How to treat oral mucosal diseases

Oral mucosal disease is closely related to the condition of the whole body. This disease is mainly a disease in which the color, shape and function of a certain part of the mouth change. It is mainly related to the body's own immunity. With the increase of age, many human body functions become disordered, and the secretion of growth hormone also decreases. In addition, poor sleep affects the mental state, and the body lacks vitamins. These are the causes of oral mucosal disease. So how can we prevent and treat oral mucosal disease?

Causes

Except for some oral mucosal diseases whose causes are relatively clear, the causes of many diseases are still unclear.

1. It is related to the physiological defect of decreased oral immunity as people age. Due to the decrease in the secretion of growth hormone in adults, the oral absorption capacity of vitamins is not as good as that of children during their growth period. The elderly are more prone to gastrointestinal dysfunction, lack of trace elements such as iron and zinc in the body, poor sleep leading to mental stress, fatigue or colds, which can induce oral ulcers.

2. Recurrent oral ulcers are a multi-gene genetic disease. If the parents have more severe oral ulcers, their children are very likely to inherit the disease.

Clinical manifestations

Oral mucosal disease refers to the damage of the oral mucosa. The specific symptoms are: oral ulcers, cracked tongue, hoarseness, dry mouth and bitter taste, which may lead to oral lichen planus, stomatitis, recurrent oral ulcers, cheilitis and other oral diseases, resulting in difficulty in eating and unbearable oral pain. The most notable feature of oral ulcers is recurrent attacks, with the number of ulcers increasing from few to many and the location from front to back. They often occur on the oral mucosa, gums, upper and lower sides of the tongue, and throat. The ulcers can be as large as soybeans or as small as rice grains, and are covered with a white ulcerated film. In mild cases, it may occur once every few months, while in severe cases, the intervals between ulcers gradually shorten and become more severe year by year. Ulcers may even occur for years or even decades without healing, and may lead to a variety of complications in the body, directly affecting the patient's physical health, work and life. Currently, Western medicine is often used to control the symptoms of this disease in clinical practice, but it is difficult to cure it, and it is listed as one of the major problems of oral disease by the medical community.

1. Herpetic stomatitis and cold sores

Both are caused by the herpes simplex virus. Herpetic stomatitis is a primary infection that often occurs in children and adolescents. It manifests as acute stomatitis, forming many blisters, which then break into ulcers. Systemic symptoms include fatigue, fever, swollen lymph nodes, etc. Cold sores are a recurrence of herpes simplex virus infection with mild symptoms limited to the lips and corners of the mouth. There is a burning sensation before blistering. The blisters are very small, but they may occur in clusters and merge with each other to form a dark brown scab. It can heal on its own after about 10 days, but it may relapse. Generally no treatment is required. For patients with systemic symptoms, antibiotics can be used to control secondary bacterial infection. Appropriate supplementation of vitamin C, vitamin B compound, etc., increasing nutrition can promote healing.

2. Recurrent oral ulcers

Diseases that cause recurrent ulcers in the mouth include recurrent aphthous ulcers, recurrent necrotizing periadenitis mucosae, and Behcet's syndrome. Recurrent aphthous ulcers are small, shallow, round or oval ulcers that occur repeatedly in the mouth. This disease does not have blisters as a precursor before it occurs, which is different from the ulcers caused by herpes. Aphthous ulcers are light yellow in color, often surrounded by a red halo, with a diameter of less than 0.5 cm. One to several ulcers may appear at the same time and are very painful. The cause of the disease is still unclear. Some people believe that it is related to L-type alpha-hemolytic streptococcus. Recently, it is believed to be related to reduced cellular immune function. Some surveys show that there is also a genetic tendency. Digestive disorders, ascariasis, mental stress, lack of sleep, exposure to certain chemicals, vitamin B deficiency, iron deficiency, zinc deficiency, premenstrual syndrome and minor bites can all trigger this disease. Patients with frequent and severe oral ulcers often have lower serum zinc than normal people. However, after taking zinc sulfate, their serum zinc returns to normal and their condition improves. Low zinc levels can cause immune deficiency, reduced enzyme activity, and incomplete keratinization of the oral mucosal epithelium. The immunological examination of severe recurrent oral ulcers is similar to that of Behcet's syndrome, which is also an autoimmune disease. Symptomatic treatment is to take 0.25% chloramphenicol orally, apply corticosteroid ointment or powder, and for severe pain, take 1% novocaine orally. Various drug films can also be attached to the ulcer. Silver nitrate corrosion of local ulcers can also relieve symptoms and promote healing. The local Chinese medicine Yangyin Shengji San has the effects of promoting tissue regeneration, relieving pain, reducing inflammation, and promoting ulcer healing. This medicine has low irritation and is widely used for recurrent oral ulcers, various stomatitis and mucosal ulcers.

Recurrent necrotizing mucosa periadenitis is a large recurrent oral ulcer, often with a prodromal history of aphthous ulcers. The ulcer surface is usually between 0.5 and 2 cm, lasts for 1 to 2 months, and forms scars after healing. Corticosteroids can temporarily control it. Some female patients experience relief from symptoms or even complete recovery during pregnancy, which suggests that endocrine system has an impact on this disease.

The three symptoms of Behcet's syndrome are recurrent oral ulcers, uveitis, and genital ulcers. If only two of the symptoms occur, it is considered an incomplete form. In addition to the three symptoms, there are also serious conditions such as gastrointestinal bleeding, thrombophlebitis, and central nervous system disorders.

3. Oral leukoplakia

It is found in the mouths of about 5% of adults, and the incidence rate among smokers is as high as over 20%. Its occurrence is related to chronic irritation (especially long-term friction) or smoking. If the white spots do not decrease or disappear after the stimulation is removed and smoking is stopped for 3 months, follow-up should be paid more attention. In pathology, there are two major categories of leukoplakia: one is benign hyperkeratosis, which is a benign lesion; the other is epithelial abnormal proliferation leukoplakia, which is a precancerous lesion. There are two clinical types of leukoplakia: one is the homogeneous type, in which the white spots are uniformly white with a flat surface and generally do not require treatment; the other is the inhomogeneous type, which includes granular, ulcerative, wart-like types and those with red parts in the white spots. About 1/5 of this type are precancerous lesions or early cancers.

There are many wart-like keratinized protrusions on the surface of verrucous leukoplakia. Topical application of 0.1% retinoic acid (vitamin A acid) can make the keratinized protrusions disappear, but it will recur if the application is stopped, so it should be applied continuously in small doses. Smoking should be stopped during the treatment of vitiligo.

4. Lip diseases

Chronic cheilitis is not uncommon and often occurs on the lower lip. Infection, sun exposure, wind and dryness are often the causes. There may be no obvious symptoms or there may be burning or itching. The lips are swollen and dark red, and longitudinal cracks often occur in the red part of the lips. In some cases, a deep longitudinal groove appears in the center of the lips, which is prone to bleeding. There is bacterial infection in the cracks and it does not heal for a long time. Chronic exfoliative cheilitis caused by allergies to cosmetics is called contact cheilitis. Cheilitis caused by sunlight exposure is called solar cheilitis, which is more common on the lower lip, but severe solar cheilitis is often a manifestation of congenital porphyria, because porphyria is particularly afraid of sunlight exposure. Diffuse swelling and hypertrophy of the lips that cannot recover is called granulomatous cheilitis. It may exist alone or be part of the May-Rowley syndrome, which includes granulomatous cheilitis as well as fissure tongue and facial paralysis. There is no effective treatment for granulomatous cheilitis and Mei-Rhoades syndrome to date.

5. Tongue diseases

The dorsal mucosa of the tongue has a special structure in the oral mucosa, with filiform and fungiform papillae distributed, and circumferential papillae, foliate papillae and lingual tonsils at the back, so the disease manifestations are different from those in other mucosa. Black hairy tongue is characterized by black hair growing in the central part of the dorsum of the tongue. The hair-like substance is formed because the filiform papillae are too long and the keratinized layer grows too quickly or does not fall off. Pigments are produced by color-producing bacteria or come from food or medicine. Long-term use of antibiotics can promote fungal growth and also cause black hairy tongue. This disease does not require treatment. In severe cases, nystatin suspension can be applied and vitamin B1 can be taken. Rhombus tongue is an almond-shaped area without papillae in front of the lambdoid groove on the dorsum of the tongue and in the middle of the tongue. Some are due to mild congenital developmental disorders, and may also be caused by Candida albicans infection. Geographic tongue, also known as migratory glossitis, is characterized by irregular annular peeling areas on the dorsum of the tongue, with the lesion site moving. Psoriasis can manifest as geographic tongue or fissured tongue in the mouth. Geographic tongue may occur in cases of vitamin B2 deficiency and digestive disorders. Gargling with alkaline (sodium bicarbonate) solution and taking vitamin B can promote healing. Fissured tongue is a condition in which fissures appear on the back of the tongue, resembling leaf veins or brain striae. Congenital fissures may be accompanied by macroglossia, and may also be a manifestation of May-Röhm syndrome or psoriasis. Smooth tongue refers to the back of the tongue being as shiny as a mirror, with the lingual papillae atrophied and disappeared. It is mainly a manifestation of anemia, chronic gastritis, niacin deficiency, etc. Strawberry tongue is characterized by the disappearance of the filiform papillae on the dorsum of the tongue, and the enlarged, reddened, and strawberry-shaped fungiform papillae. Strawberry tongue may appear in scarlet fever and Kawasaki disease.

6. Gum disease

In addition to the most common gingivitis, there are other gingival diseases such as gingival hyperplasia and necrotizing gingivitis. Gingival hyperplasia is manifested by enlargement and thickening of the gingival margin and gingival papillae. Some gingival papillae are spherical in shape, with a red, swollen and shiny surface. It is especially common in children who mouth breathe. It is common for women to have gingival hyperplasia and bleeding during pregnancy, which will heal on its own after delivery. This is called pregnancy gingivitis. Long-term use of the anti-epileptic drug phenytoin sodium can also cause gingival hyperplasia, and the hyperplastic gums may appear strange in shape. There is also a widespread gum growth that covers the teeth and runs in families, called gingival fibromatosis. The gingival hyperplasia caused by leukemia is not only irregular in appearance, but also very easy to bleed, with uneven purple-brown color, and often ulcers and necrosis. It can be distinguished from benign hyperplasia by blood tests. In situations of poverty and extremely poor living conditions, necrotizing gingivitis can be seen to be prevalent, characterized by necrosis of the gingival papilla and gingival margin, severe pain, bad breath, and drooling. It develops suddenly, which is different from general chronic gingivitis. Local bacterial smears of gingival necrosis can show a large number of fusobacteria and Vincent's spirochetes, so this disease is also called Vincent's gingivitis (formerly translated as Vincent's gingivitis). Because it occurs in harsh environments and was once prevalent in trenches, it is also called the Mouth of the Trench. The prognosis is good if the area is scrubbed with 3% hydrogen peroxide, followed by application of antibiotics and systemic supportive therapy.

diagnosis

The diagnosis can be made based on medical history, clinical manifestations, and laboratory tests.

treat

1. Topical medication

It is mainly used to reduce inflammation, relieve pain, prevent secondary infection and promote healing.

2. Systemic treatment

The principle is to treat the cause, control symptoms, promote healing, and reduce recurrence.