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12:13. DISEASES OF THE MUCOUS MEMBRANE OF THE ORAL CAVITY AND GUMS
Afta Bednar (alate ulcers). Aftami Bednar is called by the defects of a mucous membrane of the sky which arose at newborns in attempts to clear a finger an oral cavity. At this superficial injury the back part of a hard palate where then the grayish necrotic cover, usually on both sides from the average line just before connection with a soft palate is formed is bared.
Epstein's small knots (Bon's small knots) — the epithelial reteptsiopny cysts on both sides of a median seam of the sky observed at newborns. Disappear in several weeks.
Mucocele (mucous cyst). In sites of an arrangement of sialadens at any age there can be small cysts containing slime. These are roundish transparent educations with bluish an ottenka; usually they eminate a little, but can deeply be located, keeping mobility at a palpation. Such cysts are formed after a traumatic rupture of output channels of small sialadens. Usually they are covered by granulyatsionny fabric, is more rare — an epithelium. Surgical removal of cysts and superficially located glands as at conservative treatment (drainage) often there is recurrence is recommended.
Fordyce's small knots. Almost at 80% of adults multiple yellow-white small knots in the form of clusters or plaques on a mucous membrane of an oral cavity are observed (mainly on cheeks or lips). At histologic research in own and submucosal layers of a mucous membrane normal sebaceous glands are found. These glands exist since the birth, but at prepubertal age at 50% of children they hypertrophy, taking a form of yellowish papules. Treatment is not required.
Epulis. This term usually designate tumorous growth on gingivas reactive (but not neoplastic) character. Epulis can be on a leg or on the wide basis. After removal it can recur, but does not metastasize.
Moniliasis of an oral cavity (milkwoman). At newborns defeat of an oral cavity is often observed by Candida albicans mushroom. This mushroom which is constantly living on skin, mucous membranes of a mouth, a vagina and intestines at the time of delivery gets to the child's organism. At the milkwoman in language, lips, gums, multiple white scaly plaques are visible to an internal surface of cheeks. On site a remote plaque there is a bright red inflamed basis. Sick children feel discomfort during food. The moniliasis proceeds sharply at newborns and gets a chronic current from children of chest and early age at disturbance of food and other exhausting states. Also change of microflora of an oral cavity after an antibioticotherapia can be the cause of the milkwoman. The diagnosis is confirmed at direct microscopic examination of scrapings from mucous membranes and their crops on mediums.
Though the moniliasis at newborns passes and without treatment, nevertheless it is recommended to apply nystatin solution on 1 ml (100 000 pieces/ml) 4 times a day with an interval of 6 h: it allows to limit distribution of an infection in a maternity home and to avoid development of long infectious process. Solution should be installed slowly and without pressing, so that it irrigated all oral cavity before it is swallowed.
Also effectively topical administration of 1% of aqueous solution of a methylrosanilinum chloride, but this drug spoils and paints linen (spots can be removed by means of sodium bicarbonate). A methylrosanilinum chloride inflict defeats on sites, watching at the same time that too much solution as at a proglatyvaniye it can render irritating deysty did not get into a mouth. This complication can be prevented if to put the child after procedure facedown, so that the saliva containing medicine followed from an oral cavity.
At a moiiliaza, the developed pas a background of a chronic disease or insufficiency of food, paramount value gets treatment of a basic disease.
To Gerpangip and herpetic stomatitis see in appropriate sections.
Aphthous ulcers (aphthous stomatitis) — often found recurrent painful damage of a mucous membrane of an oral cavity, including language and the sky. Primary eritematoziy makula is broken off, forming very sensitive crater, okruya <unlimited by an indurirovanpy zone of an inflammation. Such picture somewhat reminds herpetic stomatitis, but aphthous ulcers are more localized and can be single or multiple; usually they arise after stressful situations. For removal of pain use benzoin tincture applications. Ulcers usually heal without formation of a hem during 1 — 2 week.
Ulcer and necrotic ulitis (Vensan's illness, Vensan's quinsy). This illness is characterized by formation of small ulcers on the hyperemic painful gingivas covered with a gryaznosery pallet. Frequent symptoms — high temperature, an indisposition and a pungent gpilostny smell from a mouth. Decrease in resilience of tissues of gum to banal microflora of an oral cavity, especially to fuzibakteriya and spirochetes is the cornerstone of an illness. These microorganisms violently breed at is long the ill children suffering from insufficiency of food. In an acute stage of process it is possible to achieve fast involution thanks to use of oxidizers (by their careful spraying in oral cavities or rinsings); in particular, it is useful to wash out a mouth each hour of 3% hydrogen peroxide solution.
As the ulcer and necrotic ulitis occurs at children extremely seldom, except for areas where the poor live, it is necessary to make this diagnosis carefully. It is necessary to exclude herpetic gigivit, and also oral displays of an acute leukosis and a reticuloendotheliosis which can have similar signs.
Noma (oral gangrene, the creeping mouth gangrene). A noma — seldom found progressing gangrene of a mucous membrane of cheeks from which ruptured ulcers result. The illness develops owing to an invasion of fuzibakteriya, spirochetes and other bacteria in fabrics at the children weakened by the accompanying diseases or insufficiency of food. In the beginning the small hardly noticeable ulcer is formed, but then it turns into a gangrenous greenish-black spot on gums, cheeks, a pas to border of skin and mucous membrane of a mouth. The necrosis zone slowly, but inevitably extends, leading to perforation of cheeks and an exposure of jaws.
Intensive antibacterial care should be begun at once after establishment of the diagnosis and to continue before full rejection of nekrotizirovanny sites of bones and soft tissues. As at such patients insufficiency of food is often observed, it is necessary to provide them an adequate diet, and special attention dolyasho to be paid on amount of protein and vitamins. Plastic surgical correction is possible only after an absolute recovery.
Corrosive burns. Except accidental introduction to an oral cavity of acids, alkalis or other caustic substances, the wrong self-treatment can become the reason of a corrosive burn; the zone of defeat has an appearance of a white spot. The most frequent reason — applying to a painful tooth or a gingiva of a tablet of aspirin which slowly resolves in a mouth. On a mucous membrane the center of koagulirovanny fabric results white, from irregular shape. The continence in a mouth of tablets of camphor is other frequent reason of a burn. Recovery is spontaneous; the only necessary treatment — refusal of similar practice.
Dilantinovy hyperplasia. Generalized increase in gums arises approximately at 10 — 30% of the patients receiving difenilgidantoip sodium or Dilantinum *, in quality protivosudoroya "gy means. The affected gum pale, dense, "granular", can hypertrophy to such an extent that completely closes crowns of teeth. The injury, an infection, insufficient hygiene of an oral cavity can cause an inflammation and feeling of discomfort. Careful care of an oral cavity allows to avoid complications or to reduce their frequency. If it is possible, it is necessary to appoint other antikonvulsaita.
* In our country dipheninum is issued under the name. — Primech. edition.
Fibromatosis of gums. This rare family idiopatnchesky disease reminding a dilantinovy hyperplasia. The fibromatosis can be combined with other defects of development, such as intellectual insufficiency or a hypertrichosis. The dense smooth hypertrophied gingiva consists of the collagen covered with a multilayer skvamozpy epithelium. Increase in gums can cause protrusion of lips and shift of teeth. The only effective way of treatment — surgical removal of excess tissue of gum, however at the same time often there is recurrence. Special attention should be paid on hygiene of an oral cavity as the irritation of gums stimulates their excessive growth.