The classification of diseases associated with the oral mucosa is very important in the daily practice of a doctor. This allows the specialist to navigate the many nosological types of pathologies, and it follows that the correct diagnosis will be made and reasonable therapy will be prescribed, as well as the implementation of preventive measures (including annual medical examination).
About classifications of the oral mucosa
At the moment, there is no classification that would be generally accepted among diseases of the oral mucosa. Those that are based on diverse attributes are popular. These include localization of changes in pathology, severe course of the disease, signs of clinical and morphological, etiology, pathogenesis, etc.
This article will discuss the classification of Supple.
Mucosal changes
Appearing changes that develop in the oral cavity after the teeth have been removed begin to capture not only the alveolar processes, but also spread to the mucous membrane, which covers them and the hard palate.
These changes can be expressed as atrophy, folds can also form. In this case, the location of the transitional fold relative to the crest of the alveolar process changes. The essence and stage of these modifications can be explained not only by the loss of teeth, but also by the reasons that became the basis for their removal.
What influences this?
Local diseases and pathologies of the whole organism, age-related changes also affect the nature of the modification of the mucous membrane that occurs after the teeth have been removed. The doctor needs to know the features of the tissues that cover the prosthetic bed, as this is of great importance when choosing a prosthetics method. To achieve good results, it is necessary to prevent the harmful effects of the prosthesis on the supporting tissue.
The following is a classification of the mucosa according to Supple.
The author pays special attention to the state of the mucous membrane of the prosthesis bed. In total, he distinguishes four classes of compliance.
First grade
The first class is distinguished by the presence on the upper and lower jaw of well-defined alveolar processes that are covered by a compliant mucous membrane. An even layer of mucous membrane is covered and the sky. Here she is also moderately malleable in the rear of his third.
From the top of the alveolar process , the natural folds of the mucous membrane on the upper and lower jaw are removed to a sufficient distance. With this class of mucous membrane, convenience appears for supporting the prosthesis, including variants having a metal base.
Second class mucosal compliance
In the second class of Supple's classification, a dead mucous membrane appears, which covers the alveolar processes and the palate with a fairly thin stretched layer. In this case, the places to which the natural folds are attached are located a little closer to the upper point of the alveolar process, in contrast to the first class. Being dense and thinned, the mucous membrane does not seem convenient for supporting a removable prosthesis, especially having a metal base.
Third class
The third class, according to the classification of Supple, is characterized by the fact that the alveolar processes and the posterior third of the hard palate are covered with loosened mucous membrane. In this state, this state of tissue is often observed in combination with a low alveolar process.
Patients with a similar mucous membrane rarely need prior treatment. After the installation of prostheses, these patients must strictly observe the regimen when using it and must undergo an examination by the attending physician.
The fourth class of compliance of the oral mucosa
In the fourth grade, the difference lies in the presence of mobile strands of the mucous membrane, which extend longitudinally and can easily be displaced with minimal pressure on the impression mass. The cords have the ability to infringe, making it difficult or almost impossible to use the prosthesis.
Such folds can be observed, as a rule, on the lower jaw, mainly in the absolute absence of the alveolar process. This type also includes a process having a dangling soft crest. In this case, prosthetics is often possible only after its removal.
Based on the conclusions made by the classification of the mucous membrane according to Supple, it is clear that its compliance is of great practical importance.
Based on its various degrees, Lund identified four zones in the region of the hard sky.
Classifications by Supple and Lund are similar to each other.
Lund classification of the oral mucosa
In the first zone, the mucous membrane is thin, there is no submucosal layer. As for compliance, it is very small. This area according to Lund is called the median fibrous zone.
In the second zone, the alveolar process is captured. Here, too, there is a coating in the form of a mucous membrane, which is practically devoid of a submucosal layer. This area is called the peripheral fibrous zone.
As for the third zone (rugae palatinae), it is covered with a mucous membrane, which has an average degree of compliance. In the fourth zone, which is the posterior third of the hard palate, there is a submucosal layer enriched with glands. It contains a small amount of adipose tissue. This area is quite soft, in the vertical direction it begins to spring, has the greatest degree of compliance and is called the glandular zone.
How does Supple's classification help in orthopedics?
As a rule, most researchers attribute the ability of the mucous membrane of the hard palate and alveolar processes to be malleable to the compositional features of the submucosal layer, or rather, to the place where the fatty tissue and mucous glands are located in it.
Sometimes they hold a different point of view when pliability of the vertical type of the mucous membrane of the jawbone is associated with the saturation of the vasculature of the submucosal layer. Only they can create conditions in which the volume of tissue decreases, due to their ability to quickly release and fill with blood.
Buffer zones are called areas of the mucous membrane of the hard palate with extensive vascular fields, and which therefore have a springy property.
The classification of Supple in orthopedic dentistry is used quite often.
Research by other scientists
Domestic histological and topographic anatomical studies with vascular filling (according to V.S. Zolotko) found that in the mucous membrane that covers the alveolar processes and the area of the hard palate along the sagittal suture, there are small vascular fields, and therefore it practically does not have buffer properties .
In areas of the mucous membranes that are located in the middle of the base of the alveolar process and the middle zone, there are saturated vascular fields, the density of which begins to increase, heading towards line "A". As a result of this process, the buffering properties of the mucous membrane of the hard palate are enhanced.
In addition to the classification of the oral mucosa according to Supple, other theories apply.
V.I. Kulazhenko devoted much time to studying the compliance of the mucous membrane of the hard palate, the studies of which were carried out thanks to the electron-vacuum apparatus. According to the results of his research, its limits range from two to five mm. In the data obtained by V.I. Kulazhenko on the mucous membrane in multiple places of the hard palate and alveolar process, there are general coincidences according to the topography of the buffer zones made by E.I. Gavrilov.
During life, there is a significant change in the buffer properties of the mucous membrane of the upper jaw prosthesis, due to the fact that the vessels change their characteristics with age, as well as as a result of metabolic disorders, possible infectious and other diseases. Their condition affects not only the compliance of the mucous membrane of the hard palate, but also its possible reaction when exposed to the prosthesis. In the appearance of various changes in the mucous membrane, necrosis of the alveolar process, which is often observed during prolonged use of the prosthesis, it is the vessels that play the fundamental role.
We have described in detail the classification of Supple.