Every disease oral mucosa(hereinafter referred to as SOPR) is characterized by the appearance on its surface of various elements of damage.

Description

The rashes that we can observe on the skin and mucous membrane (hereinafter referred to as RS) consist of individual elements. They can be combined into groups:

• change in color of the mucous membrane;
• change in surface topography;
• limited fluid collections;
• layering on the surface;
• CO defects.

The elements of damage themselves are divided into:

• primary;
• secondary.

Primary elements- these are the elements that arise on unchanged CO. Secondary elements are the result of transformation or damage to existing elements.

If a formation of identical primary elements appears on the CO, then this formation is called monomorphic. And if from different ones - a polymorphic rash. Knowledge of all elements of damage makes it possible to correctly navigate large quantities diseases of the mucous membranes and lips. If we correctly compare the clinical picture of local changes with the state of the whole organism and environmental factors, both on the affected area and on the whole, it becomes possible staging correct.

Primary elements of the lesion

these include:

• Spot;
• nodule;
• node;
• tubercle;
• bubble;
• bubble;
• abscess;
• cyst.

Spot

Hemorrhages

- stains that appear as a result of a violation of integrity vascular wall. The color depends on the stage of decomposition of the blood pigment. Can be red, bluish-red, green tint, yellowish tint, etc. The spots can be of different sizes, do not disappear when pressed. Hemorrhagic spots resolve and disappear without leaving any traces. Petechiae are point hemorrhages. Ecchymoses are large hemorrhages.

Telangiectasia

- these spots appear as a result of persistent non-inflammatory vasodilation or vasodilatation. They are formed by thin tortuous vessels anastomosing among themselves. It turns a little pale.

Dark spots

- appear due to the deposition of coloring substances in CO. It can be either exogenous or endogenous. They can be congenital and acquired. Congenital pigmentations are called nevi. Acquired pigmentations are of endogenous origin or develop with infectious diseases. Substances exogenously coloring CO:, chemicals, industrial. Also, pigmentation can occur from the penetration of their salts into the body. Such pigmentation has a clear shape. Color from - black, from - black or slate, from - greenish, from - gray, from - bluish-black, from - dark gray.

Nodule

Bubble

(-vesiculum) - is a cavity element filled with liquid. The size can be from a pinhead to a pea. The contents of the vesicle are more often serous than hemorrhagic. It is formed in the spinous layer of the epithelium. Rashes can occur not only on a healthy basis, but also on a hyperemic and edematous basis. The wall of the vesicle is formed by a thin layer of epithelium. Because of this, the tire quickly ruptures, erosion forms, and fragments of the bubble remain along its edges. Often the bubbles are located in a whole group. The formation of a vesicle may be a consequence of ballooning or vacuolar dystrophy, with the development of viral diseases. During reverse development, the bubble leaves nothing in its place.

Bubble

( -bulla) - element large sizes, to a chicken egg. Cavity, filled with liquid. It is formed either inside the epithelium or under it. In a bubble, there is a bottom, a tire and contents. , as in a vesicle, it can be serous and hemorrhagic. In the subepithelial bladder, the covering is thicker than in the intraepithelial one and therefore it exists for a longer time. Erosion after blisters heals without leaving any traces.

III. Primary and secondary skin lesions

Pathological phenomena on the skin lead to the formation of changes, which are most often expressed in the appearance of skin rashes or morphological elements.

There are primary and secondary morphological elements.

Primary- these are skin changes that are the immediate, first consequence of exposure to a pathogenic agent.

Secondary– appear after the primary ones due to their further development.

The primary morphological elements include: spot, blister, vesicle, bladder, abscess, nodule, node, tubercle (8 elements).

1) Spot (macnea) – organic, located at the skin level, of various shapes with changes in the color of the skin or mucous membrane. Spots are divided into:

a) vascular – found in syphilis, measles, typhus, liver diseases, vasculitis.

b) hemorrhagic spots are formed due to the release of blood into the tissue.

V) dark spots arise due to an increase or decrease in the content of melanin (leucoderma).

2) Blister (irtica) - is a cavity-free formation that rises above the surface of the skin, resulting from limited acute inflammatory edema of the papillary dermis. This is an element of urticaria.

3) Bubble (vesicle) - a cavity formation, slightly elevated above the skin level, filled with transparent serous, less often bloody, contents. Occurs as a result of inflammation of the epidermis.

4) Bubble (bulla) is a cavity formation that appears above the level of the skin, the size of a pea to the palm, filled with cloudy serous or hemorrhagic contents, where epithelial cells are microscopically found, ₤ are a manifestation of pemphigus, Dnoring's dermatitis.

5) Pustule (pustula) - a cavity formation filled with purulent contents, in which many ₤, albumins, and globulins are found. An abscess located around the hair follicle is called folliculitis . Located around sebaceous glands ulcers are called acne with pyodermatitis.

6) Nodule (papula) - a cavity-free formation that rises above the surface of the skin. This is a manifestation of many skin and veins. diseases.

7) Knot (nodus) is a cavityless infiltrated formation, located deep in the dermis or subcutaneous fatty tissue and is determined by palpation. An example is morplit. gumma.

8) Tubercle (tuberculum) - is a cavity-free formation that rises above the level of healthy skin or is located at its level and is sharply demarcated. The tubercle heals with a scar. The tubercles are typical for leprosy, leishmaniasis, tuberculosis, and tertiary syphilis.

Secondary morphological elements: pigmentation and depigmentation, scale, crust, erosion, crack, abrasion, ulcer, cicatricial atrophy, vegetation.

1) Pigmentation and depigmentation . Hyperpigmented spots appear in places of greatest deposition of melanin and imosiderin, appear in places of primary or secondary elements. Hypopigment spots are located in areas where macular-flaky elements and papules resolve.

2) Flake (squama) are loosened horny plates that have lost contact with each other, ready to be torn off or already torn away from the surface of the skin. The separation of scales is called peeling .

3) Crust (crusta) - occurs due to the drying out of the contents of vesicles, blisters, ulcers and discharge from erosions and ulcers.

4) Erosion (erosion) is a superficial skin defect that most often occurs at the site of a rupture: the covering of the primary cavity morphological element, repeating its shape and size. After the erosion heals, there is no scar left.

5) Cracks (rhagudes) - are linear damage to the skin in the form of a rupture that occurs due to loss of elasticity of the skin during the inflammatory process or when it is overstretched. Cracks usually appear where the skin bends. The cracks are located within the epidermis and dermis. There are superficial and deep.

6) Abrasion (excoriation) – violation of the integrity of the skin due to scratching or scratching. The abrasions are superficial and deep. Prone to infection.

7) Ulcer (ulous) is a deep defect of the skin, subcutaneous tissue, muscles, and bone fascia. Occurs as a result of the breakdown of tissue of nerve elements. They heal by forming a scar.

8) Scar (cicatrix) - is a newly formed fibrous connective tissue that replaces the lost property of the skin.

9) Scar atrophy – a regressive process that occurs as a result of the depletion of all layers of the skin. It develops without previous ulceration by converting the infiltrate into connective tissue.

10) Lichenification - a focus of increased skin pattern, accompanied by thickening and compaction, hyperpigmentation, and dryness.

11) Vegetation – papillary thickening of the skin, resulting from the proliferation of the spinous layer of the epidermis and papillomatosis of the dermis during a long-term inflammatory process. Most often they form in the area of ​​papules and ulcers.

Sit the patient so that the light source is in front of him. Determine the area of ​​damage to the mucous membrane. If the damage element is located on the unchanged surface of the mucous membrane, then it will be classified as primary elements:

Spot(Macula) – change in the color of the mucous membrane in a limited area. It can be inflammatory or non-inflammatory in nature (vascular, pigmentary, keratinization).

Nevus– congenital pigment spot;

Vitiligo– acquired pigment spot.

Erythema– diffuse hyperemia of CO.

Roseola– erythema of a round shape, with a diameter of 1.5-2-10 mm, with limited contours.

Telangiectasia– persistent vasodilation of a non-inflammatory nature.

Hemorrhage– hemorrhage in the mucous membranes (pitechiae - small, ecchymosis - large).

Nodule(Papula) – bandless infiltrate. Papule – merged nodules.

Knot(Nodus) – limited compaction of significant size.

Tubercle(Tuberculum) is an infiltrative bandless element of a rounded shape, up to the size of a pea, protruding above the level of the mucous membrane. The central part of the tubercle becomes necrotic.

Bubble(Veeesicula) – a cavity element ranging in size from a millet grain to a pea, filled with liquid. The lining of the bladder quickly opens and erosion forms.

Bubble(Bulla) is a cavity element of considerable size (up to a chicken egg), filled with liquid. The exudate is serous or hemorrhagic. The tire is thick, if it is opened, erosion occurs.

Pustule, pustula (Pustula) – a cavity formation filled with purulent contents, yellowish or yellow-green in color. It only happens on the skin.

Blister(Urtica) - a bandless cushion-shaped element of round or oval shape, the result of limited swelling of the papillary layer. Accompanied severe itching or burning, appears quickly, exists for a short time.

Cyst- a cavity formation that has a connective tissue or epithelial lining, with transparent, purulent or hemorrhagic contents.

Abscess- a cavity formation filled with pus. It occurs as a result of pathologically altered tissue and the fusion of small pustules into one focus of inflammation.

If an element is a consequence of transformation or damage to existing ones, then it will be classified as secondary elements of defeat:

Flake(Sguama) - an accumulation of sloughed keratinizing epithelial cells, usually tightly held to the underlying tissue. Various colors and sizes. Does not occur in the oral cavity.

Erosion(Erosio) – a defect in the surface layer of the epithelium. The lesion is shallow, without penetration into the connective tissue, and heals without scarring.

Aphtha- a superficial limited defect of the epithelium of a round or oval shape with a diameter of 0.3-0.5 cm, covered with a fibrinous coating of white or yellow color. There is a bright red rim along the periphery.

Ulcer(Ulcus) – a defect of the mucous membrane within the boundaries of the connective tissue layer. The edges of the ulcer may be undermined, overhanging, saucer-shaped. At the bottom of the ulcer there may be purulent plaque, necrotic masses, and granulation growths.

Crack(Ragas) - a linear defect of the mucous membrane or red border of the lips. They can be superficial or deep.

Crust(Crusta) - formed when serous, purulent, hemorrhagic exudate or lymph dries, rises above the surrounding surface. Color ranges from transparent, grayish to bloody brown.

Scar(Cicatrix) - connective tissue that replaces the defect of the mucous membrane, has different shapes and depth. There are atrophic and hypertrophic scars.

Raid– surface formation on teeth consisting of microorganisms, leftover food, fibrinous films, rejected epithelium; white, brown, dark color.

Atrophy– thinning of the mucous membrane, which becomes smooth, shiny, and easily folds. Translucent vessels are visible.

Pigmentation– change in color of the skin or mucous membrane, usually in place of morphological elements. May be primary (freckles, birthmarks, change in the color of the oral mucosa in certain races) and secondary, as a consequence of the deposition of melanin pigment after the resolution of primary or secondary morphological elements, after interstitial hemorrhage.

Vegetation(Vegetatio) – villous growth of epithelial papillae on the surface of papules, erosions, inflammatory infiltrates, lumpy appearance.

Tumor(Tumor) – tissue proliferation due to excessive cell proliferation (angiomatosis, lymphomatosis, papilomatosis, etc.).

Lichinization, lichenification(Licheniticatio) is the result of long-term inflammatory infiltration of the red border of the lips, skin, due to massive infiltration of the papillary layer and acanthosis. Elasticity is lost, they thicken, become denser, dryness and flaking appear, they are difficult to form into folds, and the pattern is enhanced.

Disturbance of keratinization:

Hyperkeratosis– a significant increase in the stratum corneum compared to its thickness with keratosis. In this case, hyperkeratosis, from a histological point of view, should be considered pathological only due to its abnormal location and too large volume. Clinically, hyperkeratosis manifests itself in changes in the color and relief of the mucous membrane. These are whitish formations that rise above the level of the normal mucous membrane, regarded as papules or plaques (according to the classification of elements of mucosal lesions).

In the literature the term “ leukokeratosis", used to designate an area of ​​white hyperkeratosis.

Dyskeratosis- This is a kind of violation of the normal physiological process keratinization of the epithelium, during which dyskeratinization and degeneration of cells of the spinous layer occur. In this case, dysplasia occurs, the cells fall out of the common connection, the connection between them is disrupted, and in all subsequent layers they appear as independent elements. The arrangement of cells is chaotic. Large round cells appear with a sharply limited and well-stained nucleus, basophilic granular cytoplasm and doubly contoured membranes that strongly refract light - these are the so-called round bodies. Dyskeratosis can be benign or malignant. Benign dyskeratosis is an independent type of disorder of the keratinization process, clinically manifested in the form of areas of fine-scaly peeling. Maybe with Daria's illness. Malignant dyskeratoses occur in Paget's and Bowen's diseases. Focal, or limited, dyskeratosis can manifest itself in the form of excessive growth of the integument, and in this case it is called productive. In other cases, it has the appearance of a defect, a flaw in the cover and is therefore called destructive. More often, there is a simultaneous manifestation of productive and destructive changes, that is, a mixed form of dyskeratosis. Productive focal dyskeratosis is characterized by the appearance in the area of ​​the red border, often at its border with the skin, of a flat or spiky protrusion above the surface. The horny layer on it periodically disappears. As it grows, it may look like cutaneous horn. A distinctive feature of focal destructive dyskeratosis is a sharp thinning of the red border in a limited area, as a result of which it takes on the appearance of a superficial ulceration. In other cases, a slit-like flaw or crack forms.

Parakeratosis– this is a histological concept - a violation of the keratinization process associated with the loss of the ability of epithelial cells to produce keratohyalin. Histologically, with parakeratosis, loosening of the stratum corneum and partial or complete disappearance of the granular layer are noted. The cells of the stratum corneum have rod-shaped nuclei. The connection between the individual cells of this layer is lost. Parakeratosis occurs in papular syphilides, psoriasis, and stomatitis. Parakeratosis can be combined with hyperkeratosis in psoriasis, exfoliative pemphigus and other long-term hyperkeratosis.

Acanthosis- a histological term characterizing the thickening of the epithelium due to increased proliferation of the basal and spinous layers - proliferative acanthosis or slower maturation of epithelial cells with a decrease in metabolism - retention acanthosis. Clinically, acanthosis is characterized by thickening of the mucous membrane, especially the interpapillary processes.

Considering that the use of the above terms as clinical and morphological simultaneously introduces some confusion, the terms “hyperkeratosis”, “dyskeratosis”, parakeratosis”, “acanthosis” should be used as morphological concepts. They truly reflect structural changes in a number of diseases that are not related to each other or etiological factors or clinical manifestations, have different outcomes and often require diametrically opposed treatment methods.

Exudative changes in the epithelium:

Vacuolar dystrophy – accumulation of fluid inside the cells of the spinous and basal layers. The size of the cells increases, the nucleus moves to the periphery, changes shape and size, and may completely disappear.

Spongiosis– accumulation of fluid inside the cells of the spinous layer, effusion of exudate into the intercellular space of the epithelium, connective tissue of the oral mucosa, intercellular connections are broken.

Ballooning dystrophy– focal changes in the cells of the spinous layer, which increase in size and acquire a rounded shape (balloon). As a result of liquefaction necrosis of such a section of the epithelium, cavities are formed filled with exudate, in which homogeneous “balloons” float.

Acantholysis– melting of intercellular connections, the appearance of gaps between individual cells, and then bubbles. Individual epithelial cells are rounded, have a large nucleus, and float freely - these are acantholytic cells, or Tzanck cells.

Epithelial hypertrophy- this is a thickening of the epithelial layer of the mucous membrane.

Papillomatosis– proliferation of interepithelial connective tissue papillae and their ingrowth into the epithelial layer.

It is advisable to adhere to the following scheme for assessing the elements of damage to the oral mucosa:

1. Nature of appearance and course.

2. The main elements of the lesion.

3. Grouping of lesion elements.

4. Growth of lesion elements.

5. Stages of development of elements.

6. Localization of elements.

Then the elements of the lesion are characterized in detail, for example.

Chapter 5.

The development of each disease of the oral mucosa is characterized by the appearance of peculiar elements of damage on its surface. The rashes observed on the skin and SO consist of individual elements that can be combined into several groups: 1) changes in the color of the mucous membrane, 2) changes in surface relief, 3) limited accumulations of fluid, 4) layering on the surface, 5) SO defects. Elements of damage are conventionally divided into primary (which arise on unchanged CO) and secondary (which develop as a result of transformation or damage to existing elements). The formation of identical primary elements on CO is considered as monoform, and different ones - as polymorphic precipitation. Knowledge of the elements of the rash makes it possible to correctly navigate the numerous diseases of the mucous membranes and lips. And the comparison clinical picture local changes with the condition of the whole organism, with environmental factors that adversely affect both the affected area and the entire organism as a whole, allows for a correct diagnosis.

The primary elements of the rash include a spot, a nodule (papule), a node, a tubercle, a vesicle, a vesicle, an abscess (pustule), and a cyst. Secondary - scales, erosion, excoriation, aphthae, ulcers, cracks, crusts, scars, etc.

Primary elements of the lesion. Spot (macula) - limited color change of the mucous membrane(rice. 15). The color of the spot depends on the reasons for its formation. The spots never protrude above the CO level, that is, they do not change its relief. There are vascular spots, pigment spots and spots resulting from the deposition of coloring substances in CO.

Vascular spots can occur as a result of temporary vasodilation and inflammation. Inflammatory spots have different shades more often red, less often bluish. When pressed, they disappear, and then, after the pressure stops, they appear again.

Erythema - unlimited redness without clear contours. Roseola - small erythema of a round shape, ranging in size from 1.5-2 to 10 mm in diameter with limited contours. Roseola observed

at infectious diseases(measles, scarlet fever, typhoid, syphilis). Hemorrhages are spots that arise as a result of a violation of the

the thickness of the vascular wall. The color of such spots does not disappear when pressure is applied to them and, depending on the decomposition of the blood pigment, can be red, bluish-red, greenish, yellow, etc. These spots come in different sizes. Petechiae are point hemorrhages; large hemorrhages are called ecchymoses. The peculiarity of hemorrhagic spots is that they resolve and disappear without leaving a trace.

Telangiectasia- spots that arise due to persistent non-inflammatory dilation of blood vessels or their neoplasm. They are formed by thin tortuous vessels anastomosing among themselves. With diascopy, telangiectasias become slightly pale.

Dark spots arise due to the deposition of coloring substances of exogenous and endogenous origin in CO. They can be congenital or acquired. Congenital pigmentations are called nevi. Acquired pigmentations have an endocrine

a a

b b

An inflammatory spot on the gum (a), its schematic image (b).

1 - epithelium; 2- lamina propria of the mucous membrane; 3 - dilated vessels.

origin or develop during infectious diseases.

Exogenous pigmentation occurs when substances that color it penetrate from the external environment into CO. Such substances include industrial dust, smoke, medications and chemicals. Pigmentation when heavy metals and their salts enter the body has a clearly defined shape. The color of the spots depends on the type of metal. They are black from mercury, dark gray from lead and bismuth, bluish-black from tin compounds, gray from zinc, greenish

From copper, black or slate - from silver.

Nodule (papule) on the mucous membrane of the cheek (a), its schematic image

1 - epithelium, 2 - lamina propria; 3 - elevation of the epithelium.

A nodule, or papula (papula) is a non-cavitary element protruding above the surface of the mucous membrane, the infiltrate of which is located in the papillary layer of the lamina propria (Fig. 16). The shape of the papules can be pointed, semicircular, round, or pin-shaped. The diameter of the papules is 3-4 mm. When they merge, plaques are formed. With reverse development, the papule leaves no trace.

Node (nodus) is a limited, significant size (from a hazelnut to a chicken egg) compaction that reaches the submucosa (Fig. 17). Nodule formation may result inflammatory process, good quality

Elements of damage to the oral mucosa

a a

b b

A node on the mucous membrane of the lip (a), its schematic image (b).

1 - epithelium; 2 - lamina propria of the mucous membrane; 3 - tissue proliferation.

natural and malignant tumor growth, as well as the result of deposition of calcium and cholesterol into the tissue.

Inflammatory nodes formed due to nonspecific or specific infiltration (with leprosy, scrofuloderma, syphilis, tuberculosis) are characterized by rapid increase. The reverse development of nodes depends on the nature of the disease. They can dissolve, necrotize, melt with the formation of ulcers, and subsequently deep scars.

Tuberculum (tuberculum) is an infiltrative cavityless element of a round shape, up to the size of a pea, protruding above the level

Tubercle on the mucous membrane of the upper lip (a), its schematic image

1 - epithelium; 2 - lamina propria of the mucous membrane; 3 - infiltration.

German CO (Fig. 18). The infiltrate covers all layers of the mucosa. A feature of the tubercle, which at first looks like a nodule, is that its central part, and sometimes the entire element, becomes necrotic, which leads to the formation of an ulcer, which scars or the tubercle resolves without violating the integrity of the epithelium with the formation of cicatricial atrophy. The tubercles tend to group or, being close to each other, merge. tubercles

Primary elements for tuberculous lupus, tertiary syphilis, leprosy, etc.

Bubble river (vesiculum) - a cavity element ranging in size from a pinhead to a city

b b

A bubble on the lower lip (a), its schematic image (b).

1 - epithelium; 2- lamina propria of the mucous membrane; 3- intraepithelial cavity.

tires filled with liquid. A vesicle is formed in the spinous layer of the epithelium; it often has serous, sometimes hemorrhagic contents (Fig. 19). Blistering rashes can be either unchanged or hyperemic and edematous. Due to the fact that the walls of the vesicle are formed by a thin layer of epithelium, its cover quickly ruptures, forming erosion, along the edges of which fragments of the vesicle remain. During reverse development, the bubble leaves no trace. Often the bubbles are located in groups. Bubbles are formed due to vacuolar or ballooning dystrophy, as a rule, with different vi-

Rice. 20.

A bubble on the mucous membrane of the tongue (a), its schematic image (b).

1 - epithelium; 2 - lamina propria of the mucous membrane; 3 - subepithelial cavity.

Russian diseases (herpes, etc.).

Bubble (bulla) is a cavity element of considerable size (up to a chicken egg), filled with liquid (Fig. 20). Formed intraepithelial or subepithelial. It distinguishes between the tire, the bottom and the contents. The exudate may be serous or hemorrhagic. The covering of the subepithelial bladder is thick, so it exists on the mucosa for a longer time than the intraepithelial bladder, the covering of which is thin and quickly ruptures. The erosion that forms at the site of the bubble heals without scar formation.

Pustula (pustula) - limited

Elements of damage to the oral mucosa

An abscess on the skin of the face (a), its schematic image (b).

1 - epithelium; 2 - lamina propria of the mucous membrane; 3 - cavity filled with purulent exudate.

accumulation of purulent exudate (Fig. 21). There are primary and secondary abscesses. Primary pustules develop on the unchanged mucosa and are immediately filled with purulent contents of a whitish-yellowish color. Secondary pustules arise from vesicles and blisters. Abscesses are formed as a result of the action of enzymes and toxins, the waste products of staphylococci and streptococci, on the epithelium. Pustules are located at different depths, that is, they can be superficial and deep.

A cyst (cystis) is a cavity formation that has a wall and contents (Fig. 22). Cysts are of epithelial origin and re-

Rice. 22.

Cyst of the oral mucosa (a), its schematic image (b).

1 - cavity; 2 - epithelial lining.

tensional. The latter are formed due to blockage of the exit ducts of small mucous or salivary glands. Epithelial cysts have a connective tissue wall lined with epithelium. The contents of the cyst are serous, serous-purulent or bloody. Retention cysts are located on the lips, palate and buccal mucosa and are filled with transparent contents, which become purulent when infected.

Secondary elements of the lesion. Scales - to a (squama) - a plate consisting of desquamated keratinized epithelial cells(rice. 23). Scales arise as a result of hyper- and parakeratosis. They come in different colors

a a

b b

Scales on the lower lip (a), their schematic representation (b).

1 - epithelium; 2- lamina propria of the mucous membrane; 3- scales.

and size. Scales are formed, as a rule, in places of reverse development of spots, papules, tubercles, etc. Scales can also appear primarily: with mild leukoplakia, exfoliative cheilitis, ichthyosis. To diagnose lesions accompanied by the formation of scales, their location, thickness, color, size, and consistency are important.

Erosion (erosio) is a defect in the surface layer of the epithelium, therefore, after healing it does not leave a trace (Fig. 24). Erosion occurs from the rupture of a bladder, vesicle, destruction of papules, traumatic injury. When a bubble ruptures, erosion follows its contours. When merging

Erosion on the mucous membrane of the lateral surface of the tongue (a), its schematic representation (b).

1 - epithelium; 2- lamina propria of the mucous membrane; 3 - epithelial defect.

When erosion occurs, large erosive surfaces with varied contours are formed. On SB, erosive surfaces can form without a preceding blister, for example, erosive papules in syphilis, erosive-ulcerative form of red lichen planus and lupus erythematosus. The formation of such erosions is a consequence of injury to the easily vulnerable inflamed mucus. A superficial defect in the mucosa that occurs due to mechanical damage is called excoriation.

Aphtha (aphta) is a superficial defect of the epithelium of a round or oval shape, with a diameter of 5-10 mm, located on the inflamed

Elements of damage to the oral mucosa

a a

b b

Aphtha on the mucous membrane lower lip(a), its schematic representation (b).

1 - epithelium; 2 - lamina propria of the mucous membrane; 3 - epithelial defect covered with fibrinous plaque.

nom area of ​​CO (Fig. 25). The aphtha is covered with fibrinous effusion, which gives the affected element a white or yellow tint. Along the periphery, the aphtha is surrounded by a bright red rim.

An ulcer (ulcus) is a defect of CO within the connective tissue layer (Fig. 26). Ulcer healing is accompanied by a scar. Since the formation of an ulcer is characterized by a number of pathological processes, to determine their nature it is necessary to evaluate all the features of the lesion: the condition of the edges, depth, shape, condition of the surrounding tissues. Knowledge of their features facilitates differential diagnosis.

An ulcer on the mucous membrane of the lateral surface of the tongue (a), its schematic representation (b).

1 - epithelium; 2- lamina propria of the mucous membrane; 3-defect of the epithelium and lamina propria of the mucous membrane.

The edges of the ulcer can be undermined and overhanging the bottom, vertical or saucer-shaped. The edges and bottom of the ulcer can be soft or hard. In addition, the bottom of the ulcer can be covered with purulent plaque, necrotic masses, papillary growths, and it can bleed easily when traumatized. Often, elements of damage to the main pathological process are preserved at the edges of the ulcer. Sometimes the ulcer spreads to the underlying tissues (muscles, bone) and even destroys them.

It should be noted that clinical assessment of the ulcer alone is not enough to clarify

Rice. 27.

A crack in the red border of the lower lip (a), its schematic image (b).

1 - epithelium; 2 - lamina propria of the mucous membrane; 3 - linear defect of mucosal tissue.

lack of diagnosis of the disease. This requires the whole complex laboratory research, as well as a general examination of the patient is mandatory.

Crack (rhagas) is a linear tear of the CO, red border of the lips, which occurs with excessive dryness or loss of elasticity, with inflammatory infiltration (Fig. 27). Most often, cracks form in places of natural folds or in places that are susceptible to trauma and stretching. A deep crack extends to the connective tissue of the lamina propria and heals with the formation of a scar.

There are superficial and deep cracks. The superficial crack is located within the epithelium and heals without scar formation.

Crust on the upper lip (a), its schematic image (b).

1 - epithelium; 2 - lamina propria of the mucous membrane; 3 - crust (dried exudate).

Crusta (crusta) is a dried exudate that forms after the opening of a bladder, vesicle, or pustule (Fig. 28). The crust is a compound of coagulated tissue fluid and blood plasma, broken blood cells and epithelial cells. The color of the crusts depends on the nature of the exudate. When serous exudate dries, grayish or honey-yellow crusts form; with purulent exudate, dirty gray or greenish-yellow crusts form; with hemorrhagic exudate, bloody-brown crusts form. When the crusts are forcibly removed, the erosive or ulcerative surface is exposed, and after natural falling off, an area of ​​regeneration, a scar or cicatricial atrophy is exposed.

Elements of damage to the oral mucosa

a a

b b

Rice. 29.

Hypertrophic scar on the mucous membrane of the lower lip (a) its schematic image (b).

1 - epithelium; 2- lamina propria of the mucous membrane; 3-fibrous formations.

Scar (cicatrix) - area connective tissue, replacing a CO defect that occurred due to its damage or pathological process. The scar consists mainly of collagen fibers, covered with a thin layer of epithelium, in which there are no epithelial projections.

There are hypertrophic and atrophic scars. Hypertrophic (keloid) scars (Fig. 29) occur after injury and surgical interventions. They have a linear shape, dense, and often limit the mobility of CO. Atrophic scars (Fig. 30) are formed after healing of elements of tuberculosis, syphilis, and lupus erythematosus. They are characterized by non-

Rice. thirty.

Atrophic scar on the lower surface of the tongue (a), its schematic image (b).

1 - thinned epithelium; 2 - lamina propria of the mucous membrane; 3 - fibrous formations.

correct shape and significant depth. Since scars formed in many diseases have a characteristic appearance for one or another disease, by looking at them, one can determine with sufficient accuracy what disease they are caused by. Thus, scars after tuberculous lupus are characterized by an irregular shape and considerable depth, after a tuberculous ulcer they are relatively shallow, after gumma they are smooth and retracted. At congenital syphilis the scars are located around the mouth and have a ray-like character.

Chapter 6. General views about diseases of the oral mucosa and their taxonomy (classification)

Among dental diseases A special place is occupied by processes associated with damage to the oral mucosa. Increased interest among scientific researchers and practitioners this pathology is explained frequent occurrence diseases of the mucous membranes, a wide variety of their forms, wide range etiological factors, a rather complex, and in many cases insufficiently clear mechanism of the pathogenetic essence of the disease.

IN Over the past decade, a number of reports have appeared in domestic and foreign literature that indicate in-depth research this pathology (dissertations, monographs, atlases). They played a positive role in studying the problem. However, many aspects of oral mucositis diseases require further study, detail and specification, development and clarification of effective methods of treatment and prevention.

IN There are no statistical data in the literature showing the frequency and number of diseases occurring in lesions of the oral mucosa. Which of them are independent processes? What are the changes in CO that occur as symptoms of organ and general somatic pathology? What diseases of the oral mucosa are syndromes?

IN In this work, we tried to summarize information about diseases that are most often given in domestic and foreign manuals. Now, according to our data total The number of described diseases, including those that are rare, reaches about a thousand nosological units.

One of the reasons that makes it difficult to create a complete picture of OM diseases is the great diversity causal factors involved in the development of a particular disease. This is typical even for those observations when the clinical manifestations of diseases are naturally the same and the mechanism of their development is the same. Hence, understanding the essence of a particular disease of the oral mucosa, clear ideas about its development are possible only by analyzing the etiological, pathogenetic factors and clinical manifestations, as a single cause-and-effect process. Based on this point of view, many researchers have tried to develop the most substantiated classifications of diseases of the oral mucosa. Considering this approach as the most rational and methodologically correct, let us briefly dwell on some of its provisions.

Etiology. At one time, in the early stages of studying the causes of diseases of the mucous membranes and their pathogenesis, during a period that was associated with the accumulation of clinical facts, analysis of the features of their appearance, development, study of the course of individual clinical forms of diseases, all pathological processes of the mucous membranes of the mucous membranes were united under the general diagnosis of “stomatitis” . Later, as facts and clinical experience accumulated, attempts appeared to systematize diseases, to combine some of them into different

Aphthae – a superficial defect of the epithelial layer with a diameter of 0.3-0.5 cm, filled with a fibrin film. At the end of inflammation, the defect is epithelialized without the formation of a scar in the lamina propria.

Erosion (erosio) – a superficial defect of the epithelial layer, the lamina propria of which is the bottom of a crater-shaped defect filled with fibrin and necrotic epithelial cells. Erosion is formed when the cavity primary elements are opened (see above).

Ulcer (ulcus) – defect of the epithelial layer and the lamina propria of the mucous membrane. The bottom of the ulcer is covered with fibrinous-purulent exudate. As the ulcer heals, a scar forms.

Crack (rhagades) – deep linear defect of the mucous membrane, a type of ulcer.

Tripe (cicatrix) – incomplete regeneration of the connective tissue of the lamina propria and the submucosal layer of the epithelial layer of the oral mucosa.

Peeling (squama) – rejection of keratinized cells of the epithelial layer in places of hyperkeratosis that has arisen above the primary non-cavitary elements.

crust (crusta) – dried (coagulated) exudate (serous, purulent, hemorrhagic), located in the superficial layers of the epithelial layer and rejected along with the damaged epithelium.

Raid – superficial application of fibrinous exudate containing leukocytes, bacteria, fungi and damaged epithelium. Candidiasis of the mucous membrane of the tongue can be manifested by the formation of a whitish coating, which is called thrush (soor).

End of work -

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Carious damage to hard tooth tissues
Caries (from the gr. caries - rotting) is a widespread disease of teeth after their eruption, manifested by demineralization and softening of their hard tissues with the formation of defects

Features of some types of dental caries
Circular caries. Caries of primary teeth in children, which develops in upper incisors, starting at the neck of the tooth. Spreads circularly around the tooth and quickly; lack of clarity

Non-carious lesions of teeth
Non-carious dental lesions include fluorosis, wedge-shaped defects, tooth erosion, acid damage to enamel and dentin, abrasion of hard tooth tissues, mechanical damage to the tooth and inheritance

Pulpitis
Pulpitis – inflammation in the pulp in response to damage caused by action various factors. Damaging factors can be: 1) pathogenic microbes; 2) chemicals

Periodontitis
Periodontitis is an inflammation of the periodontium, mainly the periodontal ligament. They get sick more often in childhood and adolescence. In the etiology of periodontitis, infection occupies a leading position.

Glossary of the topic
Dens, dentis – tooth, organ of the oral cavity, an integral part of the digestive system.

Corona dentis – the crown of a tooth is the part of the tooth covered with enamel.
Test self-control

Select one or more correct answers.
The anatomical features of the periodontal structure have great importance in understanding the development and clinical and morphological manifestations of periodontopathies.

Periodontium is a complex of tissues
Gingivitis

Gingivitis is a nosological entity based on inflammation of the gums without disruption of the periodontal junction.
Gingivitis can be caused by infection, chemical or

Periodontitis
Periodontitis is an inflammation of the periodontium, accompanied by destruction of the periodontium, bone tissue of the interdental septa and the formation of a periodontal pocket. Periodontitis occurs more often Desmodontosis Desmodontosis or idiopathic periodontal lysis is a dystrophic destruction of periodontal tissue, with predominant damage to the desmodontium (

ligamentous apparatus
tooth). Etiology unknown

Glossary of the topic
Periodontomas

Corona dentis – the crown of a tooth is the part of the tooth covered with enamel.
The histogenesis of periodontal tumors is not clear. All tumors and tumor-like growths of periodontal tissue are considered periodontal tumors. There are periodontomas in the form of epulis (supragingivals) and fibromatosis de

Parodontopathia – periodontopathy, diseases and pathological processes of the periodontium.
Gingivitis (gingiva - gums) acuta, seu chronica – Select one or more correct answers. 001. Gingivitis is... 1) inflammation of the gums without disruption of the periodontal junction, 2) inflammation of the gums with on

Some data on the anatomical and histological structure of the jaws
The bones of the lower and upper jaws form part of the skeletal apparatus of the maxillofacial region. The lower jaw is the only movable bone of the facial skeleton and temporal bone forms a joint. Verkhnya

Pathology of the jaws of inflammatory nature
Osteitis is an inflammation of the jaw bone outside the periodontium of the tooth. Infection of the jaw bone occurs when the infection penetrates from

root canal
along the neurovascular path

Odontogenic tumors of the jaws
Odontogenic tumors are rare; they grow inside the jaws, leading to their deformation and destruction. According to histogenesis, tumors are distinguished from odontogenic epithelium, mesenchymal from tissue Odontomas Odontoms denote peculiar tumor-like growths of hard dental tissues that arise as a result of irregularities in the process of tooth formation. There are complex and complex

Non-odontogenic tumors and tumor-like formations of the jaws
In the pathology of the jaws, a significant proportion is occupied by non-tumor cystic lesions, which are designated as non-epithelial and epithelial cysts.

Glossary of the topic
Nonepithelial cysts Os, ossis (Latin); osteon (gr.) – bone. Osteitis acuta, seu chronica – acute or chronic osteitis, acute or

Corona dentis – the crown of a tooth is the part of the tooth covered with enamel.
chronic inflammation

bones.
Select one or more correct answers 001. Osteitis of the jaws is ... 1) dystrophy, 2) dysplasia, 3) inflammation outside the periodontium, 4) inflammation

Major salivary glands
The parotid salivary gland (glandula parotis) has an alveolar-tubular structure, proteinaceous (serous) type. Has a well-defined connective tissue capsule; characteristic of this gland Sialadenitis Sialadenitis is an inflammation

salivary glands
. With any inflammation that occurs in response to damage, the vascular-stromal organization of the organ or t

Salivary stone disease
Sialolithiasis is a disease of the salivary glands, which is based on stone formation in the ducts and acini. According to various literary sources covering this pathology, salivary stones

Eponymous syndromes of salivary gland pathology
Sjögren's syndrome (disease) (sicca syndrome, xerodermatosis, Guzherot-Sjögren syndrome, Predtechensky – Guzherot – Sjögren syndrome) – main manifestations: xerostomia, keratoconjunctivitis, p

Tumors of the salivary glands
Tumors of the salivary glands account for only about 2% of all tumors in humans. In accordance with the WHO nomenclature, tumors of the salivary glands are divided into three groups: epithelial, non-epithelial

Corona dentis – the crown of a tooth is the part of the tooth covered with enamel.
Salivary gland cysts

Cysts of the salivary glands are classified as pseudotumor conditions. Cysts of the minor salivary glands (about 56% of all cysts) are divided into cysts of the major salivary glands.
By origin, cysts can be congenital Select one or more correct answers 001. Specify primary sialadenitis 1) tuberculous parotitis, 2) dacryoadenitis, 3) mumps, 4 Oral mucosa

The mucous membrane of the oral cavity and tongue is lined with multilayer
flat epithelium. The mucous membrane of the alveolar processes, palatine eminence and the anterior third of the hard palate is dense and immobile. He

Morphological signs of the reaction of the epithelium of the oral mucosa to inflammation
Spot (macula) – focal hyperemia of inflammatory origin; limited spot (diameter up to 10 mm) – roseola (rozeola), diffuse hyperemia – erythema (erythaema).

Stomatitis
Diseases of the entire oral mucosa, the morphological manifestations of which are based on inflammation, are called stomatitis. In cases of local manifestation of inflammation on the gums it is called

Viral stomatitis
Spicy herpetic stomatitis– primary herpetic infection oral mucosa. The causative agent is the herpes simplex virus. Occurs in adults and children

Chronic stomatitis
Chronic recurrent aphthous stomatitis. Has a long course with repeated aphthous rashes. Aphthous rashes are isolated lesions

Mycotic infections
Candidiasis. Caused by pathogenic yeast fungi of the genus Candida. Morphologically, it is manifested by hyperemia of the oral mucosa with the formation of white loose plaques, which can

Changes in the oral cavity due to poisoning with heavy metal salts
Heavy metals are potent toxic substances. Penetrate into the body through the respiratory system and gastrointestinal tract in the form of vapors, aerosols, and fine dust particles

Changes in the oral cavity due to allergies
Behçet's disease. The Turkish doctor Behçet described a disease with a chronic relapsing course, the leading signs of which were recurrent aphthae of the oral mucosa and

Cheilitis
Cheilitis is an inflammation of the red border, mucous membrane and skin of the lips. It occurs as an independent disease and as a manifestation of other diseases (lichen simplex, lichen planus,

Glossitis
Glossitis is an inflammation of the tongue. It is rare as an independent disease, usually accompanies other diseases or is a sign of some disease. G

Changes in the tongue that are not inflammatory in nature
The black (hairy) tongue (lingua villosa nigra) is represented by hyperkeratosis of filiform papillae, which as a result take on the appearance of stubble. Changed papillae change over time

Pretumor conditions of the oral mucosa
Pre-tumor conditions and processes have different nature(dystrophic, inflammatory) and are conventionally divided into obligate and facultative precancers. Obligate precancer (required)

Oral tumors
Tumors and tumor-like formations of the oral cavity differ little from those of any other localization, with the exception of organ-specific tumors of the salivary glands and granular cell myoblastoma

Tumors of the tongue
Tongue ulcer almost always occurs superficially, often due to leukoplakia, traumatic ulcer or syphilitic fissure. It develops mainly in men after 50 years of age. Have

Tumor-like formations and cysts of the oral cavity
Conditions or processes in the mucous membrane and soft tissues of the oral cavity, clinically and morphologically manifested as voluminous, are usually considered as tumor-like formations. These include

Glossary of the topic
Stomatitis acuta, seu chronica - acute or chronic stomatitis, diffuse inflammation of the oral mucosa.

Corona dentis – the crown of a tooth is the part of the tooth covered with enamel.
Stomatitis gangraenosa (noma) – gang

Select one or more correct answers 001. Primary elements of damage to the oral mucosa.
1) macula, 2) papula, nodus, 3 Pathology of the head and neck Motivational characteristics of the topic. Knowledge of the morphological manifestations of diseases and pathological processes of the soft tissues of the face and neck is necessary for successful and

quality assimilation
uh Some data on the anatomical and histological properties of the skin The skin is considered a very complex organ that interacts with the body

external environment
. The skin consists of the epidermis and dermis (the skin itself). Epidermis

Defects of the face and neck
Birth defects

faces often have the appearance of clefts, which are considered to be the result of a violation of the fusion of embryonic tissues.
Of all the facial clefts, the most common Inflammatory lesions of the soft tissues of the face and neck Inflammatory lesions of the soft tissues of the face and neck are conventionally divided into non-odontogenic and odontogenic, taking into account the sources of infection. To non-odontogenic inflammatory lesions of the soft tissues of the face and neck

Tumors and tumor-like formations of the facial skin
The most common epidermal tumor of the facial skin is basal cell carcinoma (basalioma). It occurs in people of both sexes in the elderly and old age. Tumor

Tumors of soft tissues of the face and neck
Tumors from the soft tissues of the face and neck develop from connective, fatty tissues, muscles, blood vessels and lymphatic vessels and nerves. In structure they do not differ from tumors of the same name in other countries.

Non-tumor and tumor lesions of the lymph nodes of the neck
The organs of the neck are supplied with two groups lymph nodes. Mostly children and young people are affected.

Tumors and tumor-like formations from melanin-forming tissues
Nevi are tumor-like formations of the facial skin, as well as other localizations, and can be congenital or appear after birth. Nevi develop from epidermal melanocytes

Corona dentis – the crown of a tooth is the part of the tooth covered with enamel.
Choose one correct answer. 001. Frequent birth defect

faces 1) oblique facial cleft, 2) direct facial cleft, 3) cleft lip,
Rules for sending material for biopsy research

1. Biopsies and surgical material are delivered to the pathology department immediately after they are taken.
2. If it is impossible to deliver the material on time, it should be placed in a Clinical and anatomical analysis of the results of the study of surgical biopsy material A pathologist examining the material gives its macroscopic and microscopic characteristics, using as necessary

various methods
research.

Corona dentis – the crown of a tooth is the part of the tooth covered with enamel.
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