Articles on treatment of recurrent aphthous stomatitis. Symptoms and methods of treatment of chronic recurrent aphthous stomatitis

Pathogenic microorganisms found in the oral cavity have a negative effect on the mucous membrane, and can lead to various kinds of diseases, such as, for example, aphthous stomatitis.

This disease is especially common in young children, the disease gives the baby very unpleasant, painful sensations.

As a result, the child sleeps worse and may refuse to eat. And this, in turn, is negative affects the general condition of the baby. We will talk further about the treatment of aphthous stomatitis in children.

Read about the symptoms and treatment of ascariasis in a child in ours.

Description of the disease

Aphthous stomatitis in a child - photo:

Aphthous stomatitis (ICD code -10) is a prolonged inflammatory reaction affecting the oral mucosa. The causative agent of the disease is pathogenic bacteria, such as staphylococcus, streptococcus, diplococcus.

As a result of the negative impact of these microorganisms on the mucous membrane, slight redness forms on its surface. Then on the affected areas characteristic ulcers form(aphthae). The sizes of aphthae can be different, from 1-2 to 10 mm or more.

On the surface of the mucosa, 1-2 large-diameter aphthae or a larger number of small ulcers may form.

In this case, the affected areas can merge with each other, forming a single inflammatory focus. This phenomenon is considered the most severe form of the disease.

Aphthae can form on any part of the oral mucosa. The most common ulcers that affect inner cheeks, tongue, lips. There are cases where aphthae also affected the throat.

Classification

According to the nature of the course, aphthous stomatitis can be:

According to the nature of the lesion, the disease is divided into the following types:

• deforming when significant changes in the oral mucosa are observed;
• necrotic, which provokes the gradual death of mucosal cells;
• scarring when a small scar remains at the site of the aphthae.

Depending on the cause that provoked the appearance and development of the disease, aphthous stomatitis can be:

• viral, that is, caused by various types of viral infections;
• candida if the causative agent of the disease is a fungus;
• herpes, that is, aphthous stomatitis arose against the background of a herpes infection existing in the body.

How can you tell if your child has anorexia? find out right now.

Causes of the disease

Factors causing the development of aphthous stomatitis, may be different.

These include:

1. Hereditary factor.
2. Diseases of an autoimmune nature, or a temporary decrease in immunity, which is caused by frequent colds.
3. Features of the digestive system when a child has an inability to digest certain foods (for example, cereals).
4. Frequent allergic reactions.
5. Diseases of the gastrointestinal tract.
6. Avitaminosis.
7. Overvoltage, stress.
8. Oral diseases (eg, tooth decay, gum disease).
9. Eating too hot food.
10. Bacteria, viruses, fungi that affect the oral mucosa.
11. Insufficient amounts of important microelements such as iron, folic acid.
12. Injuries and damage to the mucous membrane, for example, when eating food.
13. Using a toothbrush that is too hard, which regularly injures the child’s gums.

Find out what to do if you suspect appendicitis in a child from ours.

Clinical manifestations

Aphthous stomatitis is a disease characterized by bright, intense symptoms, a characteristic clinical picture.

Thus, the patient is often concerned about such manifestations of the disease as:

1. Significant and sharp increase in temperature (sometimes up to 40 degrees). Hyperthermia is often accompanied by fever and chills.
2. Deterioration of the child's general condition.
3. Severe pain and burning in the mouth.
4. Disorders of appetite, sleep and wakefulness.
5. Increased salivation.
6. Formation of a whitish coating on the surface of the tongue.
7. Bad breath, bitter taste in the mouth.
8. Enlarged lymph nodes and their pain.
9. Formation of specific painful ulcers in the oral cavity.

Why is stomatitis dangerous?

First of all, canker sores caused by infection are contagious and therefore pose a danger to other people.

And the lack of proper treatment can have a very negative impact on the health of the patient himself. Complications include:

Features of treatment

How to treat aphthous stomatitis in children? Aphthous stomatitis is a serious disease treatment of the disease must be comprehensive. That is, to eliminate the causes and signs of the disease, the doctor prescribes drug therapy and physiotherapy. Traditional medicine recipes are also a good help.

However, it is important to remember that their use should only be carried out in conjunction with taking medications prescribed by a doctor and strictly under his supervision.

Medication

Topical agents such as e.g. Holisal– gel, Miramistin.

These products have an antibacterial effect and the ability to relieve inflammation and pain.

Typically, these drugs are used in the early stages of development illness.

Individual intolerance to the constituent components is considered a contraindication. The drug is applied to the affected areas of the oral mucosa and left for some time.

The patient is also prescribed other medications:

• Ibuprofen– helps eliminate pain, reduce temperature;
• Solcoseryl– helps improve metabolism in the affected area of ​​the mucosa. This helps improve regeneration processes;
• Inhalipt– cools the mucous membrane, relieves pain, fights infection;
• Chlorophyllipt– has a pronounced antibacterial effect.

If there is such a need, the patient is prescribed antihistamines that eliminate the allergic reaction (for example, Suprastin).

In especially severe cases, they resort to using strong antibiotics. In addition, taking vitamin preparations is indicated to improve the general condition of the little patient.

Physiotherapy

It will help speed up the healing of aphthae and restore the oral mucosa exposure to UV rays to the affected areas.

The procedure is painless, however, there are a number of contraindications. Therefore, such treatment is carried out only with the direction of a doctor.

Folk recipes

1. Mix chamomile flowers, sage leaves and peppermint in equal proportions (3 parts each), add 1 part fennel fruit. Pour boiling water over the resulting mixture (2 tablespoons), leave, and strain. Gargle and mouth several times a day.
2. Aphthae can be lubricated sea ​​buckthorn oil or fresh aloe juice. This will help relieve inflammation and speed up the process of tissue regeneration.
3. 1 tsp Dilute calendula tinctures in 1 glass of boiled water. Rinse your mouth several times a day.

Proper nutrition

Since one of the reasons for the development of aphthous stomatitis is considered to be disturbances in the functioning of the digestive system, it is necessary to take care of the child’s diet. First of all, pay attention to the consistency and method of cooking.

Mashed, steamed or boiled dishes are suitable for your baby. It is not recommended to give fried, fatty foods.

It is necessary to avoid eating spicy, spicy, salty foods that can irritate the already weakened oral mucosa. It is important that the foods the child eats are rich in vitamins and microelements.

How to prevent it?

Preventive measures to prevent the appearance and development of aphthous stomatitis are very simple.

At the same time, compliance with these rules will reduce the risk of such an unpleasant illness.

So, you need:

1. Monitor oral health, maintain hygiene, and conduct preventive examinations with a dentist.
2. Keep your baby's toys and personal belongings clean.
3. Monitor the quality of your baby's diet.
4. Limit his contacts with sick people.

Many people believe that ulcers formed during the disease will go away on their own. However, it is worth remembering the possible complications of the disease and treatment should not be neglected.

After all, aphthous stomatitis, which has passed into a recurrent form, will significantly worsen the child’s quality of life and cause him a lot of unpleasant sensations.

Learn about the symptoms and treatment of aphthous stomatitis from the video:

We kindly ask you not to self-medicate. Make an appointment with a doctor!

Chronic recurrent aphthous stomatitis is a chronic inflammatory process of the mucous and soft tissues of the oral cavity. The disease periodically worsens and manifests itself as profuse rashes in the form of aphthae, erosions and ulcers, which may not heal for a long period. Chronic recurrent aphthous stomatitis worsens under favorable conditions, for example, when seasonal allergies occur, hormonal disorders, etc.

The disease can occur in both adults and children, mainly over 4 years of age, against the background of a previously suffered acute form, which has developed into a chronic condition. Relapses of stomatitis occur spontaneously. No specific pattern is observed.

For example, when examining people with chronic aphthous stomatitis, no significant disorders were found in the body, only inflammation appeared. Aphthae (rashes) also appear in a chaotic manner. They can merge into a single whole, forming erosion in this place, or arise far from each other.

The reason may lie in the individual characteristics of a person or be of a general nature. As a rule, the chronic form of aphthous stomatitis develops against the background of improper treatment of the acute course of the disease.

An important role is played by the causative agent of stomatitis, as well as the presence of pathologies such as tumors, diseases of the gastrointestinal tract, anemia, etc. Concomitant reasons also include advanced caries and rare visits to the dentist.

Among other things, additional factors that influence, to one degree or another, the appearance of chronic recurrent aphthous stomatitis can be added to the same list:

1. Poorly installed dentures.
2. Allergic reactions to food or medications.
3. Some toothpastes, for example, contain sodium lauryl sulfate.

Signs of aphthous stomatitis.

Dmitry Sidorov

1. You can rinse your mouth with chamomile decoction. This can relieve pain and inflammation.
2. An ointment is prepared from burdock seeds.
3. A decoction prepared from burdock, chamomile and mint has antibacterial properties.
4. Oak bark is often used.
5. If you prepare a tincture of mint, chamomile, paprika and alcohol, you can use it to burn mouth ulcers.
6. Rinse your mouth with cabbage juice diluted with water.
7. To prevent the infectious process from spreading further, you need to periodically chew aloe or parsley leaves.
8. You can also rinse your mouth with fresh carrot juice (after which you should spit out the liquid).

Preventive measures

To avoid the development of HRAS disease, it is necessary to engage in its prevention. It is necessary to maintain oral hygiene. In relation to the child, this issue is dealt with by the parents. Keep your child's hands clean. The foods that children and adults eat must be clean.

Treat all infectious and inflammatory diseases in a timely manner. The diet should be varied and enriched with vitamins. It is necessary to give up bad habits such as smoking and alcohol. The child should not be in a room with tobacco smoke.

Chronic recurrent aphthous stomatitis is an inflammatory condition of the oral mucosa, with the characteristic formation of aphthous stomatitis, a long course of the disease and frequent exacerbation. Aphtha is a soft and painful defect of the epithelial surface. Most often, preschool children and people aged 20 to 40 are susceptible to the disease.

Causes of the disease

The most likely causes of chronic recurrent aphthous stomatitis include:

1. viral infections (herpes virus, cytomegalovirus);
2. bacterial infections;
3. allergic reactions;
4. genetic predisposition;
5. avitaminosis;
6. immunodeficiency state;
7. injury to the lining of the oral cavity;
8. stress;
9. mental disorders;
10. bad environment;
11. disruptions in the gastrointestinal tract;
12. blood pathologies;
13. use of products containing sodium lauryl sulfate for oral hygiene.

When a virus or bacteria enters a human body with a weakened immune system, 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, talking, and even at rest, 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:

1. 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.
2. 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.
3. 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.
4. Lichenoid form. Aphthous stomatitis in this manifestation looks similar to 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.
5. 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.
6. Glandular form. Small salivary glands and excretory ducts do not work properly. 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 aphthae for laboratory testing of the 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 concomitant pathologies and provoking causes.

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:

1. Carrying out sanitation of chronic areas of infection.
2. Sanitation of the oral cavity. This includes regular professional oral hygiene.
3. Carrying out anesthetic procedures on the oral mucosa.
4. Carrying out treatment of the oral cavity using physiological antiseptics. You can perform oral baths or rinses.
5. Blockade of pathological elements by the type of infiltration anesthesia, increasing the rate of epithelium formation in aphthous lesions.
6. 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 ability of blood serum 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 should include fermented milk products, mashed potatoes, cereals, 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 complete recovery from a chronic disease cannot be achieved. The maximum result is prolongation of periods of remission.
You can prevent the development of chronic aphthous stomatitis if you adhere to the following rules:

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

To prevent the development of chronic diseases, you must treat your body responsibly and consult a doctor if any alarming symptoms appear. A healthy lifestyle 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, unpleasant 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 the acute form, which we described 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.

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

Allergies and heredity

The waste products of bacteria and microbes can also cause allergies, and with it signs of disease. Manifestations of a cross-allergic reaction cannot be excluded. 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. With 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 is replaced by sharp, acute 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 true cause of the manifestation of chronic stomatitis of the aphthous variety, you need to 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 - an acute disease of the skin and mucous membranes with a variety of 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, and gastrointestinal tract.

Research and differential diagnosis will allow the doctor to establish an accurate diagnosis and prescribe effective treatment suitable for 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. A full examination and treatment by other specialists is possible: 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.

Solcoseryl or Actovegin ointments, oil-based solutions with vitamins E and A, sea buckthorn or rose hip oil, and medicines with propolis will help stimulate tissue restoration of damaged oral mucosa during the development of HRAS. 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 the patient’s circulatory system.

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. Vitamin preparations are also prescribed: ascorbic, nicotinic or folic acids, pyridoxine, B vitamins, riboflavin. The daily dose is determined by the doctor.

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

Sedatives will help normalize the functioning of the nervous system: 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.

Etiology and pathogenesis. Although the etiology of CRAS remains unclear, several important predisposing and causative factors are known.
Already in 1956 I.G. Lukomsky and I.O. Novik were able to suggest the allergic nature of the occurrence of HRAS. Allergens can include food products, toothpastes, dust, worms and their waste products, and medicinal substances.
The causes of the disease also include dysfunction of the gastrointestinal tract, respiratory infections, functional disorders of the central and autonomic nervous system, hypovitaminosis B1, B12, C, Fe, chronic inflammatory diseases of the nasopharynx (otitis, rhinitis, tonsillitis).
THEM. Rabinovich et al. (1998) believe that the etiology and pathogenesis is based on the autoimmune theory, which makes it possible to associate the occurrence of pathological elements with a violation of cellular and humoral immunity, both local and general.
HRAS is observed more often in schoolchildren and adolescents; the incidence of the disease increases with age.
A genetic predisposition to the disease has been noted. Children whose both parents suffer from this pathology are 20% more likely to get the disease compared to others.
There are three periods in the pathogenesis of the disease:
. Premonitory
. Period of rash
. Fading disease
The presence of bacterial sensitization is confirmed by skin testing, a leukocytosis reaction with bacterial allergens, and an increased histamine skin test.
Clinic. In the prodromal period, children experience a burning sensation and short-term pain. When examining the oral mucosa, areas of hyperemia and slight swelling are visible. After a few hours, a morphological element appears - aphtha. It is located against the background of a hyperemic spot, round or oval in shape, covered with fibrinous plaque. Aphthae heal without a scar in 5-7 days. In some patients, the upper layer of the mucous membrane itself becomes necrotic and the aphthae deepens. Healing occurs only after 2-3 weeks, after which superficial scars remain (Setton form).
Aphthae are localized in various parts of the mucous membrane, but more often on the mucous membrane of the lips, cheeks, transitional folds of the upper and lower jaws, the lateral surface and back of the tongue.
Recurrences of rashes occur at different intervals. In mild cases of stomatitis, single aphthae recur 1-2 times a year, in more severe cases - after 2-3 months and more often, in severe cases - almost continuously. At the same time, both the number of lesion elements and their depth increase.
Differential diagnosis. HRAS is differentiated from chronic trauma to the oral mucosa, acute and recurrent herpetic stomatitis. Immunofluorescence and virological studies provide invaluable assistance here.
Treatment. A set of therapeutic measures for CRAS should be built taking into account the variety of clinical symptoms, the nature of concomitant diseases, age characteristics and laboratory tests. Inadequate therapy and the lack of a differential approach to the treatment of patients with different clinical presentations lead to an increase in relapses of the disease, a reduction in the period of remission, and an extension of the period of epithelization of elements during exacerbation. The main criteria for assessing the effectiveness of the treatment are the composition of the microbial flora of saliva, the level of secretory Ig A, phagocytic activity of leukocytes [N.V. Terekhova, V.V. Khazanova, 1980].
The success of treatment depends on examining the child in order to identify and treat concomitant pathologies, eliminate foci of odontogenic infection of the ENT organs and sanitation of the oral cavity, and adherence to a diet rich in vitamins.
General treatment includes desensitizing therapy, vitamin therapy, immunomodulatory therapy, and agents that normalize intestinal microflora. Good results have been obtained using a helium-neon laser.
Local therapy should include anesthesia of the oral mucosa, application of proteolytic enzymes, treatment with antiseptics and anti-inflammatory agents, and application of keratoplasty agents.
Scheme for providing medical care for CRAS:
1. Sanitation of 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 (“Metrogil-Denta”, 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 the use of 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 .
The drug was approved by the State Pharmacological Committee of the Russian Ministry of Health on December 10, 1998. The drug has a pleasant, refreshing mint taste and is applied to the affected areas 2 times a day. After applying the gel, do not rinse your mouth or eat food for 15 minutes. The course of treatment is 7-10 days.
The combination of metronidazole (the gold standard anaerobicide) and chlorhexidine (a recognized antiseptic) effectively suppresses aerobic and anaerobic microorganisms that cause oral diseases. Thus, the inclusion of the drug “Metrogil-Denta” in the complex of therapeutic measures for children suffering from chronic recurrent aphthous stomatitis can significantly reduce the child’s recovery time.
The prognosis of the disease is favorable.