Chronic relapsing aphthous stomatitis(CRAS) is a chronic inflammatory disease of the oral mucosa, characterized by the appearance of aphthae, occurring with periodic remissions and frequent exacerbations. Accounts for 5% of all diseases of the oral mucosa.
People of both sexes aged from 3 to 60 years and older are affected. All patients were found to have disturbances in the immunological status of local and general, correlating with severity clinical course diseases.
ETIOLOGY AND PATHOGENESIS
The leading place in the pathogenesis of diseases of the oral mucosa is given to the infectious-allergic factor. There is a change in the reactivity of the body, its sensitization, expressed in hypersensitivity to Proteus, staphylococcus, streptococcus, Escherichia coli.
A number of authors give preference to autoimmune processes in the pathogenesis of the disease, when great importance has a cross-immune reaction. It is expressed according to the following principle: there are various microorganisms on the mucous membrane of the oral cavity and intestines, and antibodies produced in response to their presence can mistakenly attack the epithelial cells of the mucous membrane due to the similarity of their antigenic structure with that of some bacteria.

Already in 1956, I.G. Lukomsky and I.O. Novik were able to suggest the allergic nature of the occurrence of recurrent aphthae, since repeated relapses coincided with disorders endocrine system, menstruation and exacerbations of diseases gastrointestinal tract, which clearly serves as indirect confirmation of the allergic pathogenesis of CRAS. Allergens can include food products, toothpastes, dust, worms and their waste products.
I.M. Rabinovich et al. believe that the etiology and pathogenesis is based on the autoimmune theory, which allows the occurrence of pathological elements to be associated with a violation of cellular and humoral immunity both local and general.
he less important role in the development of the disease is played by provoking factors, in particular - errors in diet, functional disorders of the central and autonomic nervous system, taking various medications, chronic somatic diseases, hypo- and avitaminosis, as well as foci of focal infection.
According to A.L. Mashkilleyson, E.V. Borovsky and others, in 66% of patients, relapses of the disease occur against the background of a deficiency of peripheral blood T-lymphocytes.
With HRAS, the indicators of cellular and humoral immunity and nonspecific resistance of the body change significantly, which leads to a weakening of the functional activity of antimicrobial antibodies and entails changes in the qualitative composition of the oral microflora: E. coli, fungi appear, and their associations with staphylococci and streptococci, which in turn contribute to the inhibition of immune defense factors, the development of delayed-type hypersensitivity to bacterial and tissue antigens [Yakovleva V.I., Davidovich T.P., Trofimova E.K., Prosveryak G.P., 1992].
Antibodies, due to their competence, attack epithelial cells, which in their antigenic structure are similar to some bacteria, as a result of which aphthae appear on the oral mucosa (translated from Greek as ulcers). The process begins with the appearance of a sharply limited, hyperemic spot, oval or round in shape, which after a few hours slightly rises above the surrounding mucous membrane. After 8-16 hours, the spot erodes and becomes covered with fibrinous plaque. Aphtha is painful, has a necrotic gray coating white. Sometimes the appearance of aphtha is associated with the appearance of an anemic area on the mucosa, oval or round in shape. The process begins with changes in the vessel wall, their expansion and increased permeability are observed, which leads to edema and perivascular infiltration of the spinous layer of the epithelium. Then spongiosis and the formation of microcavities. However, the alteration phase prevails over the exudation phase, the epithelial cells become necrotic and erosion and ulcers appear, although it would seem that the primary element should be a blister or vesicle, but when observing patients this fact fails.
There are 3 periods in the pathogenesis and course of the disease:

premonitory;
the period of rashes, which occurs in the form of mild, moderate and severe severity;
extinction of the disease.

CLINIC
The primary element is a pink or white spot, round in shape, not rising above the level of the layered shell. The spot turns into aphtha within 1-5 hours. Afta is a superficial defect of the epithelium, soft to the touch, painful. The aphtha is located against the background of a hyperemic spot, round or oval in shape, covered with a fibrinous grayish-white coating, which cannot be removed when scraped, and when the necrotic plaque is forcibly removed, the erosive surface begins to bleed. The favorite localization of aphthae is the transitional fold, the lateral surfaces of the tongue, and the mucous membrane of the lips and cheeks. At the same time, aphthous rashes can be found on the mucous membrane of the gastrointestinal tract, genitals and conjunctiva. As the severity and duration of the disease increases, the number of aphthae becomes greater, and their healing period lengthens from 7-10 days to 2-4 weeks. With more pronounced necrosis, the amount of fibrinous plaque on the surface of the aphtha increases, and infiltration occurs at the base of the aphtha, the aphtha appears to stand above the surrounding tissues, surrounded by a hyperemic rim, slightly swollen. Features of the disease are frequent relapses, the frequency varies from several days to months. The general condition of the patients does not suffer, however, frequent relapses lead to disorders of the central nervous system - apathy, sleep disturbances, headache, cancerophobia. The general blood test remains unchanged, but over time eosinophilia can be detected. Biochemical analysis blood gives a picture of sensitization of the body, in particular, a decrease in albumin, an increase in 3- and γ-globulins and histamine in the blood. The functional activity of the T-immune system changes, the percentage of blast-transformed blood lymphocytes is significantly lower than normal (40±4.8), the content of lysozyme decreases in saliva and the level of secretory IgA and IgA in oral fluid.
There are three forms based on severity:
Light form- single aphthae (1-2), slightly painful, covered with fibrinous plaque. From the anamnesis, symptoms of pathology of the digestive organs are revealed, namely, a tendency to constipation, flatulence. Scatological research feces detect disturbances in the digestive process - a small amount of undigested muscle fibers, which indicates disturbances in the activity of the stomach and pancreas in the digestion of protein, especially milk, meat, etc.
Moderate-severe form - the mucous membrane is slightly swollen, pale, in the anterior part of the oral cavity there are up to 3 aphthae, sharply painful when touched, covered with fibrinous plaque. Regional lim-

the phatic nodes are enlarged, mobile, not fused to the skin, their palpation is painful. The evolution of aphtha occurs within 5-10 days, which is due to the body’s resistance. The anamnesis reveals symptoms of pathology of the gastrointestinal tract function - constipation, pain in the navel, flatulence, lack of appetite. A scatological examination of stool allows us to establish a violation of the digestion of proteins, carbohydrates and fats. Undigested muscle fibers, starch, and fats are found in the coprogram.
Severe form - characterized by multiple rashes of aphthae on the oral mucosa, which are localized in different areas of the mucosa. Relapses are frequent, sometimes monthly or continuous during the course of the disease. In the first days of the disease, the temperature may rise to 37.2-38°C, headache, weakness, adynamia, and apathy may appear. There is a sharp pain in the oral mucosa when eating, talking and at rest. With gastrofibroscopy, as well as sigmoidoscopy, one can detect hyperemia of the mucous membrane, changes in the relief of folds, the presence of erosions and aphthae in the stage of epithelialization and bleeding. The history reveals chronic hypo- and hyperacid gastritis, chronic lymphadenitis lymph nodes mesenteries, biliary dyskinesia, dysbacteriosis. Patients suffer from systematic constipation, which alternates with diarrhea and flatulence. The results of a coprological study make it possible to establish a violation of the digestion of proteins, carbohydrates and fats. A scatological study gives an approximate idea of the nature of digestion and should be compared with the amount of food eaten, both in general and in relation to individual ingredients; we can talk about both insufficient digestion and poor digestion of food.
I.M. Rabinovich et al. offer clinical classification chronic recurrent aphthous stomatitis:
1) fibrinous - characterized by the appearance of 3-5 afts and their epithelization within 7-10 days;

necrotic - occurring with primary destruction of the epithelium and the appearance of necrotic plaque;
glandular - the epithelium of the duct of the minor salivary gland is primarily affected, and therefore its functional activity decreases;
deforming - characterized by the formation of disfiguring scars in place of aphthous elements, changing the relief and configuration of the mucosa.

R.A. Baykova, M.I. Lyalina, N.V. Terekhova propose to systematize the manifestations of CRAS, based on the clinical and morphological principle and patterns of development pathological process, and 6 forms of HRAS are distinguished.
Typical form. It is characterized by the appearance of Mikulicz's aphthae on the mucous membrane. Most common. The patient's general condition does not suffer. The number of aphthae in the oral cavity is 1-3, low-painful, located along the transitional fold and the lateral surface of the tongue. Mikulich's aphthae heal within 10 days.
Ulcerative or scarring form. It is characterized by the appearance of Setten's aphthae on the oral mucosa. Aphthae are large, deep, with uneven edges, painful on palpation. Healing of Setten's aphthae is accompanied by the formation of a scar, complete epithelization is completed by 20-25 days. With Setten's aphthosis, the general condition suffers, headache, malaise, adynamia, apathy appear, and the temperature rises to 38°C.
Deforming form. It is characterized by manifestations of all the signs of the scarring form of CRAS, however, deeper destructive changes in the connective tissue base of the mucous membrane are observed; the own mucosa and submucosal layer are involved in the process. At the sites of healing of ulcers, deep, dense scars form, deforming the mucous membrane of the soft palate, palatine arches, the lateral surface and tip of the tongue, the corners of the mouth, up to microstomia. The general condition suffers - headache, apathy, adynamia, temperature 38-39 ° C. Aphthae scar slowly, over 1.5-2 months.
Lichenoid form. Resembles lichen planus. On the mucous membrane there are limited areas of hyperemia, which are bordered by a barely visible whitish ridge of hyperplastic epithelium; at this stage, CRAS resembles focal desquamation of the mucous membrane. Subsequently, the mucous membrane erodes, and 1 or several aphthae appear.
Fibrinous form. It is characterized by the appearance of focal hyperemia; after several hours, fibrin effusion is noted in this area without the formation of a single film. This pathological process can develop in reverse, or enter the next phase - destruction of the epithelium, the appearance of aphthae, and fibrin effusion is noted on top of each erosion and ulcer.
Glandular company. Changes are observed in the parenchyma of small salivary glands or the walls of the excretory ducts. With changes in the parenchyma of the glands, bulging of the oral mucosa is detected, followed by ulceration of this area. Inflammation of the wall of the excretory duct of the minor salivary gland leads to an enlargement of the salivary gland, the excretory opening is sharply contoured and gapes. Subsequent transformation of the pathological process undergoes aphthous and ulcerative stages of development. The localization of the process is determined by areas of the mucous membrane with the presence of small salivary glands in the subepithelial zone.
DIFFERENTIAL DIAGNOSTICS
Chronic recurrent aphthous stomatitis should be differentiated:
- with chronic recurrent herpetic stomatitis, which is characterized by multiple aphthous rashes on the mucous membrane of the mouth, lips and skin around the lips. The mucous membrane is swollen, hyperemic, the gums bleed when touched, the papillae are hyperemic, barrel-shaped. In HRAS, redness is never affected

the border of the lips and the skin of the face, the aphthae do not merge, there is no gingivitis, and there is also no reaction from the lymph nodes. The element of the lesion is a spot and aphtha, whereas in chronic recurrent herpetic stomatitis there is a spot, vesicle, vesicle, erosion, ulcer, crust, crack;

with exudative erythema multiforme. For of this disease polymorphism of rashes is characteristic; with total erythema, blisters, vesicles, papules, erosions, ulcers can be found on the oral mucosa; crusts and cracks can be found on the lips. There are cockade-shaped elements on the body. With HRAS, there is never polymorphism of the rashes, the red border of the lips and facial skin are not affected, the aphthae do not merge, there is no gingivitis;
with chronic traumatic erosions and ulcers. The nature of the disease is a bad habit of biting the mucous membranes of the lips, cheeks, and tongue, which is revealed when taking an anamnesis and examining the oral cavity. Erosion due to injury is often irregular in shape, hyperemia is mild or absent, pain is insignificant;
with secondary syphilis. This disease is characterized by the appearance of 1-2 papules, painless to the touch, located on an infiltrated, compacted cartilage-like base. The decisive factor in diagnosis in doubtful cases is serological and bacteriological examination for the presence or absence of Treponema pallidum;
with drug-induced stomatitis. Characteristic features of this disease are catarrhal inflammation of the entire oral mucosa, multiple erosions and ulcers, blisters and blisters. The anamnesis reveals the intake medicines, more often antibiotics, sulfonamides, which have a pronounced antigenic property. In addition to changes in the oral cavity, muscle pain, joint pain, dyspeptic disorders, and urticaria are possible;
with Vincent's ulcerative-necrotizing gingivostomatitis. This is an infectious disease caused by spindle bacillus and Vincent's spirochete. Under normal conditions

spindle-shaped bacilli and spirochetes are saprophytes of the oral cavity; they are found mainly in the crypts of the palatine tonsils, in the fissures of teeth, and gingival pockets. Under certain conditions (stress, hypothermia, chronic somatic diseases), these bacilli and spirochetes can lead to the occurrence of this disease. Clinically, with Vincent's stomatitis, crater-shaped ulcers are formed, covered with abundant necrotic plaque of a dirty gray color. The plaque is easily removed and a slightly bleeding bottom is exposed. The edges of the ulcer are uneven, the surrounding mucosa is swollen and hyperemic. When the inflammatory process passes to the mucous membrane of the alveolar process, the gingival margin swells, abundant necrotic masses form along the edge, which, when removed, expose an erosive-ulcerative surface that bleeds easily. With CRAS, the aphthae do not merge, there is no inflammation of the gingival margin, the retromolar area is not affected, and the general condition does not suffer;

with Bednar's aphthosis. This disease is characterized by small erosions that easily turn into ulcers, which are localized only at the border of the hard and soft palate. The symmetry of the location of erosions is typical. The disease affects only children in the first weeks of life, when the mucous membrane of the oral cavity in the area of the hard palate is injured when wiping this area. This disease never recurs;
with Behcet's syndrome. This pathology is characterized by a triple symptom complex, determined by a triad of lesions - the mucous membrane of the oral cavity, the genitals and the conjunctiva of the eye. The course of the disease is chronic; the symptoms of the disease increase from relapse to relapse. Aphthae on the mucous membranes do not differ from ordinary aphthous elements, but may have the character of deep scarring aphthae. Eye damage is initially expressed in photophobia, then iritis, cyclitis, and hemorrhages appear in the vitreous body and in the fundus area. Touraine [19411 observed patients with CRAS, when rashes were detected not only in the oral cavity, but also on the mucous membrane of the external genitalia and anus, on the intestinal mucosa and proposed to call this disease, including Behçet's syndrome, Touraine's major aphthosis.

TREATMENT
Treatment of the disease is complex. The following measures are equally necessary for each patient.

Sanitation of chronic foci of infection. Elimination of predisposing factors and therapy of identified organ pathology.
Sanitation of the oral cavity. Rational and professional hygiene oral cavity.
Anesthesia of the oral mucosa - applications of 2% novocaine solution, 2% trimecaine solution, 2% lidocaine solution, 4% pyromecaine solution, 2-5% pyromecaine ointment, 2% lidocaine gel, 5% suspension of anesthesin in glycerin.

Applications with warm anesthetics with proteolytic enzymes. Trypsin, chemotrypsin, lysozyme, deoxyribonuclease, ribonuclease, lysoamidase can be used. Lysoamidase, in addition to its necrolytic and bacteriolyzing effect, has an immunostimulating effect. Application for 10-15 minutes once a day.

Treatment of the oral mucosa with physiological antiseptics (0.02% furatsilin solution; 0.02% ethacridine lactate solution; 0.06% chlorhexidine solution; 0.1% dimexide solution, etc.).

Mouth baths or rinses with Tantum Verde in a dosage of 15 ml 3-4 times a day for 5-6 days. The drug has a pronounced analgesic effect.
Mundizal gel in the form of applications to the oral mucosa for 20 minutes 3-4 times a day, the course of treatment is individual, on average 5-10 days. The drug has analgesic, anti-inflammatory and epithelializing effects.

Blockades under the elements of the lesion according to the type of infiltration -

tional anesthesia to accelerate the process of epithelization of aphthae. For blockades, 1% novocaine solution, 1% trimecaine solution, 1% lidocaine solution 2 ml are used. Anesthetic with hydrocortisone - 0.5 ml. Hydrocortisone has an anti-inflammatory, desensitizing and antiallergic effect, suppresses the activity of hyaluronidase, and helps reduce capillary permeability. Khonsurid 0.1 g with any anesthetic for aphthae. Active beginning- chondro-itinsulfuric acid, a high-molecular mucopolysaccharide, accelerates reparative processes in long-term non-healing ulcers. The number of blockades is selected individually (1 - 10), carried out daily or every other day. The amount of anesthetic for blockade is 2-4 ml.

Applications of collagen films with various medicinal substances, in particular, with corticosteroid drugs, diphenhydramine, anesthetics, etc. The film is fixed to erosion and exerts its anti-inflammatory and antiallergic effects within 40-45 minutes, then the film dissolves. Prolonged action medicinal substance gives the maximum therapeutic effect, for 45 minutes the aphtha becomes isolated from the oral cavity, from irritating influences from the outside.

General treatment.

Diet and diet therapy. Patients are recommended to have an antiallergic diet rich in vitamins. The consumption of hot, spicy, rough foods, as well as alcoholic beverages is prohibited.
Desensitizing therapy. Orally tavegil, diazolin, pipolfen, diphenhydramine, suprastin, fenkarol, 1 tablet 2 times a day for a month. Sodium thiosulfate 30% solution, 10 ml intravenously slowly, every other day, for a course of treatment of 10 injections. The drug has a powerful anti-inflammatory, desensitizing and antitoxic effect.
Histaglobulin or histaglobin 2 ml 2 times a week intramuscularly, for a course of treatment 6-10 injections. When entering-

When the drug is introduced into the body, antihistamine antibodies are produced and the ability of blood serum to inactivate free histamine increases.

Levamisole (Decaris) 0.15 g 1 time per day, 3 tablets per course of treatment, after 3-5 days the course of treatment is repeated. Only 3 courses of treatment, i.e. 9 tablets. The drug has a thymomimetic effect, i.e. promotes the restoration of T-lymphocytes and phagocytes. The drug regulates the mechanism of cellular immunity and is able to enhance the weak response of cellular immunity.

T-activin is a drug of polypeptide nature, obtained from the large thymus cattle. Used at 40 mcg per day, subcutaneously or intramuscularly, 0.01% solution, 1 ml once a day, for a course of 10 injections. The use of T-activin accelerates the time of epithelization and shortens it, interrupts the permanent course, and increases the duration of remissions. Instead of T-activin, you can prescribe kemantan 0.2-3 times a day for 14 days, diucifon 0.1-2 times a day.

Vitamin U 0.05 g 3 times a day, course of treatment 30-40 days. Stimulates the healing of damaged oral mucosa.
In severe cases of the disease, corticosteroid drugs are prescribed, prednisolone 15-20 mg per day. The dose of the drug is reduced by 5 mg per week from the moment of epithelization of erosions and ulcers from the edges.
Sedatives and tranquilizers are prescribed according to indications.
Plasmapheresis, course of treatment is 1-3 sessions, with exfusion of up to 1 liter of plasma in one session. Plasmapheresis shortens the period of epithelization, allows for long-term remission, and helps improve the general condition of the patient.
Delargin 1 mg 2 times a day, intramuscularly for 10 days. The drug has a pronounced analgesic effect, optimizes the epithelization of erosions and ulcers. Particularly effective in combination with local treatment[Maksimovskaya L.N., 1995].

The plan of treatment and recreational activities includes the following actions:

systematic, periodic scheduled medical examinations by a dentist-therapist: when medium degree severity of HRAS 2 times a year, with severe - 3 times a year;
in-depth examination of the patient in the presence of complaints and symptoms of the disease;
planned sanitation of the oral cavity, at least 2 times a year; complex anti-relapse treatment: medication, physiotherapy, sanatorium-resort, diet therapy.

The prognosis of the disease is favorable.

Recurrent stomatitis is an inflammatory disease of the mucous membrane oral cavity, It has chronic course with periods of remissions and exacerbations. It is the most common disease of the oral mucosa.

This nosological unit can be independent, or it can be a complication of the underlying disease.

ICD-10 code

K12 Stomatitis and related lesions

Causes of recurrent stomatitis

Recurrent stomatitis is a polyetiological disease. First of all, its appearance is associated with insufficient oral hygiene. But the following causes of recurrent stomatitis are also distinguished:

Traumatization of the oral mucosa:
1. mechanically (rough food, poor quality prosthesis, splintered tooth, biting the mucous membrane),
2. chemically (sodium lauryl sulfate contained in many toothpastes and mouth rinses dries the mucous membrane and thereby makes it vulnerable; accidental exposure to various acids and alkalis),
3. by physical means (hot, sour food, accidental burns from steam, etc.).
Poor nutrition with insufficient food content of vitamins, micro- and macroelements.
Nervous tension, stress and sleep disturbances. Many people note a recurrence of stomatitis during stressful situations.
Reduced immunity due to any disease.
Allergic reactions to food and medications.
Various infectious diseases:
1. infections of viral origin (ARVI, influenza, herpes, various forms of lichen, etc.),
2. infections caused by fungus of the genus Candida,
3. sexually transmitted diseases (syphilis, gonorrhea),
4. infections of bacterial origin (tuberculosis, various pustular diseases).
Genetic predisposition. If parents have recurrent stomatitis, then their children have a higher chance of developing it than others.
Hormonal factors. For example, some women experience relapse of stomatitis during menstruation.
Disruption digestive system(dysbacteriosis, gastritis, colitis, etc.), endocrine pathology, etc.
Alcohol abuse and smoking.

Symptoms of recurrent stomatitis

There are general and local symptoms of recurrent stomatitis.

TO general symptoms include: weakness, fever, sleep disturbance, irritability, reluctance to eat. If a child has recurrent stomatitis, then it means tearfulness and moodiness. A possible complication is regional lymphadenitis (painful and enlarged lymph nodes).

Local symptoms of recurrent stomatitis:

formation of areas of redness on the oral mucosa (anywhere, of various shapes and in different quantities), so-called catarrhal form stomatitis. At the site of redness there are discomfort in the form of burning, tingling, itching.
as stomatitis progresses, erosions (aphthae) subsequently form at the site of redness; with aphthous progressive stomatitis, and with herpetic stomatitis, vesicles (bubbles) are first formed, which open, and then ulcers form in their place. With yeast stomatitis, a milky-white coating forms on the hyperemic area, after which, after removal, a bleeding spot is formed.
the appearance of lesions (vesicles, erosions) of the oral mucosa is accompanied by a pronounced pain syndrome, especially when taking food or liquid.
typical increased salivation, available bad smell from mouth.

Chronic recurrent aphthous stomatitis

Chronic recurrent aphthous stomatitis is a chronic disease with an unknown etiology (cause), in which painful ulcerations (aphthae) form on the oral mucosa. Chronic aphthous stomatitis is characterized by a long course, with phases of exacerbations and remissions.

Remissions can last from several weeks to several months, and sometimes years. This disease is the most common among diseases of the oral mucosa (about 20% of the population is affected by it); it can occur at any age, but young people from 20 to 30 years of age are most often affected.

It is believed that recurrent aphthous stomatitis is of an allergic origin. Namely, allergies to:

food products (most often citrus fruits, chocolate, nuts, etc.);
helminthic infestations;
toothpastes;
house or industrial dust;
medications.

But predisposing factors alone for the occurrence of chronic aphthous stomatitis are not always enough. Important role Concomitant diseases also play a role in its occurrence:

functional disorders of the digestive tract;
microtrauma of the oral mucosa;
respiratory viral infections;
hypovitaminosis (lack of vitamins B and C, Iron-deficiency anemia);
frequent inflammatory processes in the nasopharynx (rhinitis, otitis, tonsillitis);
functional disorders of the nervous system;
immunity disorders.

It should be noted that there is a genetic tendency to develop recurrent stomatitis. For example, if both parents suffer from recurrent canker sores, their child has a 20% higher risk of developing this disease than others.

In the clinical picture of recurrent aphthous stomatitis, three stages are distinguished:

Prodrome period (harbinger of illness). Characterized by slight pain, tingling or burning sensation in the mouth. During examination of the oral mucosa, an area of redness and slight swelling are noted.
Stage of rash. It occurs a couple of hours after the initial stage. In the place of redness of the oral mucosa, characteristic defects appear - aphthae (ulcers), they are very painful when touched, have a round or oval shape and are covered with a fibrinous coating of grayish-white color. Aphthae can appear on any part of the oral mucosa, but their favorite place is the inner surface of the lips, cheeks and the lateral surface of the tongue.
The period of extinction of the disease. It occurs, on average, seven days after the onset of aphthae. Usually, canker sores heal without leaving scars. In case of untimely and inadequate treatment of aphthae, if personal hygiene is not observed, the aphthae take longer to heal (two to three weeks) and may leave behind scars (Setton's aphthae).

The frequency of recurrent rashes depends on the severity of aphthous stomatitis.

IN case of lung single aphthae appear once or twice a year.
With moderate severity, aphthae appear every two to three months.
In severe cases, they may appear weekly, with an increase in their number, the depth of the lesion and the duration of healing (Setton's aphthae).

As for the general condition, there is general weakness, malaise, reluctance to eat due to severe pain, increased salivation, increased temperature, irritability, disturbed sleep. Often recurrent aphthous stomatitis is complicated by lymphadenitis.

Recurrent herpetic stomatitis

Recurrent herpetic stomatitis occurs after a previous herpetic infection. It has been scientifically proven that 70% - 90% of the population remain lifelong carriers of the herpes virus. The virus is stored in the ganglia (nodes) nerve cells as hidden infection and under certain conditions makes itself felt with herpetic stomatitis.

Provoking factors of herpetic stomatitis.

Hypothermia.
Excessive insolation (overheating).
Heavy physical activity.
Constant stress.
Microtraumas to the oral mucosa.
Previous illness with high fever.
Decreased immunity.
Previous operations.

The incubation period lasts from several days to several weeks.

Redness of varying severity appears in a certain area of the mucous membrane.
There are unpleasant sensations at the site of the lesion: itching, tingling, burning.
After a couple of hours or even earlier, single or group bubbles (vesicles) appear in the area of redness of the mucous membrane, which soon open and small erosions form.
There is no tissue swelling at the site of the lesion.
Then epithelization of erosions occurs, leaving no changes behind.
Recovery in mild cases occurs after 4-5 days.
The general condition during the period of exacerbation of herpetic stomatitis is characterized by severe weakness, aching joints, muscle pain, increased temperature, and nervousness. Expressed general symptoms noted in the early stages chronic process, over time - with each subsequent exacerbation, general symptoms become easier.

Forms of recurrent herpetic stomatitis:

Mild – exacerbations of the disease once a year or no. The rashes are single, heal quickly, general health does not suffer.
Moderate - exacerbations of stomatitis two to four times a year. The rashes may already be grouped - several groups of blisters, and the general condition may slightly worsen.
Severe – more than five times a year. Due to frequent exacerbations, the oral mucosa has lesions at various stages of development. The general symptoms are very pronounced.

Recurrent herpetic stomatitis in children

Although the herpes virus affects everything age groups, but most often recurrent herpetic stomatitis occurs in children from one to six years of age. According to statistics, about 90% of children by the age of three are already infected with the herpes virus.

50% of children who have suffered acute herpetic stomatitis subsequently experience relapses. This suggests that adequate antiviral treatment is not started in a timely manner. Also, the occurrence of exacerbations of herpetic stomatitis in children depends on the characteristics of the formation immune system.

The symptoms of herpetic stomatitis in children are the same as in adults, only the general symptoms are more pronounced, especially under 3 years of age.

If you notice symptoms of herpetic stomatitis in a child, you must immediately seek help from a doctor (pediatrician, dentist, ENT doctor) in order to start treatment on time and prevent complications and relapse in the future.

Treatment of recurrent herpetic stomatitis is standard, as in adults, but using drugs in age-specific dosages.

Diagnosis of recurrent stomatitis

Typically, diagnosing recurrent stomatitis is not difficult. To make a diagnosis, an experienced and attentive doctor (dentist, ENT doctor, therapist, pediatrician) will have enough complaints, clinical symptoms and medical history data. If necessary, additional research methods are prescribed:

PCR – diagnostics for herpes virus, candida fungi.
smears from the pharynx and from the site of erosion (aphtha), their subsequent inoculation with determination of sensitivity to antibiotics and antiseptics.

For stomatitis that is difficult to treat, a broader examination and consultation with other specialists is prescribed in order to identify the underlying disease that caused recurrent stomatitis.

Treatment of recurrent stomatitis

Treatment of recurrent stomatitis has the following goals.

Relieve pain syndrome.
Improve the healing of erosions (aphthae).
Prevent relapses or reduce their number.

Principles of treatment of recurrent aphthous stomatitis.

Elimination of predisposing factors that are allergenic in nature (if you are allergic to citrus fruits, then exclude them from the diet; if you are allergic to nuts, honey, chocolate, etc., exclude them, etc.).
Treatment concomitant diseases(it is necessary to promptly treat inflammatory diseases of the nasopharynx - otitis media, rhinitis, tonsillitis; for hypovitaminosis, take appropriate vitamins, etc.)
Dieting. Eliminate coarse, spicy and sour foods from the diet to avoid additional irritation of the ulcers. Do not eat food that is too cold or hot, but only when it is warm. Include more plant (fruits, vegetables) and protein foods (lean meat, cottage cheese, fish, eggs) in your menu.
Careful oral hygiene, it is advisable to rinse the mouth with an antiseptic solution after eating (for example, chamomile decoction or rotokan, etc.).
Local therapy treatment of the oral mucosa and aphthous (erosive) rashes involves their antiseptic treatment. Sanitation can be carried out by a specialist (dentist, ENT doctor) or at home by the patient himself. It consists of periodically rinsing the mouth:
- antiseptic solutions (furacillin solution, rotokan, rekutan, etc.)
- decoctions from medicinal herbs(chamomile, string, sage, etc.).
During the period of exacerbation of aphthous stomatitis, when the aphthae is fresh, after sanitation, Metrogil denta gel (metronidazole + chlorhexidine) is often used, which has a local antibacterial, antiseptic, healing effect, and relieves inflammation well. After applying the gel, it is advisable to refrain from eating and drinking for 30 minutes.
In the period of exacerbation of herpetic stomatitis, after antiseptic treatment, local antiviral drugs(acyclovir, penciclovir, herpevir).
The specialist prescribes local painkillers:
- 5% or 10% mixture of anesthesin in glycyrin;
- you can use lidocaine 1% or 2% solution;
- They also use a 3% solution of diclofenac based on hyaluron, etc.

In severe cases of chronic aphthous stomatitis, when pain is severe, analgesic drugs can be additionally prescribed orally or intramuscularly (ketanov, movalis, dikloberl).

In the presence of necrotic plaque on the aphthae, applications of proteolytic enzymes have a good effect; they gradually and painlessly eliminate it (lidase, trypsin, etc.).
When healing (epithelialization) of erosions begins, keratoplastic substances are used: sea buckthorn oil, rose hips, vinylin, propolis, solcoseryl. They accelerate and improve the healing of ulcers.
If noted heat antipyretic drugs are prescribed (Nurofen, paracetamol, ibuprofen).
For recurrent herpetic stomatitis, antiviral therapy must be prescribed from the very beginning of the disease (interferon, Anaferon, viburkol).
Multivitamin complexes must be used, because recurrent stomatitis is a consequence of hypovitaminosis (Multifort, Vitrum).
Since stomatitis has a chronic, relapsing course, this suggests that the immune system is weakened and needs help. Therefore, immunomodulators must be prescribed general action(echinacea, Anaferon). You can also use products to increase local immunity of the oral mucosa (Immudon).
Considering the possible allergic nature of recurrent stomatitis, antihistamines are often prescribed, which will additionally help relieve inflammation and swelling at the site of the rash (erius, fenkarol, fenistil).

Chronic recurrent aphthous stomatitis is an inflammatory condition of the oral mucosa, with characteristic formation aphthae, prolonged course of the disease and frequent exacerbations. Aphtha is a soft and painful defect of the epithelial surface. Children are most often affected by the disease preschool age and people from 20 to 40 years old.

Causes of the disease

To the most probable reasons The appearance of chronic recurrent aphthous stomatitis includes:

viral infections (herpes virus, cytomegalovirus);
bacterial infections;
allergic reactions;
genetic predisposition;
avitaminosis;
immunodeficiency state;
injury to the lining of the oral cavity;
stress;
mental disorders;
bad environment;
disruptions in the gastrointestinal tract;
blood pathologies;
use of products containing sodium lauryl sulfate for oral hygiene.

When hitting human body with weakened immunity of the virus or bacteria, acute aphthosis first develops. Further, if the necessary treatment is not available, any factor can provoke a relapse of chronic stomatitis.

Symptoms

Chronic aphthous stomatitis is manifested by certain symptoms:

increased body temperature during moderate and severe stages of stomatitis;
general malaise;
before the rash appears, the child experiences a burning sensation in the mucous membranes, he is capricious, does not eat and sleeps poorly;
in the severe stage, regional lymph nodes become enlarged;
the appearance of one or many painful ulcers covered with plaque;
unpleasant odor from the mouth.

Initially, with aphthous stomatitis, a rounded pink or white spot appears. The element turns into aphtha in no more than 5 hours. Aphtha is localized on a hyperemic spot and is covered with a fibrous coating, which cannot be removed by scraping, and with strong impact the pathological surface bleeds.

Aphthae are localized on the transitional fold, on the sides of the tongue, on the surface of the mucous membranes of the lips and cheeks. Defective formations can also be found on the mucous membranes of the stomach and intestines, reproductive organs and conjunctiva. Gradually, as the disease worsens, the number of aphthae increases, and the recovery time increases to 4 weeks.

With strong necrosis in the aphthous area, the volume of plaque increases and infiltration appears.

Classification of the disease

There are several ways to classify chronic aphthous stomatitis.
Depending on the severity, the disease manifests itself in three forms:

Mild form of aphthous stomatitis.	It is determined by the presence of single, slightly painful aphthae with the presence of fibrinous plaque. With this form, symptoms of diseases of the digestive tract appear (frequent constipation, flatulence).
Medium-heavy form.	With this form, swelling of the mucous membranes and their pallor are observed. In the anterior part of the oral cavity there are up to 3 aphthae, covered with fibrinous plaque and painful when touched. There is an increase, mobility and pain in the regional lymph nodes. The change in aphtha occurs within 5–10 days and is associated with the body’s resistance. In the moderate form of the disease, symptoms of gastrointestinal tract ailments appear (constipation, pain in the navel area, manifestations of flatulence, decreased appetite).
Severe form.	Aphthous stomatitis is determined by a multitude of aphthae localized throughout the oral mucosa. The disease occurs without interruption or with frequent relapses. At the initial stage of the disease, body temperature may rise to 38 degrees, malaise, headache attacks, apathy and adynamia may appear. While eating, while talking, and even in calm state there is severe pain in the mouth. This form is characterized by the manifestation of chronic hypo- and hyperacid gastritis, diseases of the biliary system, dysbacteriosis, constipation, diarrhea, and flatulence.

Classification of chronic aphthous stomatitis according to clinical indicators:

Fibrinous form. It is characterized by the appearance of up to 5 afts, which epithelialize in 7–10 days.
Necrotic. The process of primary destruction of the epithelium and the formation of necrotic plaque occurs.
Glandular stomatitis. Initially, the epithelial layer of the duct of the minor salivary gland is damaged and its functional activity decreases.
Deforming form. The formation of ugly scars at the site of pathological formations is characteristic, affecting the relief, shape and location of the mucous membrane.

Chronic recurrent aphthous stomatitis is classified according to clinical and morphological principles and patterns of pathology development into:

Typical form. The most common variety. The appearance of Mikulich afte is characteristic. General health is satisfactory. The number of aphthae is up to 3. They are low-painful and are located on the transitional fold and lateral surfaces of the tongue. Healing of aphthae occurs within 10 days.
Ulcerative or cicatricial stomatitis. It is defined by the presence of large, deep and painful Setten aphthae with jagged edges. As it heals, a scar forms. The formation of new epithelium is completely completed by the 25th day. General health worsens, there is a severe migraine, malaise, apathy, adynamia, and a rise in body temperature to 38 degrees.
Deforming form. All the signs of the cicatricial form of chronic recurrent aphthous stomatitis are characteristic, but with deeper destructive changes in the connective tissue. In places where the ulcers have healed, deep and dense scars form, changing the mucous membrane of the soft palate, arches, tip of the tongue and its lateral surface, and corners of the mouth. My health is getting worse. Migraine attacks, apathy, and fever up to 39 degrees are observed. Scarring occurs over 1.5–2 months.
Lichenoid form. Aphthous stomatitis in this manifestation looks like red lichen planus. On the mucosa there are zones of hyperemia, bordered by barely noticeable white ridges of hyperplastic epithelium. Over time, the mucous membrane becomes covered with erosion and single aphthae appear.
Fibrinous form. Characterized by focal hyperemia, in the area of which fibrin effusion without films appears within a few hours. This process often has a reverse reaction or flows into the next stage.
Glandular form. Small salivary glands and excretory ducts work with disturbances. The pathology transforms into aphthous and ulcerative stages.

Diagnosis of the disease

If symptoms of chronic aphthous stomatitis appear, you should consult a specialist: for adults - a dentist or therapist, for a child - a pediatrician. The doctor conducts a survey and examination. Then a smear is taken from the surface of the aft for laboratory research biomaterial. Depending on the results of the analysis, a diagnosis is made and a treatment regimen is prescribed.

When diagnosing, it is important not to confuse CRAS with other diseases with similar main symptoms. These include:

chronic recurrent herpetic stomatitis;
exudative erythema multiforme;
chronic traumatic erosion and ulcers;
secondary syphilis;
drug-induced stomatitis;
Vincent's ulcerative-necrotizing gingivostomatitis;
Bednar's aphthosis;
Bechcher's syndrome.

Treatment methods

Treatment of chronic aphthous stomatitis is not an easy task. Therapy depends on the results of a comprehensive immunological examination. It is mandatory to identify and eliminate accompanying pathologies and provoking reasons.

If the examination does not provide complete information about the causes of the disease, general immunomodulatory treatment is carried out. Children are prescribed Imudon, adults - infusion of Echinacea, Amiksin, Interferon.

Therapy is always carried out in a complex. The following measures are required equally for all patients:

Carrying out sanitation of chronic areas of infection.
Sanitation of the oral cavity. This includes regular professional oral hygiene.
Carrying out anesthetic procedures on the oral mucosa.
Carrying out treatment of the oral cavity using physiological antiseptics. You can perform oral baths or rinses.
Blockade of pathological elements by the type of infiltration anesthesia, increasing the rate of epithelium formation in aphthous lesions.
Use of collagen film applications with various medicinal components. Corticosteroids and anesthetics are used as medications. The film attaches to the aphthae and has an anti-inflammatory and antiallergic effect for 45 minutes, and then dissolves.

Chronic recurrent aphthous stomatitis is treated together with local treatment and general therapy:

Desenbilizing treatment. Tavigil, diazolin, diphenhydramine, fenkarol, suprastin are taken. Sodium thiosulfate is administered intravenously.
Intramuscular injection of histaglobulin or histaglobin. When medicinal components enter the patient’s body, antihistamine antibodies are produced and the blood serum’s ability to inactivate free histamine increases.
Taking vitamin U, which stimulates the restoration of damage to the mucous membranes of the oral cavity.
In severe cases, a corticosteroid drug is prescribed.
Prescribing sedatives and tranquilizers.
Plasmapheresis is performed, which reduces the recovery time of the epithelium, helps to increase the duration of remission and improve overall well-being.
Intramuscular administration of delargin. The medicine has an analytical effect, optimizes the epithelization of ulcers and erosions. The drug is more effective in combination with local treatment.
Physiotherapy (helium-neon laser radiation).

During treatment, it is necessary to follow a diet that should be antiallergic and rich in vitamins. It is necessary to exclude from the diet hot, spicy, sweet, buttery and rough foods, as well as alcoholic beverages. Do not drink hot or cold drinks. The menu must include dairy products, mashed potatoes, porridge, fresh juices and fruits.

Prognosis and prevention

When chronic aphthous stomatitis is detected in a mild form at the initial stage, the prognosis is often favorable. But full recovery in case of illness in chronic form can't achieve it. The maximum result is prolongation of periods of remission.
The development of chronic aphthous stomatitis can be prevented if you adhere to the following rules:

Systematic and regular visits to the dentist. For moderate forms of the disease - 2 times a year, for severe forms - 3 times.
A complete and thorough examination when symptoms appear.
Sanitation of the oral cavity at least 2 times a year.
Carrying out a set of actions aimed at preventing relapse. It includes medication, physiotherapeutic and sanitary-resort rehabilitation.
A balanced diet rich in vitamins.
Hardening procedures, sports and management healthy image life.

To prevent development chronic diseases, it is necessary to treat your body responsibly and in case of manifestation of any alarming symptoms consult a doctor. The right image life and disease prevention are the key to good health.

The topic of today's article: chronic recurrent aphthous stomatitis - what it is and how to deal with it. The disease is accompanied by frequent exacerbations, during which characteristic symptoms appear: painful aphthae, bad taste in the mouth, enlarged lymph nodes and others. Cyclic relapses occur for a number of reasons and require immediate treatment. Otherwise, the disease will continue to progress.

Chronic recurrent aphthous stomatitis is characterized by periodic appearances of inflammatory foci in any part of the oral mucosa. Exacerbations alternate with remissions – periods of weakening or disappearance of the symptoms of the disease.

The abbreviated name of the disease is HRAS. People of any age and gender can suffer from the pathology, mainly in autumn and spring. Several factors can influence the manifestation of the next exacerbation.

Unfortunately, it is impossible to completely get rid of HRAS. However, strict adherence to the doctor’s recommendations and prescriptions can increase the duration of remissions and reduce the manifestations of exacerbations.

Outbreak of pathogen activity

Chronic stomatitis of the aphthous variety arises from acute form, which we talked about in articles and.

A relapse of the disease may occur due to another outbreak of pathogen activity: pathogenic bacteria or microbes. This usually occurs during a period of weakened immunity. The decrease in the body's defense is influenced by:

deficiency or excess of vitamins, minerals;
stress, prolonged depression;
bad ecology, radiation;
poor nutrition;
infectious or viral diseases;
pathologies of internal organs;
disturbances in the functioning of body systems.

The next exacerbation of chronic aphthous stomatitis may be affected by a sudden increase in the amount pathogenic bacteria in the mouth. For example, due to persistent plaque or tartar, the development of other oral diseases, or respiratory tract: caries, gingivitis, sore throat, otitis, sinusitis.

Allergies and heredity

The waste products of bacteria and microbes can also cause allergies, and with it signs of disease. Manifestations of cross-talk cannot be excluded allergic reaction. In this case, the body’s defense mistakes the cells of the oral mucosa for the cells of the causative agent of stomatitis, destroying both.

The cause of the development of chronic stomatitis of the aphthous variety may be a genetic predisposition. If the disease appears in parents or close relatives, it can be inherited.

Mild symptoms

According to the severity, chronic stomatitis of the aphthous variety can have three forms: mild, moderate or severe. Symptoms of the disease depend on its form.

So, with a mild form, 1-2 aphthae appear anywhere in the oral mucosa. Aphtha is a round erosion covered with a gray-yellow coating or a vesicular ulcer surrounded by a bright red inflamed rim. The size of the aphthae can vary from 1 to 10 millimeters.

The formation of defects causes mild pain upon contact. At timely treatment aphthae heal in 7-10 days. A mild form may be accompanied by constipation and flatulence - excessive accumulation of gases in the intestines. A mild form of HRAS occurs once every 1-2 years.

Medium clinical picture

The average form of the disease is accompanied by the formation of 2 to 5 afts. They heal in about 2-3 weeks. Mild pain gives way to sharp, sharp pain painful sensations. The area of the mucous membrane around the defects swells noticeably, the level of salivation increases, and the taste in the mouth becomes unpleasant.

The lymph nodes under the jaw are noticeably enlarged. When palpated, their mobility and pain are felt. In addition to constipation and flatulence, there is a tingling pain in the abdomen, in the navel area. Appetite may disappear. The average form of HRAS occurs up to 2 times a year.

Symptoms of advanced form

The severe form of the disease is characterized by multiple aphthous formations covering any areas of the oral mucosa. The damaged areas become very red and sometimes bleed. Healing of defects can take about 3-4 weeks.

Sharp sharp pains accompany every meal or conversation. It is possible that body temperature may increase to 37.2-38 degrees, causing headache and joint pain, general weakness, and chills. Systematic constipation is accompanied by flatulence, painful sensations in the abdomen, and alternates with diarrhea.

Relapses of severe forms of CRAS occur 3-4 times a year. In particularly advanced cases, monthly recurrences or an uninterrupted course of the disease are observed. Frequent exacerbations lead to disturbances in the functioning of the central nervous system. This is fraught with apathy, insomnia, dizziness, and phobias of various types.

Subtypes of the disease

Chronic recurrent aphthous stomatitis has five subtypes: fibrous, necrotic, glandular, cicatricial, deforming.

In the necrotic subtype, mucosal tissue dies in the inflammatory focus. Aphthae become covered with a grayish coating. Regeneration of defects lasts about 3 weeks.

Damage to the salivary glands and deformation of the mucosa

The glandular subtype is characterized by the formation of aphthae on the ducts of the minor salivary glands. This leads to a decrease in their functionality and, as a consequence, to drying out of the oral mucosa and worsening the course of stomatitis.

In the scarring subtype, inflammatory foci deepen into the mucous tissues of the surface of the mouth. Healing of aphthae lasts about a month, after which scars remain on the mucous membrane.

The deforming subtype is a progression of the scarring one. With prolonged recovery of the affected areas, deformation of the mucosa occurs, leading to a change in its relief. Regeneration of defects can take 2-3 months.

Establishing diagnosis

To determine the real reason manifestations of chronic stomatitis of the aphthous variety, you must consult a dentist or therapist. Children are treated by a pediatrician.

The doctor will interview the patient (or his parents) and examine the affected areas of the oral mucosa. If the patient has already had a relapse of the disease, the doctor should familiarize himself with his medical history and write down new data there: what symptoms accompany the next relapse, what other pathologies are present at the moment.

Differential diagnosis of pathology

It is necessary to carry out a differential diagnosis, which allows us to weed out other diseases that are similar in symptoms to chronic aphthous stomatitis. These include:

chronic recurrent stomatitis of the herpetic form;
chronic stomatitis of the traumatic variety;
exudative erythema multiforme – acute illness skin and mucous membranes with various rashes and a tendency to relapse;
secondary syphilis - a sexually transmitted disease, repeated manifestation;
stomatitis of drug origin;
Vincent's ulcerative-necrotizing gingivostomatitis;
Bednar aphthosis - traumatic erosive damage to the oral mucosa;
Behcet's syndrome is a chronic relapsing disease accompanied by the formation of ulcers on the oral mucosa and genitals, blisters on the skin, inflammation of the joints, eyes, blood vessels, Gastrointestinal tract.

Research and differential diagnosis will allow the doctor to establish an accurate diagnosis and prescribe effective treatment, appropriate to a specific clinical case.

Difficult situation

Treating chronic aphthous stomatitis is not an easy task. Late-started or incorrectly selected therapy can reduce the time between relapses. This is fraught with a deterioration in health and the development of other pathologies, including sepsis and further death.

First of all, it is necessary to get rid of the diseases associated with HRAS: dental, oral, skin, somatic, infectious, viral. It is mandatory to consult an allergist and undergo the required tests to identify allergies. Maybe full examination and treatment by other specialists: periodontist, endocrinologist, immunologist, gastroenterologist.

Local therapy

Local treatment is aimed at eliminating the pathogen and unpleasant symptoms, restoring the affected surface of the oral mucosa. You can use any medicine only with your doctor's permission.

First, the inflamed tissues are anesthetized. To do this, ten-minute applications with anesthetics are carried out in the morning and before bedtime. 2% solutions of novocaine or lidocaine, 4% solution or 5% pyromecaine ointment are suitable.

Any anesthetic can be supplemented with a proteolytic enzyme: trypsin, ribonuclease, chymotrypsin, lysozyme. The enzyme will remove dead cells, stop the destruction of the tissues of the oral mucosa and speed up their healing. Its use is especially effective for deep aphthae.

Antiseptic treatment

To destroy microorganisms, antiseptic treatment of the oral cavity is prescribed. 3-4 times a day, twenty-minute applications are carried out with a 0.02% solution of furatsilin or ethacridine lactate, 0.06% solution of chlorhexidine, 0.01% solution of Dimexide.

Additionally, 3-4 times a day you can take baths or rinse your mouth with Tantum Verde solution. For each dose, 15 milliliters of the drug is enough. The medicine not only fights the activity of microorganisms, but also relieves pain.

In severe cases, an antibiotic may be needed. The features of antibiotic therapy can be found in the article.

Before applying or rinsing, it is necessary to clean the aphthae from plaque and harmful contents. This can be done with a cotton pad soaked in a soda solution. Metrogil Denta ointment will also work. It will not only cleanse defects, but also destroy microorganisms.

Means to accelerate regeneration

Corticosteroid ointments will help prevent further growth of aphthae: Prednisolone, Belogent, Hydrocortisone. Use up to 3-4 times a day.

Ointments “Solcoseryl” or “Actovegin”, solutions with vitamins E, A for oil based, sea buckthorn or rosehip oil, medicines with propolis. Use up to 5-6 times a day.

You can speed up the regeneration of long-term non-healing aphthae with the help of chondroitinsulfuric acid, a high-molecular mucopolysaccharide. This can only be done as prescribed by a doctor.

Collagen films or keratoplastins containing the above-mentioned regenerating agents and anesthetics are effective. Applications are made from the films 1-2 times a day until they are completely absorbed. During this time, the aphthae are isolated from irritants, which speeds up recovery.

Increased duration of remissions

To speed up the healing of aphthae and increase the duration of “quiet” intervals between exacerbations of HRAS, T-actovegin, Kemantan or Diucifon are prescribed. The doctor decides whether to take these drugs orally or by injection.

In advanced cases, courses of “Dalargin” injections are carried out: 2 times a day, 1 milligram. Plasmapheresis can help - taking blood, then purifying it and returning it to circulatory system patient.

General therapy

To prevent additional irritation of the oral mucosa, the patient should go on a special diet. In the article we told you how to eat properly during the development of the disease. The tips are also suitable for chronic aphthous stomatitis.

To reduce the body's sensitivity to any allergens, desensitizing treatment is carried out using antihistamines: “Tavegil”, “Suprastin”, “Diazolin”, “Fenkarol”. 2 tablets per day are enough. In advanced cases, you will need a course of intramuscular injections of histaglobulin or histaglobin. Two injections of 2 milliliters of the drug per week are enough.

Correction of immunity and nervous system

Treatment for CRAS includes the use of medications containing potassium, calcium, iron and other minerals. Also appointed vitamin preparations: ascorbic, nicotine or folic acid, pyridoxine, B vitamins, riboflavin. Daily dose determined by the doctor.

In severe cases, immunocorrectors may be prescribed: intramuscular injections"Thymogen" or "Levamisole". The dosage is prescribed by the doctor.

Will help normalize the functioning of the nervous system sedatives: extracts of valerian, motherwort, intramuscular injections of magnesium sulfate or novocaine. The dosage is selected by the doctor.

If you have anything to add, please leave a comment.

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8) Etiology, pathogenesis, clinical picture, diagnosis and treatment of mesial occlusion.

9.) Etiology, pathogenesis, clinical picture, diagnosis and treatment of deep incisive occlusion

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Question 11). Etiology, clinical picture, diagnosis and treatment of dental arch anomalies.

Question 13). Etiology, pathogenesis, clinical picture, diagnosis and treatment of anomalies in the position of individual teeth

16) Etiology, pathogenesis, clinical picture, diagnosis and treatment of cross-occlusion

1. Route of infection:

Therapeutic section.

2. Features of the clinical course of caries in temporary teeth. Treatment methods, choice of filling materials.

3. Chronic periodontitis of temporary and permanent teeth in children. Etiology, pathogenesis, classification, differential diagnosis, treatment. Selection of filling materials for canal filling.

4. Features of the structure of the oral mucosa in children. Damage to the organs of traumatic origin. Etiology, pathogenesis, clinical picture, differential diagnosis, treatment.

5. Differential diagnosis of caries. Additional methods for diagnosing caries in children.

The following tests are used to diagnose caries.

7. Chronic recurrent aphthous stomatitis. Etiology, pathogenesis, diagnosis, clinical picture, differential diagnosis and treatment.

8. Exudative erythema multiforme. Etiology, pathogenesis, clinical manifestations in the oral cavity, differential diagnosis, dentist’s tactics.

10. Cheilitis and glossitis in children. Etiology, pathogenesis, clinical picture, differential diagnosis, treatment.

11. Etiology, pathogenesis, classification, diagnosis of caries. Clinical patterns of development and course of caries in children of different ages. The degree of activity of dental caries according to T. F. Vinogradova.

12. Initial caries of temporary and permanent teeth in children. Etiology, pathogenesis, caries in the spot stage and caries.

13. Average caries of temporary and permanent teeth in children. Etiology, pathogenesis, diagnosis, clinical picture, differential diagnosis and treatment. Filling materials.

Filling materials

15. Modern approaches to the complex treatment of caries of temporary and permanent teeth in children.

16. Planned sanitation of the oral cavity in children. Dispensary observation. Organizational forms and methods, accounting and reporting.

17. Hypoplasia and fluorosis of hard dental tissues. Etiology, pathogenesis, diagnosis, clinical picture, differential diagnosis and treatment.

18. Hereditary disorders of the development of dental tissues. Etiology, pathogenesis, diagnosis, clinical picture, differential diagnosis and treatment.

19. Classification of methods for treating pulpitis of temporary and permanent teeth in children. Indications, contraindications, choice of medications.

20. Acute and chronic pulpitis of temporary and permanent teeth in children. Etiology, pathogenesis, diagnosis, differential diagnosis and treatment.

7. Chronic recurrent aphthous stomatitis. Etiology, pathogenesis, diagnosis, clinical picture, differential diagnosis and treatment.

Recurrent oral aphthae in childhood should be considered as one of the manifestations of an abnormality in the constitution of the body. The constitution is understood as a set of genotypic and phenotypic properties and characteristics (morphological, biochemical, functional) of an organism that determine its reactivity, i.e. a complex of protective and adaptive reactions aimed at maintaining homeostasis during changes external environment. Maslov M.S. called the constitution of the child’s body “how the child gets sick.” Variants of the constitution are variants of health. Anomalies of the constitution are manifested in the inadequacy of the body's reactions to environmental factors. The ego is the background against which illnesses arise. An anomaly of the constitution, or diathesis, means “tendency”, “predisposition”; it is a feature of the body’s reactivity, characterized by a predisposition to certain pathological processes, as well as peculiar reactions to ordinary factors. Such environmental factors are food, humidity and temperature.

Chronic recurrent aphthous stomatitis (CRAS) is an allergic disease of the oral mucosa.

The disease manifests itself the formation of single aphthae (ulcers) on the mucous membrane, which occur without a specific pattern. HRAS is characterized by a long course over many years.

There are three periods in the pathogenesis of the disease:

Premonitory

Period of rash

Fading disease

There are mild, moderate and severe stages depending on the number of elements of the lesion and the frequency of relapses.

Mild degree

1-2 elements of damage, 1 time every 2 years

Medium-heavy

5-6 aft, 2 times a year

More than 6 elements of damage, more often than 2 times a year.

Differential diagnostics

With traumatic and herpetic erosions (aphthae are painful)

With Vincent's ulcerative-necrotizing stomatitis (absence of pathogens in fingerprint smears)

With Lort-Hakob's bullous dermatitis (no blisters at the onset of the disease

With syphilitic papules (aphthae are painful, there is no inflammatory rim, treponemes are not sown)

Reasons for the development of HRAS

The disease is caused the following factors: adenovirus, staphylococcus, various types of allergies, immune disorders, diseases of the digestive system (especially the liver), neurotrophic disorders.

An important role in the development of HRAS genetic factors and the influence of various harmful factors (chromium compounds, cement, gasoline, phenol, denture materials, etc.) play a role.

Manifestations of HRAS

Symptoms of HRAS appear during periods of exacerbation of the disease. One or, rarely, two painful aphthae appear on the oral mucosa. The pain worsens while eating and talking. The disease lasts for several years with periodic exacerbations in spring and autumn. As the duration of the disease increases, exacerbations recur unsystematically.

Periods between exacerbations (remissions) can last from several months, even years, to several days. In some patients, exacerbation of the disease is associated with trauma to the mucous membrane and contact with allergens. In women, it may have a clear dependence on the menstrual cycle.

During exacerbation of HRAS the oral mucosa looks pale, anemic, and swollen. The characteristic localization of aphthae (rarely two aphthae) is on the mucous membrane of the lips, the inner surface of the cheeks, under the tongue, on the frenulum, less often on soft palate and gums.

Afta represents a focus of necrosis (death) of the mucous membrane with inflammation of the mucous membrane and submucosa. Aphtha looks like an oval or round lesion measuring 5-10 mm. The aphtha is surrounded by an inflammatory rim of bright red color and covered with a gray-white fibrinous coating.

Afta lasts 7-10 days . 2-6 days after the onset of aphthae is freed from plaque and after another 2-3 days it heals. A red spot remains at the site of the aphthae.

As a rule, during exacerbation of HRAS general health does not suffer. In some patients, exacerbation of the disease is accompanied by severe weakness, physical inactivity, depressed mood, and increased body temperature.

Treatment for HRAS is in medicinal effects directly on aphthae and therapy aimed at preventing relapses or prolonging remissions.

In the treatment of aphthae they use painkillers, necrolytic (removing dead tissue) agents, proteolysis inhibitors (suppressing protein destruction), antiseptics, anti-inflammatory and keratoplastic (healing) drugs.

An examination is being carried out aimed at identifying concomitant diseases. When determining the pathology, treatment is prescribed by an appropriate specialist (general practitioner, gastroenterologist, otolaryngologist, endocrinologist, etc.)

During the period of exacerbation of the disease You should follow a diet that excludes hot, spicy, and rough foods from your diet.

When determining the source of the allergy it is necessary to eliminate the patient's contact with the allergen. If this is not possible, then treatment is carried out to reduce the effects of exposure to the allergen.

Appointed vitamin therapy, immunomodeling and immunocorrective treatment. To normalize the activity of the nervous system, sedatives are prescribed

Scheme for providing medical care for CRAS:

1. Sanitation chronic foci of infection. Elimination of predisposing factors and treatment of identified organ pathology.

2. Sanitation of the oral cavity.

3. Anesthesia of the oral mucosa

topical anesthetics

5% anesthetic emulsion

4. Application of proteolytic enzymes to remove necrotic plaque (trypsin, chymotrypsin, lidase, etc.).

5. Treatment with antiseptic and anti-inflammatory drugs (“MetrogilDenta”, etc.).

6. Application of keratoplasty agents.

7. Desensitizing therapy.

8. Vitamin therapy.

9. Immunomodulatory therapy.

10. Agents that normalize intestinal microflora.

11. Physiotherapeutic treatment (helium-neon laser radiation, 5 sessions).

One of the most effective antiseptic and anti-inflammatory drugs is Metrogyl-Denta.

Indications for prescribing the drug, in addition to aphthous stomatitis, are acute gingivitis (including ulcerative), chronic(edematous, hyperplastic, atrophic), periodontitis (chronic, juvenile), periodontal abscess, gangrenous pulpitis, post-extraction alveolitis, toothache of infectious origin.