A sore on the tongue: names, how to treat, photos

Stomatitis: features of the disease

Stomatitis is a disease related to dental pathologies in which inflammation of the oral mucosa occurs. Infection of the tongue with stomatitis in adults is also called “glossitis.”

The inflammatory process affects the mucous membrane and causes severe symptoms:

• redness and swelling of the tongue;
• formation of white plaque;
• severe pain;
• the formation of many small blisters and ulcers.

Due to severe sensitivity and soreness of the tongue, the patient cannot eat food, fever, insomnia and irritability are possible.

Stomatitis under the tongue in adults, as in other parts of the oral cavity, is classified into two types.

1. Aphthous. A form of inflammation in which the tongue becomes covered with papules and ulcers that turn into erosions (aphthae).
2. Herpetic. The inflammatory process is manifested by swelling and redness of the tongue. Small bubbles are localized in groups.

Prosthetic stomatitis and ulcerative-necrotic form of pathology are extremely rare.

Without treatment, the signs of stomatitis completely disappear, but this does not mean that the patient is cured of the pathology. The inflammatory process becomes chronic and when the immune system is weakened or exposed to an irritant, a relapse occurs.

Inflammatory diseases

Abscess and phlegmon of the tongue develop after biting, the introduction of fish bones and other foreign bodies into the thickness of the tongue, usually in domestic conditions. For these processes, characteristic signs are: pain in the tongue, severe swelling, speech impairment, difficulty eating, increased salivation, general malaise and pain in the injured area. Cellulitis is usually localized at the root of the tongue.

Treatment requires intramuscular administration of antibiotics, mouth rinses and mandatory opening of the abscess, which is carried out on an outpatient basis in consultation with a surgeon. The incision is made towards the mental triangle. Deep abscesses and phlegmon of the tongue root (the presence of swelling in the mental triangle with the greatest pain near the hyoid bone) should be opened with an external straight incision in the midline.

Stomatitis - acute and chronic inflammation of the mucous surface of the oral cavity and tongue are common, but they are not surgical diseases. In most cases, dentists treat them.

Causes of stomatitis

Stomatitis under the tongue in adults is a reaction of the immune system to certain types of irritants, which are any substances. The causes of stomatitis have not been clearly identified; presumably, the body exhibits an individual reaction to certain substances or microorganisms.

Possible causes of stomatitis on the tongue in adults:

• bacteria and infections of the oral cavity (caries, gingivitis, periodontitis, etc.);
• diseases of the gastrointestinal tract of an infectious or viral type;
• respiratory diseases (ARVI, influenza, etc.);
• frequent injury to the tongue by orthopedic or orthodontic structures;
• damage to the tongue due to a chipped tooth;
• fungal infection;
• bad habits (smoking or alcoholism);
• burning the tongue or eating “spicy” foods.

In addition to the listed causes of stomatitis on the tongue in adults, inflammation of the mucous membrane can be caused by the herpes virus (herpetic stomatitis).

Treatment Basics

If an adult has a swollen tongue, the surface is covered with plaque, or has severe hypothermia, you should consult a dentist. Even in the absence of neoplasms in the oral cavity in the form of papules, ulcers or erosions, a specialist will be able to determine the development of the inflammatory process. With timely treatment, the risk of pathology becoming chronic is minimal.

Treatment of stomatitis on the tongue in adults is carried out exclusively conservatively. Depending on the causes of the disease and the clinical picture, the doctor will determine a treatment regimen and prescribe effective drugs of systemic and local action.

The dentist’s task is not only to eliminate symptoms and inflammation, but also to identify the cause. If the provoking factor has a constant impact, then stomatitis under the tongue will constantly recur.

Treatment of stomatitis on the tongue in adults begins with the relief of concomitant diseases - the root causes.

Injuries to the tongue and mouth

Damage to the tongue and mucous surface of the oral cavity, requiring large-scale surgical intervention, is observed in the following cases:

• With penetrating gunshot wounds into the oral cavity. Characteristic features of tongue damage in this case are severe bleeding, the development of swelling and the presence of many small bone fragments.
• Injuries resulting from car accidents.
• Serious bodily harm as a result of a fight.

When surgically treating wounds, it is mandatory for the doctor to fulfill three conditions:

• if possible, do not leave foreign bodies even of a small size;
• to prevent fusion of the tissues of the floor of the oral cavity and tongue if they are simultaneously damaged;
• maintain the correct contours of the tongue by carefully matching the edges of the wound, the local plate and suturing in the longitudinal direction for defects of the lateral section.

How is the treatment carried out?

Treatment for stomatitis is comprehensive.

1. Anesthesia. To eliminate pain, the dentist may prescribe topical medications containing lidocaine or analgesics.
2. Antiviral therapy. If the disease is caused by a herpes virus, the doctor prescribes antiviral drugs of the appropriate group of effects.
3. Antibacterial therapy. In case of bacterial stomatitis, local treatment of the oral cavity with antiseptic solutions and dental ointments with antibacterial action is mandatory.
4. Antifungal therapy. Stomatitis can be the result of fungal activity in the mouth. This form is more common in children, but is not excluded in adults. The specialist prescribes the patient a strict regimen of antifungal drugs.
5. Anti-inflammatory therapy. It is carried out in cases of severe inflammation. The dentist recommends taking anti-inflammatory systemic drugs that have a targeted effect depending on the pathogen or cause of tongue stomatitis.
6. Diet. Patients with stomatitis are prescribed a diet that excludes foods that can aggravate irritation of the mucous membrane and tongue. So dentists recommend avoiding hot, spicy, sour and salty foods. Smoking and drinking alcohol should be avoided.

Together with the treatment of stomatitis, treatment of diseases of the respiratory system, gastrointestinal tract, inflammation of the gums, caries, etc. can be carried out.

Local treatment of erosive and ulcerative lesions of the oral mucosa

S. I. Tokmakova Doctor of Medicine, Professor, Head of the Department of Therapeutic Dentistry, Altai State Medical University (Barnaul)

T. N. Ulko Ph.D., Associate Professor, Department of Therapeutic Dentistry, Altai State Medical University (Barnaul)

O. V. Bondarenko Ph.D., Associate Professor, Department of Therapeutic Dentistry, Altai State Medical University (Barnaul)

O. V. Sysoeva Candidate of Medical Sciences, Associate Professor of the Department of Therapeutic Dentistry, Altai State Medical University (Barnaul)

Among the pathological processes localized on the oral mucosa (OM) and the red border of the lips, erosive and ulcerative lesions in leukoplakia and lichen planus (LP) occupy a special place. This is due to the fact that when treating them, a practitioner often has to deal with difficulties associated with the presence in patients of a long, persistent course of these diseases with frequent relapses [1, 3, 6, 7].

Complex treatment of this pathology includes measures aimed at reducing pain, relieving inflammation and accelerating regeneration processes after the maximum possible elimination of causative factors. However, the possibility of using medication and physiotherapeutic treatment in these patients is often limited due to the presence of concomitant general somatic diseases.

The relevance of the problem is also determined by the fact that this type of lesion has a significant prevalence (in the population of Barnaul in various age groups it ranges from 2 to 28% of cases) and is classified as an optional precancer with a high incidence of malignancy [1, 3—6]. This requires oncological alertness of the doctor and increased efficiency and timeliness of treatment. The experience of using a complex ointment developed at the Moscow State Medical University (2005) for the treatment of chronic lip diseases is interesting [2].

Purpose of the study

To evaluate the clinical effectiveness of using a complex ointment in the complex treatment of erosive and ulcerative lesions of the oral mucosa with leukoplakia and lichen planus.

Material and methods

Clinical studies were carried out from 2008 to 2011 at the Department of Therapeutic Dentistry of ASMU. Under observation were 35 patients diagnosed with K.13.2 “leukoplakia” (20 people) and L.43 “lichen planus of the oral mucosa, erosive-ulcerative form” (15 people).

During the clinical examination of patients, the presence of past and concomitant diseases, bad habits, and occupational hazards was revealed during the interview process. In addition, attention was paid to allergic status and heredity. The duration of the disease, the nature of the complaints, as well as the time of onset of the first symptoms were determined. They found out whether treatment was carried out for this disease and what its effectiveness was.

Examination and palpation of the maxillofacial area included determination of color, integrity, skin turgor, condition of the skeletal and muscular system, and regional lymph nodes. When assessing the state of the oral mucosa, we paid attention to the architectonics, color, moisture, and the presence of pathological elements. The condition of periodontal tissues, teeth, the presence of dissimilar metals was determined, and traumatic factors were identified.

Dental examination of the oral mucosa was performed using a “Visioner 21A” light stomatoscope from Morita Corporation (Japan) at a magnification of 10 to 40 times. Signs of malignancy were excluded visually and by palpation; if necessary, the patient was referred to an oncologist to clarify the diagnosis.

The study of the medical history of the examined patients, the results of laboratory tests, and advisory opinions made it possible to establish the background diseases accompanying the erosive-ulcerative form of leukoplakia and PL. All patients had pathology of the gastrointestinal tract (100%) and nervous system (100%). Three patients suffered from diseases of the cardiovascular and endocrine systems (9%).

To assess the timing of pain disappearance, we used the pain index (PIB) according to the Hossli-Bergman scale. The assessment was made in points from 0 to 4 before and after treatment: no pain - 0 points, mild pain - 1 point, moderate pain - 2 points, severe pain - 3 points, unbearable pain - 4 points.

The treatment plan included sanitation of the oral cavity, professional hygiene, and elimination of traumatic factors. Patients were advised to give up bad habits: smoking, drinking alcohol, biting lips and cheeks.

After local elimination of traumatic factors, treatment of erosive and ulcerative lesions was carried out according to the following scheme:

1. Application anesthesia (gel “Kamistad”, “Cholisal”, “Lidochlor”, pyromecaine ointment 5%, etc.).
2. Applications of proteolytic enzymes (0.1% solution of trypsin or chymotrypsin).
3. Treatment with antiseptics (0.05% chlorhexidine solution, 1% iodinol solution, herbal decoctions, etc.).
4. Application of a complex ointment developed at Moscow State Medical University (2005).

Composition of complex ointment:

• Sol. Retinoli acetatis olesae - 1.0
• Sol. Tocopheroli olesae - 1.0
• Thiamini bromidi - 0.2
• Insulini acropidi - 3.0
• Ung. Celestodermi - 30.0
• Ung. Solcoseryli - 20.0
• Mf unguentum
• DS For applications to the oral mucosa.

The components included in the ointment had a complex effect on various parts of the pathogenesis of diseases. An oil solution of vitamin A, when applied topically, stimulates epithelization processes, and when taken orally, helps normalize the condition of the epithelium. A solution of tocopherol acetate is an antioxidant, promotes protein synthesis, cell proliferation and acceleration of reparative processes, and also improves neurotrophic processes. Vitamin B1 normalizes the functions of the nervous system and improves local trophism. Insulin, when applied topically, helps loosen membranes and prolongs the effect of other components of the ointment. Celistoderm has anti-inflammatory and antipruritic effects. Solcoseryl improves metabolic processes, accelerates tissue regeneration, especially with neurotrophic lesions, and also has an angioprotective effect.

results

When studying the clinical picture before treatment in patients in the oral cavity, erosions and ulcers measuring from 0.5 to 2.2 cm were determined against the background of edematous, hyperemic mucosa with papules merging into a mesh pattern (43% of cases), against the background of flat foci (31% of cases). ) or verrucous leukoplakia (26%). The most common location of erosive and ulcerative lesions was the mucous membrane of the cheeks and tongue, less often the gingival margin and floor of the mouth (Fig. 1).

Rice. 1. Erosion and ulcers of the tongue with leukoplakia (before treatment).

Skin rashes characteristic of LP were present in 3 patients (20%). Dental examination revealed alternating areas of hyperemia and hyperkeratosis with epithelial defects. The surface relief of the oral mucosa was smooth or finely lumpy, keratinization of varying degrees of severity, angioarchitecture in the form of specks, stripes and loop-shaped vessels.

After a course of treatment using applications of a complex ointment, initial epithelization was observed in all patients on the 2nd day. Patients noted a decrease in pain when eating and an improvement in their general condition. After 3 days, the pain completely disappeared (Fig. 2), and after 1.5 weeks, complete epithelization of the mucous membranes was observed (Fig. 3).

Rice. 2. Epithelization of erosions and ulcers of the tongue in leukoplakia (on the 4th day of treatment). Rice. 3. Condition of the tongue 1.5 weeks after treatment of leukoplakia.

Dentoscopically, a smooth relief was noted on the oral mucosa, there was no keratinization, and the vascular architecture was presented in the form of speckles and stripes.

To increase local immunity and prevent relapses, patients were prescribed the topical immunostimulating drug Imudon, 6-8 tablets per day sublingually for 20 days.

Long-term results of treatment of patients with erosive and ulcerative lesions were monitored for 5 years. Relapses were observed after six months in 7 patients due to dietary violations and exacerbation of general somatic diseases.

Based on the above, we can conclude that the complex ointment is an effective remedy in the complex treatment of erosive forms of PL and leukoplakia of the oral mucosa and is recommended for implementation in dental practice.

1. Borovsky E. V. Therapeutic dentistry / E. V. Borovsky. - M.: Medical Information Agency, 2006. - 800 p.
2. Brusenina N.D. Lip diseases: Textbook / N.D. Brusenina, E.A. Rybalkina. Ed. Barera G.M. - M.: Federal State Educational Institution "VUNMC" of Roszdrav, 2005. - 184 p., ill.
3. Bykova I. A. Cytological characteristics of prints of the oral mucosa using the cell differentiation index / Bykova I. A., Agadzhanyan A. A., Banchenko G. V. // Laboratory work. - 1987, No. 1. - P. 33-35.
4. Vasiltsova S.V. Dental morbidity and effectiveness of therapeutic and preventive care for the population of the city of Barnaul: abstract of thesis. dis. Ph.D. honey. science / S. V. Vasiltsova. - Novosibirsk, 2005. - 24 p.
5. Therapeutic dentistry: textbook: in 3 hours / Ed. G. M. Barera. - M.: GEOTAR-Media, 2005. - Part 3. - P. 195-211, 218-233.
6. Therapeutic dentistry: national guide / Ed. L. A. Dmitrieva, Yu. M. Maksimovsky. - M.: GEOTAR-Media, 2009. - 912 p.
7. Tokmakova S.I. Oral mucosa in elderly and senile people and its changes in visceral pathology // Dis. Dr. med. Sci. - Omsk, 2002. - 291 p.

General recommendations

For stomatitis in adults, treatment is carried out on an outpatient basis. The dentist can perform initial treatment of the oral cavity, then the patient will need to perform all the manipulations independently at home.

Antiseptic treatment of the entire oral cavity is a prerequisite for the successful treatment of stomatitis and the rapid recovery of the affected mucosa. For “disinfection”, solutions containing chlorhexidine, furatsilin or metronidazole are used. Dentists also recommend rinsing with a soda solution every 2-3 hours.

Locally in the affected areas, it is necessary to remove heavy plaque using gauze and apply anti-inflammatory and regenerating gels or ointments to the areas where ulcers accumulate. The procedure is unpleasant, but significantly speeds up recovery.

Treatment of stomatitis on the tongue in adults, subject to all prescriptions and recommendations of the dentist, takes no more than 10 days. Symptoms of the disease disappear after 3–5 days; a few more days are required to restore the affected tissues.