ROT, ROTOVAYA POLOST

From Big Medical Encyclopedia

MOUTH, ORAL CAVITY [mouth, oral cavity; os (oris) (PNA), os (JNA, BNA), cavitas oris (PNA)] — the initial department of a digestive tract consisting of an actinostome and an oral cavity. The actinostome is limited top and bottom lips (see). At close lips the actinostome has the form of an oral crack (rima oris), at opened — rounded shape. The sizes of an oral crack vary and average at adult 6 — 8 cm. Men have an oral crack usually more, than at women.

In an oral cavity there is a mechanical crushing of food and its chemical treatment preparing food for further digestion in begins went. - kish. path. Besides, the oral cavity takes part in breath, and also in formation of sounds of the speech and singing.

Embryology

in the course of an embryogenesis formation of an oral cavity is closely connected with development persons (see). On the head end of a germ emboly of an ectoderm is formed, a cut grows towards to the blind end of a front gut. There is a so-called oral pole, or the bay representing a rudiment of primary oral cavity, and also a nasal cavity. During 6 — 8th week of embryonic development there is a division of primary oral cavity into a final oral cavity and a nasal cavity that is connected with formation of a hard and soft palate. Formation of an entrance of the mouth is closely connected with development of lips and cheeks. Approximately on the 7th week of embryonic development along top and bottom edges of primary oral crack there is a growth of an epithelium to its subsequent immersion in the subject mesenchyma in the form of the arc-shaped plate. On the course of a plate soon there is a crack, edges separates rudiments top and bottom jaws from rudiments of lips. Originally oral crack at a germ very wide also reaches rudiments of an outside ear. Its reduction in sizes happens due to accretion of edges of an oral crack and formation of cheeks.

The anatomy and histology

the Oral cavity is limited in front of and from sides to lips and cheeks; its upper wall is the hard and soft palate (see), and lower — a mouth floor. A basis of a mouth floor is the diaphragm of a mouth, edges consists of a pair maxillary and hypoglossal muscle (m. mylohyoideus). Above it are located mental podjyazych-nye muscles (mm. geniohyoidei), and also muscles language (see). Behind the oral cavity by means of a pharynx connects to a cavity drinks (see).

Fig. 1. A median sagittal cut of the head at the level of an oral cavity of N of a throat. Fig. 2. Oral cavity, anterior aspect (corners of a mouth are cut). Fig. 3. A frontal cut of the head at the level of molars, 1 — a hard palate; 2 — teeth; 3 — an upper lip; 4 — an oral crack; 5 — an under lip; 6 — an entrance of the mouth; 7 — a mandible; 8 — hypoglossal gland; 9 — a genioglossal muscle; 10 — a geniohypoid muscle; 11 — a maxillary and hypoglossal muscle; 12 — a hypoglossal bone; 13 — a pharynx; 14 — language; 15 — a soft palate; 16 — actually an oral cavity; 17 — a bridle of an upper lip; 18 — a gingiva; 19 — a palatoglossal handle; 20 — a palatine tonsil; 21 — a uvula; 22 — a bridle of an under lip; 23 — a palatopharyngeal handle; 24 — cross palatal folds; 25 — a front abdomen of a biventral muscle; 26 — a buccal muscle; 27 — an adipose body of a cheek.

Anatomically the oral cavity is subdivided into front department, or an entrance of the mouth (vestibulum oris), and back department, or actually an oral cavity (cavitas oris propria). The entrance of the mouth has an appearance of the crack concluded between lips and cheeks (in front and outside) both teeth and gums (behind and from within). By means of interdental spaces and pozadizubny spaces the entrance of the mouth is reported with actually oral cavity (tsvetn. fig. 1 — 3).

Actually the oral cavity is separated from an entrance of the mouth by teeth and gingivas (see). At close teeth it has an appearance of a crack, during the opening of a mouth the oral cavity gets the irregular ovoidny shape. There are individual and age distinctions in a form and the sizes of an oral cavity: at brakhitsefal it is wider and shorter, than at dolichocephalic persons. Newborns and children up to 3 months have an oral cavity very small, short and low. In an oral cavity are located teeth (see), language (see), in it output channels big and small open sialadens (see).

Both an entrance of the mouth, and an oral cavity it is covered by the mucous membrane having resistance to action of various mechanical, chemical and thermal irritants, high regenerator ability and relative stability to implementation of an infection.

Fig. 10 — 15. Microdrugs of a mucous membrane of an oral cavity are normal. Fig. 10. Mucous membrane of a cheek: the glycogen (is specified by an arrow) in surface layers of not keratosic multilayer flat epithelium revealed by means of PAS-reaction, cells of a basal layer do not contain a glycogen; x 200. Fig. 11. Not keratosic multilayer flat epithelium of a mucous membrane of a cheek; coloring by an adhan; x 400. Fig. 12. The mucous membrane of a hard palate with the subject fatty tissue covered with a keratosic multilayer flat epithelium: corneous layer of intensive-red color; coloring by an adhan; X 140. Fig. 13. Keratosic multilayer flat epithelium of a mucous membrane of a hard palate: corneous layer of intensive-red color; coloring by an adhan; x 400. Fig. 14. The mucous membrane of a gingiva covered with a keratosic multilayer flat epithelium (the corneous layer is specified by an arrow); coloring hematoxylin-eosine; x 200. Fig. 15. The mucous membrane of a red border (transitional department) of a lip covered with a keratosic multilayer flat epithelium: corneous layer of a magenta color; coloring aldehyde-fuchsin; x 140.

Throughout a mucous membrane of a mouth it is covered with a multilayer flat epithelium. The epithelium covering a mucous membrane of different departments of an oral cavity has differences. In cheeks, lips, a soft palate, and also a mouth floor the epithelium under normal conditions does not orogovevat. Idiosyncrasy of not keratosic epithelium of an oral cavity of the person is his ability to accumulation in cytoplasm of a large number of a glycogen (tsvetn. fig. 10 and 11). In a hard palate and gums the epithelium finds the expressed tendency to keratinization. In these sites over a layer of acanthceous cells the granular layer consisting of the extended cells is located, to-rye contain grains of eleidin in the cytoplasm. Above the granular layer passes into the corneous layer consisting of completely horny and deprived kernels of cells. In a keratosic epithelium the glycogen, as a rule, is absent (tsvetn. fig. 12 — 15).

The epithelium of a mucous membrane of a mouth possesses a high level of activity of fermental systems, including enzymes of a cycle of tricarboxylic acids (see. Tricarboxylic acids cycle ), glikoziltransferaz.

Own plate of a mucous membrane of a mouth, on a cut lies layer of an epithelium, forms numerous ledges, or the nipples pressing in layer of an epithelium. Distribution of cellular elements (fibroblasts, mast cells, plasmocytes, segmentoyaderny leukocytes) in various departments of a mucous membrane of a mouth unevenly: own plate of a mucous membrane of cheeks, lips is richest with cells. Fibrous structures are presented by bunches of the intertwining collagenic fibers, between to-rymi argentofil-ny and elastic fibers are located. The greatest number of elastic fibers is observed in own plate of a mucous membrane of a cheek and the sky.

Own plate of a mucous membrane of a mouth without sharp border passes into a submucosal layer (a submucosa, T.), especially well developed at a mouth floor. In a submucosal layer numerous small sialadens lie. The muscular plate of a mucous membrane, characteristic of digestive tract, is absent here. In gums, in lateral departments of a hard palate and in the field of a seam of the sky the submucosal layer in general is absent. In these sites the mucous membrane densely connects to a periosteum of the corresponding bones.

Blood supply, a lymph drainage and an innervation of walls of an oral cavity are closely connected with a vascular p nervous systems of the educations making it (see. Throat , Teeth , Sky , Jaws , Language ).

Microflora of an oral cavity

In an oral cavity over 100 different types of microbes are revealed. Aerobic and anaerobic bacteria, yeast-like fungi, mycoplasmas, the elementary are a part of microflora of a mouth. According to S. Neychev (1977), concentration of aerobic bacteria in 1 ml of saliva makes 107, anaerobic — 108.

Among constant flora of an oral cavity streptococci prevail, blow-lonelly, lactic-acid bacteriums, actinomycetes. Besides, saprophytic neysseriya, diphtheroids are a part of constant flora. bacteroids, fuzobakteriya, leptotrikhiya, spirochetes, etc.

To non-constant, or accidental, microflora carry gram-negative bacteria, including escherichias, klebsiyella, pseudo-monads, proteas, and also a clostridium. Detection of the specified microorganisms in an oral cavity testifies about dysbacteriosis (see).

Microbic flora of an oral cavity, as well as normal flora of other cavities of an organism (see. Mikroflora of the person ), is a consequence of mutual adaptation of an organism and microbes. Despite the known constancy, the fluctuations in quantity and structure of microbic flora connected with hygienic skills, age, dental health and other factors are observed. It is also necessary to note that in an oral cavity microorganisms are distributed unevenly. Most of all bacteria are on a root of language, on the surface of the gingival region and in a dental plaque (plaque). According to V. G. Petrovskaya and O. Marko (1976), a certain specificity in resettlement of flora in an oral cavity, so is noted. e.g., Streptococcus salivarius is found on a mucous membrane of language, Str more often. mitis — on a mucous membrane of cheeks and on the surface of teeth, Str. sanguis and Str. mutans allocate preferential from a dental plaque (see. Teeth, biochemistry of teeth ).

Microflora of an oral cavity performs a number of physiological functions. In a healthy organism thanks to the antagonistic properties microflora performs function of «a biological barrier», interfering with reproduction of accidental microorganisms, including pathogenic, coming to an oral cavity from the environment. Useful value of microflora of an oral cavity is connected also with its participation in decomposition of organic matters (the remains of food), i.e. in self-cleaning of an oral cavity. Besides, microflora of an oral cavity is a constant stimulator of local immunity.

The decrease in resistance of a mucous membrane of a mouth and change of reactivity of an organism (see) caused by various factors can lead to permanent change of structure and properties of flora of an oral cavity, or to dysbacteriosis (see). The changed microflora loses protective functions and becomes frequent a source autoinfections (see). Disturbance of microbic balance under the influence of nek-ry medical influences { radiations, antibiotics, immunodepressants, denture treatment, etc.) can lead to developing of such diseases of a mucous membrane as stomatitis (see), glossitis (see), ulitis (see), to-rye a thicket happen the fungal nature. Generalization of process — a visceral candidiasis is possible (see. Candidiasis ).

Microflora of an oral cavity matters in development of caries of teeth (see. Caries of tooth ), diseases parodonta (see). At caries the most essential part is assigned to the acid-forming microorganisms (to streptococci, lactobacilli, actinomycetes) creating a dental plaque. In development a disease of a parodont most the importance is attached to gram-negative anaerobic bacteria (to bacteroids, fuzobakteriya, spirochetes, veylo-nella, etc.). Believe that the endotoxins formed by this flora having antigenic activity stimulate the response immune responses supporting hron. an inflammation in fabrics of a parodont. E.g., in a pathogeny such patol. processes, as pulpitis (see), periodontitis (see), quite often developing as a complication of caries of teeth, the large role is played by a sensitization of an organism products of metabolism of microbes. Chronic inflammatory processes in an oral cavity cause allergic reorganization of an organism and can promote development of the centers of the infection sometimes passing in sepsis (see).

Life activity of microorganisms in an oral cavity substantially is defined by a condition of local protective factors. One yes have no them a direct focus against microorganisms, however make negative impact on their development. Such nonspecific factors of resistance are: pH of saliva, bacteriostatic properties of a secret of sialadens, products of exchange of fabrics, regular exfoliating of an epithelium in an oral cavity, lysozyme (see), etc. Specific factors of protection of a mucous membrane of a mouth — the immune mechanisms directed directly against microorganisms — are presented by humoral and cellular immunity. In a healthy organism at an intact oral cavity protective factors interfere with excessive reproduction of microbes, holding them in certain quantitative ratios.

Methods of a research of an oral cavity

Methods of a research of an oral cavity come down, first of all, to its careful survey using directed (it is desirable shadowless) lighting and special tools (see. Dental tools ) — the pallet, wide hooks for assignment of cheeks, lips, language and stomatol. mirrors for survey of hardly accessible sites. Sometimes for identification of lyunestsiruyushchy connections in a mucous membrane of a mouth (see. Luminescence ) make audit of a cavity of a ft in UF-light. During survey pay attention to existence of a smell from a mouth. Define mobility, density, a consistence and morbidity of various sites of a mucous membrane by a palpation and patol. educations.

For studying of the bodies surrounding an oral cavity use various methods of radiodiagnosis (see). Apply also such methods of a research as ultrasonic echolocation (see. Ultrasonic diagnosis ) and termografiya (see). According to indications make tsitol. a research of washouts and prints with patholologically the changed sites of a mucous membrane (see. Cytologic research), and also studying of microflora of an oral cavity. According to strict indications make a biopsy (see).

In some cases there is a need for carrying out immunological and biochemical researches, and also for definition of different types of sensitivity: tactile, painful, temperature, flavoring (see. Esteziometriya ).

See also Inspection of the patient, dental inspection .

Pathology

malformations, diseases of a mucous membrane of a mouth, disturbance of an innervation, a disease of the bodies surrounding an oral cavity, tumors belong To pathology of an oral cavity.

Malformations can treat inborn defects of lips (see. Lips ), the sky (see), jaws (see), language (see); seldom inborn facial clefts meet (see).

Diseases of a mucous membrane of a mouth

belong To diseases of an oral cavity, first of all, the damages of her mucous membrane differing in variety morfol. disturbances and a wedge, manifestations that represents quite often serious difficulties at differential diagnosis. Allocate several basic groups of diseases of a mucous membrane of a mouth.

Traumatic injuries of a mucous membrane of a mouth can be caused by mechanical, volumetric, thermal, beam factors. Weight and duration of a current depend on the sizes and depth of defeat, however wounds and injuries of a mucous membrane heal quicker and less often similar injuries of skin are followed by complications, than. Long influence of the irritating factors can lead to formation of traumatic erosion, hron. ulcerations, dekubitalny ulcers. Crowns of incorrectly cut through or displaced teeth, keen edges of carious cavities, incorrectly imposed seals and artificial crowns, uneven edges of dentures, their clasps, postponed for the surfaces of teeth can be the reason of a mechanical injury dental calculus (see). The irritation and injury of a mucous membrane can result from reception of excessively hot, spicy, spicy food, hard alcoholic drinks, is especially frequent — smoking, and also as a result of nek-ry traditional addictions: chewing of tobacco, leaves of a betel, etc. Often action of the chronic irritating and injuring factors leads to disturbance of process of keratinization of an epithelium of a mucous membrane, a hyperkeratosis (see), leukoplakias (see).

Inflammatory diseases of a mucous membrane of a mouth — stomatitises (see) distinguish on localization of defeat, an etiology, morfol. to changes and wedge, to a current. On localization allocate inflammations of a mucous membrane of lips, their red border — cheilitis (see), language — glossitis (see), gingivas — ulitis (see).

Allergic reactions (see. Allergy ) are rather frequent reason of damage of a mucous membrane of a mouth. Nek-rye from them carry to infectious and allergic, napr, chronic recurrent aphthous stomatitis; others are called by chemicals, especially often lekarstvennsh means, or are local manifestation of the general allergic reactions.

The mucous membrane of a mouth can react to various patol. processes and functional disturbances in many systems of an organism. Its characteristic changes sometimes are the earliest symptoms of diseases of systems of digestion, allocation, blood circulation, diseases of blood, and also hypovitaminoses and many inf. diseases. A nek-ry dermatosis is followed by characteristic changes in an oral cavity (see). Changes of a mucous membrane of a mouth are important for diagnosis of professional and household chronic intoxication various chemicals, napr, heavy metals (See. Mercury , Lead ).

Tumors of an oral cavity can develop as from a mucous membrane, and to extend from deeper fabric structures and bodies. From benign tumors of others papillomas meet more often (see. Papilloma, papillomatosis ), fibromas (see. Fibroma ), cystous formations of the small sialadens located in the thickness of walls of an oral cavity, so-called enclavomas of glands (see. Enclavomas ). Vascular tumors — hemangiomas (see. Hemangioma ), lymphangiomas are much more rare (see. Lymphangioma ) can be localized in different departments of an oral cavity.

Among malignant tumors in pathology of an oral cavity cancer is of great importance. Cancer of an oral cavity, including cancer of lips (see Lips) and language (see), makes about 10% of all cancer tumors. It is considered to be that cancer defeats develop on the sites of a mucous membrane having hron more often. damages, ulcerations, cracks, and also on the sites struck with a hyperkeratosis, a leukoplakia, nek-ry other so-called precancerous diseases (see. Pretumor diseases ). Early detection and elimination of precancerous diseases of an oral cavity is the most important part of oncological prevention.

Disturbances of an innervation of certain sites of an oral cavity can be shown in the form of an anesthesia (analgesia), emergence of the distorted and unpleasant feelings (paresthesia) and various pain syndromes connected with neuritis or neuralgia of separate branches or branches of the nerves which are taking part in an innervation of an oral cavity and its bodies. One of typical and rather frequent type of such disturbance happens glossodynia (see), shown in the form of pains or burning sensation in language.

Diseases of other bodies connected with an oral cavity

Along with diseases of a mucous membrane of one of the most widespread types of pathology of an oral cavity are diseases of teeth: caries (see Caries of tooth), pulpitis (see), periodontitis (see), periodontosis (see), and also anomalies of development of teeth (see), dentitions, bite (see).

Severe forms of odongogenny inflammatory processes are the periostitis and osteomyelitis of jaws (see), abscesses (see. Abscess ) and phlegmons of surrounding soft tissues (see Phlegmon), in particular phlegmon of a mouth floor (a diffuse purulent inflammation of cellulose of intermuscular and interfascial spaces between a body of the mandible and a hypoglossal bone), and also Ludwig's quinsy (see Ludwig quinsy). Treatment of phlegmons consists in opening by means of wide cuts of all possible sites of accumulation of pus and their drainage in combination with intensive measures of the general antiinflammatory therapy.

Among diseases of other bodies connected with an oral cavity it should be noted the diseases of sialadens exerting impact on a condition of a mucous membrane of a mouth and breaking functions of an oral cavity (see. Xerostomia , Sialadenitis , Sialolithiasis ).

At a number of diseases of a mucous membrane of an oral cavity of inflammatory or necrotic character (ulcer and necrotic stomatitis, an ulitis, etc.), diseases of teeth (caries, periodontosis, a pulpitis, etc.), hron. tonsillitis, at diseases of upper respiratory tracts (an ozena, the breaking-up tumor), lungs (bronchiectasias), went. - kish. a path (anacid gastritis, a diverticulum of a gullet), disturbances of exchange (a diabetes mellitus, a scurvy etc.) the fetor from a mouth (foetor ex ore) can be noted, elimination to-rogo requires treatment of a basic disease.

Operations

operative measures, Small on volume, in an oral cavity are performed, as a rule, by surgeons-stomatologists, most often in out-patient conditions. Before any operation in an oral cavity make sanitation of an oral cavity (see).

Operations of an exodontia are the most widespread (see. Exodontia ), and also the interventions connected with diseases of peridental fabrics and dontogenous processes. Are carried out usually under local (on a mandible preferential conduction) anesthesia (see. Anesthesia local, maxillofacial area ). Opening of gingival abscesses, suppurative focuses at periostites carry out by means of cuts to a bone with the subsequent drainage.

Cuts concerning cysts (see. Odontocele ), high-quality new growths, the sites of a mucous membrane patholologically changed make within not changed fabrics with the subsequent sewing up by a catgut. Mending of wounds at injuries of an oral cavity is made tightly. Features of surgical treatment of wounds at wounds, including fire, affecting an oral cavity — see. Person , Jaws .

More extensive interventions in oral cavities carry out in stationary conditions under a local anesthesia with premedication or under anesthetic. Plastic surgeries make in the presence of inborn malformations (a crevice of an upper lip and the sky, «a double lip», the shortened bridles of an upper lip and language, etc.), and also concerning effects of damages and diseases (hems, defects).

In cases of cicatricial deformations in the field of corners of a mouth for elimination of narrowing of an oral crack, a so-called microstoma, edge of an oral crack at their through cicatricial change cut and epithelize, twisting a mucous membrane from a cheek (Evdokimov's method). If the strip of a red border remained, it is cut a through section, keeping in the form of a crossing point between a top and bottom lip, and then after an ulotomy and tissues of a cheek tighten to the required level where fix by seams, creating thus a new corner of a mouth (Vasilyev's method).

Very seldom it is necessary to resort to plastic surgeries concerning excessively wide oral crack, the so-called macrostoma resulting from a unilateral cross facial cleft of inborn character (see the Person, malformations).

In the postoperative period careful hygienic care of an oral cavity (plentiful washing of an oral cavity, rinsing), and also purpose of the liquid or softened food, its introduction through an invalid's cup at impossibility of chewing are necessary.

Hygiene of an oral cavity

Hygiene of an oral cavity includes a complex of the general and local actions directed to preservation of teeth, a parodont, a mucous membrane of a mouth in a healthy state, ensuring full functions of chewing, swallowing, the speech, etc. (see. Personal hygiene, hygiene of an oral cavity ). (To formation of a dental plaque and tooth plaque, accumulation of the food remains in interdental spaces, carious cavities, to reproduction of pathogenic microorganisms etc.) can lead to pollution of an oral cavity: the general diseases of an organism (feverish states, diseases went. - kish. path, liver * hypovitaminoses etc.), tooth diseases, disturbance salivations (see) and change of structure saliva (see), lack of appetite, bad chewing of food, oral breath, preferential use of soft food, etc.

The role of hygiene of an oral cavity in prevention and treatment of dental diseases is big as the maintenance of a healthy condition of an oral cavity begun with the early childhood (from 2 years), reduces the frequency of developing of caries, diseases of gums and other pathology of an oral cavity. Timely removal of a dental plaque interferes with formation of a tooth plaque that improves contact of a clean surface of tooth with saliva, increases exchange of mineral substances in tooth, strengthens maturing and calcification of teeth, creating resistance of teeth to caries. Removal of a dental plaque eliminates conditions of emergence of an inflammation of a mucous membrane of a mouth, preventing development of ulites and periodontosis (see). The high level of hygiene of an oral cavity in the course of treatment of caries and periodontosis accelerates achievement of results of treatment and fixes them.

The hygienic condition of an oral cavity is reached by means of individual hygienic actions (rinsing and toothbrushing by a brush, care of orthodontic devices and dentures) and the medical recreational actions including sanitation of an oral cavity (see) and professional hygienic processing of an oral cavity.

For assessment of a hygienic condition of an oral cavity various indexes are used. Apply coloring of a vestibular surface of six lower foreteeth to definition of quality of care after an oral cavity iodine - iodide and potassium solution, at a cut the crude surface of teeth gains brown color. Quantitative assessment is made on five-point system. Normal the hygienic index does not exceed 1,1 — 1,3 points. By means of the recommended hygienic index it is possible to estimate the quality of cleaning of teeth with this or that paste clearing action of various hygienic means, and also individual degree and quality of cleaning of teeth.

Individual hygienic actions are carried out by means of personal hygiene means (toothpastes, elixirs and denture powders), to-rye on structure and purpose can be divided on hygienic, treatment-and-prophylactic and medical. Clarification of teeth pastes is made by means of toothbrushes. The persons using fixed prostheses need more long and careful clarification of teeth and all surfaces of a denture. It is recommended to brush teeth twice a day — in the morning and in the evening. After each meal it is recommended to rinse a mouth boiled water and to wash out orthodontic devices and removable prostheses under a water jet. For the same purpose dentifrice waters can be used.

Professional hygienic processing of an oral cavity is carried out on medical indications in an ostomy tolite. an office or in the room of hygiene of an oral cavity in policlinic, sanatorium, school, etc. Before processing define a hygienic index. Then carefully delete with special tools, brushes, rubber cones and circles, and also special or silk thread a dental calculus, tooth plaques and a soft plaque from all surfaces of tooth. After professional processing hold a session antiinflammatory (at an inflammation of gums) or remineralizing therapy (at caries).



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V. F. Rudko; T. F. Vinogradova (gigabyte.), V. V. Gemonov (An., gist., embr.), V. V. Hazanova (microflora of an oral cavity).

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