Inflammation of the oral cavity - stages of treatment of the mucous membrane and methods of eliminating inflammation

Ulcers caused by trauma

The main reason for the appearance of ulcers when the mucous membrane is injured is infection in the wound. Most often, white rashes occur due to the habit of biting nails or the tip of a pencil or pen.

Fans of seeds and hard toothbrushes may also be at risk. Many people believe that hard bristles remove plaque better. Actually this is not true. If you carefully brush your teeth with such a brush, you can damage the enamel, gums and cause inflammation.

Other causes of mucosal injury:

• uncomfortable dentures;
• braces or other orthodontic structures;
• habit of unconsciously biting your cheek or tongue;
• exposure to mucous membranes with drugs or acids.

How to treat?

It is enough to remove the irritating factor and wait 1 - 2 weeks. Usually the ulcers go away on their own. If this does not happen, it is recommended to consult a doctor.

Characteristics of a blood bubble on the oral mucosa

The mucous membrane protects the entire body from the negative influence of the environment, from harmful microorganisms, various types of pollution, and also has a fairly high level of regeneration. If blood blisters regularly appear on the oral mucosa, then you should take this signal seriously and take action.

A bloody ball in the mouth is a hematoma (bruise), which is characterized by the accumulation of blood in a certain place in the oral cavity. The appearance of bloody blisters is a kind of hemorrhage that occurs due to trauma to the capillaries and thin vessels of the mucous membrane.

A blister on the mucous membrane may contain clear serous fluid without the presence of blood. This means that the vessels were not damaged and the resulting wound is superficial. Such blisters on the mucous membrane heal much faster. The presence of blood in the bladder indicates a deep injury and a longer period of healing and blood resorption.

Ulcers caused by oral diseases

White sores in the mouth can appear due to diseases of the oral cavity. The most common cause is stomatitis. It comes in several types:

• aphthous;
• herpetic;
• bacterial;
• fungal.

Causes of herpes stomatitis

There are two types of herpetic stomatitis: acute and chronic. Acute herpetic stomatitis, according to Dr. Komarovsky, occurs only in children under 3 years of age, when for the first time the child’s body, already deprived of antibodies to the herpes virus received from the mother, is first exposed to a viral attack from the outside. Moreover, the source of infection, as a rule, is the parents themselves - carriers of the virus, who kiss the baby or lick his pacifier or feeding spoon.

Recurrent or chronic stomatitis is already the lot of adults. The disease is recurrent in nature as soon as the body’s immune forces are weakened. In this case, primary infection can occur either through airborne droplets (sneezing), or through household contact (for example, through the use of the same dishes with a virus carrier) or hematogenous (through blood during injections, etc.). The incubation period of the disease can last up to two weeks depending on the state of the immune system.

Attention!

The pathogenesis of the disease in dentistry is still unknown. But if the body is weakened, any injury to the palate or gums can provoke activation of the herpes virus types 1 and 2!

Treatment

Therapy comes down to the destruction of pathogenic microorganisms, drug restoration of the mucous membrane, and prevention of relapses. When drawing up a treatment plan, the type of infectious agent, the stage of development of inflammation, and the patient’s age are taken into account.

For purulent stomatitis, antibiotics (tablets or injections), antiseptics (solutions, gels and ointments) and anti-inflammatory drugs are used. Sometimes severe pain occurs, especially in severe cases of the disease, so the oral cavity is treated with painkillers. Before eating, the mucous membrane is treated with an anesthetic drug.

Also during this period, it is important to protect the oral cavity from unnecessary irritation: do not drink alcohol, spicy, sour or salty foods, as well as very hot dishes.

The mechanism of formation of a blood bubble on the oral mucosa

Bloody blisters in the mouth in most cases are not life-threatening. They are formed as a result of mechanical damage to the mucous membrane. When microtrauma occurs, harmful microorganisms attack the damaged area.

After this, a number of responses are activated in the human body:

• The immune system is activated. Monocytes and leukocytes, as well as macrophages, instantly arrive at the damaged area, attacking the harmful pathogen and quickly destroying it.
• Immune cells die. This is a signal for other cells and substances are released in the affected area that are mediators of inflammation of the mucous membrane - serotonin, histamine and bradykinin.
• These substances cause a strong spasm of the circulatory system and the outflow of blood is hampered. After the spasm is relieved, all accumulated blood immediately flows to the site of inflammation. It moves at high speed and under pressure. A detachment of the mucous membrane occurs in the mouth, and a bloody blister appears.

Types of disease

Purulent stomatitis is a complication of various types of inflammation of the mucous membrane. It happens:

• bacterial. The occurrence is provoked by various microorganisms (staphylococcus, streptococcus, fungi of the genus Candida);
• viral. Develops against the background of influenza, herpes, enterovirus and HIV infections. In this case, general health deteriorates noticeably, and the lesions have a large area;
• aphthous. Characteristic is the appearance of aphthae (erosions), which are white, yellow or gray in color. They cause discomfort, causing severe pain, and may cause pus to discharge from the mouth;
• traumatic. Develops due to mechanical, chemical or physical damage. This could be, for example, due to a drink that is too hot or ill-fitting dentures;
• vegetative pyostomatitis. Multiple small blisters containing fluid develop into ulcers and eroded areas, which may leave scars.

Lichen planus is a chronic polyetiological disease with rashes of papules on the mucous membranes and skin. Isolated lesions of lichen planus of the oral mucosa are observed in 75% of cases. This is one of the most common diseases of the oral mucosa.

The appearance of lichenoid rashes in the oral cavity is usually associated with emotional stress, neuropsychic shocks, and negative emotions. Disturbance of neuroendocrine regulation (early onset of menopause) is important.

The erosive-ulcerative form of lichen planus of the oral mucosa, being a precancerous disease, requires close attention and qualified treatment from the dentist. If a dentist identifies a total lesion of the oral mucosa with an erosive-ulcerative form of lichen planus, the patient is referred for inpatient treatment to a skin disease clinic.

In the hospital, as a rule, the patient receives large doses of corticosteroid drugs and other medications by mouth. At the same time, less attention is paid to the local treatment of erosive and ulcerative lesions of the oral mucosa [1-6].

The purpose of the study is to develop an effective method for treating the erosive-ulcerative form of lichen planus in a clinic with total damage to the mucous membrane of the oral cavity, gums and lips.

Material and methods

Clinical examination and treatment of patients was carried out at the Department of Diseases of the Oral Mucosa of the Department of Hospital Therapeutic Dentistry, Periodontology and Geriatric Dentistry.

We observed 7 patients (1 man and 6 women) aged from 46 to 71 years with an erosive-ulcerative form of lichen planus (see table).

Complaints upon admission

Patients complained of an unusual appearance of the oral mucosa, loss of taste, burning sensation, pain when eating and brushing teeth, roughness and tightness of the oral mucosa.

All patients had anxiety-hypnotic syndrome, negative psycho-emotional states with a tendency to depression, and cancerophobia. The disease progressed with alternating periods of remission and exacerbation. Exacerbation was always preceded by stress.

When examining the skin of 3 patients, single papules were revealed on the skin of the forearms of the hands. When examining the oral mucosa, multiple papular rashes were revealed on the dorsal surface of the tongue, the mucous membrane of the cheeks, lips, and the vestibular surface of the gums (Fig. 1, 2).

Figure 1. Lichen planus, erosive-ulcerative form. Patient A., 52 years old.

Figure 2. Lichen planus, erosive-ulcerative form. Patient B., 46 years old.

On the mucous membrane of the transitional folds of the cheeks and the ventral surface of the tongue, against the background of bright hyperemia, sharply painful extensive erosions and ulcers were detected (Fig. 3)

Figure 3. Lichen planus, erosive-ulcerative form. Patient G., 68 years old.

Treatment method

The essence of the method lies in the combined use of steroid drugs - both as a general course (prednisolone) and locally (diprospan). A set of therapeutic measures was carried out in the oral cavity. In addition, after consultation with a neuropsychiatrist, patients were prescribed daily antidepressants: fluoxetine 20 mg, 1 capsule in the morning or Cipralex - 10 mg, 1 tablet in the morning.

The course of treatment with antidepressants depended on the duration of the disease, the severity of psycho-emotional changes and was 3-6 months.

Successful treatment of patients in our group without prescribing oral prednisolone is currently not possible. But our task was to use this drug in gentle doses.

This scheme was proposed earlier by Prof. A.L. Mashkelleyson:

1. Prednisolone 0.005 g

Regimen: 1st week - 4 tablets per day, every other day;

2nd week - 3 tablets per day, every other day;

3rd week - 2 tablets per day, every other day;

4th week - 1 tablet per day, every other day.

2. Delagil 0.25 g 1 tablet 2 times a day, daily, course 4 weeks.

3. Vitamin PP 0.05 g 1 time per day, after meals, course 4 weeks.

4. Vitamin A, oil solution, 8-10 drops on rye bread 2 times a day, course 4 weeks.

Local treatment

We attached significant importance to this stage of treatment. Traumatic factors were eliminated, hygiene correction, professional hygiene, and replacement of prostheses made of dissimilar metals were carried out. Candidiasis was excluded. Antiseptic treatment of erosions and ulcers was carried out, followed by rubbing in prednisolone ointment, and after 10 minutes - Cholisal or Kamistad gel.

With preliminary premedication (sedatives, antihistamines), diprospan 1 dose and 4 ml of a 2% lidocaine solution (without a vasoconstrictor) were administered under elements of damage to the oral mucosa (foci of exudation and hyperemia, erosion, ulcers) with an insulin needle.

If necessary, the injection of diprospan was repeated after 4-6 weeks.

Characteristics of drugs

1. Cipralex, fluoxetine

Daytime antidepressants. Eliminate depressive reactions of various origins, panic disorders, anxiety, phobias. Helps improve mood.

The therapeutic effect develops after 3-4 weeks of continuous use. Does not cause sedation.

Fluoxetine

20 mg, 1 capsule in the morning, regardless of meals. Then the dose is gradually increased to 2 capsules - taken twice in the morning. The course of treatment is 3-6 months.

Cipralex

- 10 mg, 1 tablet in the morning.

2. Diprospan

Diprospan* is a glucocorticosteroid drug. International (nonproprietary) name: betamethasone*.

, Belgium.

Dosage form: suspension for injection. 1 ml of diprospan suspension contains 6.43 mg of betamethasone dipropionate and 2.63 mg of betamethasone sodium phosphate. The combined composition of the drug has significant advantages when used in clinical settings. One of the components of the drug (betamethasone sodium phosphate) is highly soluble and easily absorbed from the injection site, which provides an anti-inflammatory and analgesic effect within 1-3 hours. The other component of the drug (betamethasone dipropionate) is poorly soluble and is slowly absorbed from the depot formed at the injection site. The latter ensures a prolonged (up to 4-6 weeks) effect of the drug after administration.

Diprospan has high glucocorticosteroid activity, but unlike its predecessors (hydrocortisone, prednisolone, kenalog) it has a number of advantages:

- slight mineralocorticosteroid effect, rapid and at the same time prolonged powerful anti-inflammatory and analgesic effect;

— does not cause local fine-crystalline reactions;

- does not have a local degenerative effect on tissue;

- prescribed both once and repeatedly (if indicated).

3. Prednisolone

- a synthetic analogue of the steroid hormone of the adrenal cortex hydrocortisone. Glucocorticosteroids have anti-inflammatory, desensitizing, antiallergic, antishock and antitoxic effects.

Prescribed for neurodermatitis, dermatoses, eczema, allergic shock, etc. When treating the erosive-ulcerative form of lichen planus, it is used in combination with delagil. Prescribed with 2.5 mg and gradually reduce the dose until the drug is completely stopped.

Release form: tablets containing 0.001 g and 0.005 g of prednisolone.

4. Hingamin (delagil)

- antimalarial drug. Chingamine quickly causes the death of asexual erythrocyte forms of all types of plasmodium. The spectrum of action of hingamine is not limited to the effect on malarial plasmodium. It has an inhibitory effect on the synthesis of nucleic acids, the activity of certain enzymes, and immune processes. As a result, the drug has found wide use in the treatment of collagenosis (systemic lupus erythematosus, scleroderma, rheumatoid arthritis) and dermatoses (lichen planus). The drug is well and quickly absorbed and slowly released from the body.

Release form: tablets of 0.25 g; powder; ampoules of 5 ml of 5% solution.

In the treatment of erosive-ulcerative forms of lichen planus, it is used in combination with steroid drugs, 0.25 g 2 times a day for 1 month.

5. Nicotinic acid (vitamin PP, vitamin B3)

- belongs to the B vitamins. Nicotinic acid plays a significant role in the life of the body. It is a prosthetic group of codehydrase enzymes I and II, which act as hydrogen carriers and take part in redox processes.

Nicotinic acid is prescribed to normalize redox processes in the body and dilate blood vessels. For these purposes, vitamin PP is prescribed in the treatment of lichen planus.

Release form: powder and tablets of 0.05 g and ampoules containing 1 ml of 0.17% sodium nicotinate solution, which corresponds to 0.1% nicotinic acid. When treating lichen planus, vitamin PP is prescribed 0.05 g 1-2 times a day after meals for 1 month. Also injections of vitamin PP solution under the affected elements.

When using nicotinic acid orally on an empty stomach, redness of the face and upper half of the body, and dizziness may occur. Persons with hypersensitivity to nicotinic acid should be prescribed nicotinamide.

6. Retinol (vitamin A)

normalizes metabolic processes in the epithelium, the function of cell membranes, stimulates the regeneration of epithelial cells.

Vitamin A is found in animal products (butter, egg yolk, liver).

The daily requirement for vitamin A is 1.5 mg, or 5000 IU, for an adult.

When treating lichen planus, 8-10 drops of an oil solution of vitamin A are prescribed orally 2-3 times a day for a course of 1.5 months; locally in the form of applications of an oil solution of vitamin A to the affected areas 2-3 times a day for 15 minutes for a course of 1.5 months.

7. Oral gels Cholisal, Kamistad

Anti-inflammatory, analgesic effect.

Treatment results and discussion

After completion of the course of treatment, the patients had no complaints. When examining the oral mucosa, the disappearance of foci of exudation, hyperemia, complete epithelization of erosions, ulcers, and a significant decrease in lichenoid rashes were noted (Fig. 4).

Figure 4. Lichen planus, erosive-ulcerative form. Patient B., 46 years old. After treatment.

In 2 patients, due to stress, an exacerbation occurred 1-1.5 months after treatment (exudation, hyperemia and single small erosions appeared on the mucous membrane of the cheeks). These patients received a repeated course of general and local treatment.

When examining a group of patients 6 months after completion of the course of treatment, there were no complaints. Single papules were detected on the unchanged oral mucosa. The psycho-emotional state of the patients improved noticeably.

The treatment method we offer avoids hospitalization, which is a significant advantage. In addition, the effectiveness of local administration of diprospan makes it possible to prescribe gentle doses of prednisolone and reduce the risk of complications.

With local administration of diprospan with lidocaine, pain symptoms are quickly eliminated, which, in combination with the effect of daytime antidepressants, leads to a noticeable improvement in the psycho-emotional state of patients.

Thus, the effectiveness of treatment of the erosive-ulcerative form of lichen planus with total damage to all parts of the oral mucosa increases significantly due to the combined use of steroid drugs, as well as local therapeutic measures in the oral cavity. Our experience confirms the real possibility of treating patients with this disease in a clinic setting.

Diagnostics

Correct diagnosis is the key to a quick recovery. If you feel the taste of pus in your mouth, or find redness or white formations on the mucous membrane, you should contact your dentist. Based on a visual examination of the oral cavity, the patient’s complaints and determining the causes, the doctor will prescribe the correct medications. If the infection is bacterial, then additional clinical tests may be needed.

Self-medication can lead to dangerous side effects, and mechanical removal of crusts or white plaque from erosions without special solutions can contribute not only to the appearance of new ones, but also to the addition of unwanted infections. Complications may also appear: pus in the aphthae, transition to a chronic form, scar formation.