Symptoms, photos and treatment of Vincent's necrotizing stomatitis. Treatment of ulcerative necrotic stomatitis with drugs and folk remedies

Description:

Vincent's ulcerative-necrotizing gingivostomatitis is an inflammation of the gums and mucous membrane, characterized by a predominance of the alterative component, disruption of tissue integrity, necrosis and ulceration

Symptoms:

During the course of the disease, five periods are distinguished (incubation, prodromal, peak, decline and recovery).

After a short incubation period prodromal develops. Malaise appears and body temperature rises. On the gums (in the marginal part, gingival papillae) phenomena of catarrhal inflammation are observed. Patients feel itching and burning. Then it increases, body temperature rises to 39 °C. The gums are cyanotic, loosened, the apices of the gingival papillae are ulcerated. Necrotic lesions often spread to nearby areas of the buccal mucosa, hard palate, pharynx, tonsils, sometimes involving the entire mucous membrane of the oral cavity. The submandibular lymph nodes are enlarged and painful.

Causes:

Development pathological process caused by a decrease in the immunological status of the body, hypovitaminosis C and infection (fusospirillary symbiosis). The causative agents of the disease are anaerobic microflora (Vincent's spirochete, Spirocheta buccal is, fusobacteria and small treponema). They are found in carious cavities, periodontal pockets, crypts of the palatine tonsils and are saprophytic microflora. Vincent's ulcerative-necrotizing gingivostomatitis can be associated with influenza, sore throat, diseases of the upper respiratory tract, as well as blood diseases (leukemia), heavy metal poisoning, syphilis, tuberculosis, AIDS, tumors in the decay stage.

Faces hurt more often young. Epidemic outbreaks of necrotic ulcerative disease (“trench disease”) may occur.

Treatment:

For treatment the following is prescribed:

First aid for patients with Vincent ulcerative-necrotizing gingivostomatitis should be aimed at relieving pain and reducing intoxication. In order to influence anaerobic infection Metronidazole is prescribed orally - 0.25 g 3-4 times a day, tinidazole - 4 tablets of 0.5 g per dose. Desensitizing agents are indicated (diazolin - 0.1 g 2 times a day, diphenhydramine - 0.1 g 2 times a day), analgesics and a complex of vitamins.

Antiseptics and painkillers are used locally. Soft plaque is removed with a 3% solution of hydrogen peroxide, 0.1% solution of potassium permanganate, solutions of furatsilin (1:5000) and ethacridine lactate, 0.5% solution of ethanium, 0.2% solution of chlorhexidine. Necrotic areas of the mucous membrane are treated with proteolytic enzymes (trypsin, chymotrypsin, terrilitin) diluted in an isotonic sodium chloride solution, or emulsions containing enzymes, trichonol, as well as ointments (iruxol). In the reparative stage, vitamin and keratoplasty agents are used.

Most often, Vincent's stomatitis occurs in people with low level immunity, especially against the background chronic diseases. Necrotizing stomatitis is one of the varieties bacterial stomatitis with pronounced necrotizing ulcers affecting soft fabrics and the oral mucosa. Young people under thirty years of age are more susceptible to this disease, however, this does not mean that others age categories ulcerative necrotizing stomatitis does not manifest itself.

Isolated leakage of this disease occurs extremely rarely, since in most cases it is a complication of long-term illnesses gastrointestinal tract or a logical continuation of untreated catarrhal stomatitis. At the same time ulcerative form The disease is characterized by damage to the mucous membrane to the entire depth of its layer with possible education ulcers on the lips, inside cheeks, gums, soft and hard palate and tongue.

Reasons

The most important and obvious reason development of any form of stomatitis - poor oral care. In the absence of proper sanitation and timely treatment diseased teeth and gums, the risk of pathogenic Vincent spirochetes and spindle-shaped bacteria entering the resulting microcracks and damaging the mucosa increases. As a result of the symbiosis of these bacteria and their active reproduction, ulcers form in the mouth, and soft tissues undergo necrosis and decomposition.

Often the cause of the development of Vincent gingivostomatitis is complications of such serious diseases as agranulocytosis, infectious mononucleosis, leukemia, poisoning of the body by prolonged exposure to salts heavy metals, immunodeficiencies. In this case, favorable conditions for the development of ulcerative stomatitis are periodontal disease, gingivitis, periodontitis, dental trauma, untreated deep caries, tartar and even the eruption of wisdom teeth.

In addition, they contribute to the development inflammatory processes frequent smoking, drinking too hot drinks and food, stress and depression, favorable conditions work.

Symptoms

One of the most unpleasant signs ulcerative stomatitis in addition to severe pain- terrible breath odor resulting from rotting soft tissues. In some cases ulcerative stomatitis is not limited to the oral mucosa and spreads deep inside, affecting many vital organs. In this case, the following symptoms appear on the face:

• sudden increase in body temperature, chills, fever;
• loss of strength, apathy, aches in muscles and joints;
• gums swell, become loose and red;
• severe pain when eating, drinking liquids and when trying to speak, which is why the patient is often silent and sometimes completely refuses to eat;
• Enlargement and tenderness of the cervical and submandibular lymph nodes;
• migraine type headaches;
• increased salivation;
• an increase in leukocytes in the blood according to test results;
• the number of ulcers is constantly increasing, the older ones are covered with a gray film, when removed, a deep bleeding wound that does not heal for a long time is exposed;
• there is constant bleeding of the gums;
• V in rare cases If untreated, necrosis can affect not only soft tissues, but also alveolar ridge, as a result of which teeth can be seriously damaged and even fall out;
• if treatment is neglected, the pathogenic bacteria can spread to tonsils, the result of which in both adults and children can be Simanovsky-Vincent angina.

Treatment

Bacterial causes of this disease require treatment with antibiotics, anti-inflammatory and disinfectants. The most commonly prescribed medications are:

1. Rinse and treatment weak solution hydrogen peroxide, furatsilin or potassium permanganate;
2. Solutions of trypsin, pancreatin, chemotrypsin and other proteolytic enzymes to remove tissues susceptible to necrosis;
3. Trichopolum, Flagyl, Metrogyl, Dioxidin or Klion for a week;
4. General strengthening agents, immunomodulators, vitamin and mineral complexes to boost immunity;
5. Antibiotics: ampiox, gentamicin, lincomycin, penicillin, kanamycin;
6. Antihistamines to relieve possible adverse reactions from antibiotics;
7. Keratoplasty: metacil, solcoseryl, retinol acetate, aloe and kalanchoe juice, sea buckthorn oil.

How to treat ulcers on the tongue and soft tissues oral cavity, your attending physician will tell you in detail at your dental appointment. Proper treatment helps relieve the main symptoms within one to two days and heal the ulcers within a week.

Prevention

The main rule is to maintain oral hygiene! If you are vigilant about your gums and teeth, brush them at least twice a day medicinal pastes, and also regularly visit the dentist for medical examinations, removing plaque and tartar, the likelihood of you developing this disease is extremely low. And, of course, serious illnesses that lead to necrotizing stomatitis should not be left untreated. Eliminate the cause and complications will bypass you.

Vincent's ulcerative-necrotizing stomatitis is a pathology that develops as a result of infection of the oral cavity with fusiform rods.

The disease is accompanied acute course an inflammatory process that affects all mucous membranes, as well as the formation of necrotic tissue. Most often, ulcerative stomatitis with necrotic foci is detected in children against the background.

Characteristics of the disease

The pathological process develops against the background of infection of the oral cavity with spindle-shaped rods. These microorganisms are present in the body of almost all people. Pathogenic microflora is activated under the influence of certain factors.

Activation of pathogenic microflora leads to the formation of foci of inflammation in the oral mucosa. Depending on the course of the disease, it takes the following forms:

• acute;
• subacute;
• chronic.

Initially, a person develops an acute form of pathology, characterized by an intense clinical picture. Vincent's stomatitis develops under the influence of the following factors:

The above factors lead to a decrease in local and general immunity, which creates favorable conditions for the development of pathogenic microflora in the oral cavity.

Clinical picture

The main symptom of Vincent's stomatitis is ulcers that form on the surface of the mucous membrane. They can have a single or multiple distribution. Other symptoms of the pathology depend on the severity of the disease.

On initial stage (mild degree) stomatitis manifests itself as:

• pain syndrome, localized in the mouth;
• , aggravated by chewing food;
• active work of the salivary glands.

When palpating the gum tissue, painful sensations. Areas with hyperemia and edema form on their surface. In addition to pain, patients also experience a burning sensation in the gums, as well as drying of the mucous membrane.

The average severity of ulcerative stomatitis is characterized by the following symptoms:

On late stage(severe degree) the disease is accompanied by the appearance of:

• severe weakness;
• high temperature reaching 40 degrees;
• attacks of nausea and vomiting;
• pain in the abdominal area.

A characteristic sign of stomatitis is a gray-white coating that forms on the mucous membrane on the second or third day of the disease. In some cases, the inflammatory process penetrates deep into the tissue, affecting the bone structure.

Ulcerative stomatitis in children is accompanied by the following symptoms:

• increased tearfulness;
• sleep disturbance.

The clinical picture in the chronic form of the disease is characterized by the absence characteristic symptoms. The patient has bleeding gums and bad smell from the mouth.

Diagnosis and treatment

Diagnosis is based on an external examination of the oral cavity and collection of information about current state patient.

Additionally assigned histological examination fabrics. IN surface layer gums, a variety of bacteria such as cocci, fusobacteria, spirochetes and others are found. In deep tissues, dilated blood vessels and foci of inflammation.

Ulcerative-necrotizing stomatitis is one of the dangerous diseases, treatment of which takes place under the supervision of a dentist. Pathology therapy is carried out in a complex.

To suppress pain, the following are prescribed:

• Anestezin (the most common drug);
• lidocaine hydrochloride, which is used in extreme cases.

After suppression primary symptoms An operation is prescribed to remove necrotic tissue. The procedure is carried out in several stages:

1. Swabs soaked in a solution of proteolytic enzymes are applied to the affected area. These substances soften necrotic tissue.
2. Then the affected area is treated with antiseptic and antimicrobials. If there are appropriate indications, hydrogen peroxide is used to remove necrotic tissue. Treatment of the oral cavity is carried out under local anesthesia. It is important that during the procedure medicinal substances penetrated into the interdental space. For this, a syringe with a blunt needle is used.

The first results of treatment become noticeable approximately on the 2-3rd day of therapy. By this time, the gums stop bleeding and the necrotic tissue disappears. The epithelium begins to recover within 4-5 days.

Treatment of the disease is supplemented by the following procedures:

1. Reception antihistamines. They relieve swelling and suppress the inflammatory process.
2. Taking antibiotics wide range actions. These include Augmentin, Penicillin, Ampiox and others. Antibiotics are prescribed for extensive damage to the oral cavity and in advanced cases.
3. Reception vitamin complexes. They are necessary to strengthen immune defense and speeding up the recovery process.
4. Treatment .
5. Tooth extraction if appropriate indications exist.
6. The use of ointments and keratoplasty preparations to accelerate the healing of ulcerated tissues.

Treatment of ulcerative stomatitis in children is carried out according to the same scheme as that used in the treatment of the disease in adults.

During acute course pathology, bed rest is indicated.

Nutritional Features

Successful recovery during and after ulcerative necrotic stomatitis is impossible without following a specialized diet. During treatment from daily diet should be excluded:

• sour and spicy foods(especially citrus fruits);
• berries;
• products that cause an allergic reaction;
• pickled products;
• sweet, bitter;
• dry products.

From the above it follows that the patient’s diet during recovery should not contain foods that irritate the mucous membrane. The diet includes:

This diet allows for relatively short term replenish the lack of microelements and strengthen the immune system.

Possible consequences

If left untreated, necrotizing ulcerative stomatitis causes the following complications:

• pathologies of the genital tract;
• inflammation of the middle ear;
• rhinitis;
• endocarditis;
• pleurisy;
• gastroenteritis.

The long course of the disease contributes to the exposure of the roots and crown of the tooth.

Prevention measures

Prevention of the disease consists of observing the following rules:

• timely implementation;
• normalization;
• strengthening immune system, this is especially true during seasonal diseases;
• timely treatment of dental and other pathologies, elimination of microtraumas of the mucous membrane.

Vincent's ulcerative-necrotizing stomatitis is serious illness, which causes significant damage to the oral cavity.

The pathology develops against a background of weakened immune defense and requires timely treatment. Lack of therapy leads to nakedness bone structure, tooth loss and the occurrence of a number of other diseases.

Vincent's ulcerative necrotizing stomatitis(stomatitis ulceronecroticans Vincenti) is an infectious disease caused by the fusiform bacillus and the spirochete (Borrelia) Vincenti. In the world literature it is described under the following names: ulcerative stomatitis, ulcerative-necrotic stomatitis, ulcerative-membranous stomatitis, fusospirochetous stomatitis, “trench mouth”, Botkin-Simanovsky-Plaut-Vincent angina, etc.

When the gums are affected, the disease is defined as Vincent gingivitis, when the gums and other areas of the mucous membrane are simultaneously affected - stomatitis, and when the palatine tonsils are involved in the process - Vincent's angina.

What provokes / Causes of Vincent’s ulcerative-necrotic stomatitis:

The causative agents of Vincent's ulcerative-necrotizing gingivostomatitis belong to the resident flora of the oral cavity and are found in small quantities normally in all people with teeth, especially in the gingival groove. With poor care and an unsanitized oral cavity, especially with periodontitis, their number increases sharply.

Fusobacteria and Vincent's Borrelia are opportunistic microorganisms. A decisive role in the occurrence of the disease is usually played by a decrease in the body's resistance to infections. It occurs especially often during general cooling, due to general illness, overwork, stress, and malnutrition (for example, in wartime).

A predisposing factor is also a violation of the integrity of the mucous membrane, which creates conditions for invasion of microorganisms. This happens with injuries, often chronic, for example, with sharp edges of teeth, with difficulty in erupting third molars. Breakthrough of the epithelial barrier also occurs in periodontitis. Vincent's ulcerative necrotizing stomatitis occurs more often with careless hygiene care behind the oral cavity against the background of pre-existing inflammatory processes of the gums, with the deposition of supra- and subgingival stone, which prevents normal process desquamation of the epithelium, irritates the gums and, by closing the entrance to periodontal pockets, creates favorable conditions for the development of anaerobic infection.

Vincent's ulcerative necrotizing stomatitis can occur as a complication of viral infections (influenza, herpetic stomatitis), erosive allergic stomatitis, exudative erythema multiforme, some severe general diseases - leukemia, agranulocytosis, infectious mononucleosis, joins with poisoning with salts of heavy metals, scurvy. Cancerous ulcers and syphilides in the mouth are sometimes also complicated by fusospirochetosis.

Symptoms of Vincent's ulcerative necrotic stomatitis:

According to the nature of the flow diseases are divided into acute, subacute, chronic ulcerative necrotic stomatitis and relapse.

According to the severity of the flow- light, medium and heavy forms.

At the onset of the disease weakness appears headache, body temperature rises, joint aches. I am concerned about bleeding gums, a burning sensation and dryness of the mucous membrane. This period can last from several hours to several days, depending on the form of the disease.

As it progresses stomatitis intensifies general weakness, body temperature rises, headaches intensify, and ability to work decreases.

The pain in the oral cavity sharply increases from the slightest touch, the tongue is inactive during a conversation. Eating and brushing teeth become almost impossible. Salivation increases, strong putrid smell from the mouth. When the inflammatory process is localized in the area of ​​the wisdom tooth, limited mouth opening (trismus) occurs.

More often ulceration of the mucous membrane begins from the gums, from areas where local irritating factors: tartar, decayed teeth, dental crowns that injure the gums. Gradually, the ulceration spreads to adjacent areas of the mucous membrane.

For ulcerative necrotic stomatitis The gums are swollen, loosened, reddened, sharply painful, and bleed from a light touch. Initially, necrosis affects the tops of the interdental papillae, and then spreads to the entire gum. Over time, the gums become covered with necrotic masses of white-gray, gray-brown or gray color.

For light form Ulcerative necrotic stomatitis is characterized by a limited spread of the process. More often, only the tips of the interdental papillae in a certain group of teeth become necrotic. General health does not change significantly. Working capacity, as a rule, is not impaired.

At severe course Vincent's stomatitis body temperature rises to 38.5-40°C. Deteriorates sharply general health.
Ulcerations spread over a significant area of ​​the mucous membrane; the depth of the ulcer can reach muscle tissue, tendons, bones. With this course of the disease, osteomyelitis (bone melting) of the affected area of ​​the jaw bone develops.

When distributed An ulcerative-necrotic focus on the palate and tonsils, stomatitis is called Simanovsky-Plaut-Vincent angina.

Acute ulcerative necrotizing stomatitis with insufficient treatment it can recur and become chronic. This transition is more often observed against the background of chronic somatic pathology, as well as with an unsanitized oral cavity.

Mostly young people (17 - 30 years old), mostly men, are affected. The disease begins more often in autumn and spring, with a maximum of new cases occurring in October - December.

Pain in the mouth appears, especially when eating, bleeding gums, increased salivation, putrid breath, general weakness. The patient is usually pale due to severe intoxication. Regional lymph nodes are enlarged, hardened and painful on palpation, but remain mobile.

The process, as a rule, begins on the gum and manifests itself in the form of foci of necrosis of the gingival margin and gingival papillae. Then necrosis can spread to other areas of the mucous membrane. The area most often and most severely affected is the lower third molars, where necrosis quickly spreads to the buccal mucosa and retromolar region, often causing trismus and pain when swallowing. In some cases, inflammation leads to severe facial asymmetry due to swelling of surrounding tissues. In more severe cases, necrotic lesions occur on the lateral surfaces and back of the tongue, on the hard and soft palate. They have soft jagged edges, a thick, foul-smelling necrotic plaque of a grayish-green color, after removal of which a loose, heavily bleeding bottom is visible. The surrounding tissues are swollen and sharply hyperemic. There is no compaction at the base or around the ulcers.

On the hard palate, the process quickly leads to necrosis of all layers of the mucous membrane and exposure of the bone. Isolated lesions of the pharynx (Vincent's angina), as a rule, are unilateral and are rare in dental practice.

The general condition of the patient during an acute process, as a rule, worsens: the body temperature in the first 2 - 3 days rises to 37.5 - 38 ° C, but may remain normal, headache is a concern. Bad dream, difficulty eating, intoxication weaken the patient. There is a tendency to faint. There may be no pronounced changes in the hemogram, but slight leukocytosis, a shift of the formula to the left, moderate increase in ESR; in severe cases - toxigenic granularity of neutrophils.

Chronic form This disease usually develops with careless treatment or its absence, but it can also occur primarily, without a previous acute process.

Diagnosis of Vincent's ulcerative necrotic stomatitis:

Diagnosis Vincent's sore throat is diagnosed on the basis clinical picture and detection of fusospirillary symbiosis.

Examination of biopsy samples from the edges of ulcers reveals two zones: superficial - necrotic and deep - inflammatory. In the superficial layers of necrosis, the flora is abundant and diverse (cocci, rods, fusobacteria, spirochetes, etc.); in the deeper layer adjacent to living tissues, fusospirochetes predominate. The underlying tissues are in a state acute inflammation. Only spirochetes are found inside living tissue.

The cytological picture of scrapings from ulcers with Vincent's ulcerative-necrotic stomatitis corresponds to a nonspecific inflammatory process.

Differential diagnosis. First of all, it is necessary to exclude HIV infection. In addition, Vincent's ulcerative necrotizing stomatitis is differentiated from ulcerative lesions for blood diseases (leukemia, agranulocytosis, infectious mononucleosis), mercury poisoning, scorbuta. Fusospirochetes are also found in necrotic ulcers in these diseases large quantities. Rashes with secondary syphilis in the oral cavity can be secondarily complicated by Vincent's stomatitis. To avoid possible errors, in all cases of ulcerative gingivitis and stomatitis, you should carefully collect anamnesis, taking into account not only local, but also general clinical manifestations, make general clinical analysis blood test, test for HIV infection, Wasserman reaction, and if contact with mercury is detected, a urine test for mercury content. As mentioned above, fusospirochetosis can complicate the course of other ulcers (for example, disintegrating cancer of the oral mucosa). That's why great value V differential diagnosis acquires a cytological research method.

Treatment of Vincent's ulcerative necrotic stomatitis:

An important condition successful treatment is a thorough sanitation of the oral cavity. After anesthesia, the decay of necrotic tissues and dental deposits are removed. Quick cure promotes the use of broad-spectrum antibiotics. Frequent (4-5 times a day) rinsing is required. antiseptic solutions(0.05 - 0.1% chlorhexidine solution, 1 - 2% hydrogen peroxide solution). Good effect is achieved by using trichopolum 0.5 g 2 times a day for 5 - 7 days. To suppress microbial sensitization, antihistamine therapy (fenkarol, tavegil or suprastin) is carried out. Vitamin C is also prescribed (up to 1.5 g per day). Topically applied enzyme preparations to lyse necrotic plaque, and then keratoplastic ointments (solcoseryl, methyluracil). When the process is localized in the pharynx, an interferon solution is instilled. The prognosis with timely and adequate treatment is favorable. IN acute stage associated with difficult eruption of third molars, surgical procedures are not recommended. At proper treatment epithelization occurs in an acute process after 3-6 days, in a chronic process - somewhat slower. Severe cases of Vincent's ulcerative-necrotizing stomatitis, especially recurrent ones, when treatment is carried out untimely or incorrectly, lead to irreversible changes: bone resorption, subsidence (retraction) of the gums, severe forms of periodontitis. After treatment gingival papillae may disappear, creating conditions for food retention and progression of periodontitis. In other areas of the mucous membrane, except the gums, tissues are usually restored when healed; only after deep and extensive ulcers do scars remain.

Treatment of symptomatic ulcerative-necrotic stomatitis in blood diseases, scorbuta, mercury poisoning consists mainly in overall impact on the body.

Persons who have had Vincent's stomatitis should be on dispensary observation at least 1 year, with the first examination carried out after 1 - 2 months.

Forecast for sore throat and stomatitis Vincent favorable, although in some cases, in the absence of rational therapy, the disease drags on and can last for several months. Relapses are possible.

Prevention of Vincent's ulcerative necrotic stomatitis:

Which doctors should you contact if you have Vincent's ulcerative necrotizing stomatitis:

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Oral diseases cause a lot of inconvenience, forcing us to feel complex, hide our smiles, and avoid communicating with people because of bad breath. Moreover, they can lead to serious consequences. To avoid becoming a victim serious illness and pathologies, read this article, which discusses Vincent’s stomatitis.

What is it

Necrotizing ulcerative stomatitis or Vincent's stomatitis(lat. stomatitis ulceronecroticans Vincenti) is an infectious disease that is caused by spindle-shaped bacillus and spirochete (Borrelia) Vincenti. In the world literature it is mentioned under the following names: ulcerative stomatitis, ulcerative-necrotic form of stomatitis, ulcerative-membranous form of stomatitis, fusospirochetous form of stomatitis, “trench mouth”, Botkin-Simanovsky-Plaut-Vincent angina, etc.

When the gums are affected, the disease is defined as Vincent gingivitis, when the gums and other areas of the mucous membrane are affected - stomatitis, when transferred to the palatine tonsils - Vincent's angina.

When the gums are affected, the disease is defined as Vincent gingivitis.

Classification of ulcerative necrotic stomatitis

The sources of Vincent's disease are attributed to the resident flora of the oral cavity and are found in normal quantity for all people who even have healthy teeth, in particular, in the gingival groove. At improper care and periodontitis, the number of pathogenic bacteria increases sharply.

Fusobacteria and Vincent's Borrelia are opportunistic microorganisms. The main role in the formation of the disease is played by a decrease in the body’s tolerance to infections. It manifests itself especially often during hypothermia, as a consequence of a general illness, overload, stress, and abnormal nutrition.

Preceding factors are also a violation of the integrity of the mucous membrane, which creates conditions for the proliferation of microorganisms. This happens with injuries, especially chronic ones, for example, with sharp edges of teeth, with difficulty cutting through the soft tissue of third molars. Breakdown of the epithelial barrier also worsens the situation.

Vincent's ulcerative-necrotizing stomatitis manifests itself most often with improper hygienic care of the oral cavity against the background of previously developed inflammatory processes of the gums, with the deposition of tartar, which prevents natural process desquamation of the skin, irritates the gums and, by closing the entrance to the periodontal pocket, creates conditions for the development of infection.

Fusobacteria

Vincent's ulcerative necrotizing stomatitis can occur as a complication after viral infection(influenza, herpetic stomatitis), erosive allergic stomatitis, multiform exudative erythema, some are heavy general diseases- leukemia, agranulocytosis, infectious mononucleosis, joins with intoxication with salts of heavy metals, scorbuta. Oncological ulcers and syphilides in the mouth are often also complicated by fusospirochetosis.

Symptoms

According to the nature of the disease, they are divided into:

• acute;
• subacute;
• chronic;
• ulcerative-necrotic;
• recurrent.

By severity:

• light;
• average;
• heavy.

Symptoms appear gradually:

1. In the first stages of the disease, weakness, headaches, elevated temperature body, cracking in the joints. Patients complain of bleeding in the gums, burning and dryness of the mucous membrane. This stage can last from a couple of hours to several days, depending on the form of the disease.
2. As stomatitis progresses, general weakness accumulates, body temperature increases, headaches intensify, and capacity decreases.
3. The pain in the oral cavity sharply intensifies from the slightest touch, the tongue becomes numb and stiff during a conversation. Eating and brushing teeth become impossible. Salivation increases, a strong rotten smell from the mouth. When inflammation occurs in the area of ​​the wisdom teeth, difficulty opening the mouth (trismus) occurs.
4. Most often, infection of the mucous membrane spreads from the gums and areas where there are local irritants: tartar, broken teeth, dental crowns that injure the gums.
5. With ulcerative-necrotic stomatitis, the gums swell, loosen, turn red, begin to hurt, and bleed for no reason. First, necrosis covers the tops of the interdental nipples, and then spreads throughout the gum. Over time, the gums become covered with masses of white-gray, gray-brown or yellow color.
6. For mild stage Ulcerative necrotic stomatitis is characterized by a weak spread of the process. More often, only the tops of the tissues of one group of teeth die. General health does not change. Capacity is not reduced.
7. At the severe stage of Vincent's stomatitis, the body temperature rises to 38.5-40°C. General health drops sharply. Ulceration spreads over a large area of ​​the mucous membrane, ulcers can reach the location of muscle tissue, tendons, bones, and alveolar ridge. With this course of the disease, osteomyelitis may occur (melting bone tissue) infected area of ​​the jaw.
8. When the ulcerative necrotic lesion spreads to the palate and tonsils, stomatitis turns into Simanovsky-Plaut-Vincent sore throat.
9. Acute ulcerative-necrotic form of stomatitis, if not treated sufficiently, can become recurrent and become chronic. This metamorphosis is more often observed against the background of chronic somatic pathologies, as well as for pathologies of the oral cavity.

Trend

The disease affects mainly young people (18 - 35 years old), most often men. Peak occurs in December. Pain in the mouth begins, especially when eating, bleeding gums, profuse salivation, bad breath, weakness. The patient looks pale due to severe poisoning. Lymph nodes enlarge, become denser, and hurt on palpation.

The process begins from the gums and manifests itself in the form of foci of necrosis of the gum edge and papillae. Necrosis then spreads to other areas of the mucosa. The area of ​​the lower third molars is often affected, where necrosis quickly spreads to the buccal mucosa and retromolar area, causing trismus and pain when swallowing. In some cases, inflammation causes severe facial asymmetry due to tissue swelling.

In severe cases, necrotic lesions form on the lateral surface and tongue, as well as on the hard and soft palate. They have soft edges irregular shape, a dense, stinking necrotic plaque of a blue-green color, after removal of which a loose, bleeding bottom is exposed. On the hard palate, processes quickly lead to necrosis of all layers of the mucosa and exposure of bone tissue.

The general well-being of the patient during the acute process worsens: the temperature in the first 2 - 3 days rises to 37.5 - 38 ° C, but may be normal, and a headache appears. Anxious dream, difficulty eating, intoxication weaken the patient’s body.

Frequent fainting occurs, in the hemogram noticeable changes may be absent, but leukocytosis is often observed, in severe cases - toxigenic granularity of neutrophils. The chronic form of this disease develops when improper treatment or its absence, but can also occur independently, without an acute process.

Diagnosis of ulcerative-chronic stomatitis

The diagnosis is made on the basis of the clinical picture and the identification of fusospirillary symbiosis.

Biopsy analysis reveals two zones:

• superficial - necrotic;
• deep - inflammatory.

In the superficial layer of necrosis, the flora is rich and diverse (cocci, rods, fusobacteria, spirochetes, etc.), in the deeper layer, which is adjacent to living tissues, fusospirochetosis sharply predominates. These tissues are in the phase of acute inflammation. Inside living tissue there are only spirochetes.

The cytological picture of a scraping from an ulcer with Vincent's stomatitis is similar to a non-specific process of inflammation.

Differential diagnosis

First you need to exclude the possibility of HIV infections. In addition, Vincent's ulcerative-necrotizing stomatitis is differentiated from ulcerative lesions due to blood diseases (leukemia, agranulocytosis, infectious mononucleosis), mercury poisoning, morbidity. Fusospirochetosis is also found in large quantities in necrotic ulcers.

Frequent rinsing with antiseptics (chlorhexidine solution, hydrogen peroxide) is necessary.

Treatment of ulcerative necrotic stomatitis

1. Important conditions for successful treatment are detailed oral sanitation.
2. After anesthesia, the decay of necrotic tissue and dental plaque is removed.
3. Rapid treatment is facilitated by the use of extended-spectrum antibiotics. You need frequent (3-4 times a day) rinsing with antiseptics (chlorhexidine solution, hydrogen peroxide). A noticeable effect is achievable when using Trichopolum 0.5 g 2 times a day for a week.
4. To suppress microbial sensitization, antihistamine therapy (fenkarol, tavegil or suprastin) is carried out.
5. Vitamin C is prescribed (at a dosage of 1.5 g per day).
6. Enzymes are applied topically to lyse necrotic plaque, and then keratoplastic ointment (solcoseryl, methyluracil). When the process occurs in the pharynx, an interferon solution is dripped.

The prognosis with quick and adequate treatment is positive.

At the acute stage, which is associated with difficult eruption of third molars, it is not recommended to carry out surgical interventions. With correct treatment, epithelization occurs in an acute process after 3-4 days, and in a chronic process - a little slower.

Advanced cases of Vincent's ulcerative-necrotic stomatitis, especially relapses, when treatment is carried out untimely or incorrectly, will entail irreversible changes: bone resorption, gum subsidence (retraction), severe forms periodontitis.

After healing, the gingival papillae may disappear, conditions for food retention are formed, and periodontitis progresses. In other areas of the mucous membrane, except for the gums, tissues are usually restored during treatment, only after deep and severe ulcers scars remain.

Patients who have suffered Vincent's stomatitis should be monitored for at least 1 year, with the first examination carried out after 2 months. The prognosis for Vincent's stomatitis is positive, although in some situations, in the absence of proper therapy, the disease drags on and can last for several months. There may be cases of relapse.

Prevention

To prevent fusospirillosis, it is recommended to regularly carry out procedures for sanitation of the oral cavity, observe hygiene standards, especially during the period infectious diseases, lowering protective properties, as well as when using bismuth preparations.

Conclusion

Think about your health today - get diagnosed by a dentist to find out if you have progressive hidden diseases. Maintain good oral hygiene, eat right, and avoid bad habits and fast food to please yourself and your loved ones with a healthy smile for as long as possible.