Aphthous stomatitis

Aphthous stomatitis is one of the forms of stomatitis, which is manifested by the appearance of ulcerative defects in the oral cavity and is accompanied by discomfort.

Ulcerous lesion of the mucosa is a small-sized wound that causes painful sensations in the process of eating or talking. Such defects are called ashes. They can be located singly or in small clusters. Their shape varies from round to oval, having clear contours and representing a narrow red border with a grayish central coating.

Depending on the age of a person, the state of his immune defense of the body, the provoking factor, which is considered a starting point for the development of the reaction, as well as the form of manifestation of stomatitis, treatment should be selected individually, taking into account all the features of the course of the disease.

ICD-10 code

Stomatitis consists of a large number of diseases that are characterized by the development of an inflammatory reaction to the oral mucosa. As a result of developing inflammation, there are dystrophic changes, in particular ulcerative defects on the mucosa, caused by bacteria or viruses. Quite often there are cases when stomatitis accompanies other concomitant diseases, for example, hypovitaminosis, traumatic injuries, allergic reactions or various infectious diseases.

Aphthous stomatitis ICD 10 refers to a large group of stomatitis, which differ in the degree of effect on the mucous membrane. According to the International Classification, stomatitis and similar lesions are classified as diseases of the oral cavity, salivary gland and jaw. Each nosology has its own special code. For example, stomatitis is coded as K12.

Depending on the type of inflammatory reaction and the depth of the lesion, it is customary to isolate surface, catarrhal, aphthous, deep, ulcerative and necrotic stomatitis. With the course of the disease, the disease can be acute, subacute and relapsing.

Aphthous stomatitis ICD 10 has a separate code - K12.0. The last figure indicates the type of lesion of the mucosa. So, under the code K12.1 there are other forms of stomatitis - ulcerative, vesicular, etc., and K12.2 means phlegmons and abscesses of the oral cavity.

Causes of aphthous stomatitis

Stomatitis is also common, depending on the causative factor. Thus, traumatic stomatitis can develop as a result of prolonged exposure of any damaging physical or chemical agent to the oral mucosa. Infectious develops after the influence of viruses, bacteria or fungi. In addition, in this group, isolated specific stomatitis, which develops when there is a progressive tuberculous, syphilitic or other specific infection in the body. Symptomatic stomatitis appears against the background of already existing diseases of internal organs.

The causes of aphthous stomatitis can be of different nature, but the most common are herpetic, influenza, certain forms of staphylococcus, adenovirus, measles virus, diphtheria bacillus and many other viruses. In addition, the body is constantly exposed to various factors, which, when combined with a cause, can trigger the development of the disease.

Factors include low level of immune defense of the body, hypovitaminosis (C, B, lack of trace elements - iron, copper, zinc), diseases of the digestive system, weighed allergic anamnesis, genetic heredity. Also, the causes of aphthous stomatitis can be manifested by various diseases of the oral cavity (caries, inflammation of the gums), burn mucous and traumatic damage to the integrity of the mucosa after a bite or a fragment of the tooth. The most common stomatitis develops in children, and in a more mature age before the age of 40 there is a chronic form of aphthous stomatitis.

[1], [2], [3]

Pathogen of aphthous stomatitis

For the development of the disease it is necessary that the pathogen enter the body. The factors of protection include skin and mucous membranes. However, even if there is an insignificant violation of the integrity of one of the barriers, the infection gets inside and the incubation period begins. During this time, the causative agent waits for a suitable moment when the immune defense decreases or the provoking factor will act to start the reproduction.

For the development of this disease, the causative agent of aphthous stomatitis penetrates through the damaged mucous membrane of the oral cavity, the defect of which can be formed due to careless cleaning of the teeth or during chewing. Against the background of weakened immunity, the infection begins a rapid multiplication.

The causative agent can not only enter the oral cavity from outside. The normal microflora of the oral cavity is represented by bacteroids, fusobacteria and streptococci. As a result of a decrease in the protective functions of the body or under the influence of a provoking factor, even the inhabitants of microflora can become the cause of the disease. Under normal conditions, they peacefully exist in the oral cavity.

The causative agent of aphthous stomatitis can be both viral and bacterial in nature. Thus, viral agents include chicken pox, measles and herpes. In addition, bacterial infection can not only lead to aphthous stomatitis, but also provide a favorable background for the development of complications. To such pathogens it is necessary to carry streptococcal, tubercular and scarlet fever infections. With regard to fungal nature, here special attention deserves chronic candidiasis and thrush. Pathogens can enter the body as an alimentary route, with food, and airborne, through the upper respiratory tract.

Symptoms of aphthous stomatitis

Symptoms of aphthous stomatitis can vary depending on the stage of the disease. The initial period is characterized by such manifestations as with usual ARI. There is an increase in temperature up to 38 degrees, appetite decreases, general weakness and malaise appear. There is also an increase in the cervical and occipital lymph nodes. This period ends with the appearance of redness in the place of education in the future ulcer.

Further, as the disease progresses, aphthae are formed, which can represent individual small ulcers or their accumulation with a diameter of 5 mm. Defects can be located on the mucosa of all surfaces and parts of the mouth. The edges of the ulcer are separated from the healthy tissues by a reddish rim with a gray fibrinous coating in the center. In addition, the remaining symptoms of aphthous stomatitis retain their intensity (temperature and general malaise). Further, discomfortable sensations are added during the meal or during conversation, laughter or movement of the tongue. There is also burning and pain throughout the disease.

Aphthous stomatitis in the tongue

The defeat of the oral mucosa can manifest itself in various places, namely, where there is a mucous membrane itself. No exception is the language. If there is a ulcerative defect on the lateral or anterior surface of the tongue, there is a strong soreness even with the slightest movement of the tongue. Especially if the sore is located on the transitional fold.

Aphthous stomatitis in the tongue is characterized by excessive salivation, which has a reflex character. In addition, ulcerative defects in the tongue prevent the taste of food. Thus, the process of nutrition is not only painful, but also does not taste the taste of food.

Afts in the language represent areas of impaired mucosal integrity, which have a clear boundary with a healthy tissue. The plaque has a grayish shade, and the edges are red. Dimensions of the ulcer can reach 5 mm, and the shape is observed oval or round.

[4], [5]

Aphthous stomatitis in children

The reasons for the development of stomatitis in children are much greater than in adults. This is due to the fact that in childhood, various objects enter the mouth, which can injure the oral mucosa. In addition, children are more prone to infectious diseases due to an imperfect immune system.

Aphthous stomatitis in children can be observed mainly at the age from 1 to 5 years. Quite often it happens that stomatitis is taken for ARVI due to the presence of a sharp rise in temperature to 39 degrees. In addition, it is worth paying attention to a decrease in appetite, increased salivation and stale smell from the mouth. This is observed due to the presence of ulcerative defects in the oral cavity, the size of which can reach 6 mm in diameter. The kid can at all refuse meal, as aphthae are accompanied by painful sensations.

Attentive moms can independently examine the baby's mouth to visualize the defect. Especially it is worth paying attention, if the baby's irritability increased, became restless, tearful, high temperature was noted for several days. Also aphthous stomatitis in children can begin with the appearance of ulcerative defects in the corners of the mouth, and then move to the oral mucosa. In severe disease, a general disorder can be accompanied by nausea, vomiting, apathy, and panic attacks.

[6], [7], [8], [9]

Acute aphthous stomatitis

This infectious disease is considered as an epidemic condition, which affects mainly children in kindergarten. This is due to the spread of the virus by airborne droplets. Most often, acute aphthous stomatitis is caused by streptococci, staphylococci, and when a secondary infection is observed, diplococci in smears from plaque aft.

The disease is registered mainly at the age of 1 to 3 years, during the appearance of teeth. At this age, stomatitis is manifested by symptoms of influenza and inflammation of the upper respiratory tract. In addition, he can accompany measles, scarlet fever, diphtheria and whooping cough. When merging small aphids, significant damage to the mucosa can occur.

Acute aphthous stomatitis has its own peculiarities. There is a sharp rise in temperature, which lasts for several days, aphthae deliver strong pain sensations with the slightest movement of the oral cavity. The regional lymph nodes increase in size and are painful on palpation. In addition, stale smell from the mouth, headache, dysfunction of the digestive tract in the form of constipation or diarrhea is characteristic.

[10], [11], [12]

Chronic aphthous stomatitis

Morphological manifestations of the chronic form of the disease practically do not differ from ulcerative defects in acute stomatitis. However, the differences are in the course of the disease and its duration. Thus, some acute forms of aphthae can heal 5 days after their appearance, without leaving a scar. In the event that stomatitis is not treated and the provoking factor continues to act, then the epithelialization process of the ulcer will last about a month. Chronic aphthous stomatitis is characterized by the presence of long-healing ulcers, which can develop after partial scarring. Thus, the mucous membrane of the oral cavity is almost constantly in a damaged state.

This form of the disease inhibits the immune defense of the body due to the presence of concomitant pathologies, for example, AIDS. The body is not able to cope even with a common influenza virus or cold, which is what exacerbates all diseases that are in a chronic stage.

Chronic aphthous stomatitis can be allergic when the mucosa is especially sensitive to all stimuli. In this regard, ulcerative defects do not have time to heal, as new ones appear. People with bronchial asthma, urticaria, or migraine suffer from this condition. In the course of numerous studies, a high level of eosinophils in the blood was detected, which causes the allergic nature of stomatitis.

If you follow a diet and adhere to a rational diet, you can adjust the work of the gastrointestinal tract. After all, in some cases it is toxic substances that are in the intestines for a long time because of constipation, are a provoking factor in the development of stomatitis. Chronic aphthous stomatitis is most often observed in people with diseases of the large intestine, for example, colitis, helminthic invasion or chronic appendicitis.

[13], [14], [15], [16]

Recurrent aphthous stomatitis

Recurrent aphthous stomatitis is manifested by periodic rashes on the mucous membrane of the oral cavity. Cyclical eruptions can be a year or months throughout life. This form of the disease is observed mainly in adults, but it also occurs in children.

Symptoms differ from acute form, namely, with the appearance of ulcerative defects, the general condition of a person does not change. Variants are possible, when two nearby ulcers can merge into one or aphthae may increase in size independently. The most common places of localization include mucous tongue, lips, cheeks, soft and hard palate.

Clinical manifestations of chronic form do not differ from acute. An ulcerative defect with a reddish rim and gray deposits in the central region is noted. The inflammatory process develops exclusively in the epithelial layer, without affecting its own mucosa and submucosal tissue. Ulcers are very painful, and regional lymph nodes are enlarged.

Recurrent aphthous stomatitis can have a different causative nature. Thus, the influence of the infectious agent remains unproven, since it was not possible to detect it on ulcer raids. There are suggestions that the disease can develop due to the presence in the body of a violation of chloride metabolism, changes in the transmission of nerve impulses, and also as a manifestation of the exudative process. The most acceptable cause is the allergic nature of the disease, especially in people who have a tendency to this.

Aphthotic herpetic stomatitis

Aphthous stomatitis of herpetic origin belongs to the group of infectious diseases and is manifested by a violation of the integrity of the oral mucosa. The cause of the virus is herpes, which once caused the disease, remains in the body in an inactive form. The source of the infection may be a sick person or a carrier of the virus in the inactive phase.

Aphthotic herpetic stomatitis, especially in the moderate to severe form of the disease, can manifest not only local lesions, but also general. There are cases of infection of children in infancy or from a mother who does not have antibodies to the herpes virus. With the development of the disease at this age, there is a generalized form with damage to the eyes and skin.

Infection can take place by contact or airborne droplets. The incubation period lasts on average up to 4 days, and then the clinic of the disease sharply grows. It begins with a rise in temperature to 40 degrees, and after 1-2 days there is pain in conversation and with laughter. The mucous membrane is noted to be swollen and hyperemic. On it are small bubbles, located singly or in groups. Their number can reach 30 pieces.

Aphthotic herpetic stomatitis is rarely recorded at the stage of rashes, as they quickly become ulcerative. Defects have a typical picture for stomatitis. When the secondary infection is associated with the formation of deep ulcers. A typical place of localization is the sky, tongue and lips.

The increase in regional lymph nodes precedes the formation of ulcers and persists for 1-2 weeks after the epithelialization of defects.

[17], [18], [19], [20]

Diagnosis of aphthous stomatitis

To diagnose "stomatitis" the doctor must first examine the medical card. Perhaps the child already had stomatitis, or he is now more of an infectious disease. Next, a visual inspection of the skin for the presence of rashes and go to the examination of the oral cavity. Diagnosis of aphthous stomatitis is based on the search for ulcerative defects on the oral mucosa.

The tissue surrounding the nail has a healthy appearance, and the defect itself is characterized by all the typical signs of aphthous stomatitis. Differential diagnosis should be carried out with FMD, syphilitic papule, thrush and herpetic eruptions.

Diagnosis of aphthous stomatitis does not cause any special difficulties, knowing its main manifestations is a strong soreness of ulcerative defects and an inflammatory rim around each aphtha.

[21], [22], [23], [24]

Differential diagnosis

Aphthous stomatitis should be differentiated from herpetic stomatitis, pemphigus, bullous pemphigoid, red flat lichen, fixed toxicodermia, etc.

[25], [26], [27], [28], [29], [30]

Preparations for the treatment of aphthous stomatitis

Means that quickly and effectively fought with stomatitis have not yet been developed. Nowadays, there are a huge number of drugs that can improve the health of the disease, as well as relieve some of the symptoms.

Drugs for the treatment of aphthous stomatitis should contain an anesthetic component, because ulcers are quite painful. For example, on the basis of lidocaine, trimecaine or calanhoe juice. In addition, they are able to reduce the sensitivity of aft.

Remedies that purify the ulcer in order to avoid the attachment of a secondary infection must have hydrogen peroxide or carbamide peroxide in their composition. Also for this purpose antibacterial preparations for oral or rinsing are used. The effectiveness of chlorhexidine in accelerating the epithelization of aphthae has been proved.

If a viral cause of the disease has been identified, then drugs for the treatment of aphthous stomatitis should be antiviral. Otherwise, if there is a provoking factor in the body, the disease can not quickly regress. A separate group is made up of agents that stimulate the healing of ulcerative defects, for example, sea buckthorn oil, propolis ointment, vinyllin and carotolin.

Do not forget about the strengthening of immunity with vitamin complexes. Also, when severe forms should be included in the treatment of antibacterial drugs. To reduce sensibilization of the body should pay attention to antihistamines - Tavegil, Telfast. To reduce inflammation and soreness, the use of corticosteroids is justified. It is desirable to add to the treatment complex sessions of electrophoresis, phonophoresis and laser therapy.

Local treatment of aphthous stomatitis consists in rinsing with tetracycline solution (contents of 1 capsule, 250 mg, dissolved in water and kept in mouth 151 min.), Corticosteroids (0.1% triamcinolone ointment, 0.05% betamethasone ointment). Pain shows local anesthetics. A good effect is injecting corticosteroids into the lesion (3-10 mg / ml triamcinolone).

Treatment of aphthous stomatitis in adults

The therapeutic course should be accompanied by a certain diet, which includes the exclusion of gross, traumatizing food, and the use of hypoallergenic products.

Treatment of aphthous stomatitis in adults is based on a set of techniques aimed at reducing symptoms and healing aft. This requires boric acid and chamomile for the treatment of ulcers. Rinse the solution several times a day.

An unconcentrated solution of manganic acid, hydrogen peroxide, diluted with water 1: 1, tableted furacilin dissolved in water is also recommended for rinsing.

Local treatment involves the use of sea-buckthorn, peach oil or Kalanchoe juice. With the desensitizing purpose, sodium thiosulfate is used as intravenous injection or oral administration. It is mandatory to strengthen immunity, as well as taking sedatives and antihistamines.

Treatment of aphthous stomatitis in adults can take from a week to a month, so to reduce pain you should use anesthesin, tablets hexoral or lidochlor. These drugs will help to get rid of discomfort in the oral cavity.

Treatment of aphthous stomatitis in children

Treatment of aphthous stomatitis in children should include drugs aimed at getting rid of the cause of the disease. At the first stage, it is necessary to exclude from the diet food that can cause allergies, as well as spicy foods with rough food. However, sometimes stomatitis can be a reaction to taking any medications, so you should consult a doctor about his replacement.

In the complex must necessarily include anti-allergic drugs. Among them is Cetrin, Suprastin, Telfast, Diazolin. The list can be continued indefinitely, as in our time there is a huge number of them.

Local treatment of ulcerative defects should be carried out by various drugs, depending on the stage of their development. At the initial stages, it is rational to use drugs, based on antiseptics, for example, Miramistin, for irrigation of ulcers. Anti-inflammatory gels are used for the treatment of defects and their anesthesia (Holisas). These drugs are used up to 4 times a day.

Once the acute inflammatory phase has passed and the soreness has decreased, it is necessary to add funds that can accelerate the epithelization of the aphthae - Actovegin-gel. He, in addition to healing, can anesthetize a peptic ulcer.

A special place in treatment is occupied by physioprocedures. They are aimed at irradiating aphthus for their accelerated healing.

Treatment of aphosic stomatitis in children includes immunomodulators of local action. To this end, apply toothpaste with enzymes (lysozyme, lactoferrin and glucose oxidase). They help strengthen the immune defense in the oral cavity and enhance the resistance of the mucous membrane to bacteria and viruses. In addition, the preparation "Imudon" showed good results in the fight against stomatitis.

An integral part of the treatment is sanation of the oral cavity, since one of the reasons for the development of aphthous stomatitis is staphylococcus aureus. This pathogenic bacterium is present in the plaque of carious teeth and stones. In this regard, carious lesions and plaque should be removed by their oral cavity, and the child should be taught hygiene compliance.

Prevention of aphthous stomatitis

Aphthous stomatitis refers to a group of diseases of the oral cavity, which is manifested by aphtha and general symptoms. In order to prevent the development of stomatitis, it is necessary to avoid the causative factor. Thus, one should not undergo traumatization of the oral mucosa. In addition, you need to monitor your diet. In the presence of allergenic products, you must exclude them. It is also necessary to monitor the immune defense of the body, periodically taking vitamin complexes.

Prevention of aphthous stomatitis includes the timely treatment of an already existing disease, which is a provoking factor in the development of stomatitis. When the first symptoms of the formation of ulcerative defects appear, one should immediately start treatment and observe the rules of oral hygiene.

Provided a correctly diagnosed, rapidly initiated pathogenetic treatment, as well as compliance with all recommendations and diet, it is possible to achieve persistent and prolonged remission. However, complete recovery of the chronic course of the aphthous form of stomatitis is rarely recorded.