Ukrainian Medical Dental Academy

Chair of therapeutic dentistry

Etiology, pathogenesis, clinic, diagnostic , treatment

and prophylaxis of autoinfectional stomatitis

Ph.D., Olga Bojchenko

Lecture plan and organizational structure.

Preparatory stage. Determining the relevance of the topic, learning objectives of the lecture and motivation

The main stage

Lecture teaching

material according to the plan:

1. The contribution of the staff of the Department of Therapeutic Dentistry in the study

of the topic in the historical aspect.

2. Classification, substantiation of the topic.

3. The concept of autoinfectious stomatitis, risk factors, periods.

4. Acute catarrhal stomatitis. Etiology, pathogenesis, clinic, diagnosis, treatment.

5. Acute aphthous stomatitis. Etiology, pathogenesis, clinic, diagnosis, treatment.

6. Acute herpetic stomatitis. Etiology, pathogenesis, clinic, diagnosis, treatment. Stress

herpes.

Lecture plan and organizational structure.

6. Acute herpetic stomatitis. Etiology, pathogenesis, clinic, diagnosis, treatment. Stress herpes.

7. Ulcerative necrotic stomatitis. Etiology, pathogenesis, clinic, diagnosis, treatment.

8. Candidiasis SOPR. Etiology, pathogenesis, classification, clinic, diagnosis, treatment.

9. Prevention of autoinfectious stomatitis.

The final stage

1. Summary of the lecture, general

conclusions.

2. Answers to possible

questions.

3. Tasks for self-preparation of students.

Autoinfection stomatitis: inflammatory diseases of oral mucosa, appears due to the action of

conditionally-pathogenic microflora, presenting in oral

cavity (streptococci, staphylococci, fuso-spirochete

symbiosis, viruses, fungee) at decreasing of reactivity of

oral mucosa and organism at all.

Classification of diseases of oral mucosa (P.T. Maksimenko, 1998)

Primary Second (Symptomatic)

Traumatic At hetero infections

Physical trauma Mechanic, thermal, ray ,

electric Bacterial

Scarlatina, diphthery, typhoid,

whooping-cough, gonorrhoea,

tuberculosis, syphilis, lepra

Autoinfection At uninfections diseases

Bacterial

Acute aphtosis stomatitis,

ulcer-necrotic stomatitis

(gingivitis)

Digestive system

Gastritis, colitis, ulcerous

disease, gastroduodenalis,

hepatitis

Viral

Acute herpetic stomatitis,

cheilitis; herpetic

stomatitis, cheilitis

Blood and blood

producing organs

Anemia, leucosis,

agranulocytosis haemorragy

diathesis, (Verlhoff disease),

polycetemy (Vacez disease)

Classification of diseases of oral mucosa (P.T. Maksimenko, 1998)

Primary Second (Symptomatic)

Autoinfections At uninfections diseases

Micotic (fangess)

Candidosis stomatitis,

cheilitis, glossitis,

aktinomicosis of MMOC Cardio-vascular System

Trophic ulcer , cystic

syndrome and others.

Pin allergic (stomatitis, cheilitis, glossitis)

Radiation disease

Endocrine System

Saccharine diabetes

Nervous System Glossodiny, xerostomy

Skins Pemphigus, red flat lichen,

red волчанка

Hypo- and avitaminosis

Groups В, С, А, Е, РР, D

Primary stomatitis – its group of the diseases when the etiological

factor operate to the oral mucosa.

Its factors may be: traumatic (mechanic, thermal,

ray, electric), bacterial, virus, fungees.

Acute Herpetic Stomatitis

Herpetic infection — one of the most spread and

uncontrolled viral human infection.

This virus affects internal organs, nervous

system, skin and mucous membranes.

Herpetic infection of the peoples

very height – 100%. Mostly ill women,

in spring and autumn.

Acute Herpetic Stomatitis

Herpes Simplex Virus after penetration in organism

through the oral and nasal mucosa in childhood, stay to

persist in organism in latent form, without clinical

signs.

Under the inductors (decreasing of immune reactivity)

virus can lead to the active form and provoke the injury

of oral mucosa.

Transmission path

Herpes Simplex Virus

Air-tiny (through mouth, nose)

Vertical or

transplacentary

Sexual Parenteral

(surgical manipulation, injections)

Contact-home (through infected

objects)

General factors, that induce the

autoinfection stomatitis

overcooling

stresses

General factors, that induce the

autoinfection stomatitis

trauma

operative interventions

bad feeding

General factors, that induce the

autoinfection stomatitis

avitaminosis

smoking

abuse of alcohol

overstrain

Local factors, that induce the

autoinfection stomatitis

bad hygiene of oral cavity

injury of oral mucosa

Local factors, that induce the autoinfection

stomatitis presence of inflammatory process in periodontal

tissues

sharp edges of destroyed

teeth

Local factors, that induce the autoinfection

stomatitis

deeply fixed artificial

crowns

complicated eruption of

wisdom tooth, especially

at the lower jaw

Clinical current

Complaints:

general fatigue,

pain of head,

increasing of body temperature until 37-40°C .

also in a 24-48 hours appears pain in oral

cavity, increased while speaking and feeding.

Primary morphological element - vesicle.

Vesicles placed in groups, filled with

transparent liquid, becoming turbid soon.

Secondary morphological element - erosion.

After 2-3 days they burst, with appearing of big erosions of deep red color, with a non-straight borders, covered with

plaque. Salivation increases, it become viscous.

Clinical current

Local status

Location of lesions - lips, tongue of oral

cavity.

After primary herpetic

infection virus stays in human

organism for all life, and

disease transfers into latent

phase of long virus-holding,

that usually lead to recidives.

In case of recidives

rush located at: border oral

mucosa-skin (red lip border,

near skin, nasal skin, naso-

labial fold, eyes, sexual organs,

hand skin).

Chronic recurrent herpes.

Groups of vesicles at the

hyperemic red lip border

General treatment

Anti-viral therapy at severe cases (acyclovir, bonaphton, etc.);

Desensibilizing therapy (tavegil, phenkarol, calcium gluconate, etc.);

Anti-inflammatory (aspirin, diclofenak, amizon, etc.);

Strengthening therapy (ascorbic acid, polyvitamins, high-calorie diet, non-irritant diet with big amount of liquid);

Immune-modulating therapy (cycloferon, decaris, imunal, interferon, etc.).

Prophylaxis

Isolate the patient;

Using of anti-viral medicines;

Sanation of oral cavity, liquidation of

chronic hearth of infection.

Acute aphtous stomatitis

Auto-infection diseases, that appears under the action of strepto-staphylococci microflora in oral cavity.

In the development of the disease sensibilization to the strepto-stafilococci microflora plays a big role (by prof. Maksimenko P.T.) and trauma of oral mucosa (by ac. Anischenko R.I.), as a result – develops immune response of prolonged type (Artus phenomena) with the appearance of aphtas.

Clinical current

Disease starts from general fatigue, increasing of body temperature until 39-40С, headache, pain in the throat.

In period of disease development at the base of acute hyperemia appear multiple elements of lesion – aphtas, that have oval shape, covered with fibrin plaque and surrounded with hyperemia and located at the mucosal membrane of lips, frontal third of the back and sides of tongue, buccal mucosa, hard and soft palate. In the case of confluence of aphtas appear big erosions. Aphtas are very painful.

In some cases (14-25%) appear pustule (micro abscess) rush at the skin.

Pathological morphological element - aphta.

Defect of round or oval form, by a diameter

0,3-0,5 mm, located on the inflamed oral mucosa.

Laboratory diagnostics

In cytogram:

- strepto-staphylococci,

- fibrin fibers, destructed epithelium and leucocytes.

In blood test:

- leucocytosis,

- increased Sedimentation Rate.

In immunogram:

- increasing level of anti-streptococci anti-bodies,

appearing of plasma cells.

Treatment

Treatment of acute aphtous stomatitis

performed under the same scheme, as for

the therapy of acute herpetic stomatitis

with the using more anti-bacterial

medicines (antibiotics, sulfanilamides).

Assistant Anischenko R.I. elaborated new

treatment method of acute aphtous stomatitis of

medium and hard level of severity with using of

anti-bacterial medicine “Chlorophillipt” with

enzymes (trypsin, chemotrypsin, chemopsin),

that allow to increase effectiveness of local

treatment.

Ulcerative-Necrotic Stomatitis

Ulcerative-Necrotic Stomatitis of Vensan

(synonym: fuso-spirochete stomatitis, stomatitis of

Vensan) — alterative-inflammative disease of oral

mucosa, that appears at the ground of decreased

organism activity at presence of unpleasant

conditions in oral cavity, develop as a hyperergic

reaction as a response on sensibilization of oral

tissues to fusobacterias and spirochetes,

characterized by necrosis and ulceration.

Disease appears under the action of fuso-

spirochete infection — symbiosis of spirochetes of

Vensan and fusobacterias.

In normal conditions fuso-spirochete symbiosis is

the saprophyte of oral cavity and located:

In interdental spaces;

In periodontal pockets;

In carious cavities;

In the root canals;

In the tonsils.

Clinical current

Disease characterized by the signs of general intoxication. Face skin covers are pale,

covered with dew. Red lip border is dry, sometimes with the rests of clotting blood.

Patients scared about touching with the injured tongue to the teeth or injured gums. Rotten smell feels from oral cavity at the

distance. Hypersalivation signed. Regionary lymphatic nodes are swelled, painful,

mobility.

At oral mucosa appear

ulcers, covered by necrotic

masses, that can be removed

easily. After that you can find

bleeding bottom.

Ulcer borders are non-

straight, not so dense. Ulcer

can reach 2-4 cm in diameter.

Near the main ulcer, little

ulcers can appear.

Surrounding tissues are

swelled and hyperemic.

Acute ulcerative-

necrotic stomatitis

Treatment (hydratation phase)

Anesthesia (anesthesine, lidocaine – applications, mouth washes, aerosols).

Antiseptic medicines (hydrogenium peroxide, potassium permanganate, chlorhexidine).

Proteolysic (chemotrypsine, trypsine, terylitine).

Mechanical removing of necrotic tissues

(by excavator).

Anti-bacterial medicines, that fights anaerobic bacteria: metronidazole, meratin, penicillin-gramicidine mix (by prof. Maximenko P.T.).

Treatment (dehydratation phase)

Reparative processes stimulators and keratoplastic medicines (solcoseryl, levomikol, methyluracyl, olasole, panthenol, sea-buckthorn oil, wild-rose oil, aecol).

Oral cavity sanation.

Physiotherapeutic treatment (SUVI (short ultra-violet irradiation), laser-therapy).

General treatment

Anti-bacterial, anti-inflammatory,

hyposensibilizing, vitamin medicines and

detoxication therapy.

Prognosis of Vensan stomatitis is favourable,

however in some cases, without rational

therapy disease can prolong and continue for a

few months.

PROPHYLAXIS

Oral hygiene,

Regular sanation of oral cavity,

Full and in-time treatment of infections and

another diseases, that lead to the immune

depression.

Candidiasis of oral mucosa

Problem of fungee diseases still actual.

Each 4 human suffers from mycotic lesions.

All types of candidiasis in 44% have manifestation in oral

cavity. In normal conditions in oral cavity

can be found fungee.

Dysbiosis (disbacteriosis):

pathological status the organism which is

characterized by change of quantity and

quality composition of normal micriflora,

such as: increase quantity conditionally-

pathogenic micriflora and reduce probiotic

micriflora.

Adhesion with the subsequent colonization, occurs due to the fibrous-grainy layer of the wall of fungee.

Invasion of fungee Candida in epithelium due to the large amount of proteolysis enzymes, especially phospholipase, which damages the cell membrane.

Reproduction of fungee Candida, with increased proliferation of cells basal layer and the parakeratosis.

А. Probiotic microorganisms (98-99%)

1. Lactobacterias

2. Bifidobacterias

3. Neiserii

Б. Conditionally-measured microorganisms (1-2%)

1. Staphylococci

2. Streptococci

3. Fusobacterias

4. Fungee Candida

Classification of mycotic disease of oral mucosa (Marchenko О.I., Rudenko М.М., 1978).

By current:

acute;

chronic.

By clinical-morphological characteristics:

pseudomembranous;

erosive;

infiltrative;

deskvamative;

erythematous;

hypertrophic.

By localization:

stomatitis;

glossitis;

palatinit;

cheilitis.

Complains: burning in the mouth (especially during the

eating hard, spicy and salty food, dry in the mouth.

Objective:

Hyperemia, swelling of oral

mucosa tongue, cheeks, palate and

lips.

Soft plaque white or yellow in

color at the back of the tongue.

Plaque remind of “milk” and very

difficult removed of spatula.

Acute pseudomembranous candidiasis

Meets in children (especially newborns) with system diseases.

Adult people with heavy pathology, such as: diabetes militants,

diseases of blood, cancer, AIDS, irrational antibiotictherapy.

Complains: pain, burning in the mouth (especially during

the eating hard, spicy and salty food, very dry in the mouth.

Objective:

Oral mucosa of the tongue,

cheeks, palate and lips deep red

color - “fair”, dry.

Plaque is absent.

If the process localization on the

tongue, doctor see little plague in

the furrows and atrophy of filiform

papillas.

Acute atrophic candidiasis

Meets in people with hypersensitivity of oral mucosa

to fungee of sort of Candida.

Complains: dry in the mouth, pain, burning in the mouth

(especially during the eating hard, spicy and salty food, very.

Chronic hyperplastic candidiasis Meets in adult people with heavy pathology, such as:

diseases of blood, AIDS, tuberculosis, after antibiotictherapy,

cytostatics.

Objective:

Regional lymphatic knots are

painful, dense, mobile.

Oral mucosa of the tongue, soft

palate and angle of mouth have

hyperemia.

Presence plaque white, grey,

yellow and even brown color. It’s

very difficult exfoliate of spatula.

After exfoliate plaque, oral mucosa

have red color and bleeding.

Complains: pain, burning in the mouth (especially during

the eating hard, spicy and salty food), dry in the mouth.

Objective:

Oral mucosa of the tongue, palate

and angle of mouth have red

colour, dry.

Plaque at the back tongue is absent

or very little quantity in the

furrows.

Tongue have color of

“strawberry”, dry.

Atrophy of filiform papillas.

Chronic atrophic candidiasis

Meets in old people with removable plate prosthesis.

The principles of the choice

of anti-fungees treatment

Sort of the fungee Candida and present other

bacterial

Sensitivity to the anti-fungee drugs

Clinical status of the patient

The duration of diseases

LOCAL TREATMENT OF THE

CANDIDIASIS OF ORAL

MUCOSA

Professional hygiene of oral cavity.

Oral cavity sanation.

Antiseptics (etonium solution, chlorhexidine solution,

“Givaleks” (geksedin, salicylate choline, hlobutanol),

“Stomatidin” (geksedin).

Anti-fungees: apply ointments (miramistin,

miconazole and other).

Boost protective properties of oral mucosa (baths

with artificial lyzocime, tablets imudon

and lysobact.

Diet (protein-vegetable, fermented milk, decrease

carbohydrates).

General anti-fungees: “Fluconazole ”(“Diflucan”), “Orungal”

(“Intrakonazol”), “Mikomaks”, “Fucys”, “Funit”, “Pimafucin”.

It must be remembered to doctor that high effective drugs cannot

be by the monotherapy. Anti-fungees drugs change every 2-3

daysи.

GENERAL TREATMENT OF THE

CANDIDIASIS OF ORAL MUCOSA

Desensibibization therapy: tavegil, phenkarol,

diazolin, claritin.

Vitamin therapy: duovit, alfavit.

Treatment digestive diseases, diabetes militants,

hormonal diseases, correction of immunity.

Medication bacterial drugs (biotherapy) for the

correction dysbiosis of the oral cavity and gastro-

intestinal tract.

GENERAL TREATMENT OF THE

CANDIDIASIS OF ORAL MUCOSA

Інулін

Sinbiotics (“Bifìform”,

“Baktulìn”)

Bifidobacterias+

Lactobacterias

Training

hygiene of

oral cavity

Tooth paste

with soda –

bicarbonates,

vegetable

supplements

Care for the

removable

plate

prosthesis

Waiver of the irrational antibiotictherapy;

Preventative appointment eubiotics in parallel or after

antibiotictherapy during one month;

Compliance of the sanitary and hygienic events in the maternity

homes. Training of young mothers of hygiene;

The patients with chronic somatic diseases,

must pass courses of the bacterial medicines.