The oral cavity is a unique whole whose basic role is chewing and ingesting food and speech. The honeycomb glands that lie in it are lynx. The nasal cavity is coated with a mucosa constructed of a multilayer plate epithelium whose task is primarily protective. In addition to protecting the oral cavity, oral mucosa receives impulses on oral tissues, allows absorption and resorption of the substance, prevents non-physiological metabolism and stimulates the release of harmful substances from the body. The lumbar mouth also has a tasting role that gives the pleasure of receiving food.
It can be said that the oral cavity is a health problem indicator. The existence of harmony and balance in the mouth as an indicator of oral health is due to the intactness of the oral epithelium, the balance of the oral flora, the smooth function of the gastric cavity and the general health condition. Disrupting this harmony at any of the above levels results in the appearance of oral symptoms and oral diseases that may, because of their specificity, endanger the daily life functions and habits of man, and then there is a problem that we did not know could exist.
The most common oral symptoms that patients experience in oral pathology are first and foremost an uncomfortable sensation of stomatopyrosis, stomatodynia, dysgeusia and oral mucosa (xerostomia). Patients describe these symptoms as aching and burning in the mouth, the food does not taste good, it becomes blunt, the mucous membrane of the mouth is dry and sticky with the feeling of the existence of crumbs and sand in the mouth.
Oral diseases with the onset of these symptoms may affect the lips, tongue, palate, or the entire mucous membrane of the mouth and speak of heliotids, glutitis, palpitations and stomatitis. The symptom that is dominant and always present when there is loss of oral mucosal integrity is the feeling of stinging or symptom of stomatopoiosis. In this case, the non-critical use of antimycotic drugs (medicines used in the treatment of fungal diseases) such as miconazole and nistatin is not a solution because the feeling of pecking in the mouth may be of various cause as a result of viral, bacterial or fungal inflammation, the consequence of an allergic reaction in the mouth or the consequences immunological disorders such as the appearance of autoimmune diseases on the mucous membrane of the mouth. Often in the outpatient clinic are people who have been diagnosed with small tongue fungus and insist on the treatment of the disease.
In fact, they discovered the existence of small tasty buds (fungiform papilla), which provide taste sensitivity and a normal anatomical structure on the surface of the tongue. There are also people who are in panic fear to have Candida in the mouth. Candida albicans is an integral part of the oral flora and is not a pathological finding. If it is eradicated by long-term use of antimycotic agents, it will disturb the balance of the oral flora and will allow far pathogenic microorganisms to form on the mucous membrane and thus do more harm than good.
In order to at least avoid confusion and clarify the most common oral symptoms and signs of oral disease we will give a brief description of those most commonly encountered in practice.
Angular heliotis (cheilits angularis)
Disease is manifested, in deeper or thinner fissures and stubble (fissures) appear on the corners of the lips. It is most common in elderly people who carry dentures and have a reduced bite. As a consequence of a lowered bite in the corners of the mouth, a slime accumulates from the mouth of the liver and skin and thus represents the ideal basis for the colonization of fungi (Candida albicans) and bacteria (Staphiloccocus.).
The mouth are with red or with gall bladder wounds if there was a secondary inflammation of the staphylococcus. Antibiotics will be used locally in the therapy, which will reduce inflammation, an epithelial agent that will stimulate the healing of stinging or suture, and ultimately it is necessary to raise the bite and create new prosthetic replacements because otherwise the disease will be repeated. Angular heliotis may also occur in the case of vitamin B deficiency and most commonly with vitamin B2 (riboflavin), and is also called angulus ariboflavinisus. In addition to the previously described therapy, it is necessary to provide vitamin B preparations if necessary.
Exfolical glutitis (Glossitis exfoliativa areata)
It can be seen by peeling of the lining of the tongue in strictly limited areas. If the affected areas occur in the different spheres of the tongue then we are talking about the appearance of glutitis exfoliative migrans or if the described changes always occur in the same place we are talking about glutitis exfoliative non-migrans. Patients are suffocated with tongue twitching and increased susceptibility to sourness. They also describe the occasional distress of the illness and the deterioration again.
Since the tongue is an integral part of the digestive tract, all the diseases that occur with stomach can also be manifested language. The patient does not even have symptoms of gastritis in order to make such changes manifest in the mucous membrane of the tongue. These language changes may also be the first sign of gastric illness. With the local application of drugs that will calm the inflammation (corticosteroids), agents that stimulate mucosal epithelialization (vitamin A, panthenol, vitamin B groups) only by applying targeted therapy for the treatment of existing gastritis comes the regression of language changes.
The main symptom of this oral disease that occurs in people who carry mobile prosthetic replacement is the burning of the lining of the palate. The top of the palate is red, it may be hyperplastic. The main problem is the inflammation caused by Candida albicans since it is presently under the prosthesis of the saliva mucus heating up saliva and residues of food, which is an ideal nutrition for the colonization of this fungi.
It is necessary to remove the prosthesis at night, monitor it, hold it in a glass of water with the addition of special tablets for this purpose (eg Corega-tabs). Antiseptics, antimicrobial agents are widely used. It is recommended that the prosthesis should also be coated with antimycotic before the denture is put in place, as the prosthesis itself can be the nutrition of the mentioned fungi.
Oral candidiasis (Candidiasis)
As already mentioned, Candida albicans is an integral part of the oral flora and as such is not a problem. The problem arises at the time when there is a disorder of balanced mouth relations, oral flora balance disorders, loss of oral mucosal integrity. Similarly, some metabolic diseases (diabetes mellitus), hormonal disbalance (pregnancy, menopause), impaired immune states (persons under immunosuppressive therapy) may favor this fungus multiply in a large number of colonies and cause inflammation of the oral mucosa. Patients are saddened by the feeling of choking in their mouths.
There is a clinically apparent inflammation of the mucous membrane of the mouth, and pseudomembranes (psydomembranous candidiasis) may be present, which are exposed and beneath which the eroded surface is present. Along with the local administration of antimycotic, it is sometimes necessary to use systemic therapy in the form of antimycotic tablets (eg fluconazole) in stiff inflammation. Certainly it is necessary to notice and strive for the root cause of this fungal inflammation.
Chronic atrophic stomatitis (Stomatitis chronica atrophica)
This diagnosis primarily describes the condition of the oral mucosa rather than the disease as it is related to the age of the person. They are well-off women and are linked to the postmenopause period. Upon entering menopause and changes in hormonal status, all mucous membranes in the body become thin and atrophic, so the mucous membranes of the mouth. The lice is flat and atrophic, but without any other pathological changes.
There is a symptom of choking and burning in the mouth. In this way, the modified mucous membrane is much more sensitive and is more susceptible to inflammatory changes since it loses its own non-specific defense. If there is a burning and stinging symptom, the mucous membrane is only atrophic, which is of good age without other pathological changes, local use of vitamins is recommended, which will at least somewhat stimulate mucosal epithelialization (vitamin A) as well as the use of vitamin B in the form of injections.
This is a symptom of saliva but not a disease. Reduced salivation of the saliva is a consequence of the atrophy of the epithelium of the salivary gland epithelium and their degenerative age-related changes or is perhaps a symptom of destructive changes in gingivitis in autoimmune diseases such as Sjögren’s syndrome. Patients suffocate the feeling of dryness in the mouth and stickiness.
There is a clinically visible dry and brilliant mucous membrane of the mouth. If there is a reduced salivation of the saliva, the appearance of the changed normal oral conditions results in the emergence of oral infections such as candidiasis. The amount of saliva is determined by measuring the salivation quantum. Normally, 0.4-0.5 ml was extinguished in 1 min. If the amount of saline secreted is less than 0.4 ml / 1min, we are talking about oligosaccharides (reduced salivation), and if saliva less than 0.2ml / 1min we talk about xerostomia (saliva no). In this case, it is necessary to find the cause of reduced salivation. If possible, it is attempted to stimulate the glandular epithelium on the formation and delivery of saliva by local application of the Acid Citric solution or stimulation of the glandular epithelium using soft bio laser. The slice can also be compensated by the artificial substitutes of saliva.
The appearance of the disease is predicated only by the subjective feeling of burning and stinging. There is a clinical manifestation of erythema and the outbreak of tiny vesicles (blisters) that break and penetrate the chakras. The localization of these pathological changes is on the lips, palate and gums (gingiva). They mostly occur in cases of impaired immunity (immunosuppressed persons, stress, exhausting chronic illnesses). The first contact with the herpes virus is in childhood when the clinical picture is far warmer.
After that, the virus stays in a quiet, latent phase in the ganglia. At a time that favors its activation, it is “going through” along the branch the nerve and manifesto on the lips, the palate and the gingiva. Antibiotic agents (acyclovir) are used locally in the therapy, but only when vesicles are present, followed by drugs that will prevent secondary infection with bacteria and fungi and epithelial agents. It is also important to control the immune status of people who are susceptible to frequent recurrence of inflammation caused by herpes simplex virus.
It is common to have oral disease. They are included in the mucocutaneous autoimmune diseases. It is characterized by the appearance of tiny erosions with a yellowish mid-bordered red edge. The most common localization of these changes is the cheek, the tongue, the vestibulum.
They can be small in diameter up to 5 mm (aphtae minores), large and transverse to aphatae majores or clinically resembling herpes if there is a lot of tiny erosion (aphtae herpetiformes). The herpes distinguishes them from the confusion of tiny erosions. The main symptom of the disease is choking and sometimes intense pain at the site of inflammation. Disease is often associated with impaired immunity, gastric diseases, and sideropenic anemia.
Alkaline lichen ruber (Lichen ruber planus)
This is a common disease of the oral mucosa. It is considered a mucosal autoimmune disease. Women are more commonly affected by it, middle and older. The disease is still unexplained. Lethal disease, metabolic illness, and especially diabetes mellitus are mentioned. Patients are saddled with an unpleasant feeling of choking in their mouth. The lumbar mouth is inflammatory with the findings of characteristic hypersensitive (thickening of the corneal epithelial layer) of the stripe and the stripe. Clinical illness occurs in several forms: papular, reticular, plaque, anular, buloose, erosive, ulcerative, making it difficult to diagnose the disease.
Clinical diagnosis is confirmed by taking a biopsy specimen and a pathohistological diagnosis. Antibiotics (penicillins are a choice medicine), local antibiotic and corticosteroid combinations, keratolytics, retinoic acid derivatives and antimycotics are used in the treatment of basic diseases such as diabetes regulation in systemic therapy. In severe forms of disease, the systemic administration of corticosteroids is also necessary.