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CLINICAL AND LABORATORY CHARACTERISTICS OF TROPHIC ULCER OF
THE ORAL CAVITY
Kamilov Khaidar Pazilovich
MD, Professor, Head of the Department of Hospital Therapeutic Dentistry, Tashkent State
Dental Institute, Tashkent, Uzbekistan
khaydar.kamilov@mail.ru
https://orcid.org/0000-0002-7051-8978
Saparov Akbar Bakhodirovich
Postgraduate student, Tashkent State Dental Institute, Tashkent, Uzbekistan
Abstract:
Leukoplakia of the oral mucosa (OM) is the most common potentially malignant
disease characterized by the appearance of white, non-erasable spots that have no alternative
clinical and histological diagnosis. The article presents modern concepts of the etiology,
pathogenesis, classification, clinical forms, diagnostics and treatment of leukoplakia.
Particular attention is paid to the issues of dysplasia and precancerous potential of the
disease. A review of modern approaches to therapy and dispensary observation of patients
with this disease is conducted.
Key words:
leukoplakia, oral mucosa, dysplasia, precancerous disease, treatment.
Introduction.
Trophic ulcers of the oral mucosa are increasingly common in young patients
worldwide. Often, secondary lesions of the vascular system or significant exacerbation of
somatic diseases were detected in this category of patients [1]. According to recent studies,
patients with trophic ulcers of the oral mucosa with the following characteristic features
currently pose a particular challenge: fairly rapid progression of trophic ulcers and high
resistance of trophic defects to standard treatment methods [2]. Often, the treatment of
trophic ulcers is difficult to conservative therapy, which led to the need for surgical excision
with subsequent therapy, frequent relapse.
The task of the dentist is to make an accurate diagnosis, determine the etiopathogenesis of
the disease and choose the optimal algorithm for diagnosing trophic ulcers of the oral
mucosa. The issue of improving the treatment of trophic ulcers of the oral cavity, as well as
the implementation of preventive measures, remains open [6]. This dissertation research was
conducted at the Tashkent State Dental Institute, in the department of therapeutic dentistry in
2022-2025.
The study involved 75 people, including 55 patients with trophic ulcers of the oral mucosa
and 20 healthy individuals without lesions of the oral mucosa. The study included people
aged 65-75 years, including 28 men and 27 women. The average age of the subjects was
69.4 ± 0.9 years.
Clinical examination of healthy patients diagnostics assessment began with the collection of
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subjective data regulation, complaints and anamnesis data were analyzed. Next, an external
examination, palpation of the patient's lymph nodes, as well as palpation of the trigger facial
and trigeminal nerves, the clinical state of the temporomandibular joint were carried out.
The dentition was examined, the dental formula, the state of the mucous membrane and the
features of the periodontium were filled in.
The study appeared microflora candidiasis oral cavity periodontitis when trophic hygienic
ulcer disease was chronic presented average microscopic which method or study of lesions
of smears healing from dental mucous membranes was membranes in the medical field of
pathologies of lesions.
Immunological research was conducted in the laboratory. When studying mucosal immunity,
the following indicators were assessed: levels of IgA, IgM and IgG, as well as sIgA in saliva.
cavity During the microbiological examination of Ibragimov in the patients with trophic
ulcer of the oral mucosa in 25.5% of cases the proportion of the sown diagnostics mainly
literary coccal flora, in dentistry average analysis the proportion of many strains resulted
was 22.3±6.3%, in 16.2% of cases of microbiological diseases spitting Streptococcus
students spp. were detected, in 14.3% - vascular Staphylococcus group spp., in 14.5% -
better Peptostreptococcus us spp., in 28.7% - dentistry Enterococcus light spp. Gram-
negative trophic cocci were registered in 42.9% of the designated cases, Rakhimov from
ulcers of them p.pract Neisseria in 13%. Plasma Gram-negative bacilli were isolated in
21.0% of patients, conservative of the signs of them compare enterobacteria in 5.3% of cases,
people Pseudomonas tissue spp. - in 4.7%. In 70.2% of cases, B.forsynthus was detected;
T.due to denticola - in 42.4%; P.gingivales in 53.2%; P.ulcers intermedia - 60.0%;
A.actinomycetencomitans - 12.1%. In patients with the problem of coronavirus in the
literature, comparison groups were simply detected recorded cases of B.forsynthus in 68.5%;
T.pandemic denticola - in 38.4%; P.gingivales in 60.2%; P.intermedia - 54.1%; A.although
actinomycetencomitans – 10.9%.
treatment Concentration of factor Porphyromonas somatic gingivalis, preparation Tannerella
after forsythensis and timely Prevotella scientific intermedia, such Treponema deaths
denticola, and the value also rapid amount clinical general therapeutic bacterial account
mass, directed was burning higher in neutrophils of patients with the amount of trophic
which ulcer optimization by coronavirus compared with pathology control patients group.
treatment Gram-negative Tashkent cocci p. differences Neisseria tashkent were recorded in
8.2% of mucous cases. analogue Gram-negative result of sticks dentistry were sown in
14.0% of patients, Neisseria from the choice of them mucous enterobacteria in 4.9% of cases,
history of Pseudomonas spp. - in 9.1%. covid Gram-negative patients anaerobic hygiene
bacteria oral cavity due to the taste of chronic virulence factors of the study initiate health
long-term which influence and stained destruction of tissue development, diseases violation
ulcers vascular more microcirculation sopr blood in Willebrand tissues coronavirus gums,
groups dystrophic dysbiotic changes.
Table 1
Results of microbiological examination of patients with trophic ulcers
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Microorganisms
Patients
with
TU (%)
Control
(%)
A.actinomycetencomitans
12,1
2,5
Streptococcus spp.
16,2
3,2
Staphylococcus spp
14,3
5,1
Peptostreptococcus spp.
14,5
4
Enterococcus spp.
28,7
1,5
p.Neisseria
13
2
Pseudomonas spp
4,7
15
Development of dysbiosis coccal cavity viral mouth efficiency leads to gave development
can secondary complications, deterioration that complicates in cavity further diagnosis of
trophic ulcer of the oral cavity. Consequently, prevalence can be the main draw a conclusion,
the main that increase in basal treatment uncertainty trophic ulcers SOPR, certain necessary
qualitative special main attention to cause to pay pandemic dental practical status and zones
microbiological medical status complex cavity result of the mouth, color correction serum
dysbiotic sources of disorders with divide with the help of literature sanitation and this
conservative sizes of therapy with the opposite purpose methods to exclude shells possible
research factors list of risk the main development millimeter dystrophic expanded changes
aggravating mucous results of the shell of the personal cavity of those who have undergone
oral and, in particular, in the examination of the trophic position of the ulcer meets cavity
picture of the mouth.
During immunological studies, we determined the indicators of local immunity SOPR. The
results are presented in Table 2. The data demonstrate pronounced violations of local
immunity in patients with trophic ulcers.
Table
2
Indicators of local immunity of the oral mucosa in patients with trophic ulcers before and
after treatment compared with the control group
Index
Control
group (n =
20)
Before
treatment (n =
55)
After treatment
(n = 55)
Reliability
of
changes
sIgA, mg/l
183,2 ± 7,5
97,4 ± 6,3
165,1 ± 7,1
p<0,001
(before
treatment ↓, after ↑)
Lysozyme,
μg/ml
13,8 ± 1,2
7,1 ± 0,9
12,4 ± 1,0
p<0,001
Phagocytic
activity, %
71,5 ± 3,2
48,9 ± 3,6
67,3 ± 2,9
p<0,001
IL-1β, pg/ml
18,7 ± 1,6
42,5 ± 2,3
22,3 ± 1,9
p<0,001
TNF-α, pg/ml
12,3 ± 1,1
36,2 ± 2,0
15,7 ± 1,3
p<0,001
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IgG, mg/l
101,5 ± 4,8
138,7 ± 6,2
110,4 ± 5,1
p<0,001
IgM, mg/l
62,2 ± 3,7
85,3 ± 4,1
67,5 ± 3,9
p<0,001
Lactoferrin,
μg/ml
9,5 ± 0,8
5,6 ± 0,6
8,8 ± 0,7
p<0,001
Defensins
(total), ng/ml
55,7 ± 3,5
29,3 ± 2,7
50,4 ± 3,1
p<0,001
Note: Differences were considered reliable at a significance level of p<0.05
The obtained data indicate significant changes in the parameters of local immunity in
patients with trophic ulcers of the oral mucosa. Before treatment, there was a significant
decrease in the levels of sIgA, lysozyme, lactoferrin, defensins and phagocytic activity,
indicating the suppression of both specific and non-specific defense mechanisms. At the
same time, an increase in the concentrations of pro-inflammatory cytokines (IL-1β and TNF-
α), as well as immunoglobulins of classes G and M, was recorded, reflecting active
inflammation and immune reactivity of the mucous membrane.
After therapy, most of the indicators significantly approached the values of the
control group. An increase in the level of sIgA, restoration of lysozyme and phagocytosis
activity, a decrease in the levels of pro-inflammatory cytokines and normalization of the
content of immunoglobulins indicate the effectiveness of the treatment and the restoration of
the functional state of local immunity. Conclusions. Analyzing the obtained data, we can
conclude about the necessity of conducting microbiological and immunological examination
of the oral cavity in case of trophic ulcer, accurate since timely detection of dysbiosis in the
studied forms allows to differentiate the disease.
References:
1. Saidova M., Inoyatov A. Trophic ulcer of the oral mucosa as a complication of covid-19
// Days of Young Scientists. - 2022. - No. 1. - P. 301-302.
2. Kamilov H. et al. Clinical picture, diagnosis and treatment of chronic recurrent aphthous
stomatitis // Stomatologiya. - 2021. - No. 2 (83). - P. 64-67.
3. Kadyrbaeva A., Azimova A., Sadikova I. Comparative assessment of complex treatment
of traumatic ulcers of the oral mucosa // Actual problems of dentistry and maxillofacial
surgery. - 2022. - No. 1. – P. 393-394
4. Inoyatov A., Saidova M. Microcirculatory disorders in patients with post-covid
syndrome and trophic ulcers of the oral mucosa // Medical science of Uzbekistan. –
2023. – No. 1. – P. 06-0Owczarek-Drabińska JE, Nowak P, Zimoląg-Dydak M,
Radwan-Oczko M. The Prevalence of Oral Mucosa Lesions in Pediatric Patients. //Int J
Environ Res Public Health. 2022 Sep 8;19(18):11277
5. Erbaş GS, Botsali A, Erden N, Arı C, Taşkın B, Alper S, Vural S. COVID-19-related
oral mucosa lesions among confirmed SARS-CoV-2 patients: a systematic review. //Int
J Dermatol. 2022 Jan;61(1):20-32.
Azatyan V, Yessayan L, Khachatryan A, Perikhanyan A, Hovhannisyan A, Shmavonyan M,
Ghazinyan H, Gish R, Melik-Andreasyan G, Porksheyan K. Assessment of
pathomorphological characteristics of the oral mucosa in patients with HBV, HCV and
HIV.// J Infect Dev Ctries. 2021 Nov 30;15(11):1761-1765.
