Oral disease

Introduction to oral diseases Pathological phenomena in the oral cavity caused by damage of external physical and chemical factors, invasion of pathogens, abnormal development of dental and maxillofacial diseases, and systemic diseases. There are many types of oral diseases, diseases that originate in the mouth. Oral cancer is a surface cancer that can be detected early. If the lip cancer is operated in time, the prognosis is good. The prognosis of tongue cancer is poor. The tongue is a good site for cancer. The initial manifestation is often white spot and erythema. It develops to a certain extent to form an ulcer with uneven surface. Therefore, it occurs in the ulcer of the tongue. It is necessary to eliminate traumatic ulcer or tuberculosis as soon as possible. Diagnosis by ulceration. Cancer can also occur in the mucous membranes of the gums, cheeks, and moles. There is residual epithelium in the jaw bone when the tooth occurs. These epithelial tissues can form epithelial tumors or cysts, and can also become primary cancer, which is different from bone in other parts of the body. Some oral mucosal diseases are manifestations of systemic diseases in the oral cavity, such as bald tongue in anemia, enlarged gums in leukemia, and map-like tongues when vitamin B2 is deficient. Therefore, in the oral clinic, the oral cavity should be regarded as a window to visit the whole body state. basic knowledge Proportion of disease: according to different oral diseases, the proportion of illness is different Susceptible people: no special people Mode of infection: non-infectious Complications: cardiovascular disease sepsis diabetes hypertension

Causes of oral diseases

Chinese medicine believes that the spleen and stomach accumulate heat, the heart fires on the fire, and the virtual fire rises and causes oral diseases.

There are many reasons for the incidence of dental caries in children in China. The main risk factors are sugary foods (especially sucrose) entering the mouth, causing bacteria in the plaque, fermenting acid, these acids (mainly lactic acid) It is invaded from a place where the pressure surface structure is weak, and is produced by dissolving and destroying the inorganic matter of the tooth.

The body's defense function defects, endocrine disorders, malnutrition, mental stress and stimulation, work fatigue, insomnia, tuberculosis, kidney disease, heredity, etc., can cause oral diseases in all ages, gender is not significantly different.

Bacteria cause mainly facultative anaerobic bacteria and obligate anaerobic bacteria, such as streptococci, actinomycetes, lactobacilli and the like.

Oral disease prevention

1. Choose a health care toothbrush: the brush head is small, the brush is soft and elastic, and the brush head is placed in the mouth to rotate freely, neither hurting the gums nor damaging the teeth.

2, effective brushing: invalid brushing is to go through the field every day, squeeze the toothpaste in the mouth and turn around, gargle. Effective brushing is guaranteed for 3 minutes, and the teeth can be brushed face to face.

3, horizontal vibrating brush: let the brush head fluctuate 45 degrees between the tooth surface and the gums, the movement does not exceed half a tooth, after shaking 8-10 times, the vertical brush along the tooth surface, the upper teeth from the top Lower, lower teeth from bottom to top. Essentials: Horizontal vibration vertical brush.

4, squeeze the amount of toothpaste: mouth sputum: adults are crowded, children are squeezing. That is, your amount is that the toothpaste is squeezed vertically on the toothbrush side; the amount of the child is used to fill the toothbrush horizontally.

5. Fluoride-containing toothpaste: Science has fully confirmed that fluoride can increase the structure of teeth and bones, and can also prevent dental caries very effectively, so be sure to choose fluoride toothpaste when choosing toothpaste.

6, no more than two mouthwash: after using fluoride toothpaste, there will be a layer of fluorine protection on the surface of the teeth and the entire mouth. If the number of mouthwashes is too high, the fluorine will be easily removed, and the teeth will be exposed to bacteria in an unprotected state. After brushing your teeth, one or two mouthfuls of water will not cause too much fluorine loss.

Oral disease complications Complications, cardiovascular disease, sepsis, diabetes, hypertension

1. Periodontal disease can infect cardiovascular tissue and cause cardiovascular disease. When it comes to periodontal disease, the bacteria it produces enters the bloodstream, and it attaches to the fatty acids in the coronary arteries, which are prone to blood clots, hinder blood circulation, affect the normal supply of oxygen and nutrients, and cause heart disease.

2, not timely treatment of oral diseases, causing sepsis. Oral diseases produce many viruses that pass through the bloodstream and can be transmitted to other parts of the body, including the brain. Specifically, long-term retention of bad teeth in the mouth, or inflammation is not treated in time, will cause sepsis, through the brain CT, you will find a brain abscess in the skull.

3, oral diseases produce harmful bacteria, can cause diabetes. The cytokines caused by oral diseases are destructive and unfavorable to human health. For example, excessive cytokines can damage the islet glands, reduce the amount of essential insulin secretion, and easily cause type 2 diabetes. It can be said that high blood pressure and diabetes are complications of oral diseases. Therefore, if you want to prevent high blood pressure and diabetes, you should pay attention to oral care.

Oral disease symptoms Common symptoms Toothache, gums, gums, bleeding, saliva, oral mucosal ulcers, gums, swelling, oral bleeding, bubbling, premature loss, chewing function

Many oral symptoms such as dry mouth, bad breath, and toothache are not independent diseases, but they are symptoms or signs of disease manifestation and are meaningful for diagnosing diseases. Modern stomatology has differentiated into many branches, including dentistry, endodontics, periodontics, children's stomatology, orthodontics, preventive stomatology, oral science, oral and maxillofacial surgery, prosthodontics. Etc. These disciplines are responsible for the prevention and research of oral diseases.

The most common oral diseases in China include: oral ulcers, periodontal disease, dental caries, and periodontal disease mainly refers to periodontitis and gingivitis, which is a common infectious oral disease. In developed countries, 15% of people suffer from periodontal disease, and in China, two-thirds of people have periodontal disease, of which adult periodontal disease accounts for 97%. The main reason for losing teeth in people over 35 years old is positive. It is this type of periodontal disease. In addition, the incidence of dental caries is 45%, making it the second largest oral disease after periodontal disease.

Oral ulcers: The symptoms vary depending on the cause of stomatitis. Clinically, it is divided into catarrhal, aphthous, vesicular, cellular inflammatory, pseudomembranous, ulcerative and papular. Regardless of the type of stomatitis, the common clinical symptoms are salivation, loss of appetite or slow intake, bad mouth odor, flushing of the oral mucosa, warming, swelling and pain. These symptoms are most obvious in catarrhal stomatitis; in aphthous stomatitis, there is a white or grayish white small necrotic lesion on the oral mucosa, surrounded by red edges; in the case of vesicular stomatitis, in the oral mucosa Transparent blistering occurred on the inside of the tongue and the lips. After 3-4 days of blister rupture, dark red spots appeared. In the case of foot-and-mouth disease, blisters also occur in the hoofs, hooves, toes and breasts with a sense of heat, and the disease is very contagious; when suffering from cellulitis inflammatory stomatitis, the lips, upper jaw and There is a wave-like swelling around the respiratory tract. After the compression, the sputum is often pronounced. In the case of pseudomembranous stomatitis, there is a cheese-like appearance on the oral mucosa, which is somewhat white or even has a gray-yellow pseudo-membrane. This pseudo-membrane is made of fiber. It is composed of necrotic and necrotic tissue; in ulcerative stomatitis, ulcers occur on the oral mucosa and tissue defects occur; in the case of papular stomatitis, yellowing occurs in the inner and surrounding parts of the lips, in the tongue, and in the entire mouth. The flat nodules of white scorpion granule size are very infectious.

Periodontal disease:

1, physical stimulation of the gums are easy to bleed.

2, the affected area of gingival congestion, edema, periodontitis can detect the periodontal pocket, the teeth are loose to varying degrees.

3, X-ray photos can be seen in the periodontitis of the alveolar bone to different degrees of absorption, and gingivitis without alveolar bone absorption phenomenon.

Clinical manifestations: 1. The main manifestations of gingivitis are gingival and licking nipples, which are round and pure, bright, and the color of the sputum disappears. The enamel is soft and fragile, lacks elasticity, and the sputum is easy to bleed, and there are local tartar or calculus. 2, periodontitis in addition to the performance of gingivitis, there are periodontal pockets formed, there may be pus overflow in the periodontal pocket, teeth loose to varying degrees, X-ray photos showing alveolar bone is absorbed to varying degrees.

Dental caries:

The predilection site of rickets is closely related to whether the food is easy to stay. Some surfaces on the teeth are not easy to be cleaned. The bacteria and food debris are easy to stay. The plaque accumulates more and is easy to cause rickets. These parts are rickets. Good hair parts, including: pit and groove, abutment surface and tooth neck.

The pit and fissure of the tooth is a defect left in the process of tooth development and mineralization. It is also the primary pathological site of rickets. The abutment surface of the tooth is the most common site of rickets that is second only to the pit and fissure. Or the atrophy of the interdental nipple leads to food impaction. The neck of the tooth is the junction of enamel and dentin, which is good for retaining food and bacteria. It is also a weak link of the tooth tissue, especially the enamel is not in contact with the cementum. Dentin is more prone to spoilage when exposed directly.

Due to the characteristics of different tooth anatomy and growth sites, there is a difference in the incidence of dental caries in each tooth. A large number of epidemiological survey data show that the tooth position distribution of caries is basically symmetrical on the left and right sides, and the mandible is more than the upper jaw. More teeth than the anterior teeth, the lowest rate of anterior teeth of the lower jaw.

1. The color, shape and quality of the hard tissue of the tooth, the location, depth and type of the smashed body, pay attention to the sulcus of the adjacent surface, the neck or the gingival covering area, and if necessary, take X-ray examination.

2, according to the degree of sputum can be divided into 1 shallow sputum is limited to enamel or cementum, generally no symptoms, no response when exploring. 2 The sputum is invaded into the shallow layer of dentin, which can be cold, hot, sour, sweet, and painful. 3 deep sputum invasive deep into the dentin, but not puncture, generally have pain and pain, no spontaneous pain.

3, according to the type of lesions can be divided into 1 chronic sputum disease length, smashed tissue texture is hard, dry and dyed deep. 2 The course of acute sputum is short and progresses rapidly. The texture of the smashed tissue is soft, moist and lightly stained. For example, in most of the time, most of the teeth and even the entire mouth are acutely smashed, and the smashed tooth surface is wide and develops rapidly to the deep. It is often ring-shaped in the neck of the teeth, also known as fierce sputum. 3 The static cavity is shallow disc-shaped, and the development of the sputum is very slow or static. The hole often reveals a hard, smooth and pigmented dentin layer. 4 Secondary tendon occurs at the edge of the filling or restoration.

Endodontics:

According to the course of disease can be divided into

1, acute pulpitis (Acute pulpitis)

Mostly caused by accidental trauma or recent tooth surgery, there are cold, heat-induced pain and spontaneous pain, mainly caused by severe spontaneous pain, the characteristics are as follows:

1 pain often sudden, early intermittent, generally lasts for several minutes, followed by several hours of intermittent period, the patient can still refer to the tooth, with the development of the disease, the attack period is prolonged, the intermittent period is shortened, and gradually changed into persistent severe pain, And along the ipsilateral three-branch distribution area (such as the teeth to the neck, the front of the ear, the cheeks; the lower teeth to the ears, the back of the ears, the lower jaw release), often can not clearly indicate the location of the teeth.

2 Pain is often more dramatic at night, especially when lying down.

3 early cold, thermal stimulation can stimulate or aggravate pain, with cold stimulation pain more obvious; late or suppuration, heat stimulation pain, cold stimulation can only temporarily relieve pain, late patients often contain cold water, or absorb cold air to alleviate Pain, this symptom is helpful for diagnosis.

4 examination often shows that the teeth are pierced, and the pain is obvious.

2, chronic pulpitis (Chronic pulpitis)

Because most of the rickets are chronic lesions, there is a long-term continuous stimulation of the pulp, which can cause chronic inflammation of the pulp. During the development of chronic pulpitis, such as polymorphonuclear leukocytes, the released lysosomes The enzyme is also increased, and the inflammation is intensified, and the symptoms of acute attack can be clinically present.

Chronic injury to the teeth, periodontal disease, and dentin chemical stimulation can cause the pulp to undergo chronic inflammation.

Chronic pulpitis is clinically divided into three categories: chronic atresia pulpitis, chronic open pulpitis and chronic proliferative pulpitis, chronic open pulpitis, also known as chronic ulcer pulpitis, chronic hyperplasia. Pulpitis is also called pulp polyps.

Diagnosis of chronic pulpitis:

1 long-term irritative pain, X-ray photograph shows that the pericardial cavity has been widened and the hard plate is damaged;

2 have a history of spontaneous pain;

3 probing has been puncture, bleeding, severe pain;

4 There are deep or deep blind pockets or chronic damage to severe teeth.

3, chronic pulpitis in the acute attack period has chronic pulpitis symptoms, recent severe spontaneous pain, can not locate or have loose pain, hot and cold stimulation caused or aggravated pain.

4, partial necrosis of the pulp in addition to the symptoms of pulpitis, and has been through the marrow, open the marrow to check the coronary pulp is not active, the root marrow is still active.

5, the entire necrosis of the pulp may have a history of pulpitis or trauma, piercing the marrow, but no pain, or periodontal disease, no response to the vitality test, open pulp to check the pulp without vitality.

Plaque:

Plaque is a colorless, sticky, bacterial film that often forms on the surface of teeth. Depending on the type of plaque, the following types of symptoms are specific:

1. Upper plaque: The tooth surface above the gingival margin is mainly composed of Gram-positive cocci and bacilli. Gram-positive cocci, bacilli and filamentous fungi gradually increase with the growth of plaque.

2, underarm plaque: located under the armpit, covered by gums, which contains a variety of bacteria, the surface has more filamentous worms and spirals.

3, smooth surface plaque: located on the smooth surface of the teeth, containing Gram-positive cocci and filamentous bacteria.

4, cleavage plaque: located in the groove of the tooth surface, mainly containing cocci and bacilli, but also filamentous bacteria.

Oral Cancer:

1, there are lumps, nodules appear;

2, there are white, smooth scaly plaques appear;

3, there are red plaques, ulcers, areas of inflammation and other symptoms and can not heal in a long period of time;

4. Repeated bleeding without obvious cause in the oral cavity;

5. There is no obvious cause of numbness, burning or dryness in the mouth;

6. Difficulties or abnormalities when talking or swallowing.

Examination of oral diseases

1. Oral inspection.

2, blood routine examination.

3, X-ray film inspection; conditional can be used optical fiber transillumination, electrical impedance, ultrasonic, elastic mold separation, dyeing and other techniques to improve the accuracy and sensitivity of early diagnosis of rickets.

4, secretions and tissue culture + drug sensitivity test.

Histopathology: Most skin metastases are dermis deep and subcutaneous moderate to highly differentiated squamous cell carcinoma. Tumor cells sometimes invade the perivascular space and lymphatic vessels. Special staining and immunohistochemistry are the same as oral squamous cell carcinoma.

Diagnosis of oral diseases

Differential diagnosis

1, acute wisdom tooth pericoronitis and acute pulpitis, the differentiation of acute periarthritis

The teeth of acute wisdom tooth pericoronitis are incomplete, characterized by redness, tenderness and pus under the crown, which may be limited by mouth; acute pulpitis is characterized by deep cavities, pain and spontaneous pain. Acute periapical periodontitis is characterized by convulsions, tenderness, and a sense of elongation of the teeth. See Table 1.

2, the identification of trigeminal neuralgia and acute pulpitis

Trigeminal neuralgia is more common in middle-aged and elderly patients. It is often induced by touching, washing, eating and other actions touching a part of the face (trigger point). It is a paroxysmal short-lived lightning-like pain that can be along the trigeminal nerve or The two distribution areas are released, usually ranging from several to several minutes. The patient can often point out the trigger point and have a long history, so the differential diagnosis with acute pulpitis is not difficult.

3. Differential diagnosis of toothache and malignant tumor pain

When a malignant tumor of the jaw is invading the nerve, symptoms of toothache may occur. As mentioned above, maxillary sinus cancer can cause pain in the affected side of the premolar or molar. Malignant tumors of the mandible, such as the inferior alveolar nerve, may cause pain in the ipsilateral lower teeth, to prevent misdiagnosis. Check the presence or absence of malignant tumors, such as whether the skin has numbness, localized mass or ulcers, X-ray examination of the teeth and jaw, which is helpful for differential diagnosis.

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