traumatic stomatitis
Introduction
Introduction to traumatic stomatitis Traumaticstomatitis is a non-specific acute and chronic inflammation caused by mechanical, chemical, physical and other factors that cause oral mucosal damage. The pathogenic factors of the disease mainly include: mechanical factors, chemical factors and physical factors. Mechanical factors: This is the most common cause of traumatic stomatitis. Trauma ulcers are often formed. According to the duration of stimulation, they can be divided into persistent and non-persistent stimuli. Chemical factors: common chemicals are corrosive. Sexual acid, strong alkali, oral treatment phenol, silver nitrate, arsenic trioxide and other contact with oral mucosa, clinically more common in the wrong entrance cavity or improper use, sometimes self-injury; physical factors: thermal damage of the oral mucosa It is rare to see that if the beverage, tea or food is too hot, it will cause mucosal burns. Exceeding a certain dose of radiation, the whole body or head and face may cause damage to the whole body and oral tissues, causing acute radiation sickness and/or radioactive stomatitis. The main change is inflammation. In the wartime, after the explosion of nuclear weapons, in peacetime, it was caused by radiation therapy of malignant tumors or by radiation accidents. basic knowledge The proportion of illness: 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: oral ulcers thrush
Cause
Causes of traumatic stomatitis
First, mechanical factors
This is the most common cause of traumatic stomatitis. Trauma ulcers are often formed. According to the duration of stimulation, they can be divided into persistent and non-persistent stimuli. Persistent stimuli include residual crown after caries destruction. , sharp cusps, sharp edges of the teeth after wear, the snap ring of the bad prosthesis, sharp edges, too long substrate, the friction between the tongue and the short-term and the new mandibular incisor are long-term retention in the oral cavity. Factors that can cause chronic traumatic damage, non-persistent mechanical stimuli include hard, crisp foods (such as fried or toasted hard foods), nipples made of hard rubber, bites when chewed, toothbrushes Too old and untidy bristles, improper brushing, improper use of instruments by stomatologists, or other trauma can cause acute damage to the oral mucosa.
Second, chemical factors
Common chemical substances are corrosive strong acid, strong alkali, oral therapeutic phenol, silver nitrate, arsenic trioxide, etc., which are exposed to the oral mucosa. It is more common in the wrong entrance cavity or improper use, and sometimes it is self-injuring.
Third, physical factors
Thermal damage of the oral mucosa is rare. Even if the beverage, tea or food is too hot, it may cause mucosal burns. Exceeding a certain dose of radiation, the whole body or the head and face may cause damage to the whole body and oral tissues, causing acute radiation sickness and/or radioactive mouth. Inflammation, the main change is inflammation, which occurred after the explosion of nuclear weapons in wartime, and was caused by radiotherapy for malignant tumors or due to radiation accidents during peacetime.
Prevention
Traumatic stomatitis prevention
To ensure adequate sleep, avoid fatigue, strain, use the brain excessively; keep the mouth clean, clean the mouth 2 to 3 times a day, the comb of the toothbrush should not be too hard, so as not to hurt the oral mucosa, insist on using green tea to gargle, can promote The healing of the oral ulcer surface.
Correct bad habits, avoid eating overheated and hot sticky foods, and prevent infection after mucosal burns.
Complication
Traumatic stomatitis complications Complications, oral ulcers, thrush
Granuloma, scald, blood blisters, tissue necrosis, diffuse congestion of the oral mucosa, oral food damage, refractory oral ulcers, oral mucosal ulcers.
Symptom
Traumatic inflammatory symptoms Common symptoms Oral mucosa diffuse congestion, oral pain, eating hard food... Gum bleeding, swell, granuloma, oral mucosal ulcer, bloodshot, intractable oral ulcer
Although traumatic stomatitis varies depending on the stimulating factors and the lesions, most of the causes are clear, so the diagnosis is not difficult.
1. There is a history of injury, or the corresponding part of the lesion has obvious stimulating factors.
2. The characteristics of the lesion are consistent with the stimulating factors.
3. After the local stimulating factors are removed, the lesions are healed, and the chronic long-term unhealed ulcers are not healed after the stimulation is removed, or the ulcers are deeper and the base is harder, and the biopsy should be distinguished from the cancer.
[clinical manifestations]
First, traumatic ulcer
Mechanical stimuli The damage to the oral mucosa, most commonly the formation of traumatic ulcers, can be characterized by the nature of the injury, the duration of the ulcer, the location of the ulcer and whether there is a secondary infection.
1. decubital ulcer
Acne ulcer is a kind of deep mucosal ulcer caused by persistent mechanical stimulation. It is more common in adults, especially in elderly people. Long-term chronic stimulation of residual crown and bad denture can cause lesions in adjacent areas, more common in tongue. Limb and lip, buccal mucosa, early mucosa redness, mild swelling and pain, such as timely removal of stimulation, mucous membranes can return to normal, otherwise ulcers, ulcers are round or irregular, size, shape and shape Symptoms are consistent. For example, if the denture substrate is pressed, a circular or narrow-long ulcer can be formed at the bottom of the mouth or the vestibular groove. The mucosa is stimulated for a long time, and some ulcers can spread to the submucosa to form deep ulcers. Micro-bumping, central depression, yellowish or gray-white pseudomembrane on the surface of the ulcer, local lymph nodes can be touched.
Chronic periapical periodontitis in children's deciduous teeth, when the alveolar bone has been damaged, and then the pressure of the permanent teeth erupted, sometimes the apex of the deciduous teeth is worn by the damaged part of the alveolar bone through the surface of the gum surface and exposed to the oral cavity. It forms a stimulating effect on the mucous membrane and causes a sore ulcer. The root tip of the tooth is often inserted directly into the ulcer. In this case, the upper lip and the cheek are more common.
Because the stimulation of the formation of acne ulcers is mild and long-term, the surface of the ulcer is mostly inflammatory granulation tissue and lacks nerve fibers, so the pain is not obvious, but the pain can be aggravated when there is secondary infection.
2. hyperplastic lesion
More common in the elderly, due to the long-term and moderate chronic stimulation caused by the improper edge of the denture of the denture, the tissue produces proliferative inflammatory lesions, the mucosa is a tough granulomatous hyperplasia, sometimes accompanied by a small ulcer surface, sometimes only inflammatory hyperplasia Without ulcers, patients generally have no obvious pain symptoms.
3. Acute injury and damage
It causes laceration or abrasion of the oral mucosa. For example, children often stick foreign objects into the mouth, and accidentally fall when running. Foreign objects can easily cause abrasions and soft tissue lacerations caused by mucous membranes. Bites are also a common clinical type. Trauma, often occurs in the tongue, cheeks or lips, generally only cause small ulcers, a rare bite is seen in patients with epilepsy when the disease can bite the tongue into a larger ulcer, and severe cases can cause tissue defects.
4.Riga disease
Or Riga-Fede disease, which refers to the ulcer caused by the wound of the tongue of the baby. It is more common in infants with too short a tongue. The edge of the inferior incision is sharper at the beginning, and the tongue is short in the milk. The tongue can not be fully raised and extended, so the deciduous teeth are rubbed against the tongue and abdomen and the tongue bandage to form an ulcer. The edge of the ulcer is clear, the surface is not flat, and there is a gray-white pseudomembrane. For a long time, the edge is bulged and there is inflammatory hyperplasia.
5.Bednar aphthous ulcer
The baby's upper jaw is thinner, especially at the wing hooks, and under the friction of a hard pacifier or other foreign matter, a shallow or oval shallow ulcer can be formed.
Second, mucosal blood blister
Clinically, mucosal hematoma is formed in the oral mucosa due to brittle, hard food friction or inadvertent bite. It occurs in soft palate, parapharyngeal, buccal, tongue and oral mucosa. Patients have local abnormalities during chewing. Feeling or severe pain, Zhangkou can see the blood blister on the mucous membrane here, it is purple-red, the wall of the blister is thin, the size is about 1~3cm, the bullae can be quickly damaged and hemorrhage, after the broken blisters cover it, then the herpes necrosis , shedding and showing a bright red smashed surface with a small amount of secretions on the edge, the surrounding mucosa is congested, the patient feels burning pain, speaks, and the pain increases when eating. The course lasts for 7 to 14 days and heals, and the small blood blister is not easy to break. If the blood in the blister is sucked out and there is no secondary infection, it can heal in 1 to 2 days.
Third, chemical burns
Corrosive chemicals mainly cause the coagulation of mucosal tissue proteins, tissue necrosis, and a thin layer of white necrosis is formed on the surface of the lesion. If it is swabged, the red erosive surface of the bleeding is exposed, and the pain is caused. When the arsenic trioxide is inactivated, the pulp is temporarily suspended. The sealing of the cement is not strict, and the arsenic agent overflows, which not only damages the gingival and adjacent mucosa, but also causes necrosis of the alveolar bone.
Fourth, thermal burns
Mild burns only see mucosal redness, mild pain or numbness, does not form erosion or ulcers, but when the thermal damage is severe, vesicles can form, and the blister forms a smash or shallow ulcer after ulceration, and the pain is obvious.
Fifth, radiation damage
Generally, in the second week after the irradiation, when the dose reaches 1.29C/kg, the reaction may occur, causing radioactive stomatitis, which begins with diffuse erythema, which may cause blood blister afterwards, and form ulcers or erosion after breaking. The surface is covered with grayish yellow. The pseudomembrane can cause secondary infection, in addition to causing bleeding gums, tendinitis, pericoronitis, dry mouth and so on.
Examine
Examination of traumatic stomatitis
Oral examination
After the local stimuli are removed, the lesions are healed, and the chronic long-term unhealed ulcers are not healed after the stimulation is removed, or the ulcers are deep and the base is hard, and the biopsy should be performed.
Diagnosis
Diagnosis and diagnosis of traumatic stomatitis
1. Smaller ulcers need to be differentiated from mild recurrent aphthous ulcers. Traumatic ulcers have obvious local damage factors. The ulcers vary in size, consistent with the irritants, no recurrence, self-limiting, and recurrent aphthous ulcers are not obvious. Local factors, round or elliptical, 2 to 4 mm in diameter, recurrent and self-limiting.
2. Larger ulcers need to be differentiated from adenoidal ulcers, tuberculous ulcers, and cancer.
