Vincent’s ulcerative necrotic stomatitis is an infectious and inflammatory disease of the oral mucosa. It occurs against the background of a decrease in immunity, accompanied by necrosis and the formation of ulcers on the mucous membrane of the epithelium of the oral cavity.
Pathology in almost all cases proceeds with an increase in temperature, as well as an increase in the size of the lymph nodes. The treatment of this disease mainly comes down to the use of local therapy. The use of antibacterial agents is prescribed only in the most difficult cases.
Pathology feature
Ulcerative necrotic stomatitis is characterized by the fact that inflammation and a change in the structure of the mucosa occur in the mouth. In this case, ulcers and necrotic areas form on it. This process refers to an alternative type of inflammation.
Ulcerative necrotic stomatitis is characteristic of children under 3 years old, men 20-30 years old, as well as elderly people over 60 years old. Basically, the disease is more actively manifested from October to December. This is due to hypothermia, which is considered one of the causes of this type of stomatitis.
The onset of ulcerative necrotic stomatitis in all cases is associated with a sharp deterioration in the immune system. When exposed to negative factors, the pathology can spread rapidly.
Disease classification
Ulcerative necrotic stomatitis can be acute, subacute and chronic. According to the severity of the pathological process, it can be light, medium and heavy. The most common mild form of the disease. In stages, like any inflammation, it passes:
- initial form;
- midst;
- resolution stage.
In addition, the classification is carried out according to the number of mouth ulcers, which can be single or multiple. Most often, ulcers are localized in the lower jaw, especially behind the wisdom teeth. In addition, they can be located on the side of the tongue, the line of closure of the tooth and cheeks. If the ulcer is localized in the area of the hard palate, then the pathology quickly enough spreads to all layers located above, which leads to exposure of the bone.
Chronic form
Chronic ulcerative necrotic stomatitis occurs as a result of poor-quality treatment of the oral cavity and improperly conducted therapy in the acute stage of the disease, due to which the pathological process becomes chronic. It is characterized by a sluggish course, a gray coating in an insignificant amount is preserved on the surface of the ulcers. In this case, general systemic manifestations are not observed. Chronic ulcerative necrotic stomatitis, a photo of which can be seen on the stands in dental clinics, is characterized by the destruction of bones.
If the acute stage turned into a chronic one, then there will be no severe degree of inflammation. In this case, there is bad breath, slight soreness and bleeding of the gums. The edges of the gums become thickened and swollen.
Between some teeth, mainly those where there are accumulations of old plaque and tartar, foci of necrosis remain, although they are insignificant. In the area of ulcers, the alveolar processes undergo gradual resorption, as a result of which the teeth fall out. Ulcers gradually begin to heal. With a prolonged course of the pathological process, the lymph nodes begin to hurt, after 4-8 months they become denser and become like cartilage by touch.
Childhood illness
Ulcerative necrotic stomatitis in children is an acute inflammatory lesion, the main sign of which is the occurrence of ulcerative lesions on the oral mucosa. If in adults this disease is provoked by the presence of various pathogens, and then a secondary infection joins, then in children the pathological process occurs in the reverse order.
Among the main causes of necrotic stomatitis in children are the following:
- decreased immunity due to the occurrence of chronic diseases;
- digestive problems;
- avitaminosis;
- allergy;
- caries;
- gum tissue inflammation during teething.
Most often, stomatitis develops in infants due to the penetration of pathogens into the oral cavity. This may be due to the fact that the kids pull various inappropriate items into their mouths. Basically, ulcerative necrotic stomatitis is characteristic of young children. Among the main signs of the course of inflammation, it is necessary to distinguish the following:
- swelling of the mucous membrane and its redness;
- painful manifestations during the chewing and sucking process;
- moodiness while eating food.
Slight bleeding of the gums is sometimes noted. If treatment is started at this stage, then the subsequent development of the pathology can be stopped. However, this is possible provided that secondary infection does not join. With moderate inflammation, a necrotic film forms on the gums, the mucous membrane bleeds heavily, and ulcers appear on it. In addition, among the main features can be noted such:
- ulcers appear;
- the gums swell;
- purulent contents appear;
- the temperature rises sharply;
- a putrid odor appears;
- lymph nodes are enlarged.
The child at the same time begins to constantly act up and refuses to consume food. Then the general signs of intoxication of the body increase. Ulcers increase over time, bone tissue is exposed, vomiting, abdominal cramps appear.
Before you begin treatment for ulcerative necrotic stomatitis in children, you need to determine the cause of its occurrence. Initially, you need to anesthetize the oral cavity with an anesthetic, which is previously diluted in glycerin so that it does not corrode the wounds. Then purulent contents are removed, antibacterial and antimicrobial therapy is performed. Treatment is necessarily carried out under the strict supervision of a physician.
Causes of occurrence
Fusobacteria and spirochetes located in the oral cavity are causative agents of necrotic stomatitis. However, they provoke inflammation only in the presence of predisposing factors. Often, pathogens are localized in the interdental spaces. Normally, there are very few of them and they do not cause a person any discomfort at all.
A decrease in immunity also reduces the body's resistance, which ceases to fight infection. In addition to reducing immunity, such factors as:
- lack of normal oral hygiene;
- advanced form of gingivitis;
- a large amount of tartar;
- a previous cold, flu;
- heavy metal poisoning;
- pathology of internal organs;
- leukemia;
- microtrauma of the oral cavity;
- caries.
This type of stomatitis mainly manifests itself as an independent disease. In some cases, it is a secondary infection that forms against the background of existing diseases of the internal organs. In addition, ulcerative necrotic stomatitis, herpes zoster and herpetic stomatitis can provoke. In some cases, it is a complication of an untreated catarrhal form of inflammation.
Main symptoms
Initially, there is a slight malaise with a headache and a slight increase in temperature. In this case, gingivitis is observed in the form of redness, the mucous membrane becomes dry, and the gums bleed. A similar condition, depending on the subsequent form, may last several days or hours. Gradually, weakness begins to grow, lethargy, apathy appears, working capacity worsens, appetite, the patient sleeps poorly.
On the mucous membrane of the oral cavity ulcers are formed, densely covered with a yellow coating. After 3-4 days, they become greenish-gray, which indicates ongoing necrotic processes in the ulcer. This film is firmly connected to the underlying tissues, and its removal reveals a bleeding surface. This increases salivation.
In the mild form of the disease, the affected area is limited and is only catarrhal. The pain in the oral cavity is slight when touched, the well-being is not disturbed, the temperature may remain normal or increase slightly. Gum bleeding is especially pronounced during food intake. The gums become swollen, a lot of saliva is formed in the mouth, however, necrosis only affects individual parts of the tissues between the teeth. The patient remains active enough. Basically, more serious problems are observed in the patient with ulcerative necrotic stomatitis, proceeding in more advanced stages.
With moderate severity of the disease, catarrhal manifestations are replaced by the formation of an ulcer surface, the temperature rises sharply, which is accompanied by chills. At the same time, human performance decreases, ulcerative lesion grows, and also becomes covered with a necrotic film. The size of the wounds can reach 5-6 cm, they have uneven and soft edges.
After this, necrosis gradually develops, the edges of the gums become strongly altered, this violation persists even after treatment. The gums bleed very much, and a yellowish coating forms on them, which is quite easily removed. There is a fetid odor from the mouth, pus is released, the head hurts. There is also pain in the oral cavity, and the face acquires a grayish-pale hue. Lymph nodes increase, become more dense, there is a strong weakness.
The very last stage of the course of the disease is characterized by the fact that the ulcers reach the deep muscle layer, the temperature rises and severe weakness is observed. There is nausea, abdominal pain. If treatment is not performed at this stage, then the ulcer can reach the bone and jaw osteomyelitis may develop. In addition, there is a limitation in tearing off the mouth, this occurs as a result of damage to the masticatory muscles, so it becomes almost impossible to eat. Necrosis can spread to the glands.
Diagnostics
What to treat ulcerative necrotic stomatitis, can only be determined by a doctor after a comprehensive diagnosis. Initially, the doctor examines the oral cavity. Necrotic areas, ulcers with uneven edges are found on the mucosa. The submandibular lymph nodes are enlarged and painful when pressed.
After that, scraping is taken from the injured tissues, then they are examined for histology. In this case, various pathogens are detected. Laboratory blood tests are required. In this case, in the blood test, all signs of inflammation are observed.
It is worth noting that this disease is very often accompanied by the occurrence of other, no less dangerous diseases, which is why it is necessary to carry out certain diagnostic measures that will eliminate their presence.
Treatment features
How to treat ulcerative necrotic stomatitis, the doctor determines after a comprehensive diagnosis. The choice of treatment methodology largely depends on the form of the course of the disease. In adults, treatment is reduced not only to the elimination of acute symptoms, but also the causes of the disease.
If ulcerative necrotic stomatitis proceeds in a mild form, then only local therapy is carried out, including surface treatment. In adults, after applying local anesthesia, oral sanitation is performed. The sharp edges of the teeth, which can provoke a mucosal injury, grind very carefully.
Treatment of necrotic stomatitis includes rinsing with a solution of "Chlorhexidine", hydrogen peroxide, a decoction of herbs. Additionally, healing applications with Metrogil-Denta gel can be prescribed. Cleaning the surface of ulcers in adults is carried out using proteolytic enzymes. Accelerate the healing of ulcers with the help of oils of sea buckthorn berries and rose hips.
In case of a severe course of the disease, in addition to local treatment, systemic therapy is also prescribed, which includes taking antibacterial drugs and carrying out general detoxification procedures. Additionally, antihistamines and multivitamin complexes can be prescribed.
Local treatment
Local treatment of Vincent’s ulcerative necrotic stomatitis involves the removal of necrotic tissue and the use of stimulating processes for the restoration of the epithelium. Partial sanitation of the oral cavity is performed even in the acute period of the course of the disease. Anesthesia is first required by applying local applications with Lidocaine, Anestezin or Trimekaina solutions.
Then the dentist carefully removes the existing plaque and tartar. Caries teeth are treated with antiseptic agents. This whole process is carried out after complete cleansing of the ulcers.
Proteolytic enzymes are used to cleanse the ulcer surface. The oral cavity is treated with antiseptic solutions every day, as well as antimicrobial agents. To accelerate the healing of ulcers in adults, local applications are used.
Systemic treatment
The acute period of inflammation implies strict adherence to bed rest. In severe cases of the disease, additional systemic treatment is prescribed. In particular, antibiotic therapy is used. For this, such drugs are prescribed:
- "Metronidazole";
- "Trichopol";
- "Flagil";
- Klion.
In addition, broad-spectrum antibiotics can be prescribed, in particular, such as:
- "Sumamed";
- "Chloramphenicol";
- "Rulid."
Additionally, antihistamines and vitamin complexes can be prescribed. With well-chosen adult therapy, normalization of health is observed approximately 1-2 days after the onset of the disease. With a mild form of the course of stomatitis and a satisfactory condition of the oral cavity, ulcer healing occurs on about 3-6 days. In some cases, surgical treatment of the affected area of the mucosa may be required - removal of necrotic tissue. In addition, affected teeth may be removed. At the same time, constant irrigation with anesthetics and antiseptics is carried out. Treatment can also be supplemented with alternative therapies, but prior consultation with a doctor is required.
Timely initiated treatment always guarantees a positive result. The doctor must keep a protocol for the treatment of Vincent’s ulcerative necrotic stomatitis, as this will determine the correctness of the therapy.
In the absence of well-conducted timely therapy, the disease can lead to very serious complications, in particular, to bone destruction, the development of osteomyelitis, periodontitis, tooth loss. With irrational therapy, inflammation can last several months. Relapse may also occur.
Forecast and Prevention
With complex timely treatment, the prognosis is favorable, but it is important that you see a doctor immediately if the first signs of inflammation occur.
To carry out prophylaxis, dentists advise regular treatment of the oral cavity, follow basic hygiene rules, especially during the presence of infectious diseases that lead to a decrease in immunity.