Modern dentistry faces countless different diseases. Certain species, such as leukoplakia of the oral cavity, having a scanty clinical picture, can lead to serious complications.
What it is
Leukoplakia is a disease that can affect all mucous membranes (epithelium of the rectum, bladder, cervix, etc.), but the involvement of the oral mucosa is most common. Typical localization - the surface of the tongue, mucous cheeks and corners of the mouth. Hyperkeratosis (increased keratinization) develops in the epithelium, manifested by white bloom and soreness when touched or in contact with food. In the risk group middle-aged and elderly. In men, the disease occurs 2.5 times more often than in women.
Leukoplakia is not an independent pathology. It occurs as a pathological condition compared to other disorders. Starting factor can be:
- Smoking. Constant chemical and thermal effects of tobacco smoke on the mucous membrane leads to a violation of the regulation of reproduction of epithelial cells and secretion of mucus, which ultimately causes hyperkeratosis.
- Systematic consumption of cold, hot and spicy foods. Irritants (pepper, herbs), as well as inadequate food temperature cause irritation of the mucous membrane.
- Injuries to the oral cavity. Incorrectly chosen dentures, bite disorder, the use of solid products lead to multiple cracks and cuts. When exposed to the same areas of the mouth repeatedly develops the disease.
- Drinking alcohol. High-grade alcohol (from 25%) not only injures the mucous, but also creates a favorable environment for the growth of bacteria. Against the background of chronic inflammation, the epithelium begins to keratinize.
- Galvanic currents. Dental crowns, which are made of metallic materials, require constant exposure to currents. Saliva helps to hold them all over the oral cavity, which provokes the regeneration of the epithelium.
- Adverse environmental factors. Harmful production and poor environmental conditions with a high content of chemicals in the air, heavy metal salts, dust particles have a negative effect on the activity of epithelial cells.
- Chronic diseases of the gastrointestinal tract. Pathologies such as gastritis, gastroduodenitis, peptic ulcer and duodenal ulcers, reduce the natural defense mechanisms and the resistance of the oral mucosa to harmful factors.
- Genetic predisposition. It has been scientifically proven that the disease is more common in persons whose parents are ill.
In addition to the main reasons, there are factors that lead to the weakening of protective and barrier mechanisms.These include: anemia, various vitamin deficiencies, diabetes mellitus, hormonal disturbance (especially in menopause), infection with human papillomavirus, HIV infection, long stay in tanning beds.
In the early stages of the disease practically does not manifest itself. Foci of white or gray hues are gradually formed, the diameter of which is only a few millimeters. The surface of the formations is hard and rough. Around the areas involved in the pathology, the mucosa is coenotic, the vessels are full-blooded. Identify the disease is possible only with a random inspection.
Plaques are located on the inner sides of the cheeks, palate, tongue, floor of the mouth and gums. Localization of the gums causes discomfort and minor pain when brushing your teeth and eating food.
Patients seek help when the lesions become significant in size (up to 2-4 cm) and lead to a change in the habitual way of life: taste perversion, difficulties with chewing food, chronic pain during infection, etc.
Video: leukoplakia oral
Types and forms of the disease
There are several options for the course, each of which has specific symptoms, features of treatment and prognosis.
This option is the most common. In 90% of cases, the pathology is detected during preventive examinations or during a visit to the dentist for other diseases. There are no clinical manifestations for a long time. After a few months there is a feeling of burning, pressure and retraction.
With the defeat of the tongue, due to the degeneration of the epithelium of the taste buds, taste sensitivity is lost.
Foci of leukoplakia can have any shape and size (there are cases when the entire mucous membrane has undergone dyskeratosis). The mucous membrane of the cheeks most often affects the area around the excretory ducts of the salivary glands. Localization on the tongue, palate or floor of the mouth causes the appearance of white stripes with areas of a darker color. In 50% of patients, the formations rise above the surface by 1-3 mm. Characterized by the appearance of plaque, which is not scraped with a spatula.
Color plaques: white, gray or milky. Infection usually does not occur, since the activity of immune barriers is not impaired.
This type is the next, after a simple form. With further continuation of the effects of provoking factors (smoking, drinking alcohol and spicy food), the deviation progresses steadily. Hyperkeratosis becomes more pronounced. The upper layers of the epithelium are compacted and significantly elevated (3-5 mm). When feeling, they are dense, solid and slightly mobile. The pain is not typical.
The color gradually changes to yellowish shades. Typical complaints: severe burning when exposed to water and food, feeling of tightness and roughness, discomfort in the mouth.
A characteristic feature is the frequent rebirth into oncopathology.
Simple and verrukozny options in 25-30% of cases, in the absence of treatment, go into this form. On the pathological formations appear multiple cracks and sores, causing a sharp pain. The size of open wounds gradually increases, reaching significant sizes. Eating, speaking, movements in the mandibular joint become almost impossible.
Additionally, infection and the appearance of inflammatory processes in the oral cavity (gingivitis, stomatitis, etc.) can occur.
This form usually persecutes smoking abusers. It has been proven that using 10 cigarettes a day increases the risk of developing Tuppeiner leukoplakia 50 times.Foci are localized on the soft and hard palate, extremely rarely - on the gums.
Mucous membranes become gray or bluish color, become folded. Due to obstruction of the ducts of the salivary glands, the secret accumulates in the tissues, leading to stagnation and infection. Clinically, this is manifested by the appearance of multiple red-burgundy nodules and frequent infectious and inflammatory diseases of the oral cavity.
After cessation of exposure to tobacco smoke, the lesions may regress and disappear completely.
This type is a benign tumor of the oral mucosa. The affected areas are highly flaky, characterized by falling away of whole pieces of keratinized epithelium. Multiple cracks and ulcers form on the lesions, which can lead to bleeding. The tumor can reach significant sizes - up to 4-5 cm in diameter and up to 1 cm in height.
The alleged cause is chronic stress, depression, as well as sharp fluctuations in hormonal levels (for example, after discontinuation of glucocorticosteroid therapy).
The study of the problem begins with a visual examination of the pathological focus by a dentist. Additionally, a history of the disease is collected and the risk factors for the development of pathology (exposure to tobacco smoke, harmful production, dental surgery, etc.) are ascertained. After a preliminary diagnosis, a plan for additional instrumental and laboratory research methods is appointed:
- Biopsy - collection of tissue for further investigation. The procedure is performed under local anesthesia (application or injection).
- Histological examination - the study of the material obtained under a microscope. Allows differential diagnosis with other (including oncological) diseases.
- Taking a smear on oncocytology. Is scraping the surface layers of the mucous membrane. Further actively proliferating cells are detected.
- Schiller's test. The mucous membrane is stained with Lugol's solution (iodine solution in water). Sites subjected to leukoplakia are not stained.
- General blood analysis. Increased ESR will indicate the possibility of the presence of malignant neoplasms.
A general urinalysis, biochemical blood examination and chest radiography are also performed to exclude concomitant diseases, to search for possible metastases (for suspected cancer).
Additionally, consultations of medical specialists are shown: oncologist (for the purpose of early detection of cancer or malignancy of the leukoplakia focus), a dermatologist (search for other leukoplakia sites), a therapist (detection of somatic and infectious diseases).
In the process of diagnosis, differential diagnosis is carried out, since the deviation has similar clinical manifestations with diseases such as:
- Lichen planus - chronic dermatosis with multiple formation of papules, keratinization of the epithelium;
- Hyperplastic candidiasis - an infectious-inflammatory disease of the oral cavity caused by fungi of the genus Candida;
- Secondary syphilis is an infectious venereal disease caused by a pale treponema with the appearance of a rash characterized by multiple polymorphism and damage to the lymphatic system;
- Bowen disease is a neoplasm of the inner layers of the mucous membranes and skin with a high probability of malignancy.
|Comparison criterion||Oral leukoplakia||Red lichen planus||Hyperplastic candidiasis||Secondary syphilis||Bowen carcinoma|
|Typical patient complaints||Pain, burning, discomfort on the mucous membrane||Changes in the appearance and color of the mucous||Whitish-gray bloom on the mucous||Not||Having an elevation site that does not bother|
|Physical examination data||Stain (plaque), not scraped, without inflammatory changes with a characteristic location||Small papules, some merge. Vascular pattern changed. Localization: cheeks, lateral surfaces of the tongue.||Plaque is scraped off, and under it erosive or ulcerative defects||The buildup scrapes erosion beneath it, the texture of the formation is soft and loose||The lesion is always single with a crown of inflammation|
|Data from additional research methods||Histology: hyperkeratosis, parakeratosis||Histology: dystrophy of the basal layer||Histology, pathogen detection: Candida fungi||Wasserman reaction: positive. The presence of pale treponem cytological examination.||Histology: epithelial hyperproliferation, atypical mitoses, dyskeratosis|
Self-medication for leukoplakia is unacceptable. An urgent need to consult a doctor if signs of disease are detected. Only a specialist can diagnose, exclude or confirm the presence of malignant and socially dangerous diseases.
Therapy is aimed at eliminating all traumatic factors, sanitizing the oral cavity, prescribing vitamin complexes, diet and, if necessary, surgical correction methods.
The first stage is the elimination of risk factors (when smoking - quit smoking, in the presence of occupational hazards - change jobs, etc.). If necessary, correction of dentures, treatment of caries-affected teeth is carried out.
It is extremely important to normalize diet. At the time of treatment, spicy, salty, fatty and fried foods are excluded. It is recommended to use more vegetables and fruits.
The following drugs are prescribed in the outpatient polyclinic unit:
- Means to restore the normal functional activity of the epithelium of the oral cavity. Tocopherol acetate 30% is used. Applications are applied to the affected areas up to 3-4 times a day. Duration - 15-20 minutes.
- Antiseptics. Used to prevent infectious complications. Chlorhexidine 0.05% processes the entire mucosa in the morning and evening, as well as after each meal.
- Analgesics (with severe pain syndrome). Lidocaine 1% has proven itself well. Applied in the form of applications on the mucous membrane. In case of intolerance, applications with 0.5% procaine are shown. Drugs are applied before eating and according to indications.
The use of drugs that have an irritating effect (for example, 70% ethanol) is strictly contraindicated, since the risk of malignant cell transformation is high.
In the hospital
The treatment tactics in the hospital varies significantly. In the presence of ulcerative or erosive manifestations, treatment of foci with proteolytic enzymes is used, and corticosteroid ointments (Lorinden, Prednisolone ointment) are applied.
If there is no tendency to self-healing of the affected areas within 1-2 weeks, then surgical correction methods are used - cryodestruction and cryosurgery, as well as excision with a scalpel within healthy tissue. Cold treatment is carried out using a semi-fluid stream of nitrogen for 10 seconds. After this, the surface areas become necrotic and fall off, and a healthy epithelial layer forms in their place.
With a high risk of malignancy or the presence of atypical cells, the formation is excised with a healthy tissue intake of 5-10 mm, after which a course of chemotherapy can be prescribed.
Traditional medicine, despite the ban by doctors, is highly popular. The most common methods are:
- Infusions of herbs adaptogenov. Ginseng, oregano, medicinal veronica, chamomile, highlander not only have an anti-inflammatory and antiseptic effect, but also increase the body's resistance to harmful factors.
- Nut tinctures. The use of walnuts and black nuts has an antimicrobial effect and stimulates the growth of healthy epithelium.
- Rinse the mouth with a decoction of calendula, eucalyptus, St. John's wort. You can alternate the rinsing solution of ordinary soda and decoction. Up to 5-6 times a day.
- Lubrication of foci defeat olive oils and sea buckthorn. Such procedures soften the surface layer of the mucous membrane and prevent the formation of cracks.
Complications and prognosis
The disease can cause many complications. Among them:
- Malignancy. The appearance of a malignant tumor is characteristic of verrucous and erosive forms. Cancer tends to grow rapidly and develop metastases in other organs.
- The development of irreversible anatomical and functional changes. The defeat of the tongue can forever take away the taste sensitivity. Localization on the inner surfaces of the cheeks disrupts the activity of the salivary glands and develops hypo-salivation.
- Reduced local immunity. Long-term progression of leukoplakia leads to a decrease in the production of lysozyme and other antimicrobial components, ulceration increases the risk of infection.
- Bleeding The significant size of the plaques can contribute to the violation of the integrity of large vessels and the occurrence of hemorrhages and bleeding.
The frequency of complications depends on the timeliness of treatment to the doctor and the adequacy of the prescribed therapy. In the early stages, as a rule, it is possible to prevent all adverse effects.
The prognosis is favorable only with flat leukoplakia at the initial stage. In other forms, the risk of recurrence and transition to oncopathology is extremely high.
All patients should be under observation:
- 2 times a year - flat leukoplakia;
- 5 times a year - other forms.
In order to prevent the development of leukoplakia and relapse, patients should follow the following recommendations:
- Refusal of bad habits (tobacco smoking, drug and alcohol use).
- Changing the external environment. It is recommended to stay in an environmentally friendly environment (coniferous forests, parks outside the city). In the presence of harmful production factors should change the place of work.
- Compliance with the "sparing" diet and the rejection of annoying products. It is necessary to use more dairy and vegetable substances.
- Regular preventive visits to the dentist and timely treatment of lesions of the teeth and gums.
- Daily tooth brushing (2 times a day) and rinsing the mouth with plain water after each meal.
Thus, leukoplakia, despite the scarcity of clinical manifestations, is a serious disease that can not only significantly limit the usual way of life, but also transform into a malignant tumor. At the first symptoms of the disease, you need to urgently consult a doctor to protect yourself from possible complications and save your life.