Chronic stomatitis - the inflammatory damage of a mucous membrane of a mouth having a long current with periodic remissions and aggravations. Depending on a clinical form, chronic stomatitis is followed by the limited or diffusion reddening of a mucous membrane, education in an oral cavity of vesicles or painful ulcers increased by salivation, symptoms of the general intoxication, regionarny lymphadenitis. Diagnosis of chronic stomatitis includes a research of scrapes and oral liquid (bacteriological, cytologic, PTsR, biochemical, immunological), consultations of the stomatologist, etc. experts. Treatment of chronic stomatitis assumes elimination of etiologichesky factors, local processing of an oral cavity, system etiotropny therapy.
Chronic stomatitis – various on the origin, the recidivous inflammatory processes affecting a mucous membrane of an oral cavity. As the most frequent clinical form of chronic stomatitis serves recurrent aftozny stomatitis: among various diseases of a mucous membrane of an oral cavity 5% of cases fall to its share. As chronic stomatitis recurrent herpetic stomatitis, ulcer and necrotic stomatitis of Vincent, prosthetic stomatitis, stomatitis of smokers, fungal stomatitis, etc. can proceed. In most cases development of chronic stomatitis is connected not only with local factors, but also with violations of work of various systems of an organism that does this disease urgent both for stomatology, and for immunology, gastroenterology, endocrinology, otolaryngology, etc.
Reasons of chronic stomatitis
The etiology of chronic stomatitis defines this or that form of an inflammation of a mucous membrane of a mouth. So, concerning an origin of chronic recurrent aftozny stomatitis also other theories are considered infectious and allergic, virus, autoimmune. Communication of chronic aftozny stomatitis with mono - and a polyvalent bacterial allergy to a protea is experimentally proved, to L-forms of stafilokokk, streptococci, colibacillus. There are data indicating a possible etiologichesky role of an adenoviral infection.
At a part of patients with this form of chronic stomatitis in the anamnesis autoimmune diseases (nonspecific ulcer colitis, a disease Krone, Bekhchet's disease, etc.), functional violations of a gastrointestinal tract (gastritises, dysbacteriosis, locks, diarrhea, dyskinesia of biliary tract), frustration of endocrine system are traced. Cases of family forms of chronic recurrent aftozny stomatitis are described that indicates a role of hereditary predisposition to a disease.
In an etiology of chronic ulcer and necrotic stomatitis of Vincent the leading role belongs to association of a spindle-shaped stick (Bacillus fusiformis) and Spirochaeta vincenti spirokheta which can also cause ulcer gingivit, ulcer quinsy, etc. Activization of this resident microflora of an oral cavity happens at sharp decrease in resilience of an organism to an infection.
Chronic recurrent herpetic stomatitis is caused by a virus of simple herpes and especially often occurs at children of early age. The fungal stomatitis or candidiasis of an oral cavity caused by drozhzhepodobny fungi of a sort Candida develops at uncontrolled and long reception of antibacterial means.
On emergence mechanisms chronic prosthetic stomatitis can be allergic, bacterial and traumatic. The allergic form of prosthetic stomatitis is most often connected with hypersensibility to the components which are a part of the acrylic plastic used for production of removable artificial limbs. Chronic prosthetic stomatitis of a bacterial origin is caused by unsatisfactory hygienic care of artificial limbs. Constant injuries of a mucous membrane by incorrectly adjusted denture, its malfunctions (cracks, breakages) become the reasons of traumatic stomatitis.
Stomatitis of smokers arises owing to chronic irritation of a mucous membrane of an oral cavity the pitches and nicotine which are present at tobacco products.
As the factors provoking an aggravation of various forms of chronic stomatitis violations of a diet, reception of certain medicines, a stress, a SARS, overcooling, an exacerbation of chronic somatic diseases or a focal infection, hypo - and avitaminosis, helminthoses can act. The bad hygienic condition of an oral cavity (a dental plaque, a scale) started or multiple caries, existence of the local injuring factors (roots of the destroyed teeth, keen edges of seals, etc.), chronic infections of ENT organs (sinusitis, tonsillitis) can support the course of chronic stomatitis.
Symptoms of chronic stomatitis
Chronic recurrent aftozny stomatitis
Development of clinical displays of chronic aftozny stomatitis is preceded by the prodromalny period proceeding with discomfortable feelings in an oral cavity, subfebrilitety, an easy indisposition. Further against the background of hyperemic mucous primary element – the afta representing the superficial roundish sore with a diameter of 3-5 mm covered with a fibrinozny raid in an environment of an edematous bright pink rim is formed.
Aftozny rashes, as a rule, multiple; are localized in the field of a transitional fold, side surfaces of language, a mucous membrane of cheeks and lips. Afta bring sharp morbidity at meal, toothbrushing, an articulation. The healing period makes from 7-10 days to 2-4 weeks. Epitelization of ulcers happens without scarring or to formation of a gentle hem. A recurrence of chronic aftozny stomatitis happens to frequency from several weeks to several months. Frequent aggravations exhaust patients, causing apathy, a sleep disorder, a kantserofobiya.
Depending on the frequency of aggravations allocate 3 degrees of chronic recurrent aftozny stomatitis: easy (with single afta and a recurrence of 1 times in several years), medium-weight (with a recurrence 1-3 times a year) and heavy (with a recurrence is more often than 4 times a year, sometimes monthly).
Chronic ulcer and necrotic stomatitis of Vincent
Course of chronic ulcer and necrotic stomatitis of Vincent erased. The main complaints of patients are connected with morbidity and bleeding of gums, a gipersalivation, a putrefactive smell from a mouth. In an oral cavity there are sites of stagnant hyperaemia with ulcerations and necrotic changes in area of interdental intervals. At the started cases of ulcer and necrotic stomatitis in the course of sounding of desnevy edge the naked bone can be defined.
The general symptoms are not expressed; podpodborodochny and submandibular lymph nodes are condensed, and at the long course of a disease become a hryashchepodobny consistence. Chronic ulcer and necrotic stomatitis often develops against the background of an ulcer gingivit and is combined with damage of a pharynx - quinsy of Simanovskogo-Plauta-Vensana.
Chronic herpetic stomatitis
Exacerbations of chronic herpetic stomatitis usually arise in the fall and in the spring. As morphological elements of chronic herpetic stomatitis serve small bubbles (vesicles) which are quickly passing into pruinose erosion. Bubbles and erosion are localized on a mucous membrane of language, the sky, cheeks and lips. Elements of rash are sharply painful, complicate meal and the speech. Mucous oral cavities it is inflamed and edematous; salivation is increased.
At an easy form of chronic stomatitis a recurrence arises not more often than 2 times a year and proceeds with small vesiculate rashes in an oral cavity. The medium-weight current is characterized by moderate quantity of rashes and with a frequency of aggravations from 3 to 6 times in a year. The heavy course of herpetic stomatitis is followed frequent (more than 6 times a year) by aggravations and multiple rashes.
Chronic prosthetic stomatitis
Chronic prosthetic stomatitis develops at 40-50% of the patients using full removable artificial limbs. This form of stomatitis proceeds with inflammatory changes of the mucous membrane adjoining to an artificial limb.
At survey of an oral cavity it is found sharp poured hyperaemia of a prosthetic bed. On sites mucous, injured by basis of an artificial limb, chronic dekubitalny ulcers can be formed, there is local bleeding. Pain in the field of an inflammation amplifies when using of a denture. The chronic travmatization of a mucous membrane can be followed by its giperplaziya and formation of papillomas (traumatic oral cavities).
Chronic stomatitis of smokers
It is usually observed at men of middle and advanced age with a long standing of smoking. At chronic nicotinic stomatitis the mucous membrane of an oral cavity gains cyanotic-brown color, becomes covered slightly whitish for a short while. Over time develops the sky with multiple keratotichesky papules. These changes give to the sky the rough relief having an appearance of "cobblestone road".
At simultaneous damage of a mucous membrane of language there is nicotinic glossostomatit. Stomatitis of smokers is risk factor of development of cancer of oral cavity.
Diagnosis of chronic stomatitis
In diagnosis of chronic stomatitis clarification of an etiologichesky factor has a crucial role: further medical tactics will depend on it. Therefore, except visit of the stomatologist, consultations of the gastroenterologist, the endocrinologist, the allergist-immunologist, the otolaryngologist can be shown to the patient. Establishment of a kliniko-morphological form of chronic stomatitis is helped by a cytologic picture of dabs prints from surfaces of ulcer defects of a mucous membrane, a patogistologichesky research of sites of regions of ulcers, a bacteriological research, PTsR of scrapes, determination of level of a lizotsim and immunoglobulins with saliva.
For an exception of allergic genesis of chronic stomatitis skin allergoproba are carried out. For the purpose of identification of the accompanying violations the general and biochemical blood tests, level of glucose of blood, an immunogramm, RW, a koprogramm, the analysis a calla on dysbacteriosis are investigated. By means of a X-ray analysis of zubochelyustny system the chronic centers of an infection in an oral cavity come to light. In the course of diagnostics it is required to exclude a mnogoformny ekssudativny eritema, secondary syphilis, red flat deprive, a puzyrchatka, etc.
Treatment of chronic stomatitis
As the general for all forms of chronic stomatitises as medical actions serve elimination of the contributing factors and therapy of organ pathology. Professional hygiene of an oral cavity, sanitation of the centers of an infection (treatment of caries and LOR-pathology, removal of the destroyed teeth) is without fail carried out.
Treatment of chronic stomatitis includes local applications of medicines (anesthetics, proteolytic enzymes), processing of a mucous membrane solutions of anti-septic tanks, drawing keratoplastichesky means. To patients immunomodulatory, antibacterial, antiviral, antiallergic therapy, vitamin therapy, physiotherapeutic treatment can be appointed (laser therapy, Ural federal district, ). At allergic genesis of chronic stomatitis performing specific desensitization prichinno can be shown by significant allergen.
Forecast and prevention of chronic stomatitis
At chronic stomatitis treatment or considerable decrease in quantity of aggravations is possible. A frequent recurrence significantly reduces quality of life of the patient, the risk factor of progressing of a periodontal disease, development of malignant and benign tumors of an oral cavity are.
The leading role in the forecast and prevention of chronic stomatitis is played by elimination of the local chronic centers of an infection, treatment of the accompanying pathology, systematic care of an oral cavity, refusal of smoking, rational prosthetics.