative.
When dry form cheilitis patients concerned about dry lips, sometimes burning, itching, constant peeling.
In the transition zone of the lips that is on the border of the mucous membrane of the lips and the red portion of the lips, until about the middle of it, there is a band
congestive hyperemia, covered with transparent, rather tightly attached scales. After snyatrtya flakes exposing the bright red surface, sometimes with a very small and shallow erosions.
When the exudative form cheilitis lips enlarged, hyperemic, swollen, her mouth half open because of the sharp pain when closing. Characterized by the formation of massive crusts, consisting of layers of fluid shriveled and flakes easily removed with forceps under which obnaruzhevaetsya smooth or grainy bright red surface \
Glandular cheilitis - E is inflammation of the small salivary glands of the lips. There are simple glandular cheilitis and purulent.
A simple form is characterized by an increase in the number and heterogeneous zone Klein seromucous labial glands or ducts, their hyperactivity and hyperplasia. From gaping duct glands abundantly released secret in drops of dew. Due to infection and prolonged irritation secretions from the salivary glands of developing hypertrophic maceration and inflammation.
Purulent form is rare and is caused by penetration ptyalectasis pathogenic organisms. Characterized by pain, swelling lips of the ducts salivate with blood. Sometimes the mouth duct glands are clogged compacted purulent exudate. Multiselection and single abstsedirovanie.
Eczematous cheilitis. Depending on the cause of cheilitis are distinguished:
1. caused by seborrheic dermatitis;
2. microbial eczema;
3. eczematous contact.
The first form is expressed in the red portion of the lips flushing, the appearance of scales, which are easily separated.
Skin of lips, red border is dry, cracks, brown.
The second form develops in the seborrheic dermatitis due pyococcus infection of the lips and cracks at other sites. Clinical manifestations consistent microbial eczema.
The third form is developed as the result of an allergic reaction to lipstick, toothpaste, etc. Appears swelling of the lips, bright redness, blisters followed by the formation of crusts.
Actinic cheilitis. Distinguish two form actinic cheilitis: exudative and kseroznuyu.
When the exudative form baspokoyat patients, pain, increase lip observed swelling, redness, lips and then see an vesicular disease, the formation of erosions, crusts, cracking, peeling.
When the form appears kseroznoy burning, dry mouth and pain. Marked flushing red portion of the lips, education whitish-gray flakes peeling.
Angular cheilitis - It is a chronic relapsing disease character. Called streptostafilokokkovoy infection and fungi. In this case, patients complain of pain priotkryvanii mouth. At the beginning of the disease in the corners of the mouth appear superficial erosion or cracks that quickly become infected. Eczematous effects can spread to the skin of lips and chin, adjacent to the corner of the mouth.
Chronic crack lips can occur both on the upper jaw, and on the bottom. Often located in the central part of the bay, and sometimes in the corners of the mouth.
First cracks appear are slit defects mucosal epithelium, surrounded by a red border and congested bloody crusts. Sometimes they epiteliziruyutsya short and reappear. Frequent relapses lead to development in the focus area of scar crack atrophy, dense to the touch with a whitish hue.
Cheilitis treatment. Cheilitis is difficult to treat. Used hormonal ointments, antibacterial and keratoplasticheskie funds. When glandular Haley, if not effective anti-inflammatory therapy, conduct glands electrocoagulation or excision. When eczema Hale additionally prescribe sedatives and desensitizing agents.
Anomalies language. The symptoms and treatment
In the language of destruction can occur in case of injuries, infectious diseases, allergic states, beriberi, Medicine, etc.
However, we present data on the folded tongue and glossitis independent, ie such processes, which are found almost exclusively in the language. These include desquamative glossitis, rhomboid glossitis, black (hairy) language, folded tongue.
Deskeamativny glossitis. Glossitis is inflammation of the tongue.
Desquamative (geographical) glossitis is characterized by the appearance of epithelial desquamation sites filiform papillae, the periphery of which there are bands keratinized epithelium.Desquamation usually multiple foci, often located at the tip of the tongue and side. Followed by desquamation occurs epidermidalization filiform papillae, and in areas of keratinization, conversely, desquamation. As a result, parts of desquamation and epidermidalization whisker buds, one after another, migrate to the surface of the tongue and merge to form the shapes that look like a map.
Subjectively, the pain may occur, burning, aggravated by eating spicy, salty and sour foods.
In the absence of subjective symptoms treatment is needed. When the pain and burning are recommended, in addition to dental health, gargle with antiseptic solutions, applications keratoplasticheskie funds.
Rhomboid glossitis - chronic disease, when the picture language, closer to the root of the midline, appears oval diamond area, devoid of papillae. There are three forms glossitis: smooth, raised and papillomatoznye.
Rhombic shape with a smooth surface glossitis lesions is small, pink or red, clearly limited by other sites.
In the case of hilly or papillomatoznye modified form in the center of the lot is sprawl, rising above the level of the epithelium. Sometimes there is a burning sensation, tingling, worse meal.
Treatment consists of dental health, smoking cessation. With significant growths papillomatoznye their excised, followed by histopathological examination. In the absence of complaints does not require treatment.
Black (hairy) language. Hairy tongue is expressed in the proliferation and keratinization of the filiform papillae middle and posterior thirds of the tongue. Patients have an unusual type of language, sometimes a feeling of a foreign body on it or gag reflex, feeling the itch.
In the picture in front of the tongue papillae, filiform papillae fluted lengthen and turn light brown or black. Papillae length sometimes reaches 2cm. Diameter 2mm. Outwardly they resemble hair.
Treatment consists of dental health. Local application of keratolytic (3% solution of resorcinol) will give short-term effect. Give the best results during cryotherapy.
Pleated language - congenital anomaly of the shape and size of languages, which is expressed in the presence of deep sulci (folds) extending in all directions. The folds are mostly symmetrical. Most deep longitudinal fold is usually held on a median furrow. The presence of deep wrinkles favors vegetative fungal microflora. In poor oral care can develop inflammation, burning and pain occur.
Local treatment with folded tongue is not made. Requires thorough oral care, timely readjustment.
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