Desquamative glossitis is an inflammatory-dystrophic disease of the mucous membrane of the tongue, characterized by the formation of areas of desquamation - peeling of the epithelium. They can be of various shapes and located both on the lateral surfaces and on the back of the tongue.

Causes of desquamative glossitis

There are several factors that provoke desquamative glossitis: the causes most often cause trophic disorders, which leads to the formation of the disease. These include:

• mechanical impact on the mucous membrane of the tongue due to chips, fractures of teeth, wearing dental structures and appliances, incorrectly installed crowns or sharp edges of fillings;
• thermal, chemical burn of the tongue mucosa;
• teething (including irregular teething, especially for wisdom teeth).

In addition, desquamative glossitis may be a consequence of another disease. The most common of them are the following:

• chronic diseases of the gastrointestinal tract;
• liver and gallbladder diseases;
• vegetative-endocrine disorders;
• rheumatic diseases (collagenosis);
• deficiency of vitamins and microelements (hypovitaminosis of vitamins B1, B3, B6, lack of pantothenic and folic acids, low iron content);
• diseases of the hematopoietic system;
• autoimmune pathologies;
• chronic dermatitis (some of its forms).

Also, infectious processes in the body can take part in the formation of the disease: influenza, scarlet fever, viral infections, helminthic infestations. In addition, intoxication due to taking potent drugs can also lead to this disease.

Classification of desquamative glossitis

The disease has three forms:

• superficial;
• hyperplastic;
• lichenoid.

The superficial form is characterized by the formation of spots and stripes of pronounced red color with clear boundaries, which are surrounded by healthy mucous membrane. After rejection of the surface epithelium, the dorsum is characterized by smoothness. In this case, the symptoms include a slight burning sensation and itching.

The hyperplastic form is characterized by compaction of the lesions due to hypertrophy of the filiform papillae of the tongue. Symptoms include discomfort and the feeling of a foreign object in the mouth, and the lesions become covered with a white, gray or yellow coating.

The lichenoid form is characterized by the formation of lesions of various shapes and sizes, and they may not have a permanent localization and migrate. Filiform papillae of the mucous membrane are redistributed around the lesions, and in the desquamation zones themselves, hypertrophy of the fungiform papillae is observed.

Symptoms of desquamative glossitis

Depending on the form of the disease, the clinical picture may vary somewhat, but there are common symptoms characteristic of all forms.

Manifestations of the disease occur spontaneously and are often not preceded by any symptoms. Some patients may experience burning, itching, tingling of the affected areas of the tongue, as well as impaired taste perception. There is also discomfort when eating salty, spicy foods.

Desquamation areas are located on the lateral surfaces, the back of the tongue, and can have different shapes and sizes. As the disease progresses, they can change; this is the basis for the second name of the disease - “geographical tongue”. The areas can migrate along the surface of the tongue over several days; most often, several such zones are found on the tongue; a single lesion is much less common.

At the very beginning of the lesion, an area with a white-gray coating forms, which peels off, after which the areas take on the appearance of red spots with a smooth surface that is devoid of papillae. Around the lesion there are white stripes - areas of keratosis.

Quite often (up to half of all cases) this disease is accompanied by a folded tongue - it has one or several deep folds on the surface of the mucous membrane, which makes it even more similar to a geographical map.

Diagnosis of desquamative glossitis

Desquamative glossitis is diagnosed using several methods:

Desquamative glossitis is differentiated from the following diseases:

• candidal glossitis;
• lichen planus;
• some forms of oral leukoplakia (flat leukoplakia);
• secondary syphilis;
• systemic scleroderma;
• lichen planus;
• exudative erythema multiforme.

For this purpose, the doctor compares the existing symptoms, pays attention to the nature of the lesions and their movement, and also evaluates the results of laboratory diagnostics.

Treatment of desquamative glossitis

Desquamative glossitis, which is treated depending on the severity of symptoms, can be corrected in several ways.

First of all, therapeutic measures consist of eliminating the main cause of the disease: treatment of somatic diseases, normalization of the endocrine system, treatment of gastrointestinal diseases, etc. This may require consultation with related specialists - ENT specialist, therapist, allergist, gastroenterologist, dermatologist.

If the disease was caused by trauma to dental structures, artificial crowns, fillings, the doctor takes the necessary measures: replaces the structures, grinds the filling or installs a new one.

The rest of the treatment of the disease comes down to the following steps.

1. Complete sanitation of the oral cavity. Treatment of caries, removal of plaque and tartar using professional oral cleaning. If there are other foci of infection in the mouth, treatment for glossitis may not be effective.
2. Recommendations for eliminating additional irritants - hot, spicy foods and drinks, too hard foods, etc.
3. Prescription of medications:
   • for internal use: in order to eliminate the causative agent of the disease, antibacterial, antimycotic agents (allowing one to cope with a fungal disease), antiviral drugs can be prescribed;
   • for rinsing and external use: antiseptics, herbal remedies (herbal infusions), gels and ointments to relieve symptoms, preparations for baths.

Antihistamines can also be the basis of therapy if there is swelling of the tongue and there are concomitant allergic reactions.

In cases where discomfort and pain are severe, the doctor can perform a novocaine blockade into the lingual nerve. Also, biostimulants, drugs that accelerate tissue regeneration and strengthen the vascular wall, and sedative medications can be prescribed as auxiliary agents. Also common means to speed up recovery are epithelialization stimulants, vitamin and mineral complexes, and, if necessary, non-steroidal anti-inflammatory drugs. They not only locally eliminate the inflammatory process, but also anesthetize the tongue.

Physiotherapy consists of the following methods:

• electrophoresis;
• ultraphonophoresis;
• ultrasound therapy;
• SMT therapy.

Basically, therapy for desquamative glossitis is symptomatic - this is especially true for cases of the non-infectious nature of the disease.

Forecast and prevention of desquamative glossitis

The likelihood of malignancy (malignancy) of foci of desquamative glossitis is reduced to zero: it does not pose a great threat to the patient’s health, so the prognosis in the vast majority of cases is favorable. Even in the absence of treatment, the disease can go away on its own (on average within a few weeks), but if it is caused by certain factors that occur in the future, the likelihood of relapse is very high.

To prevent desquamative glossitis, a number of recommendations must be followed:

1. therapy, correction of concomitant and causative diseases. It is necessary to normalize hormonal levels, promptly correct the state of the immune system if necessary, treat gastrointestinal diseases, etc.;
2. thorough oral hygiene. It is important to brush your teeth according to the rules (twice a day - minimum), use a high-quality brush and toothpaste, and use dental floss;
3. preventive visits to the dentist. This is necessary for professional teeth cleaning, oral examination and early diagnosis of the disease;
4. timely treatment of caries and other diseases. It is also important to quickly restore chipped teeth, correct tooth fractures, and install only high-quality dental structures;
5. elimination of bad habits - smoking, excessive drinking;
6. compliance with the diet - a balanced diet, avoiding deficiencies of vitamins and microelements, food and drinks at moderate temperatures to avoid burns.

Prevention of glossitis should include a set of measures, since the disease can be caused by various factors.

LESIONS OF THE ORAL MUCOSA IN DISEASES OF INTERNAL ORGANS, INFECTIOUS DISEASES, HYPOVITAMINOSIS

The human body is a single whole, therefore any disturbances in metabolic processes can cause the development of functional or dystrophic changes in the oral mucosa, including necrotic ones. In many cases, these pathological changes represent symptoms, sometimes the earliest, which can guide the doctor in diagnosing various general diseases. Not only the dentist, but also the therapist, pediatrician and other medical specialists need to know the symptoms of common diseases in the oral cavity. A comprehensive examination of the patient is of particular importance.

In many systemic diseases, the oral mucosa reacts with the appearance of various types of disorders - tissue trophic disorders, bleeding, swelling, dyskeratosis, etc. It should be noted that in most cases the manifestation of systemic diseases in the oral cavity is not specific, however, some symptom complexes are clearly indicate one or another type of organ disorder and are of great diagnostic value.

This section will highlight the most common changes in the oral mucosa in organ disorders.

Digestive disorders. M.A. Malygina, when examining children suffering from dysentery, identified the main signs of pathology in the oral cavity: catarrhal, aphthous stomatitis, desquamative glossitis. The earliest changes in dysentery were characterized by the development of catarrhal stomatitis (2-3 days from the onset of the disease). Later, desquamative glossitis and aphthous stomatitis developed (days 7-14). Pathohistological data indicated inflammatory and dystrophic changes in the nerve fibers of damaged tissues. Dystrophy was noted in the Gasserian ganglia and superior cervical sympathetic ganglia. In the acute period of the disease, hemorrhagic rashes were observed, often transforming into aphthous ones. There have been cases of necrotic form of aphthous stomatitis. Weak children often developed concomitant candidiasis of the oral mucosa.

Kh. I. Saidakbarova, in patients suffering from chronic colitis and enterocolitis, noted glossitis, aphthous stomatitis and seizures as constant symptoms, occurring against the background of a significant deficiency of vitamins PP and B2. There was a decrease in the excretion of these vitamins in the urine. Changes in the tongue were found in 72% of those examined and were characterized by pronounced hyperemia followed by cyanosis and swelling. 38% of patients had a folded tongue, 51% had desquamation and smoothness of its relief. In chronic colitis, the diagnostic sign was a coated tongue, and in enterocolitis, desquamation and atrophic changes in the epithelium of the tongue. Lesions of the tongue and lips were a consequence of hypovitaminosis, which occurs in diseases of the lower gastrointestinal tract.

V. A. Epishev conducted studies of the oral cavity in chronic gastritis. He found that changes in the oral cavity depend on the form and duration of the underlying disease. Changes in the tongue were characterized by swelling (in 56.5% of cases), plaque (94.3%). Desquamative glossitis with atrophy and smoothness of the papillae of the tongue was often observed, which was also noted with secretory insufficiency of the stomach. Hypertrophy of the tongue papillae was determined in hyperacid gastritis. In chronic gastritis, pathological changes more often manifested themselves as recurrent aphthous stomatitis, lichen planus, and less often - acute aphthous stomatitis, leukoplakia, and cheilitis. A decrease in functional mobility and taste perception of the tongue was established. The form and duration of chronic gastritis determined the intensity of leukocyte emigration into the oral cavity and desquamation of epithelial cells. These indicators increased with hyperacid gastritis, and decreased with anacid gastritis. There was a depression in the functional state of the oral mucosa, and its hydrophilia was impaired. An anacid state slowed down the resorption of the blister test, while a hyperacid state accelerated it. Differences in the structure of the epithelium of the oral cavity and stomach also determined the difference in the nature of the inflammatory reaction. The vascular reaction is the earliest, and the congestion of the capillaries is more pronounced in the gastric mucosa. In the oral cavity, severe desquamation of the surface layer of the epithelium was observed; the increase in mucus production was less noticeable.

According to S.P. Kolomiets, pathological changes in the oral mucosa are caused by disturbances in the acid-forming function of the stomach. Exacerbation of gastric ulcer was accompanied by a decrease in the reactivity of the oral mucosa and a decrease in the resistance of capillaries. A close connection between the secretion of the salivary glands and the secretion of the gastric glands has been shown. In the stage of exacerbation of peptic ulcer disease, patients experience a perversion of the reaction of the salivary glands to mechanical and chemical irritation of the stomach receptors.

According to V. E. Rudneva, in patients with gastric and duodenal ulcers, gingivitis was detected in 100% of cases, the severity of the process was directly dependent on the severity and duration of the underlying disease. During the period of exacerbation of peptic ulcer, swelling of the mucous membrane, hyperemia and hypertrophy of filiform and mushroom-shaped papillae were observed. At the same time, the accumulation of histamine in the blood, a decrease in histaminase activity and an increase in hyaluronidase activity were established.

Studies by E. I. Ilyina, V. V. Khazanova, G. D. Savkina and R. A. Baykova showed that with dysbiosis in the digestive tract of patients with stomatitis, the inoculation of enzymatically active microbial associations increases, and the activity of intestinal enzymes increases compared with the norm. This was explained by changes in the composition and activity of normal intestinal flora involved in the inactivation of enzymes in the colon.

Research by A.I. Alekseeva showed that patients with gastric and duodenal ulcers experience morphological and functional changes in the minor salivary glands. Clinically, this was manifested by hypersalivation, often followed by dryness (in chronic peptic ulcer disease), hypertrophy of filiform papillae, swelling of the tongue, and the appearance of aphthae and ulcers.

Analyzing the literature and our clinical and experimental data, we can note the most characteristic changes in the oral mucosa in pathology of the gastrointestinal tract. Subjective sensations are manifested in burning, paresthesia of the mucous membrane, especially the tongue. In the stage of exacerbation of the pathological process in the digestive organs, the phenomena of hyper- and hyposalivation can be observed equally often. The earliest macro- and microscopic changes are characterized by the phenomena of desquamation and thinning of the epithelial cover of the mucous membrane of the mouth and tongue, and desquamative glossitis is noted. In the later stages, erosions, aphthae and ulcers appear in various parts of the oral mucosa. With the development of dysbacteriosis and secondary hypovitaminosis, candidiasis and lesions of the lips and tongue, characteristic of hypovitaminosis of group B, PP, are often associated. Often, changes in the oral mucosa do not reflect the essence of “pure” gastrointestinal pathology, but other disorders of the body that have developed secondarily. This is the difficulty in establishing the etiology and pathogenesis of inflammation of the oral mucosa in subacute, chronic and recurrent lesions of the digestive organs (Fig. 24).

Liver diseases. Depending on the form of liver pathology, the degree of its damage, the severity of the inflammatory or dystrophic process, as well as concomitant disorders in other organs and systems of the body, reactive changes in the oral mucosa manifest themselves in different ways. When assessing damage to the oral mucosa and its relationship with liver disease, the possibility of the influence of secondary factors should be taken into account.

An acute form of liver inflammation often develops with infectious liver lesions, mainly with epidemic hepatitis (Botkin's disease). During the period of increasing jaundice, hyperemia of the mucous membrane of the oral cavity, lips and tongue, dryness, and often swelling are observed; desquamation of the epithelium is noted, and the disease is often accompanied by eruptions of herpetic blisters. A characteristic sign is icteric staining of the mucous membranes. A plaque appears on the back of the tongue, the tongue is swollen, cyanotic, atrophy of the filiform papillae and focal desquamation of the epithelium are observed. The rest of the mucous membrane is hyperemic (catarrhal stomatitis), desquamation of the epithelium, and hyperplasia of the terminal sections of the excretory ducts of the minor salivary glands are noted. Often catarrhal stomatitis develops into aphthous and ulcerative stomatitis. Typical for infectious hepatitis are inflammatory changes in the area of ​​the mouths of the stenon ducts, ectericity of the mucous membrane, telangiectasia and hemorrhages on the soft palate and lips, atrophic disorders of the papillae of the tongue.

Disruption of the processes of physiological desquamation of the epithelium indicates that during acute hepatitis, metabolic disturbances occur, as a result of which the normal cycle of development of epithelial cells changes. This leads first to increased desquamation, then to the development of aphthae and ulcers.

In the oral cavity, at first, patients note a burning sensation and soreness of the tongue; its surface is bright red, shiny, the papillae are atrophied. Most patients have hypertrophic and catarrhal gingivitis. These phenomena, in our opinion, are more related to the phenomena of secondary hypovitaminosis than due to the direct effect of opisthorchid.

Diseases of the blood and hematopoietic organs. Most of these diseases have typical symptoms in the oral cavity. Often, patients with a disease of the hematopoietic system first seek help from a dentist due to the fact that the first symptoms often appear in the oral cavity. These patients require special dental treatment.

Iron deficiency anemia combines numerous etiological syndromes, the main pathogenetic factor of which is iron deficiency in the body (hyposiderosis).

In iron deficiency anemia, trophic disorders of the oral mucosa have been established, the cause of which is a deficiency of iron-containing enzymes of tissue respiration, in particular a decrease in the activity of the enzyme cytochrome oxidase. Patients note a perversion of taste sensitivity, paresthesia and dryness of the oral mucosa, which becomes pale, atrophic, and dry; There is atrophy of filiform and mushroom-shaped papillae, sometimes a smooth tongue (polished, Genter-Merrer glossitis). There are cases of patients with folds on the back of the tongue, and rarely painful cracks in the corners of the mouth. Histologically, thinning of the epithelium, a decrease in the number of cells in the basal layer, along with an increase in the number of cells in the spinous layer are revealed. Epithelial papillae are deeply embedded in their own layer of the mucous membrane. Parakeratosis is often observed with severe iron deficiency. Histochemical studies show a decrease in the amount of neutral and an increase in the amount of acidic mucopolysaccharides in the epithelium. The activity of succinate dehydrogenase and cytochrome oxidase in the epithelium decreases evenly in all its layers.

Treatment of the oral mucosa is symptomatic. Pathogenetic therapy consists of prescribing iron supplements in combination with ascorbic acid, which helps stabilize it in its active divalent form, as well as with pancreatitis, which prevents intestinal disorders. The duration of treatment is at least 1-2 months with repeated courses after 2-3 months. After taking iron, it is recommended to rinse your mouth to avoid darkening of your teeth. Reduced iron, ferric oxide lactate, iron carbonate with sugar, iron ascorbate, apple iron tincture, hemostimulip, ferroaloe are prescribed. Persons who have undergone gastrectomy or suffer from dyspepsia are prescribed fercoven parenterally. According to indications, drugs that stimulate erythropoiesis are prescribed (vitamin B12, folic acid, etc.).

Pernicious anemia (Addison-Biermer disease) develops with a deficiency of vitamin B12, leading to disruption of the metabolism of nucleic acids and cell proteins. The clinical picture of the disease includes weakness of patients, cardiovascular disorders, often dyspepsia, and irritability. The skin is pale, waxy yellow. In the oral cavity, the first symptoms of the disease are burning of the tongue and impaired taste sensitivity. Subsequently, petechiae and ecchymoses appear on the oral mucosa and skin. The mucous membrane is pale. There is focal or diffuse atrophy of the epithelium of the tongue; the tongue becomes red, flat erosions appear. Characterized by the absence of plaque on the tongue (Genter's glossitis).

Focal desquamation of the epithelium can also occur in other areas of the oral mucosa, palatine arches, and frenulum of the tongue.

Treatment is carried out jointly with a hematologist. Attention is paid to thorough sanitation of the oral cavity.

Aplastic anemia occurs due to a disorder of blood formation. The cause of bone marrow depletion (bone marrow depletion) can be various exogenous and endogenous factors. The disease is characterized by progressive anemia, bleeding and necrotic phenomena. The appearance of the patients is characteristic: severe pallor of the skin and mucous membranes with general fatness. A characteristic symptom of the disease is periodically worsening hemorrhages in the skin and mucous membranes. Severe desquamation of the tongue papillae and bleeding gums are often observed; Complications in the form of ulcerative necrotic stomatitis are not uncommon.

With the development of necrotic processes, symptomatic therapy is prescribed. Any surgical procedures in the oral cavity should be performed in a hospital setting. Patients are under dispensary observation; treatment is carried out by hematologists.

Leukemias are systemic diseases characterized by metaplasia and hyperplasia of reticular stroma cells and their transformation into blood cells. In this case, generalized damage to systems and organs occurs. Pathological blood cells are completely different from physiologically preserved cells of normal hematopoiesis. The source of development of the connective tissue of the hematopoietic organs is the mesoderm, and therefore leukemic proliferations primarily develop in those organs that are rich in stroma. These tissues include the oral mucosa.

Acute leukemia is the most severe form. Mostly young people get sick. Acute leukemia occurs either with an abundance of symptoms or with almost no external manifestations. The clinical picture is determined by anemia, manifestations of hemorrhagic syndrome and secondary septic-necrotic processes. Characterized by large fluctuations in the number of leukocytes; their composition is distinguished by the presence of blast forms along with mature leukocytes.

The diagnosis of the disease is based on studying the composition of peripheral blood and bone marrow.

In acute leukemia, in 55% of cases, ulcerative-necrotic lesions of the oral mucosa in the area of ​​the soft palate, back and tip of the tongue are observed. Histologically, numerous necrosis of the mucous membrane is determined, penetrating into the submucosal layer and often into the muscular layer.

Despite the severity of destructive changes in the mucous membrane, the usual inflammatory leukocyte infiltration is absent; there are cellular infiltrates characteristic of this form of leukemia. In areas of intact epithelium, the mucous membrane is thinned or swollen. As a result of a sharp increase in the hydrophilicity of colloids of dead cells, their swelling is observed, followed by rupture and the formation of cavities. Hyperplasia of the lymphatic apparatus of the tongue and soft palate is noted. It is characteristic that lymphoid cells remain in the central part of the follicles, and blastoma cells are located along the periphery. Often there are areas of hemorrhage in the submucosal layer and less often in the epithelium.

Leukemic infiltration of the gums is very peculiar in hemocytoblastosis. Infiltrates are located relatively shallowly. The mucous membrane over them is hyperemic, sometimes ulcerated, or parts of it are rejected, which is sometimes accompanied by sequestration of the alveolar ridge (Fig. 25).

Cytological and histological analysis confirms the specificity of hypertrophic ulcerative gingivitis.

Lip lesions in acute leukemia are characterized by thinning of the epithelium, dryness or hyperplastic changes in the epithelium. “Leukemic” seizures may develop in the corners of the mouth. In patients with acute leukemia suffering from chronic recurrent aphthous stomatitis, the disease during the period of relapse is accompanied by rashes of aphthae of the necrotic form (necrotic aphthae).

Thus, in acute leukemia, ulcerative-necrotic stomatitis, ulcerative-necrotic gingivitis, hypertrophic gingivitis, desquamatous cheilitis, seizures and hemorrhagic syndrome are characteristic. The tongue is covered with a dark brown coating; Ulceration of the back and sides of the tongue (ulcerative glossitis) and macroglossia are often observed. There is an unpleasant odor from the mouth. The teeth are often mobile. When teeth are removed, prolonged bleeding may occur.

The development of ulcerative processes in the oral cavity is associated with a decrease in the body's resistance, which is caused by a decrease in the phagocytic activity of leukocytes and the immune properties of blood serum. It should be remembered that the cause of ulcerative-necrotic changes in the oral mucosa can also be the therapy with cytostatic drugs used in the treatment of acute leukemia.

Acute reticulosis is one of the forms of acute leukemia, characterized by the proliferation of cells such as reticular, histiocytic or monocytic. The bone marrow, lymph nodes, spleen and liver are affected. There are several main symptoms: progressive tumor-like enlargement of the lymph nodes, liver or spleen, skin lesions. In the oral cavity, the main manifestations are hemorrhagic syndrome, ulcerative necrotizing gingivitis; ulcerative lesions resemble pressure ulcers.

In chronic leukemia (myeloid leukemia, lymphocytic leukemia), clinical changes in the oral mucosa differ little from changes in acute leukemia. Edema of the submucosal layer, moderate vascular congestion, and slight infiltration of lymphocytes are noted. There is hyperplasia of the lymphoid apparatus of the oral cavity and slight hyperkeratosis of the mucous membrane. Necrotic changes in the mucous membrane are rare and are mainly recorded histologically. Using the histological method, it is sometimes possible to detect infiltrates in the submucosal layer, consisting of lymphatic, plasmatic, reticular and blastoma cells. Cellular infiltrates can replace connective tissue.

In chronic myeloid leukemia, the leading sign of oral disease is hemorrhagic manifestations. According to V.M. Uvarov et al. 1/3 of patients with myeloid leukemia experience erosive and ulcerative lesions of the oral mucosa; the appearance of necrotic lesions indicates an exacerbation of the process; the development of candidiasis can be observed in the terminal stage of the disease. Pathologically, leukemic infiltrates are determined, consisting of reticular cells, myeloblasts, non-ch!trophilic and eosinophilic promyelocytes, myelocytes. In areas of necrosis, a weak leukocyte reaction was observed.

Chronic lymphocytic leukemia is accompanied by hyperplasia of the lymphoid apparatus of the oral cavity (tonsils, tongue, salivary glands). Pathohistologically, lymphoid infiltration of the stroma of the salivary glands, sometimes perivascular sclerosis and sclerosis of the connective tissue of large glands are noted.

Lymphogranulomatosis is a peculiar form of reticulosis. The three most important clinical symptoms of the disease are characteristic: excessive sweating, itchy skin and undulating fever. A symptom of the disease is enlarged lymph nodes. The hematological sign of the disease is a significantly increased ESR - up to 60 mm per hour and higher, neutrophilic leukocytosis with a band shift. In the bone marrow there is moderate hyperplasia of reticular cells, megakaryocytes and immature granulocytes. Berezovsky-Sternberg cells are found in the lymph nodes and sometimes in the bone marrow. In granulation tissue, neutrophils, eosinophils, and various reticular cells are detected. Skin changes manifest themselves mainly in the form of the appearance of nodules of various sizes. Itching is a constant accompanying symptom of the disease. By its intensity one can judge the severity and course of the process. Characterized by persistent hyperpigmentation of the skin (grayish-brown color, sometimes with an earthy tint in some areas). Erythroderma is not a constant companion of the disease. Cracks may form in the oral area. Sometimes flat, plaque-like infiltrates appear on the skin in limited or widespread areas. These changes are not specific.

Changes in the oral mucosa are characterized by thinning of the epithelium. Pathologically, small lymphoid infiltrates are detected in the submucosal layer.

Agranulocytosis is characterized by a delay and even cessation of the formation of granulocytes in the blood picture. The etiology of the disease includes allergies to certain drugs (amidopyrine, sulfonamides, barbiturates), infectious effects, and idiopathies. Characteristic signs are ulcerative-necrotizing tonsillitis (Pleau-Vincent), ulcerative-necrotizing gingivitis without signs of inflammation. The initial manifestations of the disease in the oral cavity are natural.

When examining the oral cavity in patients with agranulocytosis, white or gray necrotic deposits are found, when scraped, a hyperemic surface of the mucous membrane is visible. When ulcerating the mucous membrane, the ulcers are covered with dirty gray necrotic detritus and are clearly demarcated from the surrounding tissue. Necrotic changes are noted in the tonsils; often the root of the tongue, pharynx, and larynx are involved in the process. As a rule, regional lymphadenitis is noted. Necrotic changes and areas of hemorrhage can be detected in the lymph nodes.

Treatment. Therapy for patients with leukemia is carried out jointly with a hematologist. General therapy includes the administration of cytotoxic drugs and hormones. For necrosis, massive doses of antibiotics are prescribed. Massive doses of vitamin B and ascorbic acid are recommended. Blood transfusions are given as often as possible. Disinfectants are used for local therapy; local application of interferon has a positive effect. Dye solutions and occlusive dressings made from corticosteroid ointments are prescribed. The mucous membrane is treated with fortified oils (rose hips, sea buckthorn, carotoline, etc.). Sanitation is carried out during the period of remission of the disease. If there are indications for tooth extraction, preliminary medical preparation should be carried out; removal is carried out under the “protection” of antibiotics.

Hemorrhagic diathesis combines various diseases. The main symptom is increased bleeding. Thrombocytopenic purpura (Werlhof's disease) is the most common. The disease is observed more often in young people, but develops at any age, even in newborns. There are indications of a family predisposition to the disease. The disease is characterized by hemorrhages into the skin and bleeding from the mucous membranes. Hemorrhages can develop spontaneously or when exposed to microtrauma. Petechiae and ecchymoses on the skin are located on the anterior surface of the body and limbs. They turn from purple to purple, blue, green and yellowish, becoming paler. Bleeding from the nasal mucosa is typical, bleeding is often observed from the gums, and there are no blood clots.

Removing teeth or tonsils is very dangerous and can cause severe bleeding, even death.

Treatment. Therapy for hemorrhagic diathesis is carried out in a hospital. Blood and plasma transfusions are indicated. Vitamin K, calcium chloride, ascorbic acid, vitamin P, rutin are prescribed; in severe cases, steroid therapy is performed. Pizzoni et al. after tooth extraction, epsilon-amino-caproic acid (0.1 g/kg) was used. Tamponade of bleeding areas, dry thrombin and hemostatic sponge are used as local hemostatic agents. A solution of propolis mixed with an equal volume of plasma has a hemostatic effect. Patients are prescribed iron supplements 3-4 g per day, Campolon, liver extract. The radical treatment method is splenectomy.

Hemorrhagic vasculitis (hemorrhagic capillary toxicosis, anaphylactoid purpura, Schönlein-Henoch disease) is a disease of the vascular system, characterized by increased vascular permeability without significant blood disorders. The etiology indicates infectious, drug and autoimmune factors. The disease can be provoked by food allergens and chronic foci of infection. The skin and internal organs are affected. There are simple purpura (hemorrhagic exanthema, less often blisters, swelling of the dermis, areas of skin necrosis), rheumatoid purpura (in addition to skin phenomena, pain and swelling of the joints), abdominal purpura (damage to the gastrointestinal tract) and purpura fulminans (widespread skin lesions, lesions). kidneys, gastrointestinal tract).

Pururous spots appear on the skin, located symmetrically in the area of ​​the ankle joints, dorsum of the feet, shin and knee joints and on the buttocks. In rare cases, hemorrhagic spots appear on the oral mucosa and bleeding from the nasal mucosa. There are hemorrhages from various areas in the oral cavity. Ecchymosis is observed in the area of ​​the floor of the mouth. Heavy bleeding may occur during tooth extraction.

Patients are prescribed bed rest, a diet rich in vitamins C and P, desensitizing therapy, and sometimes blood transfusions, plasma, etc. Food should be liquid and soft. Therapeutic measures according to indications.

Endocrine regulation disorders. The endocrine system, along with the central nervous system, regulates the body's metabolic processes. Its regulatory influence is manifested in the process of growth and aging of the body and the trophic function of all systems. With some endocrine disorders, changes in the mucous membrane of the oral cavity, tongue and lips are observed.

Acromegaly. The disease, caused by the hyperfunction of eosinophilic cellular formations of the anterior pituitary gland, develops when there is an excessive intake of growth hormone in the body. The etiology of the disease includes pituitary tumors, skull trauma, and infections. Provoking factors may include removal of the ovaries, menopause, and pregnancy. Clinical signs are sexual disorders, headaches localized more often in the fronto-parietal and temporal regions, periodically - dizziness, nausea, vomiting. Later, swelling, muscle weakness, visual disturbances and proliferation of the skeleton and soft tissues appear, changing the appearance of the patient. There is an increase in the lower jaw (prognathism), facial features increase, lips thicken, and the tongue is enlarged (macroglossia). The growth of the uvula and vocal cords is accompanied by a decrease in voice timbre. There is a tendency to develop multiple lipomas and fibromas, warts and skin papillomas. With “partial acromegaly”, individual parts of the body grow: tongue, lips, nose, etc.

Addison's disease. Synonyms: Addison's syndrome, bronze disease, hypocortisolism, Addison's melasma. The disease was first described by Addison Thomas in 1855.

The disease is a consequence of chronic insufficiency of the adrenal cortex; It is extremely rare in children under 10 years of age. There is an assumption that a predisposing factor in the development of chronic candidiasis is a primary hereditary defect of the skin. The waste products of Candida albicans absorbed into the body act as toxins or as a cross-reacting antigen with subsequent progressive damage to the endocrine glands.

Candidiasis usually precedes symptoms of endocrinopathy, manifested in exhaustion, physical inactivity, physical and mental weakness, tachycardia, low blood pressure, etc. Hypoglycemia is not a mandatory sign of the disease. Brown pigmentation of the skin is characteristic, especially in areas of pressure and scarred areas (melasma). Brown spots appear on the oral mucosa without signs of inflammation. The disease should be differentiated from pigmentation of the mucous membrane in liver diseases with post-traumatic, nevoid, tumor-like changes and chloasma of pregnant women.

Patients with pigmentation of the oral mucosa need careful examination and treatment by an endocrinologist.

Itsenko-Cushing's disease develops as a result of hyperfunction of the adrenal cortex with damage to the hypothalamic-pituitary system. Obesity of the face, neck, chest, and abdomen is noted. The face is round, the cheeks are swollen, cherry red in color. Purple-red or cyanotic stripes appear on the skin of the abdomen, thighs, and shoulders. The skin is dry, furunculosis, impetigo, and acne are noted. The disease is often accompanied by osteoporosis of the jaw bones and periodontal disease; macrocheilitis manifests itself in lip enlargement. The disease is often complicated by hypertension and diabetes.

Diabetes mellitus is a disease caused by a deficiency in the body of the hormone insulin produced by the P-cells of the insular apparatus of the pancreas. In the etiology of the disease, hereditary factors, stressful situations, infections that deplete the insular apparatus, and a diet rich in carbohydrates are of great importance. Clinical symptoms: increased thirst, excessive urination, muscle weakness, itching, hyperglycemia. There is dryness of the skin and mucous membrane of the oral cavity, yellowish coloration of the skin of the palms and soles. Catarrhal marginal gingivitis does not differ in specificity. A common form of oral pathology in diabetes is candidiasis of the mucous membrane, tongue and lips. The mucous membrane is thinned and poorly moisturized. The tongue is dry, its papillae are desquamated. There are signs of angular cheilitis (jams). In the decompensated form of diabetes, there is a violation of the analyzer function of the taste receptor apparatus.

Our clinical studies have shown that patients suffering from a decompensated form of diabetes may develop decubital ulcerations of the oral mucosa in areas of injury. The ulcers had a long course, a dense infiltrate appeared at their base, and epithelization occurred slowly. The decrease in the regenerative properties of the mucous membrane is due to disturbances in redox processes. The available information about damage to the oral mucosa in our studies was confirmed in patients suffering from a severe form of diabetes for a long time. In some cases, the appearance of papular elements on the oral mucosa may be a sign of a latent form of diabetes mellitus.

In the prevention of diabetes mellitus, it is important to timely identify hidden diabetes, prevent the increase in insulin deficiency, and limit the amount of sugar in the diet. Treatment is carried out by an endocrinologist. Proper, balanced nutrition and insulin therapy are of great importance. The dentist provides symptomatic therapy depending on the signs of pathology of the oral mucosa, including anticandidiasis, keratoplasty and other agents.

Hypothyroidism - insufficiency of thyroid function - is accompanied by impaired development and growth of children, and critinism is noted. The edematous form of the disease is called myxedema. Dryness, enlargement and cracks of the lips are observed. Macroglossia manifests itself in infancy. The tongue is so enlarged that it does not fit in the oral cavity. Juvenile myxedema is accompanied by cyanosis, persistent enlargement of the tongue, lips, and gums. Xerostomia is observed. Due to the large amount of carotene in the skin, lips acquire a yellow tint.

Thyrotoxicosis (Graves' disease) develops as a result of hyperplasia and hyperfunction of the thyroid gland. Patients complain of fatigue, shortness of breath, palpitations, irritability, sweating, and weight loss. In the oral cavity, frequent symptoms are burning of the mucous membrane, decreased taste sensitivity, angular stomatitis, and desquamative glossitis. Some authors consider a folded tongue a sign of hyperthyroidism.

Cardiovascular disorders. If the cardiovascular system is impaired, changes in the oral cavity may be observed. Changes in the oral cavity are characterized by necrosis of soft tissues, the development of long-lasting ulcers and bleeding. I. O. Novik and N. A. Pashkang, with circulatory failure with symptoms of decompensation, noted hyperemia of the mucous membrane and periodontal disease in the oral cavity. The development of trophic ulcers was due to prolonged impairment of peripheral circulation. Often ulcerations were accompanied by necrosis of the alveolar bone. Desquamative glossitis and cyanosis of the mucous membrane were noted. Subjective sensations manifested themselves in the form of a burning sensation, pressure, and distension of the oral mucosa. Neuralgic pain in the dental area was often noted. A.D. Jafarova and V.V. Bobrik explained lesions in the oral cavity by the phenomena of tissue hypoxia. G. D "Atri associated the development of pathological processes in the oral cavity with microcirculatory disorders. Characteristic symptoms of this type of pathology were gingivostomatitis, desquamative glossitis, candidiasis of the oral mucosa, ischemic necrosis and paresthesia of the oral mucosa. Necrosis with sequestration of bone structures in the event of a sharp violation peripheral blood circulation was observed by B. G. Guseinov et al.; according to their data, epithelization of necrotic ulcers was accompanied by scarring of ulcers.

According to the authors of the book, compensated forms of cardiovascular failure are not accompanied by any significant changes in the oral mucosa specific to this type of pathology. These changes do not develop in cases of stability of the barrier functions of the mucous membrane, even in severe forms of cardiovascular disorders in the conditions of treatment of the underlying disease. However, exacerbations of stomatitis and the permanent nature of their course may be observed in patients with an unsanitized oral cavity, suffering from chronic tonsillitis, atonic syndromes, etc.

Cardiovascular failure with symptoms of decompensation is accompanied by swelling and hyperemia of the oral mucosa associated with local hypoxia. Trophic disorders of the mucous membrane are manifested by the development of its ulcerations.

Swelling and ulceration of the mucous membrane most often appear in those parts of the oral cavity that come into contact with the denture. In people who use metal structures of prostheses, changes are localized in the areas adjacent to the mucous membrane (marginal edge of the gums, mucous membrane under the intermediate part of the bridge). Persons using removable plates note changes in the mucous membrane under the prosthetic bed. Swelling spreads to the entire prosthetic bed, clearly demarcated from the surrounding mucous membrane.

In case of cardiovascular insufficiency, the phenomena of catarrhal gingivitis and stomatitis are not uncommon, which often turn into an ulcerative-necrotic process due to a violation of the trophism of the mucous membrane with its subsequent infection. Recurrent aphthous stomatitis occurs in a peculiar way in patients with cardiovascular insufficiency. Due to a decrease in the reactive capabilities of tissues, aphthae often transform into ulcerative-necrotic changes that develop as a hyporeactive inflammatory process. They appear in patients with stage III circulatory failure. They are most often localized in the retromolar region, transitional folds of the mucous membrane, and in areas where teeth meet. The ulcers have uneven outlines, are covered with a gray coating, and are sharply painful. Often necrosis of the mucous membrane is accompanied by necrosis of bone tissue.

A sign of cardiovascular failure may be changes in the epithelium of the tongue. On the back of the tongue, desquamation of filiform papillae is noted. It becomes smooth and shiny (polished tongue). Due to atrophy of the filiform papillae and thinning of the epithelium of the tongue, patients often note a burning sensation of the tongue.

When treating such patients, great care must be taken when performing various surgical interventions. During sanitation in order to eliminate chronic foci of infection, teeth should be removed with great caution, taking into account the decrease in the regenerative abilities of the post-extraction wound surface. In this case, an exacerbation of the underlying disease is possible, i.e., tooth extraction should be carried out under the protection of general therapy and after consultation with a general practitioner. It is unacceptable to remove several teeth at the same time.

M. P. Elshanskaya identified characteristic changes in the blood vessels of the oral mucosa in patients with atherosclerosis.

Damage to arterial vessels was manifested by the proliferation of the subendothelial layer of the inner membrane. Endothelial hyperplasia, thickening and splitting of the internal elastic membrane, and adventitious hyperelastosis were noted. As a result, there was a decrease in the lumen of the arteries. When studying venous type vessels, changes manifested themselves in the form of fibroelastosis, dystrophic changes were noted in the adventitia zone. The severity of sclerotic changes in the vessels increased with the age of the patients.

Patients suffering from atherosclerosis also had changes in connective tissue structures. Collagen fibers swelled and, when merging, formed homogeneous areas with a difficult-to-distinguish structure. Hyalinosis was noted in the collagen fibers of the mucous membrane of the gums and tongue. Signs of decollagenation were noted in the mucous membrane of the cheek and lip. These changes were regarded as dystrophic changes in connective tissue, developing against the background of sclerotic changes in blood vessels.

N. F. Kitova and Z. M. Mikanba examined patients suffering from myocardial infarction. When examining patients, especially in the first days of the disease, they noted the greatest changes in the tongue: desquamative glossitis, deep fissures, and often hyperplasia of filiform and mushroom-shaped papillae. During capillaroscopic examination, the majority of capillaries had a longitudinal or radial shape; they were located in the form of glomeruli. The venous part of the capillaries was dilated, but it was usually not possible to trace the arterial part. Stasis was sometimes observed in the capillaries and the outflow of blood was slow.

In patients with a brightly colored “crimson” tongue, hemorrhages in the papillae and interpapillary structures of the tongue were determined capillaroscopically. Such changes developed more often in severe cases of myocardial diseases accompanied by hemodynamic disturbances. As the patient's condition improved, extravasation decreased. As the general condition of the patient improved, the background of the capillaroscopic picture also improved accordingly.

Thus, these studies show that extravasations noted on the back of the tongue are a consequence of hemodynamic disturbances in the capillary bed and often develop as a result of heart damage. This fact is an important diagnostic sign of this organ pathology.

Stomatitis in infectious diseases. Changes in the oral cavity during infectious diseases are characterized by inflammation of the mucous membrane. These changes vary depending on the state of the body, the degree of its reactivity, resistance, and the form of the infectious disease.

Scarlet fever. Primary changes in the oral cavity during scarlet fever are observed in the tonsils, mucous membrane of the pharynx and pharynx. Early symptoms of the disease include diffuse catarrhal stomatitis, which develops one day before the appearance of rashes on the skin or simultaneously with them. There is dryness of the mucous membrane and its hyperemia. In the area of ​​the soft palate, bright red elements with a diameter of 1-2 mm appear. In severe cases, necrosis of the mucous membrane may develop. Necrosis can occur in the pharynx, pharynx and in certain areas of the oral mucosa. Regional lymphadenitis is noted. Characteristic changes in the mucous membrane of the tongue are caused by desquamation of its epithelium (“scarlet fever”, “crimson” tongue). At the beginning of the disease, the tongue is coated, covered with a white-gray coating, and tooth marks are visible along its edges. On the third day, desquamative changes begin. The plaque disappears at the tip and along the edges of the tongue, and subsequently on the dorsal surface of the tongue. The tongue becomes bright red, dry and shiny. Along with the disappearance of the filiform papillae, hyperplasia of the fungiform papillae is noted. They are clearly contoured and resemble raspberry seeds. This sign is a valuable diagnostic symptom of the disease. Some patients experience a yellow-white coating on the tongue throughout the entire illness. In severe cases of scarlet fever, ulcerations may develop in certain areas of the tongue. Desquamative glossitis usually manifests itself within 2 weeks, but catarrhal stomatitis accompanies the entire period of the disease. Changes in the lips during the course of the disease are characterized by their hyperemia, desquamation of the epithelium and epidermis, the appearance of cracks in the corners of the mouth, and sometimes macrocheilitis. Cases of lip ulceration due to secondary attachment of hemolytic streptococcus have been described.

Measles. Changes in the oral mucosa are characterized in the prodromal period of the disease by the appearance of Filatov-Koplik spots. Filatov-Koplik spots develop as a result of inflammatory changes in the mucous membrane and are localized on the mucous membrane of the cheeks in the distal part of the oral cavity in the area of ​​the molars. However, they can also be located on the lips, spreading to all parts of the oral mucosa. The initial manifestations of the disease are characterized by limited erythema. Subsequently, degeneration and partial necrosis of the epithelium with keratinization phenomena are noted. Ultimately, small whitish-yellow dots form in the center of the inflammatory focus, reminiscent of splashes of lime scattered over the surface of the hyperemic spot. They rise above the level of the mucous membrane. During the period of appearance of measles enanthema on the skin, the Filatov-Koplik spots disappear and measles enanthema appears on the mucous membrane of the soft and hard palate in the form of small bright red spots of irregular or round shape.

Diphtheria. A sign of the disease is damage to the mucous membrane of the pharynx. She is moderately hyperemic; Pain when swallowing is slight. There is swelling of the tonsils (diphtheritic tonsillitis), whitish-gray and yellowish plaques appear (foci of necrotic epithelium). Areas of necrosis may have a dirty gray, brownish-yellow or black tint (due to the breakdown of hemoglobin). Often necrosis and fibrinous films spread to the pharynx and pharynx. Whitish-yellow or gray plaque may appear on the gums (diphtheritic gingivitis). They may turn pink in cases of bleeding gums (due to the admixture of blood). Diphtheritic film is usually difficult to remove. This exposes the bleeding surface. In cases of progression of the process, necrotic changes spread in depth until the appearance of gangrenous areas. Isolated lesions in the oral cavity are usually rare. Therefore, the diagnosis of primary diphtheritic gingivitis is quite difficult.

Flu. In all forms of influenza, lesions of the oral mucosa may occur. Changes in the oral cavity depend on the severity of the underlying disease. First, catarrhal phenomena develop, subsequently hemorrhagic ones; Aphthous and ulcerative rashes are often observed. The predominant location is the soft palate, palatine arches, and sometimes the mucous membrane of the cheeks and gums. Viral influenza is accompanied by a specific granularity of eruptive elements (in the form of red dots) protruding against the background of the hyperemic mucous membrane of the soft palate. This granularity is nothing more than hyperplasia of the epithelium of the terminal sections of the excretory ducts of the small salivary glands, located in large numbers on the soft palate. The “grainy” sign is an early sign of the underlying disease. Flu is often accompanied by symptoms of acute aphthous stomatitis. When the process is localized, blistering rashes may occur on the lips. In cases of the addition of a fusospirillary infection, ulceration of the aphthae and transformation of aphthous stomatitis into ulcerative stomatitis are noted. Aphthae and ulcers can also develop during the recovery period.

Chicken pox. A sign of the disease is a papulovesicular rash on the skin and oral mucosa; vesicular rashes are most often localized on the tongue. Damage to the oral mucosa can develop in isolation, without affecting the skin, and then this sign is the leading one in the diagnosis of the disease.

Typhoid fever. The disease is often accompanied by rashes of erythema and aphthous elements on the soft palate in the 2nd to 5th week. The changes are localized on the anterior palatine arch. Aphthae are often found on the mucous membrane of the genital organs and other mucous membranes. Characteristic changes are the dorsal surface of the tongue. At the beginning of the disease, the tongue is covered with a whitish-yellow coating, and swelling is noted. Subsequently, the plaque acquires a brown tint and the mucous membrane of the tongue becomes covered with dry crusts. There is dryness of the tongue, the appearance of cracks and erosions (due to the prolonged febrile state of patients, accompanied by hyposalivation). Open mouth breathing (swelling of the nasal passages) aggravates the dryness of the oral mucosa. In other parts, the mucous membrane is dry, cloudy, and there are cracks on the lips. They are often covered with dark brown crusts. Rejection of plaque from the tongue begins at the end of the second week of the disease. The tongue turns red. Severe hyperemia is noted at the tip of the tongue (in the form of a triangle - “typhoid” triangle). Subsequently, after the cessation of general reactive phenomena, normalization of the function of the salivary glands is observed, the tongue is moistened and takes on a normal appearance. However, plaque remains in the area of ​​the root of the tongue for a long time.

Erysipelas of the oral mucosa. The disease is caused by group A hemolytic streptococcus. Isolated lesions of the oral cavity are rare. They are often the result of the transition of a pathological process from the skin of the face and head to the oral cavity (with the migratory form of facial erysipelas). The disease begins with sudden chills and an increase in temperature to 39-40°C. It is accompanied by signs of general intoxication. Limited redness appears on the skin. The erythematous form of the disease can become bullous. In severe cases, the pathological process can take on a necrotic and phlegmonous character, followed by gangrene (in areas rich in loose subcutaneous tissue). In the oral cavity, bright redness, swelling, and pain appear on the mucous membrane. Against the background of hyperemia, small bubbles appear. They quickly burst and erosions form. Regional lymphadenitis is noted. Lesions are localized on the mucous membrane of the soft and hard palate, uvula, tonsils and, less commonly, on the tongue. If the mucous membrane of the pharynx is damaged due to laryngeal edema, asphyxia may occur. When the lips are affected, there is hyperemia, swelling, and sometimes blisters develop. In the chronic course of the disease, macrocheilitis is observed. Erysipelas is severe in children. The clinical picture of the disease in children and adults is not fundamentally different. After an illness, there is a tendency to relapse. In diagnosis, one should distinguish erysipelas from phlegmons localized in the maxillofacial region.

Whooping cough- an acute infectious disease of childhood, manifested by spasmodic cough. The catarrhal period of the disease (2 weeks) is characterized by inflammation of the upper respiratory tract. The convulsive period (4 weeks) is characterized by signs of coughing, accompanied by vomiting, sharply expressed in the 2-3rd week. During coughing, cyanosis of the face and oral mucosa is noted. Often, children experience ulceration of the frenulum of the tongue (injury during coughing).

Children with whooping cough are isolated for a period of at least 6 weeks from the moment of illness. Dental examination and treatment of patients is carried out in a separate room, isolated from healthy people. Dental instruments are thoroughly sterilized after dental treatment and examination of the oral cavity.

Infectious mononucleosis(Filatov-Pfeiffer disease). A disease of viral origin. Occurs in children and young adults. Characterized by hyperplasia of lymphoid tissue, tonsillitis, changes in peripheral blood (leukemoid reaction of the monolymphatic type - hyperleukocytosis with a predominance of lymphocytes and monocytes, plasma cells and mononuclear cells are noted). Temperature rises to 39-39.5°C. Regional lymphadenitis is manifested by enlarged cervical lymph nodes. The latter are dense, adhesive and painful. Catarrhal, ulcerative-necrotic and diphtheritic tonsillitis are noted. Variable signs of the disease are hemorrhagic rashes on the oral mucosa and skin, ulceration of the oral mucosa. A positive reaction to heterophilic antibodies (Paul-Bunnel reaction) with a titer of at least 1:64 has a specific diagnostic value. Patients must be isolated for the entire period of the disease.

foot and mouth disease(hoof disease). A viral disease that occurs in large and small cattle, and less commonly in other animals. Human infection occurs either directly from sick animals or through contaminated dairy products (the virus is found in saliva, blood, urine, milk, blistering rashes). There is no transmission of the disease from humans, so epidemics among people are excluded. The disease among people becomes widespread during periods of epizootics among animals.

The oral cavity may be the site of primary localization of rashes when infected through dairy products. The first signs of the disease are dryness and a feeling of heat of the mucous membrane, catarrhal stomatitis. The tongue becomes covered with a whitish-yellow coating, and there is an unpleasant odor from the mouth; regional lymphadenitis. The average duration of the disease is 1-2 weeks. In severe cases, gastrointestinal disorders are observed (abdominal pain, vomiting, diarrhea mixed with blood).

To prevent the disease, you should use only boiled milk. Products from sick animals are excluded. Precautions should be taken when caring for sick animals.

Impetiginous inflammation of the lips(staphylostreptoderma). The disease is characterized by the rapid development of vesicles and blisters with transparent contents on the mucous membrane of the lips against the background of hyperemia. After the lining of the bubbles ruptures, their contents dry out in the form of yellow crusts arranged in groups.

Streptococcal cheilitis is one of the types of impetiginous streptoderma. There is hyperemia and swelling of the lips; they are covered with black crusts located in the red border area.

This lip disease usually occurs in children suffering from impetiginous facial streptoderma.

Chancriform inflammation of the lips(pyoderma). This disease is caused by Staphylococcus aureus and is usually rare. Lesions are localized on the skin of the face, lips and tongue. An isolated chancriform lesion is characterized by a compacted base of ulceration. Regional lymphadenitis is noted. A case of localization of a lesion on the dorsal surface of the tongue was described by E. I. Abramova and

S. M. Remizov. The disease should be differentiated from Manganotti's precancerous heilpt, chancroid, trophic ulcer, and aphthous ulcer.

Cracked lips(fissural cheilitis) of infectious origin.

Hypovitaminosis. Vitamin deficiency in the body occurs when there is insufficient supply of vitamins from food. Violations of vitamin balance can occur even in conditions of normal intake of vitamins into the body. This is observed when the patient is kept on a monotonous, strict diet for a long time, in patients who have been treated for a long time with antibiotics and sulfonamide drugs (they, by inhibiting the normal intestinal microflora, inhibit the natural synthesis of some vitamins, in addition, they are antagonists of some vitamins). Hypovitaminosis can develop in diseases of the gastrointestinal tract, nervous and endocrine systems, hematopoietic organs, chronic and acute infections, diseases accompanied by intoxication, etc., i.e., caused by an increased need for vitamins, increased destruction of them or impaired absorption. Usually, a deficiency of not one, but several vitamins develops (polyhypovitaminosis).

Hypovitaminosis A. Lack of vitamin A leads to disturbances in epithelial structures, accompanied by increased keratinization of the mucosal epithelium. Dry mouth and inflammatory changes are observed (against the background of xerotomy). The mucous membrane loses its shine, becomes cloudy, and whitish layers appear, reminiscent of leukoplakia. Keratinization of the excretory ducts of the salivary glands leads to a decrease in salivary secretion and hyposalivation. Keratinization of the secretory parts of diseased salivary glands leads to sialodenitis. Epidermization of the lips is noted in the red border area. Other symptoms of the disease are xerophthalmia, gastrointestinal disorders (dyspepsia, etc.).

For the prevention and treatment of the disease, foods high in vitamin A are prescribed (fish oil, cod liver, dairy products, egg yolk, vegetable and fruit products).

Hypovitaminosis B1. This disease is accompanied by hyperplasia of the fungiform papillae of the tongue. Other symptoms of the disease are polyneuritis, disorders of the cardiovascular system and gastrointestinal tract (nausea, vomiting, loss of appetite). The content of vitamin B1 in daily urine is 0.2-0.5 mg; when its content decreases to 0.1 mg, a deficiency is indicated.

During treatment, thiamine bromide is prescribed at a dose of 20-30 mg daily for several months. For gastrointestinal disorders, vitamin Bi is prescribed intramuscularly in the form of a 6% solution of 1-2 ml.

Hypovitaminosis B2. With vitamin B2 deficiency, a peculiar change in the mucous membrane in the corners of the mouth is observed (angular stomatitis), weeping appears, the epithelium macerates, small cracks in the lips become covered with crusts. Desquamative glossitis is noted in the form of a superficial form. Another symptom of the disease is conjunctivitis. In rare cases, keratitis and iritis develop.

During treatment, riboflavin is prescribed orally, 1 tablet (0.01 g once a day). Due to the low solubility and instability of riboflavin solutions, its parenteral administration is not recommended.

Hypovitaminosis B12. The requirement for vitamin B12 per day is 0.003 mg. Clinical manifestations are characterized by neurological disorders and changes in hematopoiesis. A detailed picture is revealed with endogenous B hypovitaminosis in pernicious anemia (Addison-Biermer disease). Desquamative glossitis is characteristic. Vitamin B12 deficiency can occur with partial and total gastrectomy.

For therapeutic purposes, 50-100 mcg of vitamin B12 in an aqueous solution is administered intramuscularly (daily or every other day for 10-20 days).

Hypovitaminosis PP. The daily requirement for vitamin PP is 15-25 mg. A severe degree of vitamin PP deficiency is known as pellagra. The clinical picture is characterized by a combination of lesions of the gastrointestinal tract, skin, central and peripheral nervous system (diarrhea, dermatitis, dementia). Burning of the oral mucosa, hypersalvation, and heartburn are noted. The tongue is bright red. Hyperplasia of the papillae of the tongue or their atrophy is observed, and then the tongue becomes pale and smooth, folded. Other symptoms include dry skin and increased pigmentation.

During treatment, large doses of nicotinamide up to 0.1 g are prescribed several times a day with a high protein content in the diet. It is better to take nicotinic acid after meals. Nutrition is prescribed with a sharp limitation of vegetables and carbohydrates, as patients suffer from persistent diarrhea.

Folic acid hypovitaminosis. The need for folic acid per day is 1-3 mg. Endogenous deficiency usually develops. A characteristic clinical sign of the disease is megalomacrocytic anemia. Our experimental studies to study the effect of folic acid deficiency on the body allowed us to note symptoms of vitamin deficiency (animals were injected with an aqueous solution of amethopterin, which is an antimetabolite of folic acid). On the 2-3rd and subsequent days after administration of the drug, dogs experienced severe dyspeptic symptoms, exhaustion due to dehydration.

Changes in the oral cavity were characterized by dryness and thinning of the epithelium, the development of ulcerative and necrotic defects.

Similar changes were observed in other parts of the gastrointestinal tract.

Hypovitaminosis C. The need for vitamin C depends on the intensity of the load during the day and is 75-100 mg per day. The main clinical symptom of vitamin C deficiency is hemorrhagic diathesis. Loosening of the gums and bleeding, accompanied by gingivitis, are observed. Relatively early, hemorrhage occurs in the hair follicles of the lower legs, thighs and, less commonly, on the forearms. The skin is rough and dry, hair follicles protrude above its surface. Subsequently, hemorrhages appear in the muscles, under the periosteum, etc., which leads to the formation of dense infiltrates. In severe cases, hemorrhages can also be observed in internal organs. Anemia develops, and a decrease in the body's resistance to infections is noted. The disease can develop in infants who are fed sterilized milk. Severe hemorrhagic gingivitis is noted in the oral cavity. Gum bleeding is most intense around the teeth. Hyperplastic inflammation of the gums, manifested in their swelling, is often observed. Sometimes the gums block the level of the crown of the tooth, which prevents food intake. When a secondary infection occurs, ulcerative gingivitis develops, often ending in gum necrosis. Diagnosis is carried out by determining the content of ascorbic acid in the blood and its daily excretion in urine in combination with the saturation method.

During treatment, a diet is prescribed that includes a large amount of vegetables and fruits, concentrates and infusions of vitamin carriers (rose hips, black currants). When prescribing ascorbic acid orally (300-1000 mg per day), there should be no fear of overdose. Prescribe parenteral, intravenous and intramuscular administration of ascorbic acid 100-500 mg. Treatment is carried out over many weeks.

– inflammatory-dystrophic lesion of the mucous membrane of the tongue, characterized by the formation of smooth, bright red lesions with a whitish border, cracks and furrows due to uneven detachment of the epithelium. Desquamative glossitis may be accompanied by a burning sensation, tingling of the tongue, irritation when eating, and a disturbance in the sense of taste. The diagnosis of desquamative glossitis is based on the clinical picture, data from a visual examination of the oral cavity, morphological, biochemical, microbiological, immunological studies, and ultrasound. For desquamative glossitis, treatment is aimed at eliminating causative factors.

General information

Desquamative glossitis (“geographical” tongue) is a pronounced focal rejection of the epithelium of the tongue mucosa, associated with a violation of the keratinization process and dystrophic changes in the filiform papillae. Against the background of the normal mucous membrane of the tongue, desquamation foci of different sizes and shapes appear, their outlines resembling a geographical map. Foci of desquamative glossitis very quickly appear, change or disappear, usually migrating from one area of ​​the tongue to another. Desquamative glossitis is relatively common in children, mainly in preschoolers and schoolchildren, but can often be detected in adult patients. Desquamative glossitis is more common in females.

Causes of desquamative glossitis

The causes of desquamative glossitis are not clearly defined. It is assumed that changes in the mucous membrane of the tongue are based on trophic disorders. Desquamative glossitis can be an independent disease (primary) or occur against the background of an existing pathology (secondary). Primary desquamative glossitis can develop as a result of trauma to the tongue with sharp edges of teeth or improperly fitted dentures, thermal and chemical burns of the oral cavity. In young children, desquamative glossitis may be a consequence of the eruption of primary teeth.

Since the mucous membrane of the tongue is extremely sensitive to all functional changes occurring in the body, the development of secondary desquamative glossitis can be caused by various pathological processes. Desquamative glossitis can be accompanied by chronic diseases of the gastrointestinal tract, liver and gall bladder, nutritional disorders and vitamin and mineral metabolism (hypovitaminosis B1, B3, B6, pantothenic and folic acids, iron imbalance).

Desquamative glossitis occurs in diseases of the hematopoietic system, endocrine changes (during pregnancy), autonomic disorders, autoimmune pathology (systemic lupus erythematosus, systemic scleroderma, rheumatism), chronic dermatoses (exudative diathesis, psoriasis).

Acute infections (influenza, scarlet fever, typhoid fever, etc.), helminthic infestations, and dysbacteriosis play a certain role in the occurrence of desquamative glossitis. Cases of desquamative glossitis are detected due to drug intoxication - uncontrolled use of antibiotics and potent medications. Desquamative glossitis can be hereditary (family) in nature.

Classification of desquamative glossitis

Initially, small areas with a whitish-gray coating appear on the surface of the tongue, which gradually swells and peels off to form a smooth spot of bright pink or red color that stands out against the background of the surrounding epithelium. The process of disepithelialization spreads along the periphery of the lesion, which quickly increases in size. In its center, atrophy of the filiform papillae is noted, but usually after 1-3 days rapid regeneration of the epithelium and their restoration occurs.

Foci of desquamative glossitis are often multiple, of different shapes and sizes and can cover a significant area of ​​the mucous back and lateral surfaces of the tongue. A mild inflammatory reaction is visible along the edge of the desquamation focus. Due to the changing processes of keratinization and exfoliation, the “geographical pattern” on the tongue is constantly changing.

In most patients, desquamative glossitis is not accompanied by complaints, but is discovered accidentally during an examination of the oral cavity by a dentist or otolaryngologist. Sometimes discomfort and unpleasant pain in the tongue may occur, aggravated by eating; impaired taste, problems with diction; The unnatural appearance of the tongue may be disturbing.

The course of desquamative glossitis is long-term, chronic; its foci may disappear for a short time and appear again in the same or another area of ​​the tongue. Exacerbation of desquamative glossitis is observed with emotional stress or relapse of the somatic pathology against which it developed. The absence of normal mucosa in the foci of desquamative glossitis contributes to the penetration of infection with the development of cracks, pain, general malaise, and enlargement of regional lymph nodes.

Diagnosis of desquamative glossitis

The diagnosis of desquamative glossitis is established by the dentist based on the patient’s medical history and complaints, visual examination of the oral cavity, examination of lymph nodes and additional laboratory examination, including morphological, biochemical, microbiological, immunological, and serological methods.

Desquamative glossitis is characterized by a decrease in the keratinization index by 20-50% and a several-fold increase in the number of epithelial cells ready for apoptosis. With desquamative glossitis, there is a decrease in the level of serum IgA and lysozyme activity, which are involved in local immunity. Exceeding the level of norepinephrine in saliva several times during desquamative glossitis indicates a spasm of the capillaries of the mucous membrane of the tongue, which contributes to the formation of dystrophic foci. An increase in the level of histamine in saliva may indicate an allergic form of desquamative glossitis.

Ultrasound scanning of blood vessels allows us to establish a decrease in the level of capillary blood flow in the tongue by 20-30%. Differential diagnosis of desquamative glossitis is carried out with secondary syphilis, lichenoid form, elimination of traumatic factors), a gentle diet, and, if necessary, psychotherapy.

For desquamative glossitis, sedatives, antihistamines, vascular, anti-inflammatory drugs, vitamin-mineral complexes, and biostimulants can be used. If you feel a burning sensation and pain, antiseptic rinses with solutions of citral, soda, chlorhexidine are recommended; applications to the affected areas of keratoplasty agents (vitamin A oil solution, rosehip oil), local analgesic drugs (anesthetic in glycerin, pyromecaine). If necessary, antibacterial, antifungal drugs, and immunomodulators are used. In case of severe pain, novocaine blockades are prescribed in the area of ​​the lingual nerve. Physiotherapy for desquamative glossitis includes medicinal electrophoresis, ultraphonophoresis, SMT therapy, and ultrasound therapy.

Forecast and prevention of desquamative glossitis

Desquamative glossitis does not pose a threat to the patient’s health, and the likelihood of malignant lesions is excluded. To prevent primary desquamative glossitis, it is necessary to eliminate traumatic factors (grinding fillings, fitting dentures), avoid smoking, drinking alcohol, and irritating foods. Prevention of secondary desquamative glossitis consists of treating the underlying diseases of which it is a manifestation.

Desquamative glossitis is an inflammatory-dystrophic lesion of the mucous membrane of the tongue with areas of desquamation, which are the area of ​​epithelial detachment. The disease can take various forms, and the affected areas can be located both on the back of the tongue and on the lateral surfaces. Treatment of the disease includes local and general therapy. The set of drugs is selected depending on the form of glossitis. Note that even after treatment, you need to monitor hygiene; it is recommended to carry out a complete sanitation of the oral cavity and exclude irritating foods.

Description of the disease

Most often, the tongue contains several affected areas, less often one area is affected.

The onset of the disease is characterized by the formation of areas with a gray-white coating, which flakes off over time and forms a red area with a smooth surface devoid of papillae. Around the desquamation there are white stripes - the area of ​​keratosis. Read more about why white spots appear in the mouth.

Very often the course of the disease is accompanied by a folded tongue, which has several folds on the mucous membrane, which makes the inflamed area even more similar to a geographical map.

Causes

There are several factors that can provoke the development of desquamative glossitis. These include:

• mechanical effects on the mucous membrane of the tongue during fractures and the operation of dental structures and devices, unprofessionally installed crowns or sharp edges of fillings;
• chemical or thermal burns of the tongue mucosa;
• eruption of teeth (including in the wrong place or direction), as a rule, these are wisdom teeth.

Desquamative glossitis can develop against the background of another disease. This most often occurs with the following ailments:

• chronic diseases of the gastrointestinal tract;
• problems with the liver and gall bladder;
• disorders of the autonomic and endocrine systems;
• rheumatic ailments;
• lack of microelements and vitamins in the body - hypovitaminosis of vitamins B1, B3, B6, lack of pantothenic and folic acids, low iron levels);
• diseases associated with the hematopoietic process;
• autoimmune diseases;
• some types of chronic dermatitis.

The disease can also form with the participation of infectious processes occurring in the body, such as scarlet fever, helminthic infestation, viral infections, and influenza. Intoxication due to the use of potent antibiotics can also provoke desquamative glossitis and stomatitis. For details regarding the treatment of stomatitis after antibiotics, see.

Species

Desquamative glossitis can have the following forms of the disease:

• surface form appears in the form of spots and stripes of red color with a clear border surrounding the healthy mucous membrane. After the epithelium is shed, the dorsum becomes smooth due to the absence of papillae. Symptoms of this form are itching and slight burning;
• hyperplastic form differs from the previous one in denser lesions, the size of which is associated with hypertrophy of the filiform papillae of the tongue. The symptoms of this form are as follows: discomfort and a coating of yellow, white or gray shades;

Often with the hyperplastic form, there is a feeling of a foreign object in the oral cavity.

• lichenoid form is characteristic of formations of affected areas of various sizes and shapes, which do not have a permanent location and can migrate. Filiform papillae of the mucosa are distributed around the inflamed areas, and in the desquamation zones themselves, hypertrophy of the fungiform papillae can be observed.

Diagnostics

Recognizing the disease does not present any particular difficulties, since its clinical symptoms are very characteristic. Desquamative glossitis should be distinguished from diseases such as:

Lichen planus can affect not only the tongue, but also the mucous membrane of the mouth.

• leukoplakia;
• plaques in secondary syphilis;
• hypovitaminosis B2, B6, B2;
• candidiasis.

Histological changes are characterized by thinning of the epithelium and flattening of the filiform papillae in the area of ​​desquamation, parakeratosis and moderate hyperkeratosis in the epithelium of the areas surrounding the affected area. In the mucous layer itself there is slight swelling and inflammatory infiltrate.

Treatment

Treatment of desquamative glossitis may include local and general therapy, as well as professional consultations with doctors such as a gastroenterologist, endocrinologist, allergist, psychologist, psychotherapist, and dermatologist. In the case of treatment of the disease, therapy for major somatic diseases, normalization of the function of the gastrointestinal tract, sanitation of the oral cavity, including oral hygiene by a professional dentist, elimination of traumatic moments, a prescribed diet, and, if necessary, psychotherapy are indicated.

When desquamative glossitis is detected, antihistamines, vascular, anti-inflammatory, sedative medications are used, as well as complexes of vitamins and minerals and biostimulants.

If burning and pain are clearly felt, the following are recommended:

• application to the affected area of ​​preparations containing vitamin A;
• local painkillers;
• antiseptic rinses with chlorhexidine, soda, citral.

If necessary, antifungal and antibacterial medications, as well as immunomodulators, can be used. If severe pain is observed, a novocaine blockade may be prescribed at the site of the lingual nerve.

Physiotherapy can also be used, which includes ultraphonoresis, ultrasound therapy, SMT therapy and medicinal electrophoresis.

Prevention

Desquamative glossitis may pose no danger to the patient, and there is no possibility of malignancy of the lesions. To prevent the primary symptoms of the disease, eliminate all kinds of traumatic contacts with the oral cavity (for example, polish the sharp edges of fillings), avoid the use of cigarettes and alcoholic beverages, as well as irritating foods.

Secondary desquamative glossitis can occur due to diseases existing in the body, of which it can be a symptom.

Video

For more details regarding identifying desquamative glossitis, watch the video

Etiology and pathogenesis. Not completely clarified. Most often, desquamative glossitis (glossitis desquamativa, geographic tongue, exfoliative, or migratory glossitis) occurs in diseases of the gastrointestinal tract, autonomic-endocrine disorders, and rheumatic diseases (collagenosis). It is also assumed that a viral infection, a hyperergic state of the body, and hereditary factors play a certain role in the occurrence of desquamative glossitis. The disease occurs equally often in different age groups.

Clinical picture. The process begins with the appearance of a whitish-gray area of ​​opacity of the epithelium several millimeters in diameter. Then it swells and in the center the filiform papillae slough off, revealing a bright pink or red rounded area that stands out against the background of the surrounding slightly raised zone of opacified epithelium. The area of ​​desquamation quickly increases, maintaining an even round outline, but the intensity of desquamation decreases. The zone of desquamation of the epithelium can be of different shapes and sizes and appears as reddish spots. Sometimes areas of desquamation have the shape of rings or half rings. In the area of ​​desquamation, mushroom-shaped papillae are clearly visible, looking like bright red dots. When the focus of desquamation reaches a significant size, its boundaries blur in the surrounding mucous membrane, and in its center, following desquamation, the normal keratinization of filiform papillae begins to be restored, while in areas of keratinization, on the contrary, desquamation occurs. Foci of desquamation can be single, but more often they are multiple and, as a result of constantly changing processes of keratinization and desquamation, they are layered on top of each other. Against the background of old lesions, new ones are formed, as a result of which the shape of the desquamation areas and the color of the tongue are constantly changing, which gives the surface of the tongue a look reminiscent of a geographical map. This served as the basis for the names “geographical language” and “migratory glossitis”. A rapid change in the outlines of desquamation foci is characteristic; the picture changes even upon examination the next day. Foci of desquamation are localized on the back and lateral surfaces of the tongue, usually not spreading to the lower surface.

In most patients, especially children, changes in the tongue occur without any subjective sensations and are detected by chance during an examination of the oral cavity. Only some patients complain of burning, tingling, paresthesia, pain from irritating foods. Patients are also bothered by the strange appearance of the tongue; Cancerophobia may develop. Emotional stress conditions contribute to a more severe course of the process. Desquamative glossitis, which occurs against the background of pathology of the gastrointestinal tract and other systemic diseases, can periodically worsen, which is often caused by exacerbation of somatic diseases. Exacerbation of desquamative glossitis is accompanied by an increase in the intensity of desquamation of the epithelium of the mucous membrane of the tongue. Desquamative glossitis is combined with a folded tongue in approximately 50% of cases.

The disease lasts indefinitely, without causing concern to patients, sometimes disappears for a long time, then reappears in the same or other places.

There are cases when desquamation occurs predominantly in the same place.

Diagnostics. Recognizing the disease does not present any particular difficulties, since its clinical symptoms are very characteristic. Desquamative glossitis should be differentiated from:

• - lichen planus;
• - leukoplakia;
• - plaques in secondary syphilis;
• - hypovitaminosis B2, B6, B13;
• - allergic stomatitis.

Histological changes are characterized by thinning of the epithelium and flattening of the filiform papillae in the area of ​​desquamation, parakeratosis and moderate hyperkeratosis in the epithelium of the areas surrounding the affected area. In the mucous layer itself there is slight swelling and inflammatory infiltrate.

Treatment. If there are no complaints or discomfort, treatment is not carried out. If a burning sensation or pain occurs, sanitation of the oral cavity, elimination of various irritants, and rational oral hygiene are recommended. Hygiene recommendations are especially relevant in the case of a combination of desquamative glossitis with a folded tongue, in which the anatomical features of the structure create favorable conditions for the proliferation of microflora in the folds, which can cause inflammation that brings pain. If there is a burning sensation, pain, light antiseptic rinses, irrigations and oral baths with citral solution (25-30 drops of 1% citral solution in half a glass of water), applications of a 5-10% suspension of anesthesin in an oil solution of vitamin E, applications keratoplasty agents (vitamin A oil solution, rosehip oil, carogolin, etc.). Treatment with calcium pantothenate (0.1-0.2 g 3 times a day orally for a month) gives good results. In some patients, a positive effect is observed from the use of novocaine blockades in the area of ​​the lingual nerve (10 injections per course). In case of severe pain, it is advisable to prescribe local painkillers. It is imperative to identify and treat concomitant diseases. This treatment is symptomatic, it is aimed at eliminating or reducing pain and reducing the frequency of relapses. However, there is still no means of completely eliminating relapses of the disease, especially in old age. Cancerophobia often develops. Prevention of such conditions can include individual conversations with patients and correct deontological tactics. The prognosis for life of the disease is favorable; the possibility of malignancy of desquamative glossitis is excluded.

What is Desquamative glossitis

What causes Desquamative glossitis?

The etiology and pathogenesis have not been fully elucidated. Most often, desquamative glossitis (glossitis desquamativa, “geographical” tongue, exfoliative, or migratory glossitis) occurs in diseases of the gastrointestinal tract, autonomic-endocrine disorders, and rheumatic diseases (collagenosis). It is also assumed that a viral infection, a hyperergic state of the body, and hereditary factors play a certain role in the occurrence of desquamative glossitis. The disease occurs equally often in different age groups, more often in women.

Symptoms of Desquamative glossitis

The process begins with the appearance of a whitish-gray area of ​​opacity of the epithelium with a diameter of several millimeters. Then this area bulges and in its center the filiform papillae slough off, revealing a bright pink or red rounded area that stands out against the background of the surrounding slightly raised zone of opacified epithelium. The area of ​​desquamation quickly increases, maintaining an even round outline, but the intensity of desquamation decreases. The zone of desquamation of the epithelium can be of different shapes and sizes and appears as reddish spots. Sometimes areas of desquamation have the shape of rings or half rings. In the area of ​​desquamation, mushroom-shaped papillae in the form of bright red dots are clearly visible. When the focus of desquamation reaches a significant size, its boundaries blur in the surrounding mucous membrane, and in the center, following desquamation, the normal keratinization of filiform papillae begins to be restored, while in areas of keratinization, on the contrary, desquamation occurs.

Foci of desquamation may be single; but more often they are multiple and, as a result of constantly changing processes of keratinization and desquamation, they are layered on top of each other. Against the background of old lesions, new ones form, as a result of which the shape of the desquamation areas and the color of the tongue are constantly changing, which gives the surface of the tongue a look reminiscent of a geographical map. This served as the basis for the names “geographical language” and “migratory glossitis”. A rapid change in the outlines of desquamation foci is characteristic; the picture changes even upon examination the next day. Foci of desquamation are localized on the back and lateral surfaces of the tongue, usually not spreading to the lower surface.

In most patients, especially children, changes in the tongue occur without any subjective sensations and are detected by chance during an examination of the oral cavity. Only some patients complain of burning, tingling, paresthesia, pain from irritating foods. Patients are also bothered by the strange appearance of the tongue; Cancerophobia may develop. Emotional stressful conditions contribute to a more severe course of the process. Desquamative glossitis, which occurs against the background of pathology of the gastrointestinal tract and other systemic diseases, can periodically worsen, which is often due to exacerbation of somatic diseases. Exacerbation of desquamative glossitis is accompanied by an increase in the intensity of desquamation of the epithelium of the mucous membrane of the tongue. Desquamative glossitis is combined with a folded tongue in approximately 50% of cases.

The disease lasts indefinitely, without causing concern to patients, sometimes disappears for a long time, then reappears in the same or other places. There are cases when desquamation occurs predominantly in the same place.

Diagnosis of Desquamative glossitis

Recognizing the disease does not present any particular difficulties, since its clinical symptoms are very characteristic. Desquamative glossitis should be differentiated from:

• lichen planus;
• leukoplakia;
• plaques in secondary syphilis;
• hypovitaminosis B2, B6, B2;
• allergic stomatitis;
• candidiasis.

Histological changes are characterized by thinning of the epithelium and flattening of the filiform papillae in the area of ​​desquamation, parakeratosis and moderate hyperkeratosis in the epithelium of the areas surrounding the affected area. In the mucous layer itself there is slight swelling and inflammatory infiltrate.

Treatment of Desquamative glossitis

If there are no complaints or discomfort, treatment is not carried out. If a burning sensation or pain occurs, sanitation and rational oral hygiene and elimination of various irritants are recommended. Hygiene recommendations are especially relevant in the case of a combination of desquamative glossitis with a folded tongue, in which the anatomical features of the structure create favorable conditions for the proliferation of microflora in the folds, which can cause inflammation that causes pain. If there is a burning sensation, pain, light antiseptic rinses, irrigations and oral baths with citral solution (25-30 drops of 1% citral solution in half a glass of water), applications of a 5-10% suspension of anesthesin in an oil solution of vitamin E, applications of keratoplastics (oil vitamin A solution, rosehip oil, carotoline, etc.). Treatment with calcium pantothenate (0.1-0.2 g 3 times a day orally for a month) gives good results. In some patients, a positive effect is observed from the use of novocaine blockades in the area of ​​the lingual nerve (10 injections per course). In case of severe pain, it is advisable to prescribe local painkillers. Identification and treatment of concomitant diseases are mandatory. This treatment is symptomatic, it is aimed at eliminating or reducing pain and reducing the frequency of relapses. However, there is still no means of completely eliminating relapses of the disease, especially in old age. Cancerophobia often develops. Prevention of such conditions can include individual conversations with patients and correct deontological tactics.

The prognosis for life of the disease is favorable; the possibility of malignancy of desquamative glossitis is excluded.

Which doctors should you contact if you have Desquamative glossitis?

• Dentist
• Maxillofacial surgeon
• Infectious disease specialist

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One of the unusual diseases in humans is geographic tongue (desquamative glossitis).

The name is explained by the appearance on the mucous tissue of the tongue of a pattern reminiscent of a geographical map. Quite often this disease appears in children.

Geographical language refers to inflammatory and dystrophic processes on mucous tissue. In those who suffer from this disease, mucous tissue begins to peel off.

The disease is quite dangerous. Since it can manifest itself as a result of other diseases such as disorders of the autoimmune system, stomach and liver diseases.

Therefore, if a person feels discomfort or finds strange pink-red areas, he needs to be examined by a doctor. For this may be desquamative glossitis, which directly appears due to disturbances in the functioning of the gastrointestinal organs, vitamin metabolism, endocrine system, and the like.

Forms of the disease

There are no specific forms of geographic glossitis. There are different versions regarding their shape.

So, according to one conclusion, there are three forms of desquamative glossitis:

• superficial– bright red stripes and spots with clear boundaries appear, around the spots the normal color of the mucous membrane is characteristic, when the epithelium exfoliates, the tongue becomes smooth. With the superficial form, a person develops feelings of itching and burning in the oral cavity;
• hyperplastic– focal filiform papillae become denser, in places where they increase – the areas acquire a white, yellow, gray color;
• lichenoid– damaged areas of different shapes, sizes, mushroom-shaped papillae are enlarged; a person with this form sometimes has a burning sensation, this is due to the hypersensitivity of the tongue to various metals used for prostheses, or he suffers from neuroendocrine disorders.

According to another version, desquamative glossitis has migratory and fixed forms. Most often, geographic inflammation of the migratory form occurs (occurs with mild pain, pathological elements quickly form, the epithelium of the tongue mucosa is slowly restored).

Whatever form of geographic glossitis there was, in any case it is necessary to find out the reason for its occurrence.

Symptoms

Desquamative glossitis indicates the presence of serious diseases.

Most often it is discovered by chance.

Rarely, mild tingling or burning may occur when eating food that is very hot or spicy.

Taste perception also changes. A person has a feeling of enlargement of the tongue, which makes it difficult to swallow food or speak.

The main symptom of desquamative glossitis is areas of different sizes and colors, which are similar to the geographical pattern of a map.

This disease begins to manifest itself in this way:

• inflammation of the mucous membrane of the tongue causes swelling, the spots increase;
• mucous tissues begin to peel off;
• then red spots begin to form;
• an outline appears in damaged areas;
• the spots are mainly located on the back, on the sides of the tongue.

Damaged areas often become infected. If the spots or furrows become infected, the person may experience pain and cracks in the tongue.

If a person finds a pattern on his tongue that looks like a map, he needs to make an appointment with a doctor. Because due to delay, there can be various complications, since desquamative glossitis is the main sign of disease of internal organs, failure of vitamin metabolism, and anemia.

Causes of the disease

The exact causes of desquamative glossitis have not yet been found. It is assumed that this disease manifests itself as a consequence of serious pathologies.

The main causes of desquamative glossitis are:

• various gastrointestinal diseases;
• stomach diseases: gastritis, ulcers, gastroduodenitis;
• oral pathology ();
• liver diseases;
• diseases of the adrenal glands, thyroid gland;
• failure of vitamin metabolism. In particular, the metabolism of B vitamins is disrupted;
• Thus, failure of vitamin B1 metabolism becomes a prerequisite for nervous and digestive disorders. If the mucous membranes of the mouth and tongue become inflamed, accompanied by itching and cracks, this means that the metabolism of vitamin B2 is impaired. B6 deficiency leads to damage to skin tissue and inhibits the rapid healing of wounds. Lack of B12 is a prerequisite for anemia;
• malbabsorption syndrome - impaired digestion and transport of nutrients in the intestine;
• pancreatic diseases. It may appear when the patient has acute or chronic pancreatitis. In this disease, enzymes secreted by the pancreas self-digest, this is the cause of intoxication. Toxins spread through the blood into organs, disrupting their functioning;
• autoimmune pathology;
• ARVI, exudative diathesis;
• allergy;
• taking large amounts of antibiotics and other potent drugs;
• worms are invasive.

Geographic inflammation often occurs in children during the period. Adults get this disease regardless of age.

In women, desquamative glossitis may appear during menopause, pregnancy, and in girls - during puberty.

A patient who experiences itching or burning in the mouth should immediately contact qualified doctors, since desquamative glossitis is a manifestation of other diseases. This disease will go away when the cause of its occurrence is cured.

Geographic language: photo

Geographic spots on the tongue

Desquamative glossitis: photos of forms of the disease

Diagnostics

It is not difficult for a doctor to diagnose desquamative glossitis.

Geographic glossitis can be suspected based on the following criteria:

• a person complains of a burning sensation, itching, or swelling in the mouth;
• during oral cavity signs of geographic inflammation are visible: spots of varying sizes, surrounded by a white rim;
• patient's illness chart.

When a person detects geographic inflammation, it is recommended to undergo a comprehensive diagnosis and take tests (blood, urine, stool). Having completed the necessary tests and a thorough examination, the doctor can begin to create an algorithm for treating this formation.

If a pathology is detected, the patient must undergo an examination at a dental clinic and a gastroenterologist in order to determine the reasons that led to this manifestation.

Treatment

Desquamative glossitis is easily treated. Before starting treatment, you need to find out the disease that caused it in a person. Because geographic tongue can be cured when the cause of its manifestation is eliminated.

However, it is necessary to carry out the following therapeutic measures regarding the formation of a geographic tongue:

• sanitation of the oral cavity (professional teeth cleaning, replacement of bad fillings);
• taking vitamin complexes (especially group B, zinc);
• rinse your mouth with an alkaline solution;
• it is allowed to make pain-relieving applications on the affected surface of the tongue in case of pain;
• rinse your mouth with antiseptics;
• undergo therapy to reduce allergic activity if the cause of the disease is allergy;
• follow a diet: do not eat spicy, sour, sweet, hot foods;
• do not drink sweet drinks or alcohol.

The patient needs to drink a normal amount of fluid. Thanks to it, the discomfort on the tongue will decrease. In addition, a lot of saliva will be produced, which is necessary to maintain healthy flora in the mouth.

During treatment, a person is recommended to drink green and herbal tea.

So, mint tea will help slow down the increase in bacteria in the mouth.

If a person experiences unpleasant or painful sensations on the tongue, he needs to replace the toothpaste, which will not irritate the damaged mucous membrane.

It is forbidden to rub the areas formed due to the geographic tongue with a brush. Since this can cause injury to the mucous membrane of the tongue and lead to infection. People with dentures or braces need to be careful not to allow these dental devices to injure the mucous membrane of the tongue and the surface of the lips.

A patient who may have developed a geographic tongue should not delay visiting a doctor. Since an examination by a professional is very necessary, since geographic inflammation of the tongue may be a symptom of another disease that needs to be treated urgently.

Traditional medicine

Traditional medicine can alleviate the suffering of the patient, speed up the recovery of damaged areas of the tongue, and strengthen the immune system.

The most popular folk remedies are:

• chamomile decoction for antiseptic, healing effect;
• infusion of sage, coriander, basil;
• bedstraw decoction - for healing wounds;
• oil baths;
• aloe applications – for healing and relieving inflammation;
• soda solution with a couple of drops of iodine;
• lotions or rinsing with vegetable glycerin;
• bee products.

It should be remembered that traditional medicine cannot be a replacement for official medicine; without medications it is impossible to cure the original cause of the disease.

Complications and consequences

A geographic map on the tongue is not an independent disease; it does not require special treatment.

Do not forget that desquamative glossitis accompanies much more serious diseases.

In elderly patients, due to this disease, cancerophobia manifests itself (fear that this disease is cancer of the tongue).

For this reason, if signs of this disease are detected, you need to make a visit to the doctor; you may need the services of a psychoanalyst.

Geographic inflammation is a benign condition that cannot become malignant.

Desquamative glossitis in a child

Children often develop geographic inflammation of the tongue; in many it is congenital. The causes may be gastrointestinal diseases, infection, vitamin deficiency, anemia and other diseases.

However, it often appears in a healthy child. It may appear during the appearance of milk teeth, in girls at the beginning of the first menstrual cycle. There is also an opinion that the geographical map of a language is inherited genetically.

Geographic spots in a child

The question arises, what to do with it? Should I treat it in a child or should I not do it? Since the factors for the appearance of a geographic tongue are considered to be a structural feature of the tongue or a sign of another disease, treatment is not necessary.

If the appearance of a geographical map was caused by some hidden disease, it needs to be identified and treated. When a hidden disease is cured, this symptom on the tongue will disappear.

If geographical spots on the tongue appear by inheritance, or are a feature of the child, then treatment in this case will not give anything.

If the geographic map appeared during teething, it should disappear on its own without treatment.

Also, a geographic tongue can appear due to caries and plaque. In this case, it is necessary to perform sanitation in the child’s mouth.

If a child’s tongue reveals areas similar to a geographical pattern, parents need to seek qualified help. This cannot be delayed. Because geographic language is often the main sign of dangerous diseases.

Prevention

To protect yourself from this disease, it is necessary to take certain preventive measures:

• take vitamin complexes, especially group B;
• eat foods rich in vitamins (vegetables, fruits, herbs, dairy products, meat);
• observe;
• maintain a healthy lifestyle: do not smoke, do not drink alcohol;
• Every six months, check the condition of the oral cavity with a dentist, treat your teeth and gums in a timely manner.

It is necessary to undergo a regular dental examination. If there is a hint of the presence of a geographic tongue, you should urgently contact a dental clinic.

Video on the topic

About geographic language in the video blog “PediatrPlus”:

From birth, the tongue reacts sharply to the presence of health problems, and if something is wrong in the body, it changes color, becomes coated, spots of different shapes appear on it, which, moreover, can change their location. The tongue, after peeling off, becomes like a geographical map or some kind of graphic drawing. That is why in this state it is called geographical. The second name for this phenomenon is desquamative glossitis, which literally means “peeling of an inflamed tongue.”

Many, not understanding the seriousness of the situation, can simply laugh at the unusual term, calling the language not geographical, but geometric. However, what fun can there be if this vital organ for a person indicates that something is clearly wrong with the body, because for some reason it is peeling off. Let's figure out why in adults and children the language takes on such an unnatural appearance.

Reasons for the emergence of “geographical language”

The desquamative type of glossitis in adults has many reasons why it occurs, forming a geometric pattern on the surface of the tongue. The main ones include the following:

• diseases of the gastrointestinal tract in acute form: gastritis, ulcers, duodenitis, gastroduodenitis;
• diseases of the pancreas: pancreatitis in acute and chronic form;
• diseases of the endocrine system: diabetes mellitus;
• liver diseases, hepatitis;
• autoimmune pathologies: multiple sclerosis, lupus erythematosus, rheumatoid arthritis;
• severe or modified forms of viral infection: monoculosis, ARVI;
• hormonal changes: period of bearing a child, menopause, puberty;
• kidney diseases;
• long-term uncontrolled treatment with antibiotics;
• disruption of food movement in the small intestine: malabsorption syndrome;
• metabolic disorder, which results in an acute lack of B vitamins;
• dental diseases;
• worms can also cause desquamative glossitis;
• pathologies of the skin and mucous membranes: exudative form of diathesis;
• genetic predisposition.

Symptoms of desquamative glossitis with photos

If there is a suspicion of desquamative type glossitis, the patient should undergo a general blood, urine and stool test. Other laboratory tests need to be carried out:

1. bacteriological culture of a smear taken from the surface of a graphic tongue that has acquired a geometric image (this will make it possible to determine what type of pathogen is a virus, bacteria or fungus);
2. polymerase chain reaction (determines the presence of a pathogen by its presence in DNA);
3. enzyme immunoassay (determines the presence of antibodies in body fluids that are produced in response to a disease of one type or another);
4. examination of scrapings for treponema;
5. anticardiolipin test;
6. carrying out a stool test for worms (to exclude helminthic infestation as the cause of the disease).

Treatment of “geographic tongue”

There is no specific treatment for desquamative glossitis. You can get rid of it only when the cause of its manifestation is eliminated, that is, the disease that led to the appearance of a graphic pattern on the tongue. These are mainly diseases of the digestive organs and endocrine system.

In order for the treatment of geographic tongue to bring the expected effect, the patient must follow the following instructions:

• conduct an examination of the oral cavity: find teeth with tartar or caries and treat them, as they are a source of infection;
• according to the doctor’s instructions, select the most suitable means for brushing your teeth;
• give up bad habits, and first of all, smoking;
• ban salty, spicy, sour, hot or cold foods (this will save you from discomfort while eating);
• include the necessary vitamins in your diet (a specialist will recommend them to you);
• rinse with an antiseptic (special disinfectants are suitable, which a doctor will help you choose);
• if the symptoms of desquamative type glossitis are pronounced, then the surface of the tongue must be smeared with a special anesthetic (this will help get rid of discomfort, burning and itching);
• carry out therapy to reduce the allergic reaction.

Geographical language does not appear on its own. It is a kind of response to any disease of the body. This is like a signal that you urgently need to see a doctor for advice. Therefore, if you find yourself with desquamative glossitis, that is, your tongue has become geographical, do not waste time - visit a gastroenterologist and dentist. They will refer you for additional examinations if necessary.

Prognosis and prevention

The likelihood that foci of desquamative glossitis will turn into a malignant formation is zero. A geographical or geometric pattern on the surface of the tongue does not pose a threat to the patient’s health at all. It may not even be treated. Within a few weeks, the desquamative form of the disease should go away on its own, but there is a possibility of its recurrence. This is why prevention is needed. What is needed to ensure that the geographic language does not become a constant “companion” in your life:

• normalize hormonal levels;
• constantly monitor the state of the immune system;
• pay attention to any signs that something is wrong with the gastrointestinal tract, and begin treatment without delay;
• monitor oral hygiene: brush your teeth twice or even three times a day, the toothpaste and brush should be of good quality, use dental floss;
• go for a preventive examination to the dentist once every six months;
• promptly treat caries and other dental diseases;
• If a tooth is chipped or broken, it must be corrected immediately;
• taboo to all bad habits;
• nutrition must be balanced so that the body does not experience a lack of any vitamins or microelements;
• ensure that the temperature of food and drink is moderate;
• carry out timely treatment of diseases that provoke the appearance of graphic relief tongue.