Pediatric Necrotizing Gingivostomatitis
Introduction
Introduction to necrotizing gingivitis in children Pediatric necrotizing gingivitis is an acute necrotizing ulcerative oral lesion caused by a mixed infection of Clostridium and F. Failure to treat severe cases in time can result in death. basic knowledge The proportion of illness: 0.001% Susceptible people: children Mode of infection: non-infectious Complications: Stomatitis
Cause
Causes of necrotizing gingivitis in children
First, the cause of the disease:
Mainly caused by Fusarium and F. The disease is usually a complex mixed infection, which can be combined with other bacteria, such as streptococci, filamentous bacteria, melanin and other bacterial infections.
Second, the pathogenesis:
The pathogen of the disease is Clostridium and spirochete, and a large number of Clostridium and spirochetes can be found on the lesion site.
These bacteria are inherent in the mouth. Under normal conditions, Clostridium and spirochetes are symbiotic in the mouth and are generally not susceptible to infection.
When the body has metabolic disorders, low immune function, decreased resistance or malnutrition, or when the mouth is unhygienic, the bacteria multiply and cause disease, causing acute necrotizing ulcerative oral lesions.
Or when the local or systemic resistance is reduced, the two bacteria can be multiplied and become ill, and when the oral hygiene is poor and the nutritional status is poor, the disease is rapid and the lesion is serious.
Prevention
Pediatric necrotizing gingivitis prevention
1, regular physical examination: to achieve early detection, early diagnosis, early treatment.
2, good follow-up: to prevent the disease from getting worse.
3, pay attention to personal hygiene, especially the health of the genitals during menstruation and puerperium.
4, enhance physical fitness, improve their own immunity: reasonable feeding, enhance physical fitness, develop a good habit of oral hygiene, for weak children, long-term sick children, especially during the eruption of teeth, it is necessary to strengthen oral care, timely replacement of new toothbrushes , dental appliances, etc., to effectively prevent the occurrence of this disease.
Complication
Pediatric necrotizing stomatitis complications Complications , stomatitis, bad breath
Severe sputum sputum inflammation can occur, a large number of toxins into the blood can cause death, prolonged unhealed can be converted to chronic, severe alveolar bone absorption, periodontal pocket formation.
First, gangrenous stomatitis:
Also known as cheeks gangrene, the motherland medicine is called the horse. The disease is easily confused with severe necrotizing sputum inflammation, and some people think it is a serious or malignant change of necrotizing gingivitis. It mainly occurs in children with teeth, which are mostly related to systemic weakness or extreme malnutrition. The literature has reported occasionally seen this disease in infants with severe combined immunodeficiency disease.
Second, periodontal pocket:
It is a pathological deepening sulcus and is one of the most important clinical manifestations of periodontitis.
Periodontal pockets are formed by the long-standing chronic gingivitis spreading deeper. There is a large amount of neutrophil infiltration, which will seriously affect the nutrition and adhesion of epithelial cells, and move the bottom of the sulcus to the root to form a periodontal pocket. As the periodontal pocket deepens, it is more conducive to the accumulation and retention of plaque, which makes the inflammation more serious, and the inflammatory reaction makes the periodontal pocket deeper, thus forming a vicious circle of progressive destruction of the periodontal pocket.
Clinically, it can be found that the gums in the periodontal pocket have different degrees of inflammation, the gums are red or dark purple, the gums are swollen, soft, and the spots disappear, the rim is round and separated from the tooth surface, and probed or eaten with a probe. The gums are easy to bleed, the gums are lightly pressed, and sometimes the pus overflows. The patient can consciously have bad breath. The investigation revealed that the bottom of the bag was below the enamel bone boundary.
Progressive deepening of the periodontal pocket can lead to continuous destruction of the periodontal support tissue, causing the teeth to gradually loosen and shift, so that the interdental space is gradually widened and even the teeth are detached. However, patients generally have no pain, and occasionally may have local swelling, chewing pain and other symptoms.
Symptom
Pediatric necrotizing fistula symptoms common symptoms stomatitis, salivation, lymph node enlargement, periodontal pocket formation, oral mucosal ulcer, gum bleeding
Clinical manifestations:
1, the general symptoms:
The onset is rapid, the symptoms are significant, there is fever, general malaise and submandibular lymphadenopathy. Pain is obvious, often accompanied by symptoms such as salivation, headache, and lymphadenopathy.
2, ulcers:
Ulcers occur in the gums and buccal mucosa, the shape is uncertain, the size is about 1cm, superficial, covered with a dirty, grayish white coating, when the moss film is wiped off, there is a bleeding surface of the ulcer, but soon it is covered again with the same The coating of the moss, the surrounding mucosa has obvious congestion and edema, obvious tenderness, and a particularly strong necrotic tissue odor. On the surface of the necrotic tissue, there may be a gray-white pseudomembrane formed, which is easy to wipe off, and a bleeding wound can be seen after wiping off.
3. Edema:
Lips, cheeks, tongue, sputum, pharynx, mouth and other mucosa can be affected, forming an irregular shape of necrotizing deep ulcer, covered with gray or grayish black pseudomembrane, the surrounding mucosa has obvious congestion and edema, easy to touch Bleeding.
4, gum performance:
Necrosis occurred at the edge of the gingiva and at the tip of the nipple, and the lower anterior teeth were more common. The edge of the gingiva is "worm-like", and the gingival nipple disappears and flattens as "knife-shaped". The gingival nipple is severely damaged, the gums lose their normal shape, and the gingival margin is anti-wavy. In severe cases, the alveolar bone can be absorbed and the periodontal pocket is formed.
5, cheek performance:
In the acute phase, if it is not treated in time, necrosis will spread to the adjacent oral mucosa and deep tissues, and the resistance of the whole body will drop sharply. At the same time, when the infection with Clostridium perfringens is infected, it can also cause a hole-piercing defect on the cheek. Bad cheeks.
Examine
Examination of necrotizing gingivitis in children
First, peripheral blood examination:
It can be seen that the total number of white blood cells and neutrophils are significantly increased.
Second, smear examination:
A large number of Clostridium and spirochetes can be seen.
Third, histopathological examination:
1, epithelial destruction, a large number of fibrinous exudation, necrotic epithelial cells, polymorphonuclear leukocytes and a variety of bacteria and fibrin form a pseudomembrane.
2. The lamina propria has a large amount of inflammatory cell infiltration.
3, the base layer edema degeneration, connective tissue capillary expansion.
Fourth, other:
If necessary, do chest X-ray, B-ultrasound and other checks.
Diagnosis
Diagnosis and diagnosis of necrotizing gingivitis in children
diagnosis
The diagnosis was based on specific bad breath, moss film and small ulcers, and a large number of Fusarium and F. sinensis were found in the smear.
1. Acute onset, short course, spontaneous bleeding, pain.
2. There is necrosis at the edge of the gingiva and at the tip of the nipple. The affected mucosa forms an irregularly shaped necrotizing deep ulcer with a grayish yellow or grayish black pseudomembrane.
3. Has a typical septic bad breath, increased saliva and thick.
4. A large number of Clostridium and spirochetes can be seen in the necrotic area smear, which helps to confirm the diagnosis.
Differential diagnosis
It should be differentiated from the following conditions:
First, herpetic gingivitis:
1 Introduction:
Herpetic gingivitis is an infection caused by herpes simplex virus (Herpessimplex) involving the mouth, throat and face. This is a common childhood disease, most commonly in children between the ages of 6 months and 5 years. Adults and older children are also infected with the disease. Once a child is infected, it becomes a carrier. The virus is hidden in the body and occasionally appears in the lips.
2. Clinical manifestations:
It generally has high heat and its body temperature exceeds 38 °C. The range of congestion affects the full mouth gums and oral mucosa. The typical lesion is the ulcer surface formed by multiple vesicles and blister rupture, without necrosis.
Second, chronic gingivitis and periodontitis:
1 Introduction:
Chronic gingivitis is caused by long-term stimulation of tartar and tartar. Since food and debris are easily embedded in the teeth and pockets, the calcium salts in the saliva are easily deposited in these places, and many anaerobic bacteria are used as a breeding ground for breeding. The main symptom of chronic gingivitis is bleeding gums.
Chronic gingivitis is also known as unclean gingivitis or marginal gingivitis. Chronic gingivitis has a high incidence and is a widespread disease in humans with a prevalence of more than 80%.
2, identification points:
Although the two diseases have symptoms such as swelling, bleeding, bad breath of the gums, but the general course of disease is long, no spontaneous blood and pain, no necrosis, bad breath is inflammatory bad breath.
Third, cocciic stomatitis:
1 Introduction:
A cocciform infection caused by Staphylococcus aureus, Streptococcus viridans, Streptococcus hemolyticus, Pneumococci, and the like. When the body's resistance is reduced, the bacteria grows actively or the virulence of the infection increases. Usually mixed infections. Sometimes it is a secondary infection of other oral mucosal diseases.
2, identification points:
The oral mucosa is extensively congested, the gums are congested and edema, and it is easy to bleed, but there is no necrosis in the gingival margin. In the cheeks, tongue, and lips, a superficial flat erosion surface can be seen, covered with a yellow pseudomembrane. It can also be seen in the attachment of sputum, but no odor and spoilage.
3. Related inspections:
Smear microscopic examination showed various cocci, such as streptococci, Staphylococcus aureus and pneumococci.
