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STOMATITIS (Greek stoma, stomatos of companies + - itis) — an inflammation of a mucous membrane of a mouth. The page develops as a result of an injury of a mucous membrane of a mouth, implementation of activators in it a bacterial or viral infection and other reasons, often is a symptom of a number of the general diseases.

Depending on an etiology distinguish the following types of S.: traumatic, infectious (nonspecific, specific, fungal), allergic, S. at intoxication salts of heavy metals, S. at nek-ry somatopathies, a dermatosis, heylita (see). Besides, damages of a mucous membrane of a mouth are observed at malformations and diseases of language (see. Language , Glossitis ), pretumor diseases and tumors of a mucous membrane of a mouth (see. Roth, oral cavity ).

Traumatic stomatitis

Traumatic stomatitis develops as a result of a mechanical injury, influence of volumetric or physical disturbing factors. Its manifestations depend on a type of irritation, intensity and duration of action, and also on body resistance. The acute mechanical injury is quite rare and arises usually accidentally from biting of a mucous membrane of a mouth or wound sharp objects. Usually does not demand treatment.

Hron. the mechanical injury is one of the most frequent reasons of injury of a mucous membrane of a mouth. Keen edges of teeth and dentures, a dental calculus can be the injuring factors. Hron. the mechanical injury is often combined with infection of affected areas of a mucous membrane.

Fig. 10 — 18. External manifestations of various forms of stomatitis. Fig. 10 — 13. Traumatic stomatitis. Fig. 10. Catarrh. gums, caused by a dental calculus (the stone is removed); hypostasis and hyperemia of a mucous membrane. Fig. 11. The ulcer on a side surface of language caused by long traumatizing by a keen edge of the destroyed crown of tooth. Fig. 12. The hypertrophy of a mucous membrane of an oral cavity on a transitional fold caused by long traumatizing a removable denture by the region (a prosthetic granuloma). Fig. 13. The hypertrophy of a gingival nipple caused by long traumatizing by the mobile, incorrectly located lower central cutters. Fig. 14. The erosion covered with a whitish plaque on a lower surface of language at acute herpetic stomatitis. Fig. 15. The superficial ulcerations covered with a whitish plaque on gingival nipples at ulcer and necrotic stomatitis, gingivas bleed. Fig. 16. A hyperemia and hypostasis of a mucous membrane of gingival edges at allergic stomatitis. Fig. 17. The erosion covered with a whitish plaque (1) and the large opened bubble (2) on a mucous membrane of a hard palate at a vesical and erosive form of allergic stomatitis. Fig. 18. Single afta on a lower surface of language at chronic recurrent aphthous stomatitis (are specified by shooters).

At hron. to a mechanical injury there can be a catarrh with hypostasis and a hyperemia of a mucous membrane of a mouth (tsvetn. fig. 10), an erosion, and then and a traumatic ulcer with the expressed morbidity and inflammatory infiltration (tsvetn. fig. 11). Traumatic ulcers are complicated by a purulent infection or candidiasis. Hron. ulcers of a mucous membrane of a mouth malignizirutsya quite often. Long action of a weak irritant, napr, a denture, can lead to a hypertrophy of sites of a mucous membrane (tsvetn. fig. 12, 13), papillomatous growths of a mucous membrane of cheeks, lips, sky. Besides, hron. the irritation of a mucous membrane of a mouth can cause its keratinization and development of a leukoplakia (see tsvetn. the tab. to St. Leukoplakia ).

The diagnosis of the traumatic S. which resulted from a mechanical injury is put on the basis by a wedge, pictures. The differential diagnosis of a traumatic ulcer of a mucous membrane of a mouth is carried out with a trophic ulcer (see. Trophic ulcers ), with an ulcerated tumor (see Cancer), tubercular and syphilitic ulcers (see. Tuberculosis extra pulmonary , Syphilis ), chronic ulcer nekroticheskpm Vincent's stomatitis (see below).

Treatment consists in elimination of an irritant, antiseptic processing of a mucous membrane and rinsing of an oral cavity. At sharp morbidity applications are shown by anesthetics. Carry out careful sanitation of an oral cavity (see).

Forecast favorable.

Chemical irritants (to - you, alkalis, etc.) at impact on a mucous membrane of a mouth cause a superficial or deep necrosis. At hit of chemical substance on a mucous membrane it is necessary to wash out quickly an oral cavity solution of neutralizer. Further treatment of patients with chemical burns is carried out, as at acute nonspecific inflammatory process (the anesthetics, antiseptic agents, means accelerating epithelization, high-calorific food). At extensive hems an operative measure is shown.

The pages caused by the physical irritating factors arise at impact on a mucous membrane of a mouth of hot water and other liquids, steam, fire, electric current, ionizing radiation in high doses. Treatment is same, as at acute nonspecific inflammatory processes. At beam damages (see) volume to lay down. actions depends on degree and a stage of a radial illness (see).

In prevention of S. caused by influence of the chemical irritating substances and physical factors actions for the accident prevention (see) and labor protection are important (see).

Infectious stomatitis

To the most widespread inf. to diseases, at to-rykh the mucous membrane of a mouth is involved in process, viral infections belong — deprive idle time, the causing acute herpetic S., shingles (see Herpes), flu (see) and grippopodobny diseases (e.g., vesicular S.), an infectious mononucleosis (see M ononukleoz infectious), measles (see), a foot-and-mouth disease (see), etc.; ulcer and necrotic stomatitis of Vincent; bacterial infections — gioynichkovy diseases, diphtheria (see), tuberculosis (see), leprosy (see); mycoses, napr, actinomycosis (see), candidiasis (see); venereal diseases, napr, gonorrhea (see), syphilis (see). If damage of a mucous membrane of a mouth dominates in a wedge, a picture inf. the disease, needs special treatment.

Acute herpetic stomatitis occurs preferential at children. Its emergence is considered as manifestation of primary infection of an oral cavity with a virus of a herpes simplex. Distinguish easy, medium-weight and heavy forms. The last two are followed by the expressed disturbance of a condition of the patient, fervescence to 38 — 40 °, acceleration of ROE to 20 mm/hour, a leukopenia. The mucous membrane of a mouth at the same time is edematous, hyperemic, with a large number of the small vesicles which are quickly passing into erosion, pruinose (tsvetn. fig. 14). Erosion preferential on a mucous membrane of the sky, language, cheeks, lips, in transitional folds are localized. Diffusion damage of gums — an acute catarral ulitis is characteristic. Can be surprised and other mucous membranes, first of all went. - kish. path.

Differential diagnosis is carried out with other viral diseases (vesicular S., a foot-and-mouth disease, etc.) with the help virusol. methods of a research (allocation of a virus, increase of a caption of specific antibodies). Acute herpetic S. is differentiated also with allergic Page.

At treatment with tselyo strengthenings of protective forces of an organism intramusculary enter Prodigiosanum, a lysozyme; the oral cavity is processed antiseptic solutions, proteolytic enzymes, appointed UF-te-rapiyu.

Forecast favorable. Prevention consists in holding anti-epidemic actions (isolation of the diseased, control of personnel of child care facilities for the purpose of identification of patients with herpetic S.'s recurrence).

Vesicular stomatitis causes a virus from this. Rhabdoviridae, to-ry is transferred to the person from the domestic animals sick with this acute inf. disease. Contagiums are transferred in the alimentary way, in the conditions of laboratory — aerogenno.

At people vesicular S. proceeds in the form of a grippopodobny infection and is followed by emergence of vesicles on a mucous membrane of a mouth. The incubation interval makes 1 — 5 days. Against the background of sudden rise in temperature symptoms of the general intoxication develop (a joint pain, muscles, neuralgia, a headache). In 2 — 3 days on a mucous membrane of a mouth and face skin (cheeks, wings of a nose, an upper lip) vesicular rashes develop, to-rye 10 — 12 days remain. At the same time regional lymphadenitis develops.

Lab. diagnosis is carried out by allocation of a virus from washouts of a nasopharynx and contents of bubbles. For statement of the retrospective diagnosis use serological methods. Differential diagnosis is carried out with a foot-and-mouth disease (see), herpetic, aphthous S., and also the stomatitis developing as a result of reception of pharmaceuticals.

Symptomatic treatment. Prevention of vesicular stomatitis consists in observance of the hygienic rules applied with tselyo preventions of intestinal infections.

Forecast, as a rule, favorable.

Ulcer and necrotic stomatitis of Vincent (a stomacace, ulcer and hymenoid stomatitis, fuzospirokhetozny stomatitis, an ulcer oral gangrene, Plaut's stomatitis — Vincent, trench stomatitis) causes symbiosis of a spindle-shaped bacterium (see) and a usual spirochete of an oral cavity (fuzospirokhetoz). Developing of a disease is promoted by decrease in the general body resistance, a hypovitaminosis, etc. Persons of young age are ill usually. At the beginning of a disease body temperature to 37,5 — 38 ° increases, morbidity and bleeding of gums are noted, there are an increased salivation, a putrefactive smell from a mouth. Catarral manifestations on a mucous membrane of a mouth turn into ulcer process (oral gangrene), to-ry a thicket begins with gingival edge (tsvetn. fig. 15) also extends to other sites of a mucous membrane of a mouth. At distribution of activators on palatine tonsils there is Simanovsky's quinsy — Plauta — Vincent (see. Quinsy ).

The diagnosis pictures of blood (a small leukocytosis, shift to the left, moderate acceleration of ROE), results tsitol establish on the basis of data of the anamnesis, a wedge, manifestations. researches of scrapings from a surface of ulcers (abundance of spindle-shaped bacteria, spirochetes, the destroyed leukocytes, the unstructured masses, erythrocytes). Differential diagnosis is carried often out with damage of a mucous membrane of a mouth at leukoses (see).

In treatment crucial importance has local influence: careful removal of tooth deposits, processing of a mucous membrane of a mouth antiseptic solutions, and also appointment in polyvitamins.

The forecast at timely treatment favorable. Prevention consists in respect for hygiene of an oral cavity.

Allergic stomatitis

according to a number of researchers, damage of a mucous membrane of a mouth at allergic diseases (see) arise approximately in 20% of cases. In stomatol. to practice the medicinal allergy most often meets, for a cut not specificity of allergic reaction to this medicine is characteristic. Allergic S.'s feature — variety of forms p options of its clinical current.

Allergic S. can be shown in the form of the catarral, hemorrhagic, vesical and erosive, necrotic, and also combined defeat with localization on the limited site or on all mucous membrane of a mouth. At the allergy caused by various pharmaceuticals there are catarral and kataralnogemorragichesky defeats more often. At the same time patients complain of burning sensation, an itch, dryness in a mouth, morbidity at meal. The mucous membrane of a mouth is edematous, hyperemic (tsvetn. fig. 16), can come an atrophy of nipples of language (the so-called varnished language). At a vesical and erosive form of damage of a mucous membrane against the background of the expressed hypostasis and a hyperemia bubbles appear, after opening to-rykh the erosion covered with a fibrinous plaque are formed (tsvetn. fig. 17).

The diagnosis is made on the basis of the anamnesis and data tsitol. researches (identifications akantoliticheskttkh or multinucleate cells). Puzyrnoerozivny damages of a mucous membrane of a mouth differentiate with a pemphigus (see), herpetic S., a mnogoformny exudative erythema (see the Erythema exudative much formnaya). Ulcer and necrotic defeats at intolerance of pharmaceuticals differentiate with cankers at diseases of blood (a leukosis, an agranulocytosis), ulcer and necrotic stomatitis of Vincent.

Treatment provides elimination of the reason which caused emergence of an allergic state, appointment inside giposensibilizi-ruyushchnkh and antpgistaminny drugs. In hard cases intravenously enter solution of sodium thiosulphate, in the conditions of a hospital appoint drop injection of Haemodesum, poliglyukon, isotonic solution of sodium of chloride, and also corticosteroids.

The forecast depends on timeliness of elimination of the reasons which caused an allergy.

Chronic recurrent aphthous stomatitis — the inflammatory disease having as is believed, the infectious and allergic nature. It is characterized by emergence of single painful aft (see) on a mucous membrane of a mouth (tsvetn. fig. 18), to-rye in 7 — 10 days begin to live. Recurrent afta can be one of symptoms of a generalized aphthosis (see. Bekhcheta disease ). A recurrence is more often observed during the ve-Senna-autumn period. Over time disease severity increases: the quantity aft increases, and the period of their healing is extended to 2 — 4 weeks, a recurrence becomes frequent. Sometimes remissions in general are absent.

The diagnosis is made on the basis of characteristic by a wedge, pictures.

Treatment shall be complex and strictly individual. Are shown specific (bacterial allergens) or the nonspecific hyposensibilizing therapy, sanitation of an oral cavity (special attention is paid to elimination of the dontogenous centers of an infection), the local therapy (anesthetizing, antiseptic, epithelizing).

The forecast at systematic treatment favorable.

== Stomatitises at intoxication catarral S. with sites of pigmentation of a mucous membrane (first of all, gingival edge) arises salts of heavy metals == At slight intoxication salts of heavy metals (lead, bismuth, mercury) usually. In hard cases the ulcerations which are characterized by a persistent current develop. Except morbidity in an oral cavity, disturbance of salivation and feeling of metal smack, the general weakness, apathy, disturbance of digestion, etc. are noted. At treatment apply antidotes, the created diuresis, etc. (see. Bismuth , Mercury , Lead ).

Stomatitises at some somatopathies

Patol. changes of a mucous membrane of a mouth can arise at hypovitaminoses, endocrine diseases, diseases went. - kish. path, cardiovascular system, blood, nervous system, collagenic diseases. Usually they are not specific to this or that somatopathy. Quite often patol. changes of a mucous membrane of a mouth advance emergence of the main a wedge, symptoms.

Watch articles devoted to individual diseases, e.g. in more detail. Gastritis , diabetes mellitus , Leukoses , Colitis , Lupus erythematosus , Pernicious anemia etc.

Stomatitises at a dermatosis — see. Deprive red flat , Pemphigus .

Bibliography: Barerg. M. O of reaction of a mucous membrane of an oral cavity at radiation therapy of new growths of maxillofacial area, Stomatology, No. 6, page 17, 1962; Bohr E. V., etc. Therapeutic stomatology, M., 1982; B a shouting about in with to and y E. V. and Danilevsky N. F. Atlas of diseases of a mucous membrane of an oral cavity, M., 1981; Vinogradova T. F., etc. Some indicators of an immune responsiveness at the children sick with acute herpetic stomatitis, Stomatology, t. 52, No. 6, page 76, 1973; Viral diseases of the person, under the editorship of A. F. Bilibin, page 307, M., 1967; M and sh to and l of l e y with about N of A. JI. Precancer of a red border of lips and mucous membrane of a mouth, M., 1970; Fishermen A. I. and Banchenko G. V. Diseases of a mucous membrane of an oral cavity, M., 1978; Severova E. Ya. and Bokano-v and Zh. V. Display of a medicinal allergy in an oral cavity, Stomatology, No. 6, page 28, 1968; With yu r and V. N. N and F about m and - N and N. V. Private veterinary virology, page 294, M., 1979; H and r in and V. T. Changes in dentoalveolar system and in an oral cavity at an agranulocytosis, Stomatology, No. 2, page 21, 1968; L e h n e r T. Immunologic aspects of recurrent oral ulcers, Oral Surg., v. 33, p. 80, 1972; Matthews R. E. F. Classification and nomenclature of viruses, Intervirology, v. 12, p. 222, 1979; P a n d i D. N. Herpetic erythema multiforme, Brit. med. J., v. 1, p. 746, 1964; Pindborg J. J. Atlas of diseases of the oral mucosa, Copenhagen, 1973; R i with k 1 e s N.H. Allergy in surface lesions of the oral mucosa, Oral Surg., v. 33, p. 744, 1972; Stanley H. R. Aphthous lesions, ibid., p. 407.

E. V. Borovsky; B. F. Semenov (vesicular stomatitis).