7. Chronic recurrent aphthous stomatitis. Etiology, pathogenesis, diagnosis, clinical picture, differential diagnosis and treatment.
Recurrent oral aphthae in childhood should be considered as one of the manifestations of an abnormality in the constitution of the body. The constitution is understood as a set of genotypic and phenotypic properties and characteristics (morphological, biochemical, functional) of an organism that determine its reactivity, i.e., a complex of protective and adaptive reactions aimed at maintaining homeostasis during changes in the external environment. Maslov M.S. called the constitution of the child’s body “how the child gets sick.” Variants of the constitution are variants of health. Anomalies of the constitution are manifested in the inadequacy of the body's reactions to environmental factors. The ego is the background against which illnesses arise. An anomaly of the constitution, or diathesis, means “tendency”, “predisposition”; it is a feature of the body’s reactivity, characterized by a predisposition to certain pathological processes, as well as peculiar reactions to ordinary factors. Such environmental factors are food, humidity and temperature.
Chronic recurrent aphthous stomatitis (CRAS) is an allergic disease of the oral mucosa.
The disease manifests itself the formation of single aphthae (ulcers) on the mucous membrane, which occur without a specific pattern. HRAS is characterized by a long course over many years.
There are three periods in the pathogenesis of the disease:
Premonitory
Period of rash
Fading disease
There are mild, moderate and severe stages depending on the number of elements of the lesion and the frequency of relapses.
Light degree
1-2 elements of damage, 1 time every 2 years
Medium-heavy
5-6 aft, 2 times a year
More than 6 elements of damage, more often than 2 times a year.
Differential diagnostics
With traumatic and herpetic erosions (aphthae are painful)
With Vincent's ulcerative-necrotizing stomatitis (absence of pathogens in fingerprint smears)
With Lort-Hakob's bullous dermatitis (no blisters at the onset of the disease
With syphilitic papules (aphthae are painful, there is no inflammatory rim, treponemes are not sown)
Reasons for the development of HRAS
The disease is caused the following factors: adenovirus, staphylococcus, various types of allergies, immune disorders, diseases of the digestive system (especially the liver), neurotrophic disorders.
An important role in the development of HRAS genetic factors and the influence of various harmful factors (chromium compounds, cement, gasoline, phenol, denture materials, etc.) play a role.
Manifestations of HRAS
Symptoms of HRAS appear during periods of exacerbation of the disease. One or, rarely, two painful aphthae appear on the oral mucosa. The pain worsens while eating and talking. The disease lasts for several years with periodic exacerbations in spring and autumn. As the duration of the disease increases, exacerbations recur unsystematically.
Periods between exacerbations (remissions) can last from several months, even years, to several days. In some patients, exacerbation of the disease is associated with trauma to the mucous membrane and contact with allergens. In women, it may have a clear dependence on the menstrual cycle.
During exacerbation of HRAS the oral mucosa looks pale, anemic, and swollen. The characteristic localization of aphthae (rarely two aphthae) is on the mucous membrane of the lips, the inner surface of the cheeks, under the tongue, on the frenulum, less often on the soft palate and gums.
Afta represents a focus of necrosis (death) of the mucous membrane with inflammation of the mucous membrane and submucosa. Aphtha looks like an oval or round lesion measuring 5-10 mm. The aphtha is surrounded by an inflammatory rim of bright red color and covered with a gray-white fibrinous coating.
Afta lasts 7-10 days . 2-6 days after the onset of aphthae is freed from plaque and after another 2-3 days it heals. A red spot remains at the site of the aphthae.
As a rule, during exacerbation of HRAS general health does not suffer. In some patients, exacerbation of the disease is accompanied by severe weakness, physical inactivity, depressed mood, and increased body temperature.
Treatment for HRAS is in medicinal effects directly on aphthae and therapy aimed at preventing relapses or prolonging remissions.
In the treatment of aphthae they use painkillers, necrolytic (removing dead tissue) agents, proteolysis inhibitors (suppressing protein destruction), antiseptics, anti-inflammatory and keratoplasty (healing) drugs.
An examination is being carried out aimed at identifying concomitant diseases. When determining the pathology, treatment is prescribed by an appropriate specialist (general practitioner, gastroenterologist, otolaryngologist, endocrinologist, etc.)
During the period of exacerbation of the disease You should follow a diet that excludes hot, spicy, and rough foods from your diet.
When determining the source of the allergy it is necessary to eliminate the patient's contact with the allergen. If this is not possible, then treatment is carried out to reduce the effects of exposure to the allergen.
Appointed vitamin therapy, immunomodeling and immunocorrective treatment. To normalize the activity of the nervous system, sedatives are prescribed
Scheme for providing medical care for CRAS:
1. Sanitation chronic foci of infection. Elimination of predisposing factors and treatment of identified organ pathology.
2. Sanitation of the oral cavity.
3. Anesthesia of the oral mucosa
topical anesthetics
5% anesthetic emulsion
4. Application of proteolytic enzymes to remove necrotic plaque (trypsin, chymotrypsin, lidase, etc.).
5. Treatment with antiseptic and anti-inflammatory drugs (“MetrogilDenta”, etc.).
6. Application of keratoplasty agents.
7. Desensitizing therapy.
8. Vitamin therapy.
9. Immunomodulatory therapy.
10. Agents that normalize intestinal microflora.
11. Physiotherapeutic treatment (helium-neon laser radiation, 5 sessions).
One of the most effective antiseptic and anti-inflammatory drugs is Metrogyl-Denta.
Indications for prescribing the drug, in addition to aphthous stomatitis, are acute gingivitis (including ulcerative), chronic(edematous, hyperplastic, atrophic), periodontitis (chronic, juvenile), periodontal abscess, gangrenous pulpitis, post-extraction alveolitis, toothache of infectious origin.
Therapeutic dentistry. Textbook Evgeniy Vlasovich Borovsky
11.4.3. Recurrent aphthous stomatitis
Recurrent aphthous stomatitis (stomatitis aphtosa recidiva) is a chronic inflammatory disease of the oral mucosa, characterized by recurrent eruptions of aphthae and ulcers, a long course with periodic exacerbations.
Recurrent aphthous stomatitis is one of the most common diseases of the oral mucosa. The prevalence of recurrent aphthous stomatitis, according to various authors, ranges from 10 to 40% in different age groups of the population. Over the past 10 years, there has been a pronounced tendency towards an increase in the number of patients with recurrent aphthous stomatitis, and with its severe form.
Etiology and pathogenesis. Most researchers who have studied the etiology and pathogenesis of recurrent aphthous stomatitis are inclined to the leading role of the immune system in the pathogenesis of this disease.
Recurrent aphthous stomatitis is a disease characterized by reduced immunological reactivity and impaired nonspecific defense. The development of which is caused by foci of chronic infection in the body (tonsillitis, chronic tonsillitis, pharyngitis, diseases of the gastrointestinal tract, etc.), as well as the influence of a number of unfavorable factors (chronic stressful situations, frequent changes in climate zones, occupational hazards, etc.).
In patients with recurrent aphthous stomatitis, disorders of the immune status and nonspecific defense were revealed: depression of the T-immune system was established, expressed in a decrease in the number and functional activity of T-lymphocytes. Disturbances in the subpopulation of T-lymphocytes, a marked decrease in the number of T-helpers and an increase in T-suppressors were revealed. Changes in the B-immune system were noted, which is manifested by an increase in the number of B-lymphocytes, an increase in the level of serum immunoglobulin G, circulating immune complexes, against the background of a decrease in the content of immunoglobulin M.
With recurrent aphthous stomatitis, the indicators of nonspecific humoral and cellular defense change (decrease in the concentration of lysozyme and increase in beta-lysines in the blood serum, decrease in the content of complement fractions C3, C4 and increase in C5 fractions). Against the background of the established weakening of the phagocytic activity of leukocytes to the majority of the studied microbial allergens, its strengthening to S. salivarius and C. albicans was noted.
Violation of local oral protective factors in patients with recurrent aphthous stomatitis is characterized by a decrease in the concentration of lysozyme, an increase in beta-lysines, as well as a decrease in the content of secretory and serum immunoglobulin A in the oral fluid. As a result, the protection of the oral mucosa from the effects of microorganisms is disrupted, and the quantity and species composition of resident microflora also changes. As a result, the number of microbial associations in the oral cavity increases and their virulence increases.
Microbial associations of the oral mucosa in patients with recurrent aphthous stomatitis are mainly represented by coccal flora, in which coagulase-negative staphylococcus and anaerobic cocci (peptococci, peptostreptococci) occupy a significant place, and the number of anaerobic cocci increases with the increase in the number of microbial associations. Microbial associations contain a significant amount of bacteroids, the content of which increases with the growth of associations. With an increase in the virulence of microorganisms, the bacterial sensitization of the body of patients with recurrent aphthous stomatitis increases - a chain of immediate and delayed immunological reactions is activated, causing frequent relapses of the disease.
In the pathogenesis of recurrent aphthous stomatitis, a significant role is played by the so-called cross-immune reaction, which operates according to the following principle. On the surface of the oral mucosa of patients with recurrent aphthous stomatitis there is a large number of streptococci (52.9%). among them Streptococcus mutans. sanquis, salivarius. milis, which have antigenic similarity to the cells of the oral mucosa. It has been established that the oral mucosa is capable of depositing antigen to a significant extent. In patients with recurrent aphthous stomatitis, impaired recognition of target cells by T lymphocytes is partly genetically determined. on the one hand, and along with this there is a diverse antigenic spectrum on the surface of the oral mucosa, on the other. As a result, the mechanism of antibody-dependent cytotoxicity is activated, which, according to some authors, is the cause of this disease. This mechanism may well explain the formation of aphthae as a result of the Arthus phenomenon, as well as the significance of gastrointestinal diseases and foci of chronic infection, accompanied by an imbalance between the macroorganism and the bacterial flora in the origin of recurrent aphthous stomatitis.
Clinical picture. There are two clinical forms of recurrent aphthous lesions of the oral mucosa: mild and severe (recurrent deep scarring aphthae), which have their own specific clinical characteristics. The symptom complex that determines the severity of recurrent aphthous stomatitis includes the frequency of relapses of the disease and, accordingly, the duration of its remission, the nature and number of lesions on the oral mucosa and the period of their epithelization.
Rice. 11.32. Recurrent aphthous stomatitis. Light form.
Aphthae on the tip of the tongue with a halo of hyperemia around.
Recurrent aphthous stomatitis may be one of the symptoms of generalized aphthosis, which affects the genital and intestinal areas. In addition to recurrent aphthous rashes on the oral mucosa, eye lesions and sometimes pyoderma occur.
RECURRENT APHTHOSIC STOMATITIS (MILD FORM). Ordinary aphthae on the oral mucosa appear very characteristically. The process of aphtha formation on the oral mucosa begins with the appearance of a small spot up to 1 cm in diameter, hyperemic, sharply demarcated, round or oval, painful, which after a few hours slightly rises above the surrounding mucous membrane. After a few more hours, the element is eroded and covered with a fibrinous, grayish-white, dense coating. Such a fibro-necrotic focus is often surrounded by a thin hyperemic rim (Fig. 11.32). Aphtha is very painful when touched, soft to the touch. Infiltration occurs at the base of the aphtha, as a result of which the aphtha slightly rises above the surrounding tissues, necrotic masses on its surface form a grayish fibrinous film. The aphtha is surrounded by a sharply demarcated, brightly hyperemic, slightly edematous rim. It is sharply painful and is often accompanied by lymphadenitis. After 2–4 days, the necrotic masses are rejected, and after another 2–3 days, aphtha usually resolves; For some time, congestive hyperemia remains in its place. Often, a few days before aphtha occurs, patients feel a burning sensation or pain at the site of future changes. In mild forms of recurrent aphthous stomatitis, one or two aphthae occur simultaneously, rarely more. A feature of the disease is the recurrent nature of the rash. The frequency of occurrence of aphthae in recurrent aphthous stomatitis varies from several days to months. The rashes are most often localized on the mucous membrane of the cheeks, lips, tip and lateral surfaces of the tongue, but they can occur on any part of the oral mucosa.
A mild form of recurrent aphthous stomatitis, as a rule, is invisible to the patient, since at first it occurs with rather poorly expressed clinical symptoms. In 50% of patients with this form of recurrent aphthous stomatitis, exacerbations occur 1–2 times a year, as a result of which they rarely consult a doctor. The other half of patients with recurrent mild aphthous stomatitis seek help from a doctor more often, since exacerbation of the disease occurs 5-6 times a year and the severity of its course worsens.
Factors that provoke an exacerbation are trauma to the oral mucosa, stress, fatigue, a previous viral infection, the premenstrual period, etc. In some cases, patients cannot associate the occurrence of an exacerbation with any specific factor.
Clinical observations have shown that during the first three years of its existence, recurrent aphthous stomatitis occurs predominantly in a mild form. Sometimes there are cases of rapid transformation of the disease into a severe form. This is mainly typical for young people (17–20 years old). In most cases, exceeding the duration of existence of recurrent aphthous stomatitis for more than three years is accompanied by an aggravation of the severity of its clinical course and the transformation of a mild form into a severe one. Factors that accelerate the transition from a mild form of recurrent aphthous stomatitis to a severe one include occupational hazards, frequent changes in climate zones, the presence of chronic diseases (sore throat, diseases of the gastrointestinal tract - chronic gastritis, colitis, peptic ulcer of the stomach and duodenum), in some cases young age (up to 25 years).
Histological examination of ordinary aphtha reveals deep fibrinous-necrotic inflammation of the mucous membrane. The process begins with changes in the lamina propria and submucosa. Following vasodilation and slight perivascular infiltration, swelling of the spinous layer of the epithelium occurs, followed by spongiosis and the formation of microcavities. Alternative changes result in necrosis of the epithelium and erosion of the mucous membrane. The epithelial defect is filled with fibrin, which is firmly adhered to the underlying tissues.
Differential diagnosis. In appearance, aphthae are similar to:
Traumatic erosion;
Herpetic erosion;
Syphilitic papules, on the surface of which, some time after their appearance, a necrotic grayish-white coating forms.
Herpetic erosion differs from aphtha in its polycyclic outlines, less pronounced pain, and a more diffuse inflammatory reaction around; erosion in herpes is preceded by grouped blisters. Syphilitic papules are characterized by low pain, the presence of infiltrate at the base, the stagnant nature of the inflammatory rim along the periphery and the presence of pale treponemas in the erosion discharge.
RECURRENT APHTHOSIC STOMATITIS (SEVERE FORM), or recurrent deep scarring aphthae, or Setton's aphthae. The severe form of recurrent aphthous stomatitis can have the following types of clinical course:
The element of the lesion on the oral mucosa is aphtha, the period of its epithelization is 14–20 days. The course of the disease is characterized by the occurrence of monthly exacerbations;
Deep, crater-shaped, sharply painful ulcers with a long period of epithelization (25–35 days) form on the oral mucosa. Exacerbations of the disease occur 5–6 times a year;
Aphthae and ulcers are found simultaneously on the oral mucosa. The period of their epithelization is 25–35 days.
During the year, the severe form of recurrent aphthous stomatitis worsens 5–6 times or monthly. The course of the disease is chronic. In a number of patients, aphthae appear in paroxysms over several weeks, replacing each other or occurring simultaneously in large numbers. Other patients develop single aphthae at different times. The course of the disease in the same patient may change over time.
In patients with a severe form of recurrent aphthous stomatitis, the general condition suffers: increased irritability, poor sleep, loss of appetite are noted (in 70% of patients), in 22% of patients a neurotic status is formed due to constant pain in the oral cavity, and regional lymphadenitis is often present. The influence of seasonal factors on the occurrence of exacerbations of the disease in severe forms of recurrent aphthous stomatitis is very insignificant. As a rule, exacerbations of the severe form of recurrent aphthous stomatitis occur monthly and the disease becomes permanent, and the severity of its course worsens with increasing duration of the disease.
An exacerbation of the disease usually begins with the appearance of a limited painful compaction of the mucous membrane, on which a superficial, fibrinous coating is formed first, and then a deep crater-shaped ulcer with slight hyperemia around (Fig. 11.33). The ulcer usually increases in size. Sometimes a superficial aphthae initially forms, at the base of which, after 6–7 days, an infiltrate forms, and the aphtha itself transforms into a deep ulcer. Ulcers in severe forms of recurrent aphthous stomatitis epithelialize extremely slowly (up to 1.5–2 months). After their healing, rough connective tissue scars remain, leading to deformation of the oral mucosa. When such ulcers are located in the corners of the mouth, deformations may occur, sometimes leading to microstoma. The duration of existence of scarring aphthae varies from 2 weeks to 2 months. The rashes are most often located on the lateral surfaces of the tongue, the mucous membrane of the lips and cheeks, and are accompanied by severe pain.
Rice. 11.33. Recurrent aphthous stomatitis. Severe form. An ulcer with raised infiltrated edges, the bottom is covered with fibrinous plaque.
Diagnostics. Histologically, with deep recurrent aphthae, an area of necrosis is determined with complete destruction of the epithelium and basement membrane, as well as inflammation in the lamina propria of the mucous membrane and submucosa. Often at the affected sites there are salivary glands with pronounced periglandular infiltration, which led Sutton to call this disease recurrent necrotizing periadenitis of the mucous membrane. However, A.L. Mashkilleyson observed deep scarring aphthae without the phenomena of periadenitis.
Differential diagnosis. The severe form of recurrent aphthous stomatitis is differentiated from:
Traumatic erosions;
Traumatic ulcers;
Recurrent herpes;
Behçet's disease;
Vincent's ulcerative necrotic stomatitis;
Ulcers due to specific infections (syphilis, tuberculosis);
Malignant ulcers.
In Behçet's disease, combined aphthous ulcerative lesions of the mucous membrane of the mouth, eyes and genitals are observed.
With Vincent's ulcerative-necrotic stomatitis, scrapings from ulcers reveal an abundance of fusobacteria and spirochetes.
The edges of a malignant ulcer are dense, slightly painful, and there is often a chronic injury. Cytological examination reveals atypical cells.
Treatment. Treatment for recurrent aphthous stomatitis is effective only in the case of an in-depth clinical and immunological examination of patients, which allows, based on the data obtained, to select the appropriate individual complex pathogenetic therapy. Before starting treatment, it is necessary to examine the patient with a therapist, otolaryngologist and other specialists in order to identify concomitant diseases, primarily the gastrointestinal tract, foci of chronic infection, and the state of the immune system. Particular attention should be paid to identifying and treating dental and periodontal diseases.
All these measures make it possible to individualize the process of complex pathogenetic treatment of patients with recurrent aphthous stomatitis.
Complex pathogenetic treatment of patients with recurrent aphthous stomatitis includes the use of immunocorrective agents, metabolic correction drugs with mandatory sanitation of foci of chronic infection.
For immunocorrection, thymogen is used, which has a regulatory effect on the reactions of cellular and humoral immunity, as well as on factors of nonspecific resistance of the body. Thymogen is administered intramuscularly at 100 mcg daily for 10 days. Be sure to monitor the immunogram before and after treatment.
Levamisole (Decaris) is also used to treat recurrent aphthous stomatitis. The drug is prescribed 2 days a week (in a row or at intervals of 3-4 days, 150 mg at a time or 50 mg 3 times a day). Treatment is carried out for 1.5–2 months under the control of the clinical formula of peripheral blood and the general condition of the patient.
In order to normalize the cellular metabolism of lymphocytes, patients with recurrent aphthous stomatitis are prescribed metabolic drugs that stimulate metabolic processes at the level of mitochondria. The selection of drugs and the duration of metabolic therapy are determined by cytochemical indicators of the enzymatic status of blood lymphocytes (activity of mitochondrial succinate dehydrogenase, alpha-glycerophosphate dehydrogenase).
Patients are prescribed two sets of metabolic drugs. The first complex is aimed at improving energy processes in lymphocytes. It is prescribed for 10 days: calcium pantothenate (2 ml of a 20% solution intramuscularly, or orally 0.1 g 4 times a day), riboflavin mononucleotide (1 ml of a 1% solution intramuscularly); lipamide (0.025 g 3 times a day after meals); cocarboxylase (0.05 g intramuscularly); Potassium orotate (0.5 g 3 times a day 1 hour before meals).
Over the next 10 days, a second set of metabolic drugs is prescribed: vitamin B 12 (1 ml of 0.01% solution intramuscularly); folic acid (0.005 g 3 times a day); pyridoxal phosphate (0.02 g 3 times a day after meals); methylmethionine sulfonium chloride (0.1 g 3 times a day after meals); calcium pangamate (0.05 g 3-4 times a day); Potassium orotate (0.5 g 3 times a day 1 hour before meals).
The sequence of administration of the complexes is determined by the indicators of cytochemical analysis, but, as a rule, the first complex, which optimizes the energy of the cells, is introduced first, then the second, which requires the energy preparedness of the tissues for its utilization.
To achieve a state of stable clinical remission of recurrent aphthous stomatitis, characterized by normalization of the cytochemical status of blood lymphocytes, it is necessary to carry out 4-6 courses of metabolic correction at intervals of 6 months, regardless of the characteristics of the clinical course of the disease. It should be especially noted the need for metabolic therapy in the spring, when pronounced phenomena of hypovitaminosis in the body are characteristic. Hypovitaminosis, as a rule, leads to severe exacerbations of recurrent aphthous stomatitis.
In some cases, the complex of treatment measures includes sedatives (valerian root, “minor” tranquilizers).
Particular attention should be paid to measures to eliminate foci of chronic infection in the body of patients with recurrent aphthous stomatitis, the treatment of which must be carried out along with metabolic correction (treatment of chronic diseases of the ENT organs, gastrointestinal tract, etc.).
The presence of foci of chronic sepsis in patients with recurrent aphthous stomatitis causes constant bacterial sensitization, including lymphocytes, which leads to frequent exacerbations of the disease.
In order to stimulate specific and nonspecific protection factors in patients with recurrent aphthous stomatitis, modern methods of physical influence on the body (transcutaneous electrical neurostimulation, laser therapy on reflexogenic zones, aeroion massage on the affected oral mucosa) are effectively used.
A set of therapeutic measures, including immunocorrective, metabolic and reflexology, promotes the rapid elimination of exacerbation of the disease, significantly lengthens the periods of its remission, eliminates cellular and tissue hypoxia and normalizes immunological parameters in patients with recurrent aphthous stomatitis. A positive therapeutic effect can also be obtained from using each of the previously mentioned treatment methods separately, but its effectiveness is less pronounced. Therefore, it is recommended to use these methods for treating recurrent aphthous stomatitis in combination.
Diet plays an important role in the successful treatment of recurrent aphthous stomatitis. Patients are prohibited from eating hot, spicy foods, alcoholic beverages, and smoking.
Local treatment comes down to sanitation of the oral cavity, elimination of traumatic factors and foci of chronic infection. During the period of exacerbation of the disease, painkillers are used, since aphthae and especially ulcers cause pain. For pain relief, anesthetic applications are used (1–2% lidocaine solution, 1–2% trimecaine solution, 1–2% pyromecaine solution or 5% pyromecaine ointment). For pain relief, a 5 or 10% suspension of anesthesin in glycerin or liquid oils (peach, apricot, sunflower) is also used.
The combined effect of medicinal and physiotherapeutic methods of pain relief is effective (microelectrophoresis on the affected area of the oral mucosa with a 2% novocaine solution followed by aeroion massage; laser irradiation).
Fibrinous and necrotic plaque from the surface of afts and ulcers is removed using proteolytic enzymes (trypsin, chymotrypsin, chymopsin, lysoamidase). Antiseptic treatment is carried out with antiseptic solutions (1% etonium solution, 0.02-0.06% chlorhexidine solution, 0.02% furatsilin solution, etc.).
To stimulate epithelization of the affected oral mucosa with recurrent aphthous stomatitis, it is advisable to prescribe an oil solution of vitamins A, E, carotolin, 5% linetol ointment, solcoseryl ointment and jelly, 5% ointment and 20% actovegin jelly, etc.
Applications and irrigation of the oral mucosa are carried out 3-4 times a day after meals.
A good therapeutic effect is achieved by the use of biopolymer soluble films containing various drugs. To stimulate the regeneration of the oral mucosa, oblecol film containing sea buckthorn oil is successfully used.
Forecast. With recurrent aphthous stomatitis, the prognosis is favorable, especially in the case of early diagnosis and treatment of its mild form.
Prevention. It consists mainly in the timely identification and elimination of foci of chronic infection, including in the oral cavity, early diagnosis and treatment of chronic diseases of the gastrointestinal tract, nervous and endocrine systems, etc. Systematic oral care and regular sanitation are important. It is necessary to strictly adhere to the work and rest regime, active physical education, hardening, and a rational, balanced diet.
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Chronic recurrent aphthous stomatitis (CRAS) is a chronic inflammation of the soft tissues and mucous membrane of the oral cavity.
The disease is expressed in the form of small erosions (afts) covered with fibrinous plaque.
If the disease becomes chronic, relapses occur. According to statistics, children from 4 years old and adults up to 40 years old suffer from this disease. In the age range of 30–40 years, women are most susceptible to the disease.
Reasons
Medical scientists are still studying the etiology of HRAS. The causes of the disease were formed after many years of observing patients and maintaining statistics.
There are only a few of the most likely factors that provoke mouth ulcers:
- weak immunity;
- past illnesses (influenza, ARVI, laryngitis, sinusitis, adenovirus);
- damage to the oral mucosa;
- problems in the functioning of the digestive system;
- anti-hygiene;
- stress;
- avitaminosis;
- any allergic reactions (including to food).
Harmful chemicals play a major role in the manifestation of stomatitis. Thus, low-quality toothpaste, brush or mouthwash with an expired expiration date can cause a mucosal reaction. Dental health, the quality of dentures or braces - all this affects the state of the microflora of the oral cavity.
Any type of stomatitis is diagnosed by excluding other diseases, because the causative agents of the disease have never been detected in the analysis.
Pathogen
The disease begins to develop after the pathogen enters the body.
Resistance to infection is provided by the mucous membrane and skin.
In the event of even a minimal violation of the protective system, the pathogen penetrates inside and an incubation period begins.
At this time, the infection waits for the time when the motivating factor will act or the immune defense will fail. When this happens, the pathogen turns into a disease and begins to multiply.
The causative agent for stomatitis can be a virus, bacteria or fungal infection. Viral provocateurs can be herpes, measles or chicken pox. Bacterial factors that provoke stomatitis include scarlet fever, streptococcal and tuberculosis infections.
The main fungal danger is thrush. The ways pathogens enter the body are through food and airborne droplets.
Provoking factors
Chronic recurrent aphthous stomatitis can develop under the influence of certain factors:
- deterioration of the condition of the whole organism;
- poor nutrition;
- bad habits;
- the result of chemotherapy (for cancer).
Various diseases are also provoking factors, but much less frequently. This could be gastritis or colitis, advanced stages of sore throat or flu, and even pollen from certain plants.
Classifications
Depending on the severity of CRAS, it has three forms of manifestation:
- light– 1–2 ulcers, pain practically does not bother;
- medium-heavy– swelling of the mucous membrane, 2-3 aphthae, pain when touching the formations;
- heavy– multiple rashes on different parts of the mucous membrane, elevated body temperature, frequent relapses.
Classification of the disease according to the principle of ontogenesis (patterns of development):
In 2008, WHO established another type of chronic stomatitis - a mixed type. This infection is most often diagnosed in children over 4 years of age. For young patients, the disease causes considerable discomfort, since aphthae often recur.
Chronic recurrent aphthous stomatitis is differentiated from traumatic erosions and ulcers, and Behcet's disease.
The older the child, the more pronounced the symptoms of stomatitis. With every year of a person’s life, treatment becomes more difficult due to the constant increase in the number of aphthae.
Symptoms
Clinical signs of chronic recurrent aphthous stomatitis appear in stages. It depends on the form of the disease, the age of the patient and his lifestyle.
To simplify diagnosis, doctors have compiled a list of generalized symptoms of CRAS:
- the initial stage of the disease is characterized by swelling and pallor of the oral mucosa. In some areas of the cavity, hyperemia and the appearance of small red spots may be observed;
- aphthae develop quickly, within a few hours. Then they become painful and burning. Eating becomes problematic, and the ulcers increase and multiply;
- with stomatitis, children develop lethargy, drowsiness, moodiness and increased body temperature (37°C - 37.5°C);
- People between the ages of 30 and 40 may experience aching pain in their muscles and joints. There is often sleep disturbance, nausea and even vomiting;
- Frequent exacerbations of stomatitis significantly worsen the patient’s well-being. The consequences of relapses are: apathy, headaches and depression.
A subtle symptom of the disease is excessive salivation. This sign should alert parents. If a child has a large amount of saliva, it is worth showing him to a specialist.
The first indicator of the initial development of CRAS may be an enlargement of the lymph nodes, as well as a sharp decrease in the sensitivity of the oral cavity and tongue.
Diagnostics
To make a diagnosis, a patient with signs of stomatitis is assigned a differential diagnosis.
This procedure is performed in a laboratory and involves taking a swab of the entire mouth.
Doctors are sensitive to the results of the analysis, since the disease can be a sign of other, more dangerous diseases.
This may be anemia, ulcerative colitis, immunodeficiency virus and others. It is for this reason that experts cannot come to an identification of the reasons for the occurrence of HRAS.
Treatment
With a disease such as chronic recurrent aphthous stomatitis, treatment should solve three problems for the patient: eliminating pain and discomfort, promoting the healing of ulcers and preventing relapses of the disease. First of all, the patient is prescribed anti-inflammatory and painkillers.
To relieve excruciating pain, the following anesthetic-based medications are used:- solutions of Diclofenac, Ledocaine or Tetracycline;
- benzydamine hydrochloride;
- benzocaine;
- amlexonox.
In order to suppress the progression of infection, as well as to prevent the disease, the doctor prescribes such drugs;
- triamcinolone acetonide;
- clobetasol propionate;
- flucinodide.
Diclofenac solution
Traditional medicine practitioners use natural medicines for treatment. Doctors also recommend the use of folk remedies, but only as excipients in addition to drug treatment.
During the healing period of ulcers you can use:
- rosehip oil;
- vanillin;
- Kalanchoe;
- calendula;
- caratoline;
- chamomile;
- aloe.
All folk remedies and medications are quite effective in treating this disease. However, it should be remembered that improper intervention in the disease process can lead to the worst. HRAS is the consequences of reluctance to visit a specialist, because the chronic stage manifests itself over a long period of time.
There are no special drugs in the world for the treatment of CRAS due to the lack of causes of the disease. Doctors prescribe a standard set of medications for skin diseases: painkillers, antibiotics and corticosteroids.
Video on the topic
Dr. Komarovsky knows everything about the treatment and prevention of stomatitis in children:
To avoid an unpleasant disease, you should be attentive to your health and follow basic preventive measures. The more scrupulous a person is about infection, the better his lifestyle, the less likely it is that this infection will manifest itself. If you notice the very first symptoms of the disease in an adult or child, you should immediately visit a doctor. At an early stage of development, stomatitis is mild, and treatment is quick; recovery occurs within 7–10 days.
RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2016
Recurrent oral aphthae (K12.0)
Dentistry
General information
Brief description
Approved
Joint Commission on Healthcare Quality
Ministry of Health and Social Development of the Republic of Kazakhstan
from August 16, 2016
Protocol No. 9
HRAS- an inflammatory disease of the oral mucosa, characterized by recurrent rash of aphthae, a long course and periodic exacerbations.
Correlation of ICD-10 and ICD-9 codes:
| ICD-10 | ICD-9 | ||
| Code | Name | Code | Name |
|
K12.0 |
Chronic recurrent aphthous stomatitis | ||
Date of development of the protocol: 2016
Protocol users: dentists, general practitioners, allergists, gastroenterologists.
Level of evidence scale:
| A | A high-quality meta-analysis, systematic review of RCTs, or large RCTs with a very low probability (++) of bias, the results of which can be generalized to an appropriate population. |
| IN | High-quality (++) systematic review of cohort or case-control studies or High-quality (++) cohort or case-control studies with very low risk of bias or RCTs with low (+) risk of bias, the results of which can be generalized to an appropriate population . |
| WITH |
Cohort or case-control study or controlled trial without randomization with low risk of bias (+). The results of which can be generalized to the relevant population or RCTs with very low or low risk of bias (++ or +), the results of which cannot be directly generalized to the relevant population. |
| D | Case series or uncontrolled study or expert opinion. |
Classification
Classification:
I. Traumatic injuries(mechanical, chemical, physical), leukoplakia.
II. Infectious diseases:
1) Viral (herpetic stomatitis, herpes zoster, foot and mouth disease, viral warts, AIDS);
2) Bacterial infections (Vincent ulcerative necrotizing stomatitis, pyogenic granuloma, leprosy);
3) Fungal infections (candidiasis);
4) Specific infections (tuberculosis, syphilis).
III. Allergic diseases(anaphylactic shock, Quincke's edema, allergic stomatitis, glossitis, cheilitis, exudative erythema multiforme, chronic recurrent aphthous stomatitis).
IV. Changes in the mucous membrane in some systemic diseases(hypo- and avitaminosis, pathology of the gastrointestinal tract, blood system).
V. Changes in the oral cavity with dermatoses(lichen planus, lupus erythematosus, pemphigus, Dühring's dermatitis herpetiformis).
VI. Anomalies and diseases of the tongue(folded, diamond-shaped, black hairy, desquamative glossitis).
VII. Lip diseases(exfoliative glandular, eczematous cheilitis, macrocheilitis, chronic lip fissures).
VIII. Precancerous diseases of the red border of the lips and oral mucosa(obligate and optional).
Diagnostics (outpatient clinic)
OUTPATIENT DIAGNOSTICS
Diagnostic criteria
Complaints and anamnesis:
Complaints in mild forms of CRAS include pain when eating and talking, loss of appetite, single aphthae on the oral mucosa, preceded by a burning sensation, pain, paresthesia of the mucous membrane at the site of aphthae.
Complaints in severe forms of CRAS include pain in the oral mucosa, which intensifies during eating and talking, and a long-term non-healing ulcer in the mouth.
History: the presence of household and/or food allergies, chronic diseases of the ENT organs and/or gastrointestinal tract against the background of psychoneurological status. Identification of occupational hazards, bad habits, nutritional patterns, factors associated with recurrent canker sores: Behcet's disease, Crohn's disease, ulcerative colitis, HIV infection, anemia caused by deficiency of iron, folic acid and vitamin B12, neutropenia, celiac disease. Possible chronic diseases of the gastrointestinal tract, ENT organs, intolerance to certain medications, nutrients, etc.
Physical examination:
In mild forms, single rashes are localized on the mucous membrane of the cheeks, lips, transitional folds of the vestibule of the mouth, lateral surfaces of the tongue and other places where keratinization is absent or weakly expressed. The process begins with the appearance of a small, up to 1 cm in diameter, hyperemic, round or oval spot, which rises above the surrounding mucosa; the element is eroded and covered with a fibrous grayish-white coating, surrounded by a hyperemic rim. The aphtha is painful on palpation, soft, infiltration occurs at the base of the aphtha, there is regional lymphadenitis, after 3-5 days the aphtha resolves. The frequency of occurrence of aphthae in recurrent aphthous stomatitis varies from several days to months.
In the severe form (Setton's aphthae), the aphthae takes a long time to heal with the formation of scars, and worsens 5-6 times or monthly. The course of the disease is chronic. In a number of patients, aphthae appear in paroxysms over several weeks, replacing each other or appearing simultaneously in large numbers, turning into deep ulcers with hardened edges. Patients' general condition worsens: there is increased irritability, poor sleep, loss of appetite, and regional lymphadenitis occurs. First, a subsurface ulcer is formed, at the base of which, after 6-7 days, an infiltrate forms, 2-3 times larger than the size of the defect, the aphtha itself transforms into a deep ulcer, the area of necrosis increases and deepens. Ulcers epithelialize slowly - up to 1.5-2 months. After their healing, rough connective tissue scars remain, leading to deformation of the oral mucosa. When aphthae are located in the corners of the mouth, deformations occur, subsequently leading to microstomia. The duration of existence of scarring aphthae is from 2 weeks. up to 2 months The rashes are most often located on the lateral surfaces of the tongue, the mucous membrane of the lips and cheeks, and are accompanied by severe pain.
As the duration of the disease increases, the severity of its course worsens. An exacerbation of the disease begins with the appearance of a limited painful thickening of the oral mucosa, on which first a superficial, covered with fibrous coating is formed, then a deep crater-shaped ulcer with hyperemia around it, constantly increasing.
Laboratory tests (there are no specific abnormalities in laboratory tests if there are no systemic diseases):
- general blood test;
- biochemical blood test.
- according to indications: immunological examination, allergy examination, cytological examination of a smear to detect giant multinucleated cells.
Instrumental studies: no;
Diagnostic algorithm:(scheme)
Differential diagnosis
Differential diagnosis and rationale for additional studies:
| Diagnosis | Rationale for differential diagnosis | Surveys | Diagnosis exclusion criteria |
| Traumatic ulcer | A single painful ulcer with a smooth red surface, covered with a whitish-yellow coating and surrounded by a red rim, soft on palpation; with chronic trauma, vegetations may appear on the surface of the ulcer, the edges become denser and it resembles cancer, the size may vary. The most common localization is the edge of the tongue, the mucous membrane of the cheeks, lips, buccal-alveolar folds, palate and floor of the mouth. Upon examination, depending on the nature of the stimulus and the particular reactivity of the body, it is revealed in the form of catarrhal inflammation, erosion and ulcers. |
Clinical manifestations of the disease are determined by the type, duration of exposure to the traumatic factor, the state of the oral mucosa, its resistance, and the general condition of the patient. Cytological examination |
The presence of a traumatic factor, Signs of common inflammation |
| Herpetic stomatitis | Multiple small vesicles, after opening of which superficial ulcers are formed, prone to fusion. Possible combined lesions of the skin and other mucous membranes | Cytological examination of a smear from the oral mucosa | Detection of multinucleated giant cells |
| Behçet's disease | Aphthous ulcerations (small, large, herpetiform or atypical). Lesions of the skin, eyes, and genitals are observed | The disease belongs to systemic vasculitis | Skin test for nonspecific hypersensitivity is 50-60% positive |
| Vincent's ulcerative necrotizing stomatitis |
An infectious disease caused by spindle bacillus and Vincent's spirochete. There is weakness, headache, increased body temperature, and aches in the joints. I am concerned about bleeding gums, a burning sensation and dryness of the mucous membrane. Pain in the oral cavity intensifies, salivation increases, and a strong putrid odor appears from the mouth. Ulceration of the mucous membrane begins from the gums. Gradually, the ulceration spreads to adjacent areas of the mucous membrane. Over time, the gums become covered with necrotic masses of white-gray, gray-brown or gray color. |
Cytological examination of smears from the oral mucosa | Identification of fusospirochetes |
| Manifestations of syphilis in the oral cavity | Syphilitic papules are more friable; when the plaque is scraped off, erosion is exposed. A syphilitic ulcer on the oral mucosa and red border of the lip is characterized by a long course, absence of pain, dense edges and base. The edges are even, the bottom is smooth, the surrounding mucous membrane is not changed. Lymph nodes are enlarged and dense. | Wasserman reaction, scraping from the surface of the ulcer |
Positive Wasserman reaction Presence of pale treponema in the discharge |
| Tuberculous ulcer | Ulcer, pain when eating, talking. Enlarged lymph nodes. A sharply painful ulcer has soft, uneven edges and a granular bottom. Often there are yellow dots on the surface and around the ulcer - Trel grains. | History of pulmonary tuberculosis, Examination for tuberculosis - microscopy and culture of saliva, chest x-ray, tuberculin test | Positive reaction to tuberculosis |
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Treatment
Drugs (active ingredients) used in treatment
Treatment (outpatient clinic)
OUTPATIENT TREATMENT* *:
treatment is aimed at eliminating pain and associated discomfort, reducing the healing time of aphthae and preventing relapses
Treatment tactics: Treatment tactics for CRAS depend on the severity of the pathological process, the presence of background pathology, and include the elimination of causative and predisposing factors. Drug treatment is palliative.
Non-drug treatment: aimed at eliminating etiological and predisposing factors - sanitation of the oral cavity, avoiding trauma to the oral mucosa, teaching rational oral hygiene, eliminating stress factors, restoring the balance of female sex hormones (in women), identifying relationships with food, following a gluten-free diet, even in the absence of celiac disease ;
Drug treatment: (depending on the severity of the disease):
Local treatment:
- Anesthesia: 1-2% lidocaine for pain relief, 5-10%.
- Pathogenetic therapy: tetracycline 250 mg in 30 ml. water 4-6 times a day for mouth rinses, 0.1% triamcinolone for applications 3-6 times a day for 4-6 days, 0.05% clobetasol for applications 3-6 times a day for 4-6 days, if available viral etiology 5% acyclovir for applications 4-6 times a day for 5-10 days
- Antihistamines: loratadine 10 mg once a day for 10-15 days, desloratadine 5 mg once a day, duration of administration depends on symptoms;
- Symptomatic therapy: chlorhexidine bigluconate, solution, 0.05% for treating the oral cavity 3 times a day until epithelization begins, tocopherol, 30%, in the form of applications to the lesions until complete epithelization.
List of essential medicines
1. 2% lidocaine;
2. tetracycline 250 mg in 30 ml. water;
3. 0.1% triamcinolone;
4. 0.05% clobetasol;
5. 5% acyclovir;
6. 10 mg loratadine;
7. 5 mg desloratadine;
8. 30% tocopherol;
9. 0.05% solution of chlorhexidine bigluconate.
List of additional medicines:
- antiviral drugs - acyclovir 0.2, 1 tablet 5 times a day for 5-10 days; dissolve interferon in ampoules of 2 ml (powder) in 2 ml of warm water in the form of applications for 5-10 days;
- antiseptic treatment of mucous membranes (furacilin 0.02% solution, hydrogen peroxide 1% solution)
- proteolytic enzymes for processing lesions in the presence of necrotic film/plaque (chemotrypsin solution, etc.);
- antiviral ointments in the form of applications to the affected elements (5% acyclovir, etc.);
- oral irrigation (interferon solutions, etc.);
- epithelialization therapy (methyluracil 5-10%,)
Indications for consultation with specialists: the presence of somatic diseases, a burdened allergic history.
Preventive measures:
Detection and treatment of diseases of the gastrointestinal tract, nervous and endocrine systems. Elimination of foci of chronic infection and traumatic factors. Timely detection and treatment of viral infection. Thorough sanitation of the oral cavity, systematic hygienic care.
Monitoring the patient's condition - No;
Indicators of treatment effectiveness: reduction of treatment time, increase in remission period.
Information
Sources and literature
- Minutes of meetings of the Joint Commission on the Quality of Medical Services of the Ministry of Health of the Republic of Kazakhstan, 2016
- 1. Order of the Ministry of Health of the Republic of Kazakhstan No. 473 dated October 10, 2006. “On approval of the Instructions for the development and improvement of clinical guidelines and protocols for the diagnosis and treatment of diseases.” 2. Diseases of the mucous membrane of the oral cavity and lips / Ed. Prof. E.V. Borovsky, Prof. A.L. Mashkilleyson. – M.: MEDpress, 2001. -320 p. 3. Zazulevskaya L.Ya. Diseases of the oral mucosa. Textbook for students and practitioners. – Almaty, 2010. – 297 p. 4. Anisimova I.V., Nedoseko V.B., Lomiashvili L.M. Diseases of the mucous membrane of the mouth and lips. – 2005. – 92 p. 5. Langlais R.P., Miller K.S. Atlas of Oral Diseases: Atlas / Translation from English, ed. L.A. Dmitrieva. –M.: GEOTAR-Media, 2008. -224 p. 6. George Laskaris, Treatment of Oral Diseases. A Concise Textbook, Thieme. Stuttgart-New York, p.300 7. Darshan DD, Kumar CN, Kumar AD, Manikantan NS, Balakrishnan D, Uthkal MP. Clinical study to know the efficacy of Amlexanox 5% with other topical Antiseptic, Analgesic and Anesthetic agents in treating minor RAS. J Int Oral Health. 2014 Feb;6(1):5-11. Epub 2014 Feb 26. http://www.ncbi.nlm.nih.gov/pubmed/24653596 8. Descroix V, Coudert AE, Vigé A, Durand JP, Toupenay S, Molla M, Pompignoli M, Missika P, Allaert FA . Efficacy of topical 1% lidocaine in the symptomatic treatment of pain associated with oral mucosal trauma or minor oral aphthous ulcer: a randomized, double-blind, placebo-controlled, parallel-group, single-dose study. J Orofac Pain. 2011 Fall;25(4):327-32. http://www.ncbi.nlm.nih.gov/pubmed/22247928 9. Saxen MA, Ambrosius WT, Rehemtula al-KF, Russell AL, Eckert GJ. Sustained relief of oral aphthous ulcer pain from topical diclofenac in hyaluronan: a randomized, double-blind clinical trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997 Oct;84(4):356-61. http://www.ncbi.nlm.nih.gov/pubmed/9347497 10. Colella G, Grimaldi PL, Tartaro GP. Aphthosis of the oral cavity: therapeutic prospects Minerva Stomatol. 1996 Jun;45(6):295-303. http://www.ncbi.nlm.nih.gov/pubmed/8965778
Information
Abbreviations used in the protocol:
HRAS - chronic recurrent aphthous stomatitis
Oral mucosa - oral mucosa
AIDS - acquired immunodeficiency syndrome
ENT - otorhinolaryngology
Gastrointestinal tract - gastrointestinal tract
List of protocol developers with qualification information:
1) Yesembayeva Saule Serikovna - Doctor of Medical Sciences, Professor, RSE at the PVC “Kazakh National Medical University named after S.D. Asfendiyarov”, director of the Institute of Dentistry, chief freelance dentist of the Ministry of Health of the Republic of Kazakhstan, President of the NGO “United Kazakhstan Association of Dentists”;
2) Bayakhmetova Aliya Aldashevna - Doctor of Medical Sciences, Associate Professor, RSE at the PVC “Kazakh National Medical University named after S.D. Asfendiyarova”, Head of the Department of Therapeutic Dentistry;
3) Svetlana Toleuovna Tuleutaeva - Candidate of Medical Sciences, Head of the Department of Pediatric Dentistry and Surgical Dentistry of the Republican State Enterprise at the Karaganda State Medical University;
4) Manekeyeva Zamira Tauasarovna - dentist at the Institute of Dentistry of the RSE at the RV "Kazakh National Medical University named after S.D. Asfendiyarov";
5) Mazhitov Talgat Mansurovich - Doctor of Medical Sciences, Professor of Astana Medical University JSC, Professor of the Department of Clinical Pharmacology and Internship, Clinical Pharmacologist.
Disclosure of no conflict of interest: No.
List of reviewers: Zhanalina Bakhyt Sekerbekovna - Doctor of Medical Sciences, Professor of the RSE at the University of West Kazakhstan State Medical University named after. M. Ospanova, Head of the Department of Surgical Dentistry and Pediatric Dentistry
Conditions for reviewing the protocol: review of the protocol 3 years after its publication and from the date of its entry into force or if new methods with a level of evidence are available.
Attached files
XI Congress KARM-2019: Treatment of infertility. VRT
Pathogenic microorganisms found in the oral cavity have a negative effect on the mucous membrane, and can lead to various kinds of diseases, such as, for example, aphthous stomatitis.
This disease is especially common in young children, the disease gives the baby very unpleasant, painful sensations.
As a result, the child sleeps worse and may refuse to eat. And this, in turn, is negative affects the general condition of the baby. We will talk further about the treatment of aphthous stomatitis in children.
Read about the symptoms and treatment of ascariasis in a child in ours.
Description of the disease
Aphthous stomatitis in a child - photo:
Aphthous stomatitis (ICD code -10) is a prolonged inflammatory reaction affecting the oral mucosa. The causative agent of the disease is pathogenic bacteria, such as staphylococcus, streptococcus, diplococcus.
As a result of the negative impact of these microorganisms on the mucous membrane, slight redness forms on its surface. Then on the affected areas characteristic ulcers form(aphthae). The sizes of aphthae can be different, from 1-2 to 10 mm or more.
On the surface of the mucosa, 1-2 large-diameter aphthae or a larger number of small ulcers may form.
In this case, the affected areas can merge with each other, forming a single inflammatory focus. This phenomenon is considered the most severe form of the disease.
Aphthae can form on any part of the oral mucosa. Most often ulcers affect inner cheeks, tongue, lips. There are cases where aphthae also affected the throat.
Classification
According to the nature of the course, aphthous stomatitis can be:
According to the nature of the lesion, the disease is divided into the following types:
- deforming when significant changes in the oral mucosa are observed;
- necrotic, which provokes the gradual death of mucosal cells;
- scarring when a small scar remains at the site of the aphthae.
Depending on the cause that provoked the appearance and development of the disease, aphthous stomatitis can be:
- viral, that is, caused by various types of viral infections;
- candida if the causative agent of the disease is a fungus;
- herpes, that is, aphthous stomatitis arose against the background of a herpes infection existing in the body.
How can you tell if your child has anorexia? find out right now.
Causes of the disease
Factors causing the development of aphthous stomatitis, may be different.
These include:
- Hereditary factor.
- Diseases of an autoimmune nature, or a temporary decrease in immunity, which is caused by frequent colds.
- Features of the digestive system when a child has an inability to digest certain foods (for example, cereals).
- Frequent allergic reactions.
- Diseases of the gastrointestinal tract.
- Avitaminosis.
- Overvoltage, stress.
- Oral diseases (eg, tooth decay, gum disease).
- Eating too hot food.
- Bacteria, viruses, fungi that affect the oral mucosa.
- Insufficient amounts of important microelements such as iron, folic acid.
- Injuries and damage to the mucous membrane, for example, when eating food.
- Using a toothbrush that is too hard, which regularly injures the child’s gums.
Find out what to do if you suspect appendicitis in a child from ours.
Clinical manifestations
Aphthous stomatitis is a disease characterized by bright, intense symptoms, a characteristic clinical picture.
Thus, the patient is often concerned about such manifestations of the disease as:
- Significant and sharp increase in temperature (sometimes up to 40 degrees). Hyperthermia is often accompanied by fever and chills.
- Deterioration of the child's general condition.
- Severe pain and burning in the mouth.
- Disorders of appetite, sleep and wakefulness.
- Increased salivation.
- Formation of a whitish coating on the surface of the tongue.
- Bad breath, bitter taste in the mouth.
- Enlarged lymph nodes and their pain.
- Formation of specific painful ulcers in the oral cavity.
Why is stomatitis dangerous?
First of all, canker sores caused by infection are contagious and therefore pose a danger to other people.
And the lack of proper treatment can have a very negative impact on the health of the patient himself. Complications include:
Features of treatment
How to treat aphthous stomatitis in children? Aphthous stomatitis is a serious disease treatment of the disease must be comprehensive. That is, to eliminate the causes and signs of the disease, the doctor prescribes drug therapy and physiotherapy. Traditional medicine recipes are also a good help.
However, it is important to remember that their use should only be carried out in conjunction with taking medications prescribed by a doctor and strictly under his supervision.
Medication
Topical agents such as e.g. Holisal– gel, Miramistin.
These products have an antibacterial effect and the ability to relieve inflammation and pain.
Typically, these drugs are used in the early stages of development illness.
Individual intolerance to the constituent components is considered a contraindication. The drug is applied to the affected areas of the oral mucosa and left for some time.
The patient is also prescribed other medications:
- Ibuprofen– helps eliminate pain, reduce temperature;
- Solcoseryl– helps improve metabolism in the affected area of the mucosa. This helps improve regeneration processes;
- Inhalipt– cools the mucous membrane, relieves pain, fights infection;
- Chlorophyllipt– has a pronounced antibacterial effect.
If there is such a need, the patient is prescribed antihistamines that eliminate the allergic reaction (for example, Suprastin).
In especially severe cases, they resort to using strong antibiotics. In addition, taking vitamin preparations is indicated to improve the general condition of the little patient.
Physiotherapy
It will help speed up the healing of aphthae and restore the oral mucosa exposure to UV rays to the affected areas.
The procedure is painless, however, there are a number of contraindications. Therefore, such treatment is carried out only with the direction of a doctor.
Folk recipes
- Mix chamomile flowers, sage leaves and peppermint in equal proportions (3 parts each), add 1 part fennel fruit. Pour boiling water over the resulting mixture (2 tablespoons), leave, and strain. Gargle and mouth several times a day.
- Aphthae can be lubricated sea buckthorn oil or fresh aloe juice. This will help relieve inflammation and speed up the process of tissue regeneration.
- 1 tsp Dilute calendula tinctures in 1 glass of boiled water. Rinse your mouth several times a day.
Proper nutrition
Since one of the reasons for the development of aphthous stomatitis is considered to be disturbances in the functioning of the digestive system, it is necessary to take care of the child’s diet. First of all, pay attention to the consistency and method of cooking.
Mashed, steamed or boiled dishes are suitable for your baby. It is not recommended to give fried, fatty foods.
It is necessary to avoid eating spicy, spicy, salty foods that can irritate the already weakened oral mucosa. It is important that the foods the child eats are rich in vitamins and microelements.
How to prevent it?
Preventive measures to prevent the appearance and development of aphthous stomatitis are very simple.
At the same time, compliance with these rules will reduce the risk of such an unpleasant illness.
So, you need:
- Monitor oral health, maintain hygiene, and conduct preventive examinations with a dentist.
- Keep your baby's toys and personal belongings clean.
- Monitor the quality of your baby's diet.
- Limit his contacts with sick people.
Many people believe that ulcers formed during the disease will go away on their own. However, it is worth remembering the possible complications of the disease and treatment should not be neglected.
After all, aphthous stomatitis, which has passed into a recurrent form, will significantly worsen the child’s quality of life and cause him a lot of unpleasant sensations.
Learn about the symptoms and treatment of aphthous stomatitis from the video:
We kindly ask you not to self-medicate. Make an appointment with a doctor!
