The first of the internal areas of the body that "meets" with food is the oral cavity. Its structure is directly related to digestion processes. It performs many specific functions. Consider one of the components - the vestibule of the oral cavity, its structure, norms, features of the examination and correction of possible deviations.
Human Oral Functions
The structure of the human oral cavity , which is in direct contact with food and is responsible for digestion, performs a number of basic functions. Namely:
- Crushing food. Separation of food into pieces, grinding of small and solid particles.
- Softening. That is, the maximum grinding of food, even soft ones. Everything is thoroughly chewed so that subsequently the food is processed more quickly with saliva and gastric juice.
- Food wetting. Even a piece of soft bread does not just go into the larynx. It is in saliva that the necessary enzymes are contained for the digestion of all substances.
- Analysis of the composition of food. A language is involved in this process, which contains various receptors that transmit information about food (temperature, taste) to the brain.
What is the vestibule of the oral cavity?
The oral cavity is the beginning of the digestive canal. Many functions that are responsible for the process of food intake into the body depend on it.
It consists directly of the vestibule and the oral cavity itself. The vestibule is the space that is located between the teeth and gums from the inside and the lips and cheeks from the outside. This is a soft tissue through which the opening of the mouth occurs. A large number of small salivary glands and ducts of the parotid salivary glands are located here.
Structure
Excretory ducts of the salivary glands open in the oral cavity: sublingual, submandibular and parotid. In addition, there are a large number of small glands. The glands, which make up the vestibule of the oral cavity and the oral cavity itself, can be of three types, depending on the nature of the secret: serous, mucous and mixed.
Large salivary glands that extend beyond the mucosa, reaching large sizes, retain through their excretory ducts a connection with the oral cavity. These include:
- Parotid gland (Glandula parotidea). This is the largest gland of the serous type, as well as the complex alveolar gland. It is located on the lateral side of the face in front and just below the ear. It is covered with fascia, has a lobed structure.
- Submandibular gland (Glandula submandibularis). Alveolar-tubular has a mixed character and is the second largest.
- The hyoid gland (Glandula sublingualis). Complex alveolar-tubular mixed type of iron. It is located at the bottom of the oral cavity, forming a fold.
How is the examination
Specialists examine the oral cavity from the vestibule, while the jaws are closed and the lips are relaxed. The doctor pulls the lower lip with a dental mirror and examines the corners of the mouth and lip rim first. The walls of the vestibule of the oral cavity should have a pinkish tint, there should be no crusts and scales. In this case, the inner surface of the lip may be slightly tuberous, which is caused by the presence of small salivary glands.
Point openings, i.e., excretory ducts with an accumulation of droplets of secretion, may also be visible. Next, with the help of a mirror, an examination of the inner surface of the cheeks, determination of color and moisture is carried out. Imprints of the teeth may be visible on the mucosa. Thus, the doctor can be diagnosed with an incorrect bite.
In addition, the oral cavity is examined according to the nature of salivation (lowered or increased), whether there is bad breath, whether gums are bleeding. In the presence of diseases, the mucosa can be hyperemic, edematous, with rashes, which indicates the development of inflammation.
Dimensions and Depth
The depth of the vestibule of the oral cavity can be shallow (less than 5 mm), medium (8-10 mm) and deep (more than 1 cm), which depends on the distance between the moving part and the stationary gingival region. If the vestibule is small, it is fraught with the development of gingivitis or marginal periodontal disease. In this case, a kind of periodontal pockets may form, that is, a depression between the tooth and gum. The cause of this condition can be a normal conversation, brushing your teeth or eating. With increased mobility of the nipples, delaying the free end of the gums, periodontal disease may occur.
If the dimensions of the vestibule deviate from the norm, they carry out operations called vestibuloplasty. They can be both open and closed and carried out in various ways.
Norm and causes of deviation
Examination of the oral mucosa begins with an examination of the vestibule of the oral cavity, namely its depth. To determine this indicator, use a graduated ironer or periodontal probe. The distance from the gingival margin to the level of the transitional fold is measured. Normally, the depth should be 5-10 mm. If the indicator is less, the vestibule is considered shallow, more - deep.
An anomaly can be detected by the following signs:
- an increase, narrowing or complete absence of the area to which the mucous membrane is attached;
- in the area of attachment of teeth and gums there is tension of the gum tissue;
- bleeding and inflammatory processes that hit the gums;
- hypersensitivity of incisors;
- anatomical deformities of the dentition and gum;
- short bridle;
- problems with diction.
With a decrease in the size of the vestibule, incomplete closure of the lips, malocclusion, partial immobility of the lips or a slightly reduced size of the upper jaw may be observed compared with the lower dentition.
The consequences of deviations from the norm of the vestibule of the oral cavity can include:
- in the process of eating food, a marginal periodontium may be injured;
- muscle tone of the chin increases;
- blood does not enter the gum tissue well;
- malocclusion forms;
- lip mobility is reduced;
- the upper jaw row slows in growth;
- atrophy and gum disease;
- dentition is loosening;
- periodontitis develops.
Shallow vestibule of the oral cavity
The attachment height of the gums, especially in children, is variable. With the development of dental follicles, as well as teething (both milk and permanent), the dimensions of the vestibule can be modified.
There are certain norms for deepening the vestibule of the oral cavity in children:
- 6-7 years - depth is 4-5 mm;
- 8-9 years old - from 6 mm to 8 mm;
- to 15 years - up to 14 mm.
The small vestibule refers to abnormalities in the development of the mucosa. This can lead first to catarrhal gingivitis, which affects one or more teeth, to local periodontitis. The development of this process can contribute to a low level of oral hygiene and various orthodontic disorders.
The reasons for the development of a small vestibule of the oral cavity can be:
- congenital pathology with a hereditary factor;
- consequences of surgical interventions;
- mechanical damage to soft tissues in the oral cavity.
The treatment is complex, including therapeutic, orthodontic and surgical procedures. In some cases, plastic surgery of the vestibule of the oral cavity is carried out for prophylactic purposes.
Vestibuloplasty
Plastic surgery of the vestibule of the oral cavity is often performed with its reduced size. Through surgery, open or closed type, a deepening of the area occurs, which in turn helps to avoid the development of problems with the dentition in the future.
Indications for vestibuloplasty are:
- lack of attachment of the gums;
- tension, displacement or blanching of the gingival margin when pulling the lips;
- the depth of the vestibule is less than 1 mm;
- gum tissue is severely inflamed;
- preparation for orthodontic therapy;
- the need for prosthetics;
- atrophy of the gum tissue.
The operation is carried out in different ways, which can be divided into groups: open, closed, patchwork and the use of the plate. An open method involves dissecting the mucosa of the lower lip and displacing soft tissues, after which the depth of the vestibule increases. As a result of this method, a wound is formed, which is subsequently scarred, and the recovery period lasts about 14 days.
With a closed operation, the mucosa is practically not damaged, the recovery period is short, but there is a big minus - the possibility of relapse. According to statistics, several years later, the depth of the vestibule decreases almost twice.
Patchwork is carried out with a strong tension of the gum tissue, which can subsequently lead to loosening of the teeth and inflammatory processes in the oral cavity. It is performed using vertical and horizontal sections. In this case, the patches are fixed with suture materials. The use of the plate also allows you to deepen the vestibule of the oral cavity. This is a vestibular structure, which is superimposed on the site of cutting the mucosa and is fixed with sutures. To achieve the result, it should be worn for at least two months.
Other treatments:
- Vestibuloplasty according to Edlan-Meyher. A sufficiently effective way to eliminate the shallow vestibule. The incision of the mucosa and periosteum, as well as the movement of the submucosa to the anterior and lateral sections of the vestibule, is performed under local anesthesia, the recovery period is up to two weeks.
- Vestibuloplasty according to Schmidt. The operation is similar to the previous one, but the periosteum is not flaked. The method is used for both the upper and lower jaw.
- Clark vestibuloplasty. It is carried out with pathology of the upper row of the jaw. Exfoliation of the mucosa is carried out with scissors, the depth of the incision does not exceed 15 mm. Next is the displacement of the peeled area and fixation with seams.
- Glickman vestibuloplasty. It can be carried out both on the entire plane of the oral cavity, and in a certain area. Dissection, movement and suturing occurs under anesthesia.
- Tunnel vestibuloplasty. The least traumatic method that is used for both the lower and upper jaw. The recovery period after cutting, moving the patch and securing it, lasts no more than ten days.
But plastic, regardless of the method or method, is not for everyone. There are a number of contraindications, namely:
- chronic diseases of the oral mucosa;
- caries, which affected almost the entire dentition;
- inflammatory processes affecting the musculoskeletal tissue;
- disturbances in the work of the nervous system;
- poor blood clotting or other pathologies of the circulatory system;
- malignant neoplasms;
- radiation therapy that has been performed in the head or neck in the past.
Stages of vestibuloplasty and possible complications
Since the ducts of the salivary glands open on the eve of the oral cavity , it is important to conduct an examination to determine the height at which the gum is attached. If a specialist establishes that the vestibule is still small and vestibuloplasty is indicated, it is necessary to thoroughly prepare for the operation. This will reduce the possible risk of future complications.
Principles of preparation:
- complete rehabilitation of the oral cavity;
- refusal to take solid food at least six hours before surgery;
- do not take medications except those prescribed by the doctor, or necessary to maintain normal human activity.
Experts also note that a psychological attitude is important. In general, regardless of the method of vestibuloplasty, the operation is painless, since it is performed under local anesthesia and lasts about an hour.
Stages of vestibuloplasty:
- An anesthetic is administered after the doctor discusses with the patient the possible intolerance of certain drugs and excludes them. It depends on the choice of anesthesia how much a person will feel during the operation and after it.
- Direct surgical intervention using one of the methods described above. It takes no more than an hour.
- Ice is applied to the place where the operation was performed for 15 minutes to remove puffiness and minimize pain after surgery.
After the operation, swelling and redness of the skin are possible, which is considered the norm. During the day after vestibuloplasty, the use of pain medications is indicated, but this depends on the patient's well-being.
Complications that occur extremely rarely after surgery to deepen the vestibule of the oral cavity can develop against the background of non-compliance with the recommendations of a specialist and with poor oral hygiene.
Possible side effects:
- increased bleeding, especially at the site of suturing;
- scar tissue;
- low sensitivity;
- severe swelling of the gums.
If this condition is observed within a few days after vestibuloplasty, this indicates the development of the inflammatory process. It is worth contacting a doctor for a consultation.
Conclusion
Inspection of the vestibule of the oral cavity in the presence of problems with the dentition is mandatory. Determining its depth allows you to identify the causes of diseases associated with teeth, the development of malocclusion or speech impairment. Regardless of the form (small, medium or deep vestibule), as well as the nature of the pathology (congenital or acquired), it can be treated. Specialists perform vestibuloplasty using various methods to correct the situation.