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Skin inside mouth: The inside of my mouth is peeling

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The inside of my mouth is peeling

Anxious about peeling skin on the inside of your mouth? The lining of the mouth can be neglected professionally, with the GP leaving it to the dentist and the dentist leaving it to the GP.

Fortunately help is at hand. Implant Surgeon, Specialist Oral Surgeon and Co-founder of The Implant Centre Dr Bill Schaeffer gets to the bottom of oral skin peeling:

Is it normal for your mouth to peel?

The skin on the inside of the mouth is called the Oral Mucosa. It works as a tough flexible barrier, preventing food from penetrating the mucosa while still being flexible enough to allow for the wide range of movements involved in eating and speaking.

Small localised areas of peeling of the oral mucosa are very common and resolve within a few days. More widespread or longer-lasting peeling of the oral mucosa should be checked out by your dentist or doctor.

What might cause mouth skin to peel?

A number of things can cause the skin in your mouth to peel, but the most common causes include the following:

• Thermal burn

The most common cause of peeling of the oral mucosa is a burn after eating food that is too hot.

• Chemical burn

In a similar way to a thermal burn, chemical burns can cause the skin to peel. We sometimes see this if a patient has let an aspirin dissolve against the gum to try and relieve a toothache. These are both localised areas of peeling.

• Autoimmune disorders

More rarely, some autoimmune disorders can cause the oral mucosa to peel in a more widespread pattern, sometimes dramatically so.



Oral skin peeling treatment

Treatment for the skin in your mouth peeling will obviously depend on the cause. The simple causes like thermal or chemical burns should resolve fully after a week or so.

The autoimmune disorders require an accurate diagnosis to be made and then specialist treatment can be started.

If the skin peeling is widespread – you must seek treatment for this from your doctor or dentist.



Do you have Stevens-Johnson syndrome?

Stevens-Johnson syndrome is a rare, serious disorder of your skin and mucous membranes. It’s usually a reaction to a medication or an infection.

Often, it begins with flu-like symptoms, followed by a painful red or purplish rash that usually affects the mouth and lips but can be more widespread. This then spreads and blisters. Then the top layer of the affected skin dies, sheds and finally heals.

Stevens-Johnson syndrome is a medical emergency that usually requires hospitalisation so you would definitely know something was seriously wrong if you had it.

Could it be oral keratosis?

Oral keratosis is a thickening of the keratin layer of the oral mucosa. Because the oral mucosa is always wet, this results in a slightly raised white patch.

The most common site that this is seen is in the palate of smokers where the hot irritant smoke causes the skin covering the palate to lay down a thicker layer of keratin in an attempt to protect itself.



Should you see your GP about skin peeling?

Localised burns are easy for a patient to diagnose themselves and resolve fully after only a week or so. More widespread peeling of the mouth must be checked out by a dentist or a medical doctor.

If any patient has an ulcer in their mouth that takes longer than two weeks to fully resolve, then they should see their dentist to get it checked out as soon as possible.

You should visit a doctor if you are worried about any symptoms in your mouth that have not resolved after two weeks, though it may well be that your dentist will be more familiar than your doctor with conditions that can affect the mouth.



Last updated: 08-10-19

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Skin Sensitivity and Peeling Inside the Mouth – Dental Health

Q2. I’ve heard that my old silver fillings probably contain dangerous mercury, and I should have them replaced. I don’t think insurance will pay for replacements — but I don’t want to leave poison in my mouth! Is it really dangerous to leave old fillings in place? What are the options for replacing them?

— Jill, New York

The safety of dental silver fillings (amalgams) is one of the hottest topics in dentistry today. Silver fillings are called amalgam restorations because they are an amalgamation of several metals (tin, zinc, copper, and silver) combined with elemental mercury. These metals are mixed together and then placed in the carefully prepared holes made by the dentist. Over the years, people have questioned whether the mercury portion of the fillings leaches, or comes out, and if so, whether the mercury affects their health.

It seems as if the answer is no. Recently a series of articles appeared in national publications, including the Wall Street Journal (September 12, 2006), questioning the safety and long-term efficacy of amalgams. However, an FDA advisory panel had reported on September 6 that there was no new scientific evidence to justify regulation of dental amalgams. The report was based on a review of 34 recent studies, which found “no significant new information,” though the panel did say that more research is needed.

Immediately after the FDA announcement, the American Dental Association issued a news release welcoming further study on amalgam safety, while reiterating that “the overwhelming weight of scientific evidence supports the safety and efficacy of dental amalgam” and that amalgam should remain available for dentists and patients.

I have a number of amalgams in my mouth that my dad (also a dentist) placed there 30 to 40 years ago. I personally feel they are safe and would not remove them unless I had a crack or decay around them. Amalgams are amazing restorations and are relatively low-cost, especially given the length of time that they last.

However, fillings don’t last forever; your dentist must check the integrity of them during your regular cleaning appointments. If it should come to pass that an old amalgam needs replacement because of a crack or decay, you do have options. Replacement fillings can be made of gold (one of the best materials for teeth but no longer stylish), tooth-colored bonding materials, or tooth-colored porcelain. Discuss the options with your dentist to determine which material is best suited for your mouth. People who grind their teeth may be better off with gold restorations since porcelain tends to fracture more easily. It also depends on how much tooth structure has been lost to decay and what type of bite you have.

Q3. I am 30 years old and had been seeing the same dentist my whole life, then I moved and had to find a new one. I went for my first cleaning with the new dentist and was told I had 10 cavities. I was shocked since I had just gone for a cleaning 6 months earlier and there was no problem at all. In fact I have no history of having any problems with my teeth. How do I know if I really have that bad of a problem? My teeth never even bother me.

– January, Connecticut

Dentists trained in U. S. dental schools receive very similar dental educations. There are standardized textbooks, curriculums, and local and national exams to take. These exams are written, oral, and practical. Thus, a diagnosis should be the same everywhere. However, a treatment plan or treatment options can vary. These differences can depend on the dentists’ abilities, knowledge, experience, confidence, ethics, concern and continuing education.

All dentists should agree on whether or not a cavity (a hole in the tooth) exists. But many dentists may disagree on when to treat the cavity, for there are different guidelines on this. Some dentists treat a cavity when it is only in the enamel (outer layer of tooth structure) whereas others would make note of this hole to watch and treat only if it gets deeper. Many others would wait until the cavity penetrated into the dentin (the second layer of tooth structure). This is a judgment call—there’s no right or wrong.

The answer to your question is to get a second opinion from a well-respected dentist in your area. Word of mouth may be a good indicator but in seeking a second opinion, make sure you analyze several factors including :

  • Respect in community
  • Office staff
  • Office cleanliness
  • Technology
  • Education and continuing education
  • Reputation for honesty
  • Level of compassion and caring

What is the Black Spot on the Inside of my Cheek?

During your regular brushing and flossing routine, you may be alarmed if you find a black spot on the inside of your cheek. Black spots or dark spots on the inside of your cheek can be caused by a variety of different things, most of which are mild and easily treatable. However, some causes of black spots are more serious, like oral cancer. For this reason, it is important to schedule an appointment with your dentist to determine the cause of your black spot. Some possible causes of a black spot inside the cheek include: 

 

Blood Blister

A blood blister is a sac of fluid and blood that forms when the skin gets pinched. They can appear reddish or purplish in color and are usually big enough to be felt with the tongue. In addition to forming on the cheeks, blood blisters can also form inside the lips. In most cases, a blood blister will resolve on their own, however if they last longer than two weeks you will need to visit your dentist. 

 

Melanotic Macules

A melanotic macule is a small area, usually around a quarter of an inch in diameter, of hyperpigmentation. Melanotic macules are flat, benign, and have a defined border. However, your dentist may perform a biopsy to rule out oral cancer or refer you to your doctor for further testing. 

 

Leaky Dental Filling

For several years, amalgam fillings were commonly used in dentistry to restore decayed teeth. Dental amalgam is composed of multiple metals including copper, tin, mercury, zinc, and silver. Unfortunately, when these fillings get old they can leak and cause the surrounding tissues to stain a dark blue, gray, or black color. These stains are permanent and are known as amalgam tattoos. If your dentist suspects a leaky filling is the cause of your dark spots, the filling will either need to be repaired or replaced to prevent other complications. 

 

Smoker’s Melanosis

Around 22% of smokers can develop a condition called smoker’s melanosis, which is characterized by blotchy dark stains on the gums and insides of the cheeks. The stains themselves are harmless and don’t require treatment, but a biopsy may be performed to rule out oral cancer. Stains caused by smoker’s melanosis are permanent. 

 

Oral Cancer

In extremely rare cases the cause of a black spot on the inside of the cheek can be oral cancer, specifically oral melanoma. Oral melanoma can appear white and unpigmented, dark brown, or a blue black color. In the later stages, it may also be accompanied by additional symptoms such as pain, ulcers, and bleeding. Due to the seriousness of oral cancer, you will need to schedule an appointment with your dentist to rule out oral cancer as the cause of your dark spot. They may perform a biopsy or refer you to your doctor for further testing. 

 

 

Certain Medical Conditions

In some cases, dark spots in the mouth can be caused by certain medical conditions such as Peutz-Jeghers syndrome or Addison’s disease. In these cases, a visit to your primary care physician will be needed to confirm the diagnosis and to get the right treatment. 

 

The Anatomy of the mouth

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    Because the office has taken care of me

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    Today my son had unexpected extraction’s, due to infection. Dr. Jess, and another woman I can’t remember her name, dark hair, made a super traumatic event so much easier. My son was Waylon, and I was the mom crying in the corner and holding his feet. You guys were all so sweet and got a tough job done! I loved dr. Jess absolutely so patient and thorough!

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    U r great with the my daughter and she loves to come and see Emily

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    Everyone is so nice and worked my kids in for sealants while we were there

    Josiah W.

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    Everyone was so polite and so good with my kids.

    Colton W.

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    Fast, friendly, affordable

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    Kid friendly

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    On time, personable, friendly, thorough, kind, team environment.

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    I’m pleased with the results of Miles braces

    Miles W.

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    Great care this appointment

    Aspen G.

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    Organized and friendly..

    Janine R.

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    I love the great treatment you get from everybody

    Gayle T.

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    Exceptional service by Cheryl

    Alex M.

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    The staff is very friendly, knowledgeable and the office is very clean. I constantly see them right after a patient uses the equipment take a disinfectant wipe and clean the station before they leave. The dentist is kind,very through, explains what’s being done before hand and what the costs would be. The best dentist I have met! Thank you

    Dede S.

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    I have been coming to The Dental Center for years. My visits have always left me feeling better than when I came in. The staff is so friendly and upbeat. I have always received the best of care.

    Pamela W.

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    I’ve always had great experiences with the hygienists and Very happy with the work dr metzler does…. They all seem to genuinely care about the patient.

    Debbie H.

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    I found the care to be of the highest quality, both in terms of dental care and attentiveness to patient care. Notably, Sam. who was my primary dental assistant, was especially outstanding in all respects, but all care was great.

    Edward C.

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    Best service at affordable price

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    Very nice service

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    on time,good service ,friendly staff

    Robert R.

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    Did very well at getting my daughter to get to know you better before you just took her to do her teeth

    Skyaira P.

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    friendly and efficient attention

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    It was a great experience.

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    I love the employees always nice and pleasant.

    Tessa L.

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    Everyone is fantastic!

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    The staff is the best.

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    Friendliness, thorough, and on time

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    always kind , care for my children as if there own great group of women .

    Alejandra G.

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    Friendly employees and it’s clean atmosphere.

    Alexander T.

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    Your team is wonderful with Dr. Cochran, Amber, Stacy, Melody and everyone to make a great experience!

    Jeff M.

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    Everyone was so nice especially my Hygienist.

    Steven S.

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    First time great experience…everyone is really nice and professional I loved it wouldn’t go anywhere else i was afraid my kids were going to be scared but they treated them with lots of kindness and patient’s that they gave in

    Aubrey R.

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    Everyone is always so friendly. They always do a great job.

    Allyssa Z.

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    Very professional and time efficient. Boys were both comfortable.

    Aaron A.

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    This was my second visit to the dental center in Goshen they are wonderful. My first visit was a cleaning. My second was to put my crown back on after it came off. They are awesome thank you so much for the great and fast service.

    Sue M.

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    The hygienist was very good. I had very little pain after my 6 month cleaning.

    Douglas M.

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    love everything!

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    love everything

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    Friendly, efficient, and knowledgeable

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    Awesome people, I have had the best experience with my dental care.

    Larry A.

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    My experience at the Granger Dental Center was amazing! Megan Yeager was my hygeinist and she was very knowledgeable, polite, professional, and helpful with how I can improve my dental health.

    Nathan Y.

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    Excellent staff with personality plus.

    Donald H.

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    The technician, Julie, did a really good job cleaning my teeth and taking a few x-rays. The dentist, Dr. Cochran, was very pleasant and reassuring. Good job all around. Thanks.

    Nellie T.

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    Everyone in the office is very personable!! Everyone smiled and talked with such ease and with a caring nature. The dentist was honest and gave me options for care. My appointment was at 9:15 and they took me back at that time. Very prompt with your appointments.

    Liliana G.

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    Your office staff was friendly and helpful. I was treated like a valued guest in your office.

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    They were great with my daughter

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    Friendly, on-time service.

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    Everyone was extremely friendly and professional, making the experience more than pleasant!

    Garrett S.

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    You treat your clients with the upmost respect and understanding to there needs.

    Roberta E.

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    Dr Carrol was the best oral surgeon i have ever seen. I asked him to be gentle when giving the numbing shot and was very gentle when extracting the tooth. I have had little to no pain afterwards. No swelling. He made having my tooth pulled a low key simple non traumatic experience.

    Isreal D.

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    Great drs

    Jessica S.

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    My first visit was yesterday and my hygienist was great and even though the dentist only came to see me briefly, he was also very nice! I feel I was treated well and I will continue going back for all of my dental needs!

    Jenny E.

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    Deanna is very thorough and does an excellent job explaining the work being performed. The hygienist that shares work space with Deanna has cleaned my teeth in the past and is great as well.

    Jeff J.

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    Quality of care. Reasonable charges.

    John P.

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    The hygienist and denist are always very nice and understanding. Great experience for my special needs daughter and me.

    Lydwine W.

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    Great people. Everyone was so friendly. And great price. It was a good experience all around.

    Martin M.

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    I had excellent service here. The staff was super nice and helpful. Also, they did an excellent job on my teeth!

    Jaycee L.

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    I always have good service and it is very easy to make an appointment. There is always just a short wait and they are very efficient!

    Emily S.

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    The dental assistant really cares about your dental health. She is excellent.

    Kathy P.

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    The hygienist was gentle and thorough

    Jose G.

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    Very friendly went out of their way to help

    Edward D.

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    So far the customer service is excellent. The dentist was professional. Scheduling an appointment was easy.

    Kelsey B.

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    My dad and I love it here!! They were really good with him during his appointment to get an extraction and are all about saving teeth. Marci, the assistant and Dr. Keiser are amazing and we both have appointments to go back soon!

    MissSpiderbite T.

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    Dr Douglas is fantastic! He makes sure to take the time to get your dental work done precisely. Each time I go, I feel like I’m his only patient there. I feel comfortable in there care. They provide you with options instead of making decisions for you. He always makes sure you’re not in any pain. The office is clean and in a newly built building. I’ve moved my son and husband to…

    BMoney B.

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  • Oral Mucocele Condition, Treatments, and Pictures for Teens – Overview

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    Information for
    TeenAdultChild

    caption goes here…

    Images of Mucocele, Oral

    Overview

    A mucocele is a small, painless, blister-like lesion that occurs on the inner lips or floor of the mouth. The blister is usually filled with clear fluid and is caused by damage to the inner, wetter skin of the lip or mouth (mucosal surface). The damage is often caused by braces, lip biting, or other injury to the mucosal surface. Mucoceles may go away on their own or may be treated by your doctor by being carefully cut out.

    Who’s at risk?

    Mucoceles are common in anyone experiences injury to the mouth. They often occur in children or young adults who are lip biters or who wear braces. A similar lesion, called a mucus-retention cyst is more common in older adults who have not had any injury to their lips. Unlike mucoceles, these mucus-retention cysts tend to look less like fluid-filled blisters and more like small bumps. They are also painless and noncancerous (benign).

    Signs and Symptoms

    Mucoceles usually occur on the lower lip and inner part of the cheek, as these are frequent areas of injury in the mouth, but they can occur anywhere inside the mouth. A mucocele typically is a single bump with a slight bluish or normal skin color, varying in size from 1/2 to 1 inch, and it is soft and painless. A mucocele may appear suddenly, while a mucus-retention cyst may slowly enlarge.

    Self-Care Guidelines

    Many mucoceles will go away on their own in 3–6 weeks. Mucus-retention cysts often last longer. Avoid the habit of chewing or sucking on the lips or cheek when these lesions are present.

    When to Seek Medical Care

    See your doctor if the bump persists for over 2 months or if it is growing, bleeding, interfering with talking or chewing, or painful.

    Treatments Your Physician May Prescribe

    If the doctor is not sure of the diagnosis, a biopsy may be done. Minor surgery may be suggested to remove the lesion.

    Trusted Links

    Clinical Information and Differential Diagnosis of Mucocele, Oral

    References

    Bolognia, Jean L., ed. Dermatology, pp.1729-1730. New York: Mosby, 2003.

    Freedberg, Irwin M., ed. Fitzpatrick’s Dermatology in General Medicine. 6th ed. pp.1087-1088. New York: McGraw-Hill, 2003.

    Lichen Planus | Johns Hopkins Medicine

    Lichen planus is a common disease that causes inflammation (swelling and irritation) on your skin or inside your mouth. On your skin, lichen planus causes a rash that is usually itchy. Inside your mouth, it may cause burning or soreness.

    The cause of lichen planus is usually not known, although possible causes include:

    • Hepatitis C, a virus that attacks your liver

    • Certain medicines, including some drugs used to treat high blood pressure, diabetes, heart disease, and malaria

    • Reactions to metal fillings in your teeth

    • An autoimmune reaction, meaning the body’s own defense system, the immune system, attacks your mouth and skin cells by mistake

    Symptoms

    Symptoms of lichen planus depend on the part or parts of your body affected. Common symptoms include:

    • Skin: The most common symptoms are shiny red or purple bumps. These bumps are firm and may itch a little or a lot; you may have just a few or many of them. Fine white lines or scales may accompany the bumps. They can occur anywhere, but are most common on your wrists, arms, back, and ankles. Thick scaly patches may appear on your shins and ankles. Sometimes, bumps on your skin may appear in an area where your skin has been scratched or burned. Dark skin patches may replace skin bumps that fade. These patches usually fade away after many months.

    • Mouth: Lichen planus inside your mouth looks like lacy patches of tiny white dots. These patches may occur on the inside of your cheeks or on your tongue. They may not cause any other symptoms; in severe cases, redness and sores develop.

    • Nails: Lichen planus may appear on a few, or all, of your fingernails and toenails. Thinning, ridges, splitting, and nail loss are signs of the condition.

    • Scalp: Redness, irritation, and tiny bumps can form on your scalp. In some cases, hair may start to thin and patches of hair loss may occur.

    • Genitals: Lichen planus in your genitals can cause bright red, painful areas.

    Who’s at risk?

    About 1 in 100 people will get lichen planus at some time. It is not caused by an infection, and you can’t pass it on to others. Lichen planus usually affects men and women in middle age. Equal numbers of men and women get lichen planus of the skin, but women are twice as likely to get oral (inside the mouth) lichen planus. The disease is rare in people who are very young or very old.

    Diagnosis

    Your doctor or dentist may diagnose lichen planus, based on the changes on your skin or in your mouth. To make sure of the diagnosis, your doctor will perform a biopsy. He or she will remove mouth mucosa, or a small piece of skin, and send it to be examined it under a microscope.

    Treatment

    If your biopsy shows lichen planus and you have no symptoms, you probably do not need treatment. In most cases, lichen planus will go away within 2 years. If you have symptoms, such as severe itching or sores in your mouth or genital area, treatment can help. If you have lichen planus on your scalp, treatment is important to prevent permanent hair loss.

    Lichen planus has no cure, but different treatments can help relieve your symptoms and speed healing. Possible treatments include:

    • Antihistamine medicine to relieve itching

    • Steroids on your skin or in your mouth to fight inflammation (You may also take steroids in pill form for severe cases)

    • A type of ultraviolet light treatment called PUVA

    • Retinoic acid, a medicine derived from vitamin A and usually used for acne

    • Tacrolimus and pimecrolimus, ointments used for eczema.

    Complications

    Some evidence suggests that oral lichen planus may be an early warning for oral cancer. Make sure you see your dentist for an oral exam at least twice a year.

    When to call the doctor

    If you have any symptoms of lichen planus, talk with your doctor. You may need to see a dermatologist for the most effective care.

    How to manage or live with the condition

    You can’t do much to prevent lichen planus, but once you have it, you can take steps to keep it from getting worse.

    • Avoid injuries to your skin.

    • Apply cool compresses instead of scratching.

    • Limit the stress in your life.

    • For oral lichen planus, stop smoking, avoid alcohol, maintain good oral hygiene, and avoid any foods that seem to irritate your mouth.

    Lichen planus is not a dangerous disease, and it usually goes away on its own. However, in some people, it may come back.

    How to spot mouth cancer

    Beating mouth cancer is so dependent on diagnosing it at an early stage.

    If it is caught early, the chances of surviving mouth cancer are nine out of ten – those odds are pretty good, and that’s why early detection is so important.

    Sadly, far too many mouth cancers are not spotted early enough.

    Mouth Cancer Action Month promotes the message ‘If in doubt, get checked out’. We encourage everybody to be mouthaware and pay more attention to what’s going on inside the mouth. Most importantly, if you notice anything out of the ordinary, it is essential that you tell your dentist or doctor immediately.

    Checking for mouth cancer

    As mouth cancer can strike in a number of places, including the lips, tongue, gums and cheeks, and given that early detection is so crucial for survival, it’s extremely important that we all know what to look out for.

    Three signs and symptoms not to ignore are:

    • Red and white patches in the mouth.
    • Unusual lumps or swellings in the mouth or head and neck area.

    When checking for signs of mouth cancer you should follow the following routine:

    Head and neck

    Check if both sides look the same and search for any lumps, bumps or swellings that are only on one side of the face. Feel and press along the sides and front of your neck being alert to any tenderness or lumps to the touch.

    Lips

    Pull down your lower lip and look inside for any sores or changes in colour. Use your thumb and forefinger to feel the lip for any unusual lumps, bumps or changes in texture. Repeat this on the upper lip.

    Cheek

    Use your finger to pull out your cheek so that they can see inside. Look for red, white or dark patches.

    Then place your index finger inside your cheek, with your opposing thumb on the outside gently squeeze and roll the cheek to check for any lumps, tenderness or ulcers, repeat this action on the other cheek.

    Roof of the mouth

    With your head tilted back and mouth open wide, your dentist will look to see if there are any lumps or if there is any change in colour. They will run their finger on the roof of your mouth to feel for any lumps.

    Tongue

    Examine your tongue, looking at the surface for any changes in colour or texture.

    Stick out your tongue or move it from one side to another, again looking for any swelling, change in colour or ulcers. Finally, take a look at the underside of the tongue by placing the tip of your tongue on the roof of your mouth.

    Floor of the mouth

    Look at the floor of the mouth for changes in colour that are different than normal. Press your finger along the floor of your mouth and underside of your tongue to feel for any unusual lumps, swellings or ulcers.

    If you find anything unusual in any of these areas, or are unsure of anything, visit your dentist or doctor as soon as possible.

    Resources

    How can mouth cancer be detected early?

    Mouth cancer can often be spotted in its early stages by your dentist during a thorough mouth examination. This happens during your routine dental check-up.

    In the below video, Oral Health Foundation Trustee, Dr Ben Atkins, talks through what to expect from a visual mouth cancer check.


    Useful links:


    Mouth Cancer Action Month is sponsored by Simplyhealth Professionals and in association with the Mouth Cancer Foundation.

    We are proud and delighted to be working alongside both our partners. Their commitment and passion for raising awareness of mouth cancer is vital to the success of our campaign. 

    Published:

    Updated:

    Author:

    Gavin Hawes

    Damage to the oral mucosa and skin in Wegener’s granulomatosis

    Wegener’s granulomatosis (HS) (synonyms: malignant granuloma, non-infectious necrotic granulomatosis).

    For the first time the disease was described in 1931 by H. Klinger. Later F. Wegener (1936, 1939) identified the disease as an independent syndrome with a characteristic triad of signs:

    1) systemic necrotizing vasculitis with damage to small-caliber arteries and venous bed;

    2) glomerulonephritis;

    3) necrotizing granulomatous vasculitis of the upper respiratory tract (URT) [1].

    At present, HS is considered an autoimmune granulomatous inflammation of the walls of blood vessels, with the involvement of the URT, lungs, eyes, kidneys, skin and other organs. The disease belongs to systemic antineutrophilic cytoplasmic antibody-associated necrotizing vasculitis (A) [2].

    The disease can begin at any age (on average, about 40 years), somewhat more often in men, but children rarely get sick. About 15% of patients are under 19 years of age [3].

    The etiology of hepatitis B is unknown; chronic focal infection (nasopharyngeal) may play a role.The hyperreactivity of the humoral link of immunity matters: an increase in serum and secretory IgA, IgG and IgE, there are CEC, autoantibodies of the IgG class.

    The disease is associated with the presence of histocompatibility antigens HLA B7, B8 and DR2, which indicates a certain genetic predisposition.

    Most patients have antibodies to the cytoplasm of neutrophils, mainly to protease-3 [4].

    GV develops gradually: damage to of the upper respiratory tract occurs in 92% and is manifested by rhinitis with ulcerative-necrotic changes in the mucous membrane of the paranasal sinuses, larynx, trachea; there may be purulent otitis media.

    Lung damage is observed in 85-90% of patients and is manifested by cough, shortness of breath, hemoptysis and chest pains. In 1/3 of patients, radiological signs may not be accompanied by clinical manifestations of pulmonary pathology.

    Eye damage, which is observed in 52% of cases, manifests itself in the form of conjunctivitis, dacryocystitis, episcleritis, scleritis, granulomatous scleroouveitis, iridocyclitis, granuloma of retrobulbar tissue and exophthalmos.

    Heart damage is observed in 8% of cases and causes the development of pericarditis, coronary vasculitis, myocardial infarction, mitral and aortic valve lesions, AV blockade.

    Damage to the nervous system is observed in 23% of patients and includes neuropathy of the cranial nerves, multiple mononeuropathy, occasionally cerebral vasculitis and cerebral granulomas.

    Kidney damage occurs in 77% of patients, prevailing in the clinical picture. It may be limited to mild glomerulonephritis with proteinuria, hematuria, and erythrocyte casts, but rapidly progresses in renal failure.

    During exacerbations, nonspecific symptoms appear – malaise, weakness, arthralgia, loss of appetite, weight loss, fever [5].

    Skin lesions are observed in 46% of patients with hepatitis B and are represented by papules, vesicles, palpable purpura. However, nodes and ulcers caused by necrotizing angiitis of the dermal vessels with their thrombosis and necrosis are considered typical manifestations.

    The defeat of the oral mucosa occurs in almost all patients and is manifested by granulomatous growths in the gums, palate, arches, tonsils. They have a bumpy surface, stagnant red color, dense consistency and quickly disintegrate with the formation of ulcers of varying depth.In a number of patients, the process is accompanied by an increase in the submandibular lymph nodes. Necrosis of periodontal tissues, perforation of the hard palate, destruction of soft tissues and bones of the middle third of the face can occur. In this case, when examining the patient, a fetid odor is felt [6].

    There are two forms of hepatitis B – localized and generalized. The first begins with damage to the upper respiratory tract or eyes. Less commonly, the mucous membrane of the mouth and pharynx is primarily affected. In the generalized form, the process begins with damage to the tracheobronchial tree and lungs and is clinically manifested by fever of varying severity, polymorphic rashes, and a cough with purulent-bloody sputum.Then symptoms of damage to other organs join. Possible arthritis, arthralgia and myalgia, anemia, neutrophilic leukocytosis, accelerated ESR. Chondritis of the auricles and other pathological processes may develop.

    The prognosis of the disease is unfavorable. Without timely initiation of treatment, death can occur within 6-12 months. Death occurs more often from renal or cardiovascular failure [7].

    Diagnostics. 90,024 ¼ (25%) of patients in the initial stage do not have signs of kidney or lung damage, and only 50% of patients with hepatitis B is diagnosed in the first 3-6 months from the onset of the disease, and in 7% this disease is not diagnosed even for 5-16 years from the appearance of the first clinical symptoms.

    Typical laboratory findings in hepatitis B are: a significant increase in ESR, anemia, leukocytosis, hypergammaglobulinemia (mainly due to IgA), the appearance of rheumatoid factor, urinary syndrome characteristic of glomerulonephritis, antibodies to protease-3 (ANCA) are found in 90% of patients with lesions respiratory tract and kidney, and only in 70% of patients without kidney damage (T.V. Beketova, 1995).

    The histological diagnosis of hepatitis B is made when necrotizing vasculitis, accompanied by granulomatous inflammation, is detected in the biopsy specimen [8, 9].

    Differential diagnosis is carried out with the median granuloma of the face and lymphomatoid granulomatosis.

    The median granuloma of the face affects only the upper respiratory tract, including the paranasal sinuses, and is accompanied by extensive destruction of soft tissues and ulceration of the facial skin, which is uncharacteristic for HS. Inflammation and necrosis can invade the vessels, but vasculitis is almost never primary.

    Lymphomatoid granulomatosis is a disease from the group of angiocentric lymphomas.With the disease, the lungs, skin, central nervous system and kidneys are affected, where there is an infiltration of the walls of blood vessels and surrounding tissues with atypical lymphocytes and plasma cells. Unlike HS, with lymphomatoid granulomatosis, there is no vasculitis as such, but the formation of granulomas is noted. In more than half of patients, the disease becomes frankly malignant. Determination of the titer of antibodies to protease-3 is of great importance in the differential diagnosis of hepatitis B.

    Differential diagnosis should be carried out with other vasculitis, especially with Churg-Strauss syndrome, as well as with Goodpasture’s syndrome, tumors of the upper respiratory tract and lungs, mucocutaneous leishmaniasis, scleroma, and other infectious and non-infectious granulomatosis.

    Treatment. Since the disease has an autoimmune genesis, the drugs of choice are immunosuppressants: cytostatics in combination with glucocorticoids. Of the cytostatics, cyclophosphamide at a dose of 2 mg / kg / day has proven itself well. Glucocorticoids are prescribed in a dose equivalent to prednisolone 1 mg / kg / day. Good results were shown by pulse therapy with cyclophosphamide at a dose of 1000 mg. There are reports of a positive effect of treatment with human donor polyvalent immunoglobulin.Certain hopes are pinned on anticytokine therapy [10].

    Here is our observation.

    Patient F ., 29 years old, was referred by a dentist for a consultation with a dermatologist at the MNPCDK DZM in the consultative and polyclinic department.

    Complains of severe weakness, bloody-purulent discharge from the nasal passages. Examination of the skin of the face revealed small ulcers on the skin of the left cheek, deep, with purulent-hemorrhagic discharge; on the mucous membrane of the gums there are abundant granulations of a rich pink-red color (Fig.1, 2, 3).

    Rice. 1. Ulcers on the skin of the left cheek.

    Rice. 2. Granulation on the gums.

    Rice. 3. Granulation in the palate.

    Sick since the end of July 2015, when, after placing the nail in the tooth, I noticed the “itching” of the gums, then, within a few weeks, pink-red granulations appeared in the area of ​​the gums of the upper and lower jaw. She repeatedly consulted dentists of various medical institutions in Moscow, but the diagnosis was not made.She underwent courses of antibiotic therapy (unidox solutab, ceftriaxone intramuscularly), without effect. After consulting the patient at the Department of Skin and Venereal Diseases, Moscow State University of Medicine and Dentistry. A.I. Evdokimov was diagnosed with Wegener’s granulomatosis, and a referral was given for inpatient treatment and examination at the Clinic of Nephrology, Internal and Occupational Diseases. EAT. Tareeva.

    Upon admission: on the skin of the right cheek there are four oval-shaped ulcerative defects ranging in size from 7 to 4 mm in diameter.The edges of the ulcers are even, on the surface there are purulent-hemorrhagic crusts, under them there is a rather abundant purulent discharge of a yellowish color. On the mucous membrane of the oral cavity in the area of ​​the gums on the upper and lower jaw, abundant multiple granulations of pink-red color were found without ulcerative defects. Submandibular lymph nodes are not enlarged.

    There are no side respiratory sounds in the lungs. Heart sounds are clear, rhythmic, blood pressure is 110/80 mm Hg.

    Data of instrumental and laboratory research methods.General blood analysis: ESR – 11 mm / h, general urine analysis – no pathology; urine analysis according to Nechiporenko – no pathology, blood biochemistry – no pathology, coagulogram – fibrinogen within normal limits. Antibodies to HIV – negative, HBsAg – negative, quantiferon test – negative, seroreaction – negative.

    Complete blood count normal, C-reactive protein – 33.3 mg / l (normal – 0.0-5.0 mg / l), antibodies to proteinase-3 (c-ANCA) – 13.42 U / ml (the norm is 0-5 U / ml).

    ECG: sinus arrhythmia; mild changes in the myocardium.

    Ultrasound of the abdominal organs: slight diffuse changes in the liver and pancreas.

    Computed tomography (CT) of the chest organs: no organic changes were found.

    ENT examination: the nasal septum is thickened in the upper sections. The mucous membrane of the nasal cavity is bright pink, moist, moderately edematous. There is a thinning of the mucous membrane, areas of inflammation with a small amount of crusts are revealed. Nasal passages: the inferior turbinates are enlarged on both sides.Swollen.

    Oral cavity: there is granulation tissue in the gingival mucosa of the upper and lower jaw. Granulation inflammation of the mucous membrane in the area of ​​holes 6 and 7 teeth.

    Oropharynx: the palatine arches are hyperemic. Palatine tonsils are not enlarged, scar-changed. The posterior wall of the pharynx is hyperemic. Hyperemia of the lateral ridges, posterior pharyngeal wall, more on the right.

    Diagnosis: necrotizing rhinitis, perichondritis, right-sided sinusitis, sphenoiditis.

    Data from additional examination methods: CT data of the nose and paranasal sinuses: CT signs of inflammatory changes in the right maxillary and main sinuses.

    Pathohistological examination: the preparation contains fragments of the gingival mucosa covered with multilayer squamous non-keratinizing epithelium with foci of necrosis, leukocyte infiltration and symptoms of papillomatosis and acanthosis. In the lamina propria of the mucous membrane and submucosal layer, foci of necrosis are found, as well as fields of granulomatous tissue from plasma cells, macrophages, lymphocytes with an admixture of leukocytes, rich in capillary-type vessels with phenomena of destructive-productive vasculitis.

    Conclusion: chronic granulomatous inflammation of the oral mucosa is a local form of hepatitis B.

    The patient was prescribed treatment: prednisolone 40 mg / day, methotrexate 10 mg / day (2 times), biseptol 960 mg / day, folic acid 3 mg / day (5 days a week), omez 20 mg / day, calcium D 3 nikomed forte 400 IU / day

    As a result of treatment, an improvement in the condition was noted: a decrease in nasal congestion, epithelialization of skin defects, granulomatous lesions on the gingival mucosa regressed.

    Was discharged in satisfactory condition under the supervision of a rheumatologist, therapist, ENT doctor.

    There is no conflict of interest.

    90,000 Major diseases of the oral mucosa

    The mucous membrane of the oral cavity protects tissues from damage, penetration of microorganisms and toxic substances. And the presence of many capillaries that shine through the epithelium give it the pink color we are accustomed to.

    The structure of the oral mucosa differs in its different areas – in areas where mechanical loads are significant, the epithelium is keratinized, and in areas where greater flexibility is required from the tissues, they are covered with non-keratinized epithelium.The dorsum of the tongue is covered with epithelium, consisting of keratinizing and non-keratinizing epithelium.

    The keratinized epithelium contains four layers: basal, spinous, granular and horny.

    Non-keratinizing epithelium contains an intermediate layer instead of a granular layer, and a superficial layer instead of a stratum corneum.

    On the mucous membrane of the oral cavity, pharynx and epiglottis there are taste buds – the organs of human taste. The cells that form the taste bud are modified epithelial cells, some of which, lying at the top of the kidney, are taste receptors.Food particles dissolved in saliva come into contact with taste receptors, passing through small holes in the epithelium of the mucous membrane – taste pores.

    Prevention and treatment of mucosal diseases never lose their relevance, due to the high prevalence of this pathology.

    Depending on the localization of the inflammation focus, there are stomatitis, glossitis, gingivitis, periodontitis and other diseases.

    First of all, it is necessary to eliminate local and general factors leading to pathological processes in the oral cavity.The cause of mucosal lesions may be a systemic disease, in such cases, specific therapy is prescribed

    There is practically no pathology that would not be reflected in the condition of the oral mucosa.

    At the same time, the similarity of clinical manifestations in the oral cavity of diseases of different etiology and pathogenesis contributes to the difficulties in making the final diagnosis. The study of combined lesions of the skin, internal organs, oral mucosa, their relationship with general pathology is necessary for the doctor for the correct diagnosis.There is a relationship between most of the pathological processes occurring between the mucous membrane of the mouth and the red border of the lips and various organs and systems of the body, therefore, it is the lesions of the oral mucosa that are often the first signs of metabolic disorders, as well as various general somatic diseases.

    In all cases, thorough oral hygiene and sanitation is required.

    Antifungal agents are used for candidiasis, antibiotics for bacterial infections.For extensive painful lesions, mouth rinses are prescribed. Sometimes medical intervention is required: removal of tartar, replacement of fillings, surgical plastic surgery of the vestibule of the mouth and frenum.

    Most common oral diseases:

    Stomatitis – inflammation of the oral mucosa.

    Symptoms – inflammation and extremely unpleasant sensations in the oral cavity (burning, dryness), sometimes the disease is accompanied by fever.

    First of all, you need to determine the cause of stomatitis (the therapist will help you with this) and begin to eliminate it. Treating stomatitis with folk remedies, such as rinsing with soda, will only help relieve symptoms, but will not relieve you of the disease, and stomatitis will reappear.

    Stomatitis must be treated, it does not go away on its own over time.

    Glossitis – inflammation of the mucous membrane of the tongue.

    Most often, only the mucous membrane of the tongue is inflamed, but with deep trauma to the tongue in the thickness of the muscles, purulent inflammation with swelling of the tongue, impaired swallowing and high body temperature can develop, sometimes an abscess is formed.

    Inflammation of the mucous membrane of the tongue often provokes the development of many diseases. More often, glossitis proceeds in a catarrhal form: the tongue is slightly swollen, the mucous membrane is red, rawness and soreness are felt.

    A general examination of the patient is often necessary to identify diseases of the internal organs that caused inflammation of the mucous membrane of the tongue. Therefore, it is important to consult a dentist on time, to fulfill all his appointments. Self-treatment is fraught with complications.

    Symptomatic treatment is carried out by a dentist and a physiotherapist, consultations and treatment are prescribed by appropriate specialists – a gastroenterologist, endocrinologist, hematologist.

    Gingivitis is an inflammation of the gums accompanied by swelling, redness and bleeding.

    This is a fairly common disease. Distinguish between acute, chronic and recurrent forms of the disease.

    The most common cause of gingivitis is poor oral hygiene, which results in tartar formation.Also, factors such as bite pathology, improperly applied or outdated fillings, and mouth breathing play a role in the occurrence of gingivitis.

    Gingivitis is more common in adolescents and pregnant women due to hormonal changes in the body.

    Gingivitis can also be a sign of a systemic disease (for example, herpes, allergies, vitamin deficiency, leukopenia, debilitating disease, diabetes mellitus).

    Also, long-term use of certain drugs, for example, oral contraceptives, can increase inflammation in the gums.

    Symptoms of gingivitis – the gum becomes inflamed, swelling occurs, its contour changes. Due to edema, the gingival groove between the tooth deepens and a so-called gingival pocket is formed. As a result, there is redness of the gingival margin, swelling and bleeding of the gums, the gums become sensitive and painful, and there are difficulties in chewing and swallowing.

    Treatment of gingivitis consists in influencing dental plaque, eliminating local and general predisposing factors and should be carried out only by a dentist.Sometimes significant medical intervention is required: thorough removal of calculus, replacement and grinding of overhanging or poorly fitted fillings, in some cases, surgical intervention is necessary.

    Gingivitis often indicates a decrease in the body’s own defenses, therefore, treatment should be aimed not only at eliminating the inflammatory process, but also at increasing immunity.

    Preparations of the group of immunocorrectors activate the defenses of the oral mucosa and contribute to the enhancement of phagocytic activity (phagocytosis – the capture and neutralization of bacteria by the cells of the immune system), an increase in the content of a special enzyme in saliva – lysozyme, known for its bactericidal activity, stimulation and an increase in the number of immunocompetent cells responsible for the production of antibodies.

    For successful prophylaxis of gingivitis, it is enough to remove dental plaque daily with toothpaste and floss, undergo regular examinations and professional teeth cleaning at the dentist every 6 months.

    Cheilitis – inflammation of the red border of the mucous membrane or skin of the lips

    Usually develops with trauma and cracked lips, due to burns, prolonged exposure to the sun or frost in windy weather.

    Fungal cheilitis is combined with a fungal infection of the oral mucosa, but it can also occur in isolation on the red border of the lips, usually in the elderly.With the long-term existence of a fungal seizure on the skin of the lips, diffuse redness, peeling, slight swelling, small cracks may develop. The picture resembles a common eczema.

    Cheilit catarrhal

    Inflammation of the red border of the lip, which occurs under the influence of biological, mechanical, chemical, physical stimuli, sometimes due to damage during medical procedures.

    Clinical picture. There are foci of hyperemia with subsequent destructive disorders in the form of erosion, ulcers.Characterized by edema, desquamation of the epithelium.

    Cheilitis treatment

    The task of cheilitis treatment at the dentist is to normalize the stereotype of lip closure. An external sign of physiological architectonics is the equality of the width of the proper red border of the upper and lower lips, that is, the closure along the line dividing the mucous membrane and the red border.

    Cheilitis therapy complex includes:

    • Normalization of nasal breathing by eliminating the habit of breathing through the mouth or by treating diseases of the nasopharynx
    • correction of malocclusion
    • myotherapy to restore the normal tone of the circular muscle of the mouth

    What are the diseases of the oral cavity and gums – dentistry DS

    Stomatitis

    This is a group of diseases characterized by inflammation of the oral mucosa with hyperemia, edema, and an increase in the amount of mucus in the oral cavity.Depending on the severity and depth of the lesion, even sores or foci of necrosis can form in the oral cavity, which sharply violate the general condition – fever, weakness, anxiety, refusal to eat.

    There are many causes of the disease: mechanical, chemical, thermal, bacterial factors. Contaminated nipples, toys, and other items that enter the baby’s mouth are often the cause of illness in infancy. Often stomatitis develops with infectious diseases (measles, scarlet fever, influenza, whooping cough, etc.) The mucous membrane of the oral cavity becomes bright red, becomes edematous, teeth imprints are visible on the mucous membrane of the cheeks and tongue. Saliva becomes viscous, stringy. The mucous membrane is covered with a whitish coating. Tongue dry, edematous, often with a brown tint, painful chewing. The duration of the disease is from 1 to 3 weeks, the prognosis is favorable.

    The general preventive rule for children and adults is to observe good oral hygiene.

    Gingivitis

    Inflammatory process, in which there is swelling and soreness of soft tissues.With late treatment, the problem is aggravated and becomes chronic.

    Main causes of gingivitis:

    • Poor oral hygiene;
    • thermal or chemical burns;
    • use of certain medications;
    • unbalanced diet (insufficient amount of vitamins in food)
    • smoking;
    • some infectious diseases;
    • gastritis;
    • ulcerative processes in the digestive system;
    • caries.

    Forms and varieties of gingivitis

    Depending on the clinical situation and the nature of the development of the disease, acute and chronic gingivitis are distinguished.
    Acute gingivitis manifests itself as the classic signs of the disease: redness, swelling and bleeding of the gums.
    Chronic gingivitis develops more calmly, without pronounced signs, but gradually leads to the proliferation of gum tissue (hyperplasia), which entails a partial and complete coverage of the surface of the tooth crown by the gum.

    Preventive measures

    Following simple rules can reduce the likelihood of serious oral diseases:

    • Brushing your teeth at least 2 times a day after eating;
    • Use of dental floss and mouthwash;
    • Rational nutrition;
    • Quitting bad habits;
    • Visit the dentist at least once every six months.

    Periodontitis

    Periodontitis is an inflammation of the periodontal tissues, which includes the teeth, ligaments, cement and gums.Periodontitis as a disease is a consequence of gingivitis, a minor inflammation of the gums, the main cause of which is neglect of oral hygiene. If, with gingivitis, inflammation extends exclusively to soft mucous membranes, then with periodontitis, the ligaments that hold the teeth in the holes suffer. That is why, in 90% of cases, when diagnosing this disease, teeth mobility is observed, which eventually leads to their loss.

    The most common causes of the disease are the following:

    1.Improper or irregular oral care 90 120. Dental plaque, which is present on the surface of the teeth and in the interdental spaces, is not as safe a substance as it might seem at first glance. Soft and easily removable in the beginning, it goes through certain cycles of “development”. The result is plaque mineralization and its transformation into hard tartar. This process in most cases is observed in those who do not pay due attention to the daily care of the oral cavity or use an incorrectly selected toothbrush, toothpaste and rinse aid.

    2. Poor blood supply to the gums 90 120. Periodontitis is one of the most common problems in smokers. Substances contained in tobacco smoke lead to narrowing of the vessels of the oral mucosa and their fragility, which impairs the blood supply to the tissues of the gums and the supporting apparatus of the teeth. The lack of chewing load caused by eating habits (for example, the predominance of soft foods in the diet) also contributes to the slowdown of blood circulation and, as a result, the development of periodontitis.

    3.Nutrient Deficiency 90 120. The lack of fresh vegetables, fruits, herbs, a sufficient amount of fish, meat and fermented milk products in the diet quickly leads to a lack of essential substances in the gum tissue. If improper nutrition is of the nature of a constant habit, then over time metabolic processes are disrupted in the gums, which creates the basis for inflammation and periodontitis. Deficiency of vitamins A, C and group B can lead to negative consequences.

    Treatment of periodontitis

    Professional teeth cleaning is an integral step in the treatment of periodontitis.This procedure removes physical obstacles (plaque and calculus) that prevent the gums from returning to their original position and tightly gripping the teeth.

    Drug treatment – the use of topical antiseptics. This need is due to the high risk of spreading inflammation and infectious process to other tissues.

    Surgical treatment

    In the advanced stage of periodontitis, when the inflammation has spread deep into the bone tissue, surgical intervention becomes necessary.Such manipulations include partial excision of the gums (gingivectomy), rinsing periodontal pockets with medicinal solutions, removing stones, and flap operations. In some cases, surgical treatment of periodontitis involves the implantation of bone substitutes or the imposition of collagen or artificial membranes to restore the supporting apparatus of the tooth.

    Compliance with the rules for the care of the oral cavity

    Without the regular removal of plaque and the protection of the oral cavity from bacteria, it is impossible to achieve sustainable results in the treatment of periodontitis.Hygiene procedures twice a day with the right products, the use of dental floss and rinses will help make your recovery faster.

    Periodontal disease

    Periodontal disease of teeth is a serious disease in which the last stage of gum inflammation occurs. This is often the cause of the development of infectious diseases, gastritis, stomach ulcers or cirrhosis of the liver. Even more often, the patient simply falls out of his teeth, and he cannot lead his usual way of life, eat his favorite food.

    How to recognize periodontal disease

    Signs of this dental disease are indistinct, blurred. The patient is most often worried about:

    • Exposure of the necks of the teeth;
    • presence of tartar;
    • burning gums;
    • Discomfort while eating.

    There are 3 stages of periodontal disease:

    • Light. The patient has no complaints, very rarely there is a reaction to cold or hot food.The presence of periodontal disease can be determined during a dental examination. Mild disease is best treated.
    • Medium. The roots of the teeth are bare by an average of 4-6 mm. The patient begins to worry about a burning sensation in the mouth, there is an acute reaction to the intake of hot, cold or acidic foods.
    • Heavy. The roots of the teeth are exposed by 8-10 mm. Chewing food is very painful.

    Treatment methods

    Diagnostics

    Before starting the treatment of periodontal disease, the dentist conducts an initial examination, which determines the degree of damage to the teeth and gums: which teeth need to be restored, and which ones will have to be removed.This is necessary in order to draw up an algorithm for further actions. The patient is then referred to a diagnostic room for targeted and panoramic X-rays. According to them, the periodontist determines the depth of the pockets and the condition of the bone tissue.

    Removal of plaque and calculus

    Inflammation of the gums, which is always observed with periodontal disease, mainly occurs due to soft plaque, subgingival and supragingival calculus. The main reason for their appearance is poor oral hygiene.Therefore, the specialist’s task is not only to treat the disease, but also to educate the patient in proper hygiene.

    General and local therapy

    To increase immunity, the patient is prescribed a complex of vitamins and anti-inflammatory drugs. If the inflammation is insignificant, the dentist prescribes a course of local therapy, which can be carried out independently at home.

    Splinting of teeth

    An increase in the mobility of the teeth indicates that the jawbone and soft tissues around them began to rapidly deteriorate.To avoid changing the position of the teeth and their loss (for example, they can fan out), they are held together with fiberglass tape and filling material. It is also necessary before surgical treatment.

    Surgical operations

    If the periodontal pockets reach 5-10 mm, it is impossible to prevent the progression of the disease without surgery. First, the pockets are cleaned of granulations and food deposits. This procedure is called curettage. It is of two types – open and closed.

    Closed is carried out with special instruments, curettes. It is carried out only in case of periodontal disease at the initial stage (pockets reach 3 mm), when there is a slight inflammation of the gums.

    Open curettage is necessary at the advanced stage of periodontal disease. With its help, all granulation and food deposits are completely removed. This operation is more difficult to perform. To completely empty the pockets, incisions are made in the gum. The mucous membrane flaps are peeled off the bone and the root surface is cleaned with curettes and an ultrasonic scaler.To restore bone tissue, the periodontist implants synthetic bone.

    Next, the patient undergoes a flap operation to prevent the gum from dropping. The doctor removes the 1.5 mm marginal strip of the gums, since after prolonged inflammation the gums are modified in such a way that they can no longer adhere to the tooth normally. After that, the flaps of the mucous membrane are pulled to the neck of the tooth.

    Timely diagnosis and selection of the correct treatment will help stop periodontal disease and maintain healthy teeth!

    Lichen planus

    Lichen planus

    Lichen planus (LP) is a chronic disease, which, in its external manifestations, is distinguished by a rather large variety of rashes, in the form of nodules on the skin, mucous membranes, the mucous membrane of the mouth and the red border of the lips are especially often affected.

    Key Facts:

    • Lichen planus is a disease of unknown etiology, but can manifest itself as an allergy;
    • The disease affects approximately 1–2% of people;
    • Lichen is more common in women;
    • The disease is much more common in people over 50 years of age;
    • Lichen planus is not contagious;
    • Causes damage to the skin, oral mucosa and genitals;
    • If the disease occurs in the oral cavity, then various forms of lichen planus are possible – from white, lace-like stripes to erosions and ulcers;
    • White lesions during lichen planus disease are most often painless, erosive – accompanied by pain and burning;
    • Treatment of lichen lichen in humans can be both simple and quite complex, it depends on the timeliness and correctness of the prescribed treatment;
    • Gum disease is accompanied by desquamation, gums may bleed profusely;
    • Lichen planus may appear as a reaction to medications, filling materials, certain oral hygiene products, hard candy and even chewing gum;
    • Quite often, nervous disorders play a significant role in exacerbating the symptoms of the disease;
    • Lichen planus may be temporary or chronic;
    • Psoriasis and lichen planus are different concepts.

    The causes of mouth lichen can be very different.

    Lichen planus on the mucous membrane can occur due to an allergic reaction to certain medications that can become a strong impetus for the onset of the disease – these are beta-blockers, antimalarial drugs, non-steroidal anti-inflammatory drugs, some inhibitory drugs, as well as sulfanyl drugs. Also, stress and weakening of the immune system can become the cause.

    Most often, with the defeat of lichen planus of the oral mucosa, people feel in the mouth:

    – slight tuberosity, roughness,

    Photo 1.2. Typical form KPL

    – the mucous membrane becomes very sensitive to the temperature and taste of food – sourness, pungency, and so on.

    – painful sensations in the mouth – an uncomfortable condition of the gums, palate, as well as small ulcers throughout the mouth.

    Photo 3.Erosive and ulcerative form of KPL

    Photo 4.5. Hyperkeratotic form of KPL

    Causes of the disease.

    The causes of lichen planus are disorders of metabolism and immune processes in the human body. This is what causes a completely inadequate reaction of surface tissues. Genetic factors can also affect the occurrence of LP.

    The main theories of the onset of the disease are allergic, stressful, toxic, viral.

    The disease can also occur as a result of pathology of the gastrointestinal tract, kidneys and liver, diseases of the endocrine and vascular systems, as well as injury to the oral mucosa.

    Certain medications may also be the culprits, which, having had a damaging chemical effect, caused an allergic reaction, followed by lichen planus.

    Treatment of lichen planus.

    Successful treatment of lichen lichen is possible only if individualized, complex treatment is applied and only modern methods and means are used.During treatment, it is necessary to take into account the factors that contributed to the onset of the disease. These factors must initially be eliminated.

    90,000 causes, symptoms, diagnosis and treatment in adults – Dentistry in Moscow – Clinic of the Central Clinical Hospital of the Russian Academy of Sciences

    The oral cavity is covered with mucous membranes. Inflammation of this layer of the epithelium is stomatitis. The disease is an immune response to the occurrence of adverse factors. Previously, stomatitis was considered an exclusively childhood disease, but today it increasingly affects adult patients.Often, the zones that are affected by the disease are lips, cheeks, palate.

    Causes of stomatitis

    There are several reasons that provoke stomatitis:

    • Attachment of infection – viruses and bacteria that colonize very quickly, revealing damaged areas of the mucous membrane.
    • Improper nutrition – if the diet is too meager, the body does not have enough strength and resources to fight off the pathogens attacking it.
    • Wounds and other injuries in the mouth – these can be scratches from sharp edges of teeth with carious cavities, bitten cheeks, cracked lips, burns.
    • Poor oral hygiene – inadequate cleaning of the teeth and tongue leaves a plaque in which bacteria multiply very quickly.
    • Lack of hygiene in general – dirty hands, unwashed fruit that become a source of bacteria.
    • Consequences of a dental intervention performed in violation of the norms.
    • Use of pastes with sodium lauryl sulfate, which reduce salivation. In such a situation, the epithelium can dry out and, as a result, it is not enough to resist bacteria.
    • Alcohol and smoking.
    • Chronic diseases of a general nature that affect the state of the body, digestion of food, and other vital processes.

    What stomatitis can tell about

    The appearance of stomatitis may indicate the appearance in the body of some more serious pathologies. Sometimes stomatitis is a concomitant symptom of conditions such as:

    • Transferred ionizing radiation or chemotherapy.
    • Oncological diseases of the nasopharynx, mouth, neck.
    • Disorders in the digestive tract, intestinal parasites.
    • HIV infection.
    • Prolonged dehydration.
    • Hormonal disorders in women.
    • Diabetes mellitus.
    • Anemia.
    • Bronchial asthma.

    Types of stomatitis

    1. Viral. Infection with Epstein-Bar virus or herpes simplex.It manifests itself in the form of bubbles, in the place of which erosion subsequently occurs.
    2. Bacterial. Caused by the multiplication of streptococci and staphylococci. Looks like pustules turning into wounds.
    3. Fungal. Decreased immunity and multiplication of Candida fungi. It looks like small foci of white plaque, after damage of which painful erosion remains.
    4. Chemical. Burns with acids and alkalis.Deep ulcers with the formation of scars and mucosal deformities.
    5. Beam. Arising from exposure to ionizing radiation. Expressed in the form of erosion and tissue deformation.
    6. Allergic. Occurs as a reaction to medication, dentures.

    Stomatitis symptoms

    Stomatitis can be recognized by a number of symptoms, the most common of which are:

    • Redness with swelling and soreness.
    • Subsequent formation of ulcers with an even edge under a thin film (with bacterial stomatitis).
    • Burning and pain at the site of the lesion.
    • Increased saliva secretion, characteristic odor from the mouth.
    • Bleeding gums.
    • Rise of temperature, local or throughout the body.
    • The appearance of ulcers is often concentrated on the inner side of the lips, it is also possible to damage the area under the tongue, tongue and gums, the inner surface of the cheeks.

    Stomatitis treatment

    You can get treatment in the paid dentistry of the Central Clinical Hospital of the Russian Academy of Sciences. The approach to the process depends on the nature of the disease and the cause of its occurrence:

    1. If the stomatitis is catarrhal, that is, arising as a result of non-compliance with hygiene standards, it can be cured quite simply, in a week at home. To do this, it is necessary to exclude irritating foods from the diet – sour, hot, spicy, salty, etc. Rinse your mouth with solutions that fight germs.
    2. If there are more serious manifestations, indicating an infectious lesion, an appeal to a dentist or therapist is a prerequisite for the correct fight against the disease. At the consultation with a dentist, after examination and questioning, the doctor will prescribe treatment. These are measures to relieve pain, relieve inflammation, and fight infection. Both rinses, local preparations, and general-action drugs in the form of tablets are used.
    3. Stomatitis due to allergies is not considered a disease in its own right.The treatment is based on identifying the object that caused the allergy, taking antihistamines.
    4. Treatment of herpetic stomatitis is similar to the elimination of other types of stomatitis. It consists in taking drugs for edema and pain, application with drugs and rinsing, antiviral, antihistamines, as well as means to restore immunity.
    5. Candida stomatitis is treated with oral antifungals, topical fungal agents.To increase the effectiveness of treatment, it is recommended to exclude or minimize the use of simple carbohydrates, since it is sugars that are the main food for mushrooms.

    Prevention

    The most common reason for the onset of the development of the disease is trauma to the oral mucosa. That is, damage is the first thing to beware of. Sharp edges of teeth, broken or poorly sealed, burns and other factors that can lead to the appearance of minimal wounds should be excluded.In addition, it is recommended:

    • Carefully observe hygiene, both in the mouth and in the rest – wash the products before use, keep your hands and nails clean.
    • Gently brush and floss your teeth, do not use low-quality toothpastes.
    • Keep dentures, if any, clean.
    • At the first manifestations of anxiety, consult a dentist immediately.
    • Monitor the general condition of the body, the digestive system.
    • Give up bad habits.

    Attention to your body and a timely visit to dentistry in Moscow on the basis of the Central Clinical Hospital of the Russian Academy of Sciences will help to avoid the disease or stop it at the very beginning, avoiding complications.

    90,000 Learned the language: COVID can cause oral lesions | Articles

    Dentists warn: coronavirus can cause a number of inflammatory processes in the mouth of patients.In particular, doctors from Brazil described the occurrence of ulcers and plaques, as well as cracks in the tongue in an elderly patient hospitalized with COVID-19. In addition, those infected may develop a taste disorder, fungus, candidiasis and other pathological conditions in the mouth. Russian experts believe that such symptoms can be observed as secondary manifestations of infection, as well as side effects from taking medications, in particular antibiotics. Moreover, dental problems themselves can serve as a risk factor for infection, as they weaken the protective functions of the body.Therefore, it is advisable to include a dentist’s examination in the list of necessary studies for COVID-19.

    Secondary lesion

    Scientists from the Oral Histopathology Laboratory, Faculty of Public Health, University of Brazil described oral mucosal lesions in a patient with coronavirus infection in their article. An elderly man who was admitted to the hospital with COVID-19, in addition to losing taste on the 24th day of hospitalization, developed yellow sores in the mouth, similar to herpes, as well as deep cracks and a specific white plaque on the back of the tongue.Dentists were called in to assess these injuries. Doctors came to the conclusion that these are secondary lesions resulting from systemic deterioration in health due to COVID-19.

    Photo: RIA Novosti / Varvara Gertier

    Scientists also reported that among the oral signs and symptoms of coronavirus, dysgeusia (taste disorder. – Izvestia), petechiae (punctate hemorrhages in the form of red bumps), candidiasis, traumatic ulcers and other various lesions of the tongue and mucous membranes can be found. Therefore, it is advisable to include a dental examination in the list of necessary studies for COVID-19.

    “The relevance of the dentist as part of an interdisciplinary team to support critical patients in intensive care units should be emphasized,” the article says. In addition, dental care should be provided after the patient is discharged from the hospital.

    Hides in the mouth

    Despite the fact that no dental symptoms specific to COVID-19 have yet been found, the infected often develop conditions caused by the general effect of the infection on the body.For example, many patients complain of dry mouth. As Izvestia was told by the head of the Department of Therapeutic Dentistry of the First Moscow State Medical University. THEM. Sechenova Irina Makeeva, this often happens in people with diabetes. Also, this symptom can be a side effect of drugs that are used in the treatment of coronavirus: diuretics, blood pressure lowering, antiallergic.

    – Probable occurrence of persistent lymphadenitis (enlargement of lymph nodes. – “Izvestia”) for no apparent reason. Scientists also reported that patients with COVID-19 on the body and on the oral mucosa may develop ulcers that have never been seen before , the specialist explained. – A very common symptom is the disappearance of gustatory sensitivity. Patients characterize food intake as “chewing soap, cotton wool” .

    Photo: TASS / dpa / picture-alliance / Hendrik Schmidt

    The situation when the coronavirus becomes the cause of diseases of the oral cavity is quite possible, Maret Khashiyeva, Director General of the German Dental Implant Center, told Izvestia.Against the background of this infection, diseases such as herpes and stomatitis can appear.

    – This is due to a decrease in immunity. Diseases of the oral cavity can also be provoked by drugs that are prescribed for the treatment of coronavirus infection. These primarily include antibiotics. Taking them, especially for a long time, disrupts the balance of microflora, which can cause the development of candidiasis (thrush) of the oral cavity , the expert emphasized.

    Moreover, people with dental problems are at risk of contracting coronavirus.Among the diseases that increase the risk of infection, various types of stomatitis, gingivitis and periodontitis can be distinguished, Maret Khashiyeva noted. As for caries, in itself it is not a “gateway” for infection, but immunity in any case will be “distracted” by such lesions. And this greatly weakens the body’s defenses.

    The ubiquitous enzyme

    The reason the coronavirus can damage the mucous membranes of the mouth and tongue is not only in a general drop in immunity and drug therapy.According to Irina Makeeva, SARS-CoV-2 is able to bind to the ACE-2 molecule (angiotensin-converting enzyme 2 – a membrane protein, the gateway for the virus into cells – Izvestia) and is expressed (multiplied) on the epithelial cells of the oral mucosa.

    – In the latest published data, it was found that the cells of the oral cavity have a high expression of ACE-2, comparable to the cells of the lung tissue, – explained the expert.

    Thus, most oral tissues contain target cells for the Wuhan pathogen.However, so far it is impossible to draw a clear parallel between the manifestations of dental diseases and the severity of coronavirus infection, since there are too few statistical data and clinical observations available, the chief physician of a private dental clinic Marina Kolesnichenko told Izvestia.

    Photo: Izvestia / Kristina Kormilitsyna

    – Such patients are not under the supervision of a dentist, because an infectious disease must first of all be treated.The only exceptions are cases requiring immediate dental care, the expert emphasized.

    As for carrying out dental examinations in intensive care units, there are a number of difficulties, experts noted. A large number of viral agents are found in saliva and blood. In this case, there is a high probability of infection of medical personnel. Therefore, such events are not being held now. However, according to the Sechenov University, a dental examination can be recommended for patients in intensive care units.With due observance of safety measures to correct the general hygienic status of the subject and reduce the negative impact of inflammatory diseases on the course of infection.

    Oral cavity cancer – DZM

    is a malignant neoplasm that affects the lips (most often the lower lip), the inner surfaces of the oral cavity, as well as the back of the pharynx, tonsils and salivary glands. The disease is more common in men, usually people over 40 years of age.

    Causes and risk factors.

    • Smoking, including chewing and sniffing tobacco.
    • Drinking alcoholic beverages.

    ! With a combination of these two factors, the likelihood of damage to the oral cavity increases.

    • Male
    • Sharp filling edges, an uncomfortable denture, or other factors that have a traumatic effect on the oral mucosa can lead to the development of cancer.
    • Infection of the cavity with papilloma virus, which belongs to the sixteenth type, can cause cancer.
    • The presence of red lichen planus of the mucous membrane of the oral cavity flat – the threat of cancer.
    • Weakening of immunity with systemic administration of chemicals is a risk factor for the onset of oncology.
    • Malnutrition with insufficient intake of fruits and vegetables and a deficiency of antioxidants – vitamins A, C and E creates conditions for the growth of cancer cells.
    • Frequent exposure to asbestos contributes to oral cancer. Polycyclic organic compounds have the same adverse effect on humans.

    Clinical manifestations.

    • thickening of the tongue, resulting in discomfort while eating and talking,
    • numbness of the tongue,
    • numbness of the gums, some teeth,
    • loss of teeth for no apparent reason,
    • jaw edema,
    • chronic oral pain,
    • Chronic enlargement of lymph nodes located in the neck,
    • voice change,
    • weight loss,
    • the appearance on the lips or in the mouth of a formation that does not go away for a long time and tends to increase in size, it may be:
      • red spot,
      • whitish spot,
      • ulcer,
      • seal,
      • build-up.

    ! These phenomena may not be cancerous, but reborn in them over time.

    Formations go through three phases of development:

    • Initial stage – a person notices unusual phenomena in the state of health of the oral cavity. There are unclear pains, seals, ulcers in the mouth.
    • The advanced stage of the disease – ulcers become in the form of cracks.They can be located over the tumor. There are painful sensations that can radiate to different areas of the head. Cancer can develop without severe pain.
    • The neglected stage – the disease is actively destroying the surrounding tissues.

    Forms of oral cavity cancer (classification by appearance):

    • Knotty – A clear-cut seal appears in the mouth. The surface of the mucous membrane in this place either does not change, or has whitish spots.New education usually grows rapidly.
    • Ulcerative – manifests itself as an ulcer on the mucous membrane. It worries the patient and does not heal for a long time. Pathology in the form of an ulcer progresses rapidly. This form of oral cancer affects the mucous membranes more often than other types.
    • Papillary – looks like a tumor of a dense structure that hangs down into the oral cavity. The cover of the mucous membrane does not change externally.

    (cancer of the oral mucosa in the initial stage)

    Certain types of tumors of the oral cavity.

    Depending on the location of the formation, the following are distinguished:

    • Cheek cancer – Dislocation of education often on the line of the mouth, at the level of its corner. It may look like a sore at first. Over time, there are restrictions in opening the mouth, discomfort when chewing and talking.
    • Cancer of the floor of the mouth – The tumor is located on the muscles of the floor and can invade nearby areas: the lower part of the tongue and into the salivary glands. The patient complains of pain and increased salivation.
    • Tongue swelling – Difficulties with chewing and discomfort while using the speech apparatus are sometimes the result of oncology of the tongue. The tumor is deployed on its lateral surfaces – cases of this pathology are common. Less commonly, cancer occurs on the lower surface of the tongue or on its upper part, affects its root or tip.
    • Tumor in the area of ​​the alveolar processes – The problem can be located on the upper and lower jaw.Cancer can also affect the teeth, causing bleeding and pain in these areas.
    • Cancer in the area of ​​the palate – Depending on which tissue is affected, a different form of cancer of the palate appears. If soft tissue is engulfed, a cancer called squamous cell develops. The hard palate can have a disease: cylindroma, adenocarcinoma, and a squamous cell is also found. The problem manifests itself in the appearance of pain and discomfort while eating.
    • Metastases:
      • Cancer can actively grow into adjacent layers.The spread of the tumor depends on its type and location. The development of the disease occurs in the advancement of cancer cells to the lymph nodes.
      • Cancer of the mucous membrane of the cheeks and alveolar processes of the lower jaw triggers metastases in the area of ​​the submandibular nodes. Formations that have arisen in the distal regions metastasize to the nodes near the jugular vein.
      • Cancer of the tongue, located in the region of its tip and lateral surfaces, progresses to the lymph nodes of the neck, and can also invade the submandibular nodes.
      • At
        pathology – cancer of the oral cavity occurs, but rarely distant metastases.
        They spread to internal organs:
        liver, lungs, brain, heart, and also into bone tissue.

      (bottom cancer
      oral cavity)

    Diagnostics.

    • The specialist determines the tumor visually.
    • The laboratory method for determining the clinical analysis of peripheral blood allows you to assess the general condition of the patient and detect anemia (anemia), and with a biochemical blood test, liver and bone damage can be suspected.
    • The degree of spread of the disease into soft tissues is diagnosed by palpation and the use of instrumental imaging methods:
    • Biopsy – taking a piece of tissue for examination in order to confirm the diagnosis of a tumor. Material can be obtained as a result of scraping in the area of ​​a suspicious area, puncture with a fine needle, or surgical removal of part of the tumor.
    • Chest X-ray makes it possible to identify damage to the lung tissue, which is rare, but possible with a widespread tumor process.
    • Computed tomography (CT) (CT), sometimes with the addition of a contrast agent, helps determine the size, shape and location of the tumor, as well as the presence of enlarged lymph nodes.

    Treatment.

    There are various treatments for cancer. The choice of the method depends on the stage of development of the neoplasm and its form.

    Surgical . If it is impossible to do without cutting off the tumor, surgical intervention is used.After removal of the formation, manipulations can be carried out to restore the impaired appearance of the patient.

    Radiation therapy . This method is used most often in the fight against cancer of the oral cavity. It can be used on its own or after surgery.

    For small tumors, radiation therapy may be the primary method. After the operation, the method helps to relieve pain, neutralize the remainder of cancer cells, and improves the ability to swallow.

    If necessary, use brachytherapy (internal irradiation). The rods containing the material for irradiation are implanted into the tumor for a certain time.

    Chemotherapy. The use of drugs of the cytostatic group (kill cancer cells) is advisable in combination with radiation and / or with surgery.

    Medicines are selected depending on the tolerance and stage of the disease.