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INFLAMMATORY PROCESSES OF THE MUCOUS MEMBRANE
OF THE ORAL CAVITY
Rasulova Mohigul Matekub kizi
Bukhara State Medical Institute
Abstract : Stomatitis is an inflammatory process on the oral mucosa caused
by the immune system's reaction to an irritant from the external environment. It
manifests itself as swelling, redness and ulcers on the walls of the mucous membranes.
This disease requires immediate treatment. If you delay, you cannot do without
antibiotics, stomatitis spreads to healthy tissues. In addition, the patient cannot eat
food calmly, he is bothered by a burning sensation, painful sensations when chewing
food and talking.
Key words : primary inflammation, stomatitis, harmful microorganisms,
propolis infusion, swelling, redness.
The oral mucosa is an indicator that reflects the work and condition of the
internal organs and systems of the entire div. Inflammatory diseases of the oral
mucosa are pathologies that affect patients of different ages. Inflammatory pathology
of the oral mucosa, like other diseases of the oral cavity, causes the patient some
discomfort and disrupts the usual rhythm of life: speech, eating, sleep. Doctor of
Medical Sciences, Professor Andrey Vladimirovich Sevbitov noted that the
inflammatory process in the oral mucosa can be influenced by various factors:
(bacterial, viral, infectious, traumatic, etc. ) [ 20] .
When the mucous membrane covering the hard and soft palate, lips, gums,
cheeks, floor of the mouth, lower and back surface of the tongue becomes inflamed,
it is stomatitis. To this day, chronic recurrent aphthous stomatitis remains one of the
most common diseases of the oral mucosa in the practice of a dentist. According to
the World Health Organization, this pathology affects up to 20% of the population.
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Patients experience severe pain and burning from a variety of irritants, including
during speech and eating, which in turn leads to a decrease in social adaptation [1].
The oral mucosa has a number of features: it is resistant to the effects of
physical, thermal and chemical irritants, prevents the introduction of infectious
agents, and has an increased regenerative capacity [ 2].
At the same time, for colonization by microorganisms, the process of protein
adsorption and bacterial adhesion seems to be more important than mechanical
attachment of bacteria [16]. Inflammatory pathology of the mucous membrane, like
other diseases of the oral cavity, causes the patient a certain discomfort and disrupts
the usual rhythm of life: speech, eating, sleep [ 22] .
The development of clinical manifestations of chronic aphthous stomatitis is
preceded by a prodromal period, which occurs with discomfort in the oral cavity,
subfebrile temperature, and mild malaise. Subsequently, against the background of
hyperemic mucosa, a primary element is formed - aphtha, which is a superficial round
ulcer 3-5 mm in diameter, covered with fibrinous plaque surrounded by an edematous
bright pink rim. Aphthous rashes are usually multiple; localized in the area of the
transitional fold, lateral surfaces of the tongue, mucous membrane of the cheeks and
lips. Aphthae cause severe pain when eating, brushing teeth, and articulating. The
healing period of aphthae ranges from 7-10 days to 2-4 weeks. Epithelialization of
ulcers occurs without scarring or with the formation of a delicate scar. Relapses of
chronic aphthous stomatitis occur with a frequency of several weeks to several
months. Frequent exacerbations exhaust patients, causing apathy, sleep disturbances,
and cancerophobia [ 19] .
One of the pressing problems in dentistry is the early diagnosis of
precancerous diseases and malignant neoplasms of the oral mucosa. Precancerous
diseases (PD) are usually not diagnosed at early stages of development, 5 since they
occur without visible clinical signs, and patients do not seek medical help [25].
The prevalence of diseases of the upper gastrointestinal tract in adolescence
is high and, according to a number of authors, amounts to 60% to 70% of
gastroenterological pathology, including the majority of which is chronic
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gastroduodenitis: from 65% to 80% of cases, while Helicobacter infection pylori
accounts for 80% to 83% of sick adolescents [3].
It is important to note that the studies conducted suggest that in combination
with inflammatory diseases of the gastrointestinal tract, the incidence of recurrent
aphthous stomatitis increases to 11.6% and in some cases can reach up to 40-50% of
cases [ 4].
In long-term pathology of the gastrointestinal tract, as a rule, erosive and
ulcerative lesions of the mucous membrane of the stomach and small intestine
develop, which is combined with the appearance of aphthae on the oral mucosa [ 5].
The phylogenetic unity of the digestive tract allows us to assume that erosive
and ulcerative lesions of the oral mucosa are a reflection of inflammatory changes in
the underlying parts of the gastrointestinal tract; in particular, the manifestation of
recurrent aphthous stomatitis may be one of the first symptoms of exacerbation of
chronic gastroduodenitis [ 6].
Generalized stomatitis (affects most of the mouth) appears as a rash of blisters,
yellow sores, or white ulcers in the mouth. Sometimes there is a burning sensation in
the mouth, dryness due to changes in the composition of saliva ( xerotomy ). The
phylogenetic unity of the digestive tract allows us to assume that erosive and
ulcerative lesions of the oral mucosa are a reflection of inflammatory changes in the
underlying parts of the gastrointestinal tract, in particular, the manifestation of
recurrent 8 aphthous stomatitis can be one of the first symptoms of exacerbation of
chronic gastroduodenitis [11].
People who wear dentures often develop candidal stomatitis, especially if
patients use a removable denture made of acrylic plastic. According to medical
research, 15-30% of people who do not have inflammatory complications have
Candida fungi on the mucous membrane of the denture bed and the adjacent surface
of a complete removable denture . Fungi can be present in a slightly acidic
environment (pH 5.8-6.5), and they produce enzymes that break down proteins,
carbohydrates, fats, and keratin. This leads to damage to the structure of the denture
material, especially acrylic, including due to organic acids such as citric, oxalic,
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succinic, acetic, lactic, etc. When plastic ages and its physical and chemical properties
change, additional conditions are created for the best development of fungi [ 7].
The surface of the denture, especially the base of the removable denture, has
retention points for nutrients and acts as a kind of incubator for species such as
Candida albicans . If healthy children and young people have Candida albicans is
found in the oral cavity in 45-65%, while older people who use removable dentures
are carriers of fungi in 60-100% [15].
In severe cases, it does not even allow drinking regular water. Then the wound
heals, and the person forgets about the problem for a while. Chronic herpetic
stomatitis develops against the background of the proliferation of the herpes simplex
virus type 1, which mainly affects the skin of the lips and the mucous membrane of
the mouth. It is highly contagious and can be easily transmitted by contact and
airborne droplets [ 21 ] .
Age-related characteristics and lack of skills in removing plaque from the
surface of the prosthesis and natural teeth lead to conditions when the oral mucosa
becomes more susceptible to opportunistic infections, both bacterial and fungal [ 13].
The increase in the incidence of candidiasis in recent decades is associated, in
addition to the increase in the number of elderly people, with an increase in the
number of patients with weakened immunity, such as cancer patients receiving
chemotherapy, and those with viral infections, including the human
immunodeficiency virus [14] .
Fungi of the genus Candida are present in the oral cavity, which usually cause
stomatitis when the immune system is weakened. Children, the elderly, pregnant
women and people with diabetes are at risk. Oral candidal lesions often occur if a
person wears dentures or takes antibiotics without consulting a doctor. When infected
with fungi of the genus Candida, white coatings similar to cottage cheese appear in
the oral cavity and on the tongue. Pain when swallowing, burning and an unpleasant
taste in the mouth are disturbing. Candida biofilms albicans develop in three stages.
The first occurs within 1-11 hours: the fungi attach to the surface within two hours,
microcolonies appear after 3-4 hours to 11 hours. The second stage occurs within 12-
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30 hours. Candida biofilms appear as a bilayer consisting of yeast, germ tubes and
young hyphae with an extracellular polymer matrix. The last stage is the maturation
process, which occurs within 38-72 hours [ 8].
Advanced age is also a risk factor for the development of denture stomatitis,
because in old age, cellular immunity, which provides protection against candidal
infection, decreases [ 25].
Dietary habits can also influence the resistance of fungi in the biofilm to
antifungal agents and the formation of biofilm on acrylic surfaces of dentures,
promoting more active formation of extracellular matrix and metabolic activity [ 9].
Dietary habits can also influence the resistance of fungi in the biofilm to
antifungal agents and the formation of biofilm on acrylic surfaces of dentures,
promoting more active formation of extracellular matrix and metabolic activity[17].
Another important factor is the state of the immune system. Immunological
disorders are often accompanied by the formation of Candida albicans infections,
including the formation of systemic and generalized candidiasis, which can manifest
itself in various clinical forms with the participation of one or more strains vegetating
on the oral mucosa [ 18].
However, the methods of treatment and diagnostics known to date, in addition
to obvious advantages, also have a number of disadvantages: 1. Antibacterial drugs
contribute to the development of dysbacteriosis in the oral cavity. Regular use of the
same drugs, caused by frequent relapses of CRAS in patients, causes an “addiction
effect” and a decrease in the div's resistance to pathogenic microflora; 2. Systematic
use of such a number of drugs has a negative effect on the div as a whole; 3.
Previously known algorithms do not provide for really working mechanisms for
preventing relapses of CRAS [24].
After the complex therapy, the greatest positive changes in free radical
oxidation and lipid peroxidation were noted in the group of patients with recurrent
aphthous stomatitis who received combined local and systemic treatment with
hyaluronic acid- based drugs [ 10].
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s a result of complex treatment with Tykveol oil (Group 1), patients showed a
tendency to normalize the microbial flora of the oral cavity by the 14th–18th day, a
decrease in cases of dysbacteriosis with traditional therapy occurred by 10.0%, and in
the main group — by 40.0%. Thus, the results of observations indicate that Tykveol
oil is an effective means of symptomatic therapy of chronic recurrent aphthous
stomatitis and can be recommended as a means of choice in the complex treatment of
patients. Availability, simplicity, and effectiveness allow us to recommend them in
clinical practice [ 12] .
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