In medical practice, along with a description of pathologies of the oral cavity, the concept of Vincent's symptom is often found. What kind of condition is it, in what inflammatory process does Vincent’s symptom arise and what is the favorable soil for the occurrence of such a pathology? We will deal with these issues in our article today.
What is this symptom?
Vincent’s symptom is a condition in which a person loses sensitivity in the chin area, more precisely - in the area of the lower lip.
The symptom is a consequence of various painful conditions of the body, such as jaw osteomyelitis and acute apical periodontitis. This pathology is also mentioned with ulcerative-filmy angina, the second name of which is Simanowsky-Vincent's tonsillitis (the symptoms of the pathology are quite diverse).
Let us consider in more detail each of the pathologies leading to the manifestation of the above symptom.
Peptic ulcer - a disease leading to inflammation of the tonsils. The cause of the pathology is the activity in the body of the spindle-shaped stick of Plaut - Vincent together with the spirochete of Vincent. With angina, ulcers with a characteristic dirty green coating are formed. The patient's breathing is accompanied by a putrid odor. I must say that such bacteria are constantly present in the oral cavity of a healthy person, however, under the influence of various factors, for example, during caries of molars, in the presence of foci of necrosis in the oral cavity, as well as with a general weakening of the immune system, microorganisms are activated, and their activity leads to the development of pathological states.
Angina Vincent. Symptoms and treatment
Peptic ulcerous tonsillitis manifests itself as a whole complex of characteristic symptoms. These include:
- Enlarged tonsils. Mostly the disease affects one of the parties.
- Enlarged and moderate soreness of regional lymph nodes.
- The formation on the mucous membrane of the tonsils of the tonsils is a grayish-yellow coating, which can cause the formation of superficial painless ulcers with a gray bottom. If the pathology progresses, ulcers occur in other parts of the pharynx, as well as on the mucous membranes of the cheeks or gums. Sometimes ulcers can heal without forming any defects.
- When eating food (when swallowing), painful sensations arise, while patients note increased salivation, bad breath.
- The body temperature in pathology in rare cases exceeds normal limits, although sometimes the disease can begin with a high temperature and a state of chills.
- Numbness and loss of sensation in the chin area.
Treatment of pathology is aimed at eliminating inflammation of the mucous membrane of the throat. Otolaryngologists often prescribe a rinse or lubrication of the affected area. In the case of a prolonged course of the disease, they resort to antibiotic therapy. Patients with ulcerative-filmy angina are always isolated, with severe forms of pathology they are hospitalized. The main principle of disease prevention is to strengthen the protective functions of the body and increase immunity.
Vincent's symptom in dentistry. Periodontitis
Periodontitis is a pathology caused by infection from the cavity in the bone tissue through the apex of the root. The disease causes inflammation of the lining of the tooth root. If untreated, periodontitis is manifested by various signs, including Vincent's symptom. The reversibility of the disease depends on many factors: the timeliness of seeking medical help, the general condition of the human body, etc. Consider the mechanism of the occurrence of pathology.
Deep caries leads to pulpitis - inflammation of the pulp, as a result of which microorganisms enter the periodontium through the root canal.
There are also other ways for bacteria to enter bone tissue, for example due to trauma, in sepsis, but pulpitis is the most common cause of inflammatory processes in the bone. With inflammation, sweating of the liquid occurs, and periodontium - a tissue saturated with receptors - responds to an increase in pressure. In this case, inflammation causes pain.
A characteristic feature of periodontitis is an increasing throbbing pain, which is strictly localized. Sometimes when closing teeth, pain is difficult to endure, patients can not eat. It hurts a person to just touch the edge of the tooth, which also becomes mobile, the gums around the tooth, as well as the lip and cheek, swell, the body temperature rises sharply. A concomitant sign of periodontitis may be a symptom of Vincent. Signs of it have already been noted earlier: numbness and loss of tissue sensitivity in the chin area.
Forms of periodontitis
There are acute and chronic forms of periodontitis. If, during inflammation, the liquid that forms flows through the root canal of the tooth, periodontitis becomes chronic. The pain syndrome is not very pronounced, and pathological processes in the apex of the tooth flow slowly. Bacteria, multiplying in the affected bone area, secrete toxins that “poison” the human body and lead to the development of diseases of various organs and systems (joints, heart, kidneys).
In the opposite case, the development of an acute form of periodontitis, which over time, in the absence of proper treatment, can go into a purulent stage.
The above forms of periodontitis require a long and highly qualified treatment. The main goal of therapy is to ensure the outflow of pus from the site of localization of inflammation. In the course of treatment, the inflammatory process is stopped first, then the antiseptic treatment of the pulp is carried out, then a temporary filling is established. During the period of therapeutic measures, the state of bone tissue is monitored by radiography.
Treatment
In the treatment of chronic periodontitis, medications are used that stimulate the recovery of periodontal disease. Concomitant methods of treatment may include physiotherapy: electrophoresis, UHF, microwave, laser therapy, magnetotherapy. In some cases, antibacterial treatment is used.
Antibiotics can be used topically in the case of deep periodontal pockets. Root canal filling is performed with materials that are selected individually in each case.
If inflammation affects large areas of tissue, or conservative therapy does not produce the desired result, surgery is performed. The purpose of the manipulation is the resection of the apex of the tooth root. A small incision is made in the gum in order to gain access to the bone tissue. Then the affected structure is removed, the top of the canal is sealed. Bone regeneration is a long process. If the treatment does not lead to a positive trend, the tooth may undergo extraction.
In order to avoid the development of such a disease, it is necessary to carefully monitor oral hygiene.
This implies a mandatory daily two-time brushing. In this case, the toothbrush should be periodically changed, carefully approach the choice of toothpaste. At least once a year, consult your dentist for a professional tartar removal procedure.
Emptiness of the dentition leads to the fact that an increased load is placed on the teeth remaining in the mouth. Molars become vulnerable, an inflammatory process can develop in the oral cavity, which in the future will lead to periodontitis.
Periodontitis is a rather insidious disease, because it causes many complications, among which are acute sepsis, inflammation of the soft tissues of the face, and osteomyelitis of the jaw.
What is osteomyelitis?
Another reason Vincent's symptom occurs is osteomyelitis. This pathology, regardless of which section of the human skeleton appears, belongs to the group of infectious diseases of an inflammatory nature.
With osteomyelitis of the jaw, all tissues are affected: periosteum, bone marrow, bone marrow. Pathology occurs mainly in people no older than forty years. However, there are cases of the development of the disease in children, as well as in the elderly. It all depends on how badly the person’s teeth are affected by caries. Osteomyelitis equally worries both men and women. Vincent's symptom in osteomyelitis affects the chin area, and this is primarily due to the fact that pathology often affects the lower jaw than the upper.
Previously, when oral hygiene was not given due attention, osteomyelitis of the jaw occupied about 40% of the pathology of other bones. Not so long ago, the situation has changed for the better.
Today, due to the widespread planned rehabilitation of the oral cavity in both children and adults, the percentage of patients with jaw osteomyelitis has decreased, and the use of antibiotics has made the course of the disease less severe.
Osteomyelitis Classification
In most cases, jaw osteomyelitis is a consequence of caries, as well as a complication after periodontal disease.
This group of osteomyelitis is usually called odontogenic (stomatogenic). The infection enters the bone structures through caries affected by caries. In the foci of inflammation there is a diverse microflora. This is streptococcus, and staphylococcus (white and golden), pneumococcus and other bacteria.
Contact osteomyelitis is a pathology that occurs as a result of infection of the skin or mucous membrane (for example, with a facial boil). Specific osteomyelitis is distinguished here:
- tuberculosis
- syphilitic,
- actinomycotic.
Sometimes damage to the bone marrow of the jaw occurs by the ingestion of bacteria with a blood stream. This condition is classified as hematogenous osteomyelitis, which occurs after infections such as influenza, typhoid fever, scarlet fever, and measles.
A separate group is made up of osteomyelitis resulting from an injury (fracture, severe bruise). Vincent’s symptom in fractures, when sensitivity is disturbed in the area of the chin nerve and patients notice numbness of the lower lip, occurs due to compression of the lower hole of the nerve, resulting from inflammation of the exudate.
Course of the disease
The course of the disease can be different, and most often it depends on the state of the body as a whole, on the magnitude of circulatory disorders in the affected area. In some cases, the extent of bone necrosis is small, due only to the primary focus. In such cases, we are talking about limited osteomyelitis. If the disease progresses, the inflammatory process is transferred to the soft tissues surrounding the jaw. This condition can manifest itself in the form of periostitis or phlegmon. Phlegmon is an acute purulent inflammation of spaces (often soft tissues), which is spilled and does not have clear boundaries, such as an abscess. By the way, often a Vincent symptom can be observed with phlegmon, patients note a loss of sensitivity in the affected area.
At the beginning of the pathological process, the bone marrow at the point of inflammation acquires a brown, dark red color. Later, purulent foci are formed, which merge into whole cavities. Pus enters the periosteum, gum and causes necrosis of the jaw areas. Sequestries are formed. In small blood vessels, blood clots occur that undergo melting. Areas of bone necrosis appear in the bone, its blood supply gradually decreases, which leads to an increase in the degree of necrosis of the bone structure. The size of the sequestration is due to the size of the thrombosed vessels. In especially difficult cases, necrosis of the entire jaw may occur. Similar conditions are associated with diffuse osteomyelitis.
Symptomatology
There are several forms of pathology. In the period of subacute osteomyelitis, a so-called shaft occurs between a healthy bone and a dead one. In some cases, resorption of sequestration is observed. Regeneration processes may occur - a new bone structure forms around the affected area . In reverse cases, sequestration rejection is observed. The subacute form is borderline between acute osteomyelitis and chronic.
In the period of the acute form of osteomyelitis, the inflammatory process is actively developing. Patients note severe pain in the jaw (boring, shooting), which develop against a background of high fever, chills, rapid breathing and pulse. In addition to pain in the jaw, the sensitivity of the lower lip may disappear - this is how Vincent's symptom manifests itself in osteomyelitis. After several days from the onset of the disease, the teeth adjacent to the diseased tooth acquire mobility.
Palpation of the jaw reveals swelling and is accompanied by painful sensations. There is inflammation and swelling of the gums, cheeks, or other areas on the face. During the period of the disease, an increase in lymph nodes occurs. Subsequently, all these symptoms can be accompanied by trismus - reduction of the jaw muscles, numbness (Vincent's symptom). The reversibility of the disease depends on the timeliness of diagnosis and further treatment.
The general condition of the patient is classified into conditionally mild, moderate and severe. Unfortunately, sometimes the disease ends in death within a few days from the start of the pathological process.
It is reliably known that at first the patients may seem awake, but soon the state of euphoria is replaced by a decline in strength with a sharp drop in blood pressure and increased heart rate. The appearance of a person changes dramatically.
With diffuse osteomyelitis, a gradual lesion of inflammation of new areas of the bone occurs. The patient's condition can be characterized as unstable, with temporary improvements and poor health, during which the body temperature may first return to normal, and then rise again and be accompanied by repeated chills.
The stage of acute diffuse osteomyelitis can last up to four weeks. In this case, there is a sharp decrease in the content of lymphocytes in the blood (up to 15% –18%), protein is present in the urine.
The chronic form of the disease in the absence of therapeutic measures can last for months, and sometimes years, and lead to various complications: lung abscesses, the formation of suppuration in the cranial sinuses, acute and chronic kidney damage.
Diagnosis and treatment
Radiography is one of the methods in the diagnosis of osteomyelitis and helps to determine the extent of damage to bone structures. However, the initial changes in the bone can only be considered on the 7-10th day after the onset of the disease.
The first thing that is determined with the help of the image is the areas of rarefaction in the bone structures. Further, if the course of the disease can be stopped, the x-ray reveals the formed boundaries between healthy and dead tissue. Based on the size of this border, conclusions can be drawn about the size and location of sequesters. In addition to radiography, the general picture of the state of the human body and the analysis of concomitant signs, including Vincent's symptom, help to identify the disease.
Treatment of osteomyelitis involves the integrated use of antibiotics and surgical intervention. Often, penicillin injections, streptomycin or biomycin are prescribed as a conservative treatment. With antibiotic therapy, however, it is important to remember the ability of bacteria to get used to drugs.
It is important to continue drug treatment for 7-10 days, even after the temperature drops to normal levels. Otherwise, the disease will proceed secretly. Often the fate of the tooth, due to the disease of which inflammation has arisen, is decided unambiguously - it must be removed. Although there are exceptions to the rules.
They try to preserve neighboring teeth by restoring their functionality. For this, wire tires are used, which are installed on the entire dentition. In addition, inflammation of the pulp in the teeth is also eliminated if possible. Mobile sequestration is subject to surgical removal, which is carried out no earlier than 4-6 weeks after the onset of the disease. This is due primarily to the fact that only after the specified period the boundaries of the sequestration are clearly distinguishable.
Thus, Vincent’s symptom is one of the main signs of the development of serious inflammatory diseases in the human body, including osteomyelitis, periodontitis, and Simanovsky-Vincent’s tonsillitis (the symptoms of this particular form of the disease are distinguishable from the general symptoms of angina due to the manifestation of Vincent’s symptom).