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Home , Aphthous stomatitis, Shingles, Stomatitis

MINISTRY OF HEALTH OF UKRAINE UKRAINIAN MEDICAL STOMATOLOGICAL ACADEMY

METHODICAL GUIDELINES

FOR INDIVIDUAL WORK OF STUDENTS FOR PRACTICAL CLASS

Educational discipline Therapeutic dentistry Module number 4 of the . Theme of class 5 Auto-infectious . Primary catarrhal stomatitis. Acute herpetic stomatitis. Acute . Etiology, pathogenesis, clinic, diagnosis, treatment, prevention. Course V Faculty Faculty of preparation of foreign students

Poltava – 2020

М.4/Т.5 1. Actuality of theme : Acute catarrhal, acute aphthous and acute herpetic stomatitis are autoinfective. Its are quite common at the dentist's appointment. Its often have a severe course with a decrease in the reactivity of the oral mucosa and the organism as a whole. These diseases require from dentist comprehensive clinical and laboratory examination of patient, use of complex treatment and prevention. 2. Specific objectives: Interpretation definition: primary auto-infectious stomatitis. • To analyze the etiological factors and the pathogenesis of acute catarrhal, acute aphthous and acute herpetic autoinfectious stomatitis. • Explain the diagnosis and treatment tactics for various clinical manifestations of auto-infectious stomatitis. • Draw up a treatment plan for a patient with acute catarrhal, acute aphthous and acute herpetic stomatitis. • Analyze measures to prevent auto-infectious stomatitis.

3. Base knowledge, abilities, skills, needed to study themes (interdisciplinary integration): Name of previous disciplines Acquired skills Anatomy, Determine normal anatomical formations and features of the tissues of the oral cavity Interpret cytological data Propaedeutics of internal diseases, Own examination methods for a dental propaedeutic of patient therapeutic dentistry Microbiology with immunology Conduct material sampling, write out Normal physiology directions and interpret results from additional examination methods Apply painkillers, antiviral, anti- Pharmacology inflammatory, antimicrobial, antihistamines, immunomodulators, vitamins. Determine indications, contraindications, mechanism of action, side effects, dosage. Write out recipes

4. Task for independent work during preparation to employment.

4.1. List of basic terms, parameters, characteristics that a student must learn in preparation for the lesson: Terminology Definition Primary stomatitis Inflammatory diseases, the etiological factor of which acts directly on the oral mucosa Autoinfectious stomatitis Stomatitis that occurs due to the action of opportunistic microorganisms growing in the oral cavity with a decrease in the reactivity of the oral mucosa and the organism as a whole Streptococci, Make up a significant portion of pathogenic oral staphylococci microflora. Most of them belong to the facultative (, anaerobes Staphylococcus) Belongs to the family- ; virus which has DNA.It causes damage to the central , organs, skin, mucous membranes with a characteristic manifestation of vesicular eruptions. It is well established that there are 8 representatives of the virus which are pathogenic to humans Acute catarrhal stomatitis There is exudative of the oral mucosa, (Stomatitis catarrhalis which is characterized by hyperemia, increased acuta) desquamation of epithelial cells, enhanced release of leukocytes and serous through oral mucosa, and an increase in the amount of mucus in the oral fluid There is auto infectious , which occurs under Acute aphthous the influence of conditionally pathogenic streptococci- stomatitis(Stomatitis staphylococcus microflora of oral cavity with the aphthosa acuta) reduction in reactivity in the organism Acute herpetic stomatitis There is contagious infectious disease caused by initial (Stomatitis herpetica contact with and the oral mucosa with the herpes acuta) virus There is contagious infectious disease, caused by the Acute herpes on during the initial contact, with ( acuta) the localization on the lips

4.2. Theoretical questions for the lesson: 1. Which microflora in the oral cavity is in normal condition? 2. Give the definition to autoinfectious stomatitis. Name the main periods of development acute autoinfectious diseases. 3. Expand the etiology and pathogenesis of acute catarrhalis stomatitis? 4. Expand the etiology and pathogenesis of acute aphthous stomatitis? 5. Expand the etiology and pathogenesis of acute herpetic stomatitis? 6. What is the clinic of acute catarrhalis stomatitis? 7. What is the clinic of acute aphthous stomatitis? 8. What is the clinic of acute herpetic stomatitis? 9. Describe the elements of the oral mucosa lesions in acute aphthous stomatitis and acute herpetic stomatitis? 10. What are the principles of treatment and prevention of acute catarrhalis aphthous stomatitis? 11. What are the principles of treatment and prevention of acute aphthous stomatitis? 12. What are the principles of treatment and prevention of acute herpetic stomatitis?

4.3. Practical works (task) that are performed in class: 1. To survey the patient with diseases of the oral mucosa. 2. Make an inspection of the patient with diseases of the oral mucosa. 3. Write down the referral to a general analysis of blood, interpret all the information you got. 4. Write down the referral for microbiological examination, to collect the material , interpret all the information you got. 5. Establish a clinical diagnosis with the etiology, severity and the general state of the organism. 6. To make a plan of treatment of patient with acute catarrhalis stomatitis. 7. To make a plan of treatment of patient with acute aphthous stomatitis. 8. To make a plan of treatment of patient with acute herpetic stomatitis. 9. To conduct therapeutic manipulation (irrigation, application of medical drugs). 10. Fill out-patient medical record (F.0-43). 11. Write out prescriptions for medicine for treatment of acute catarrhalis and aphthous stomatitis. 12. Write out prescriptions for medicine for treatment of acute herpetic stomatitis.

5. Content of the topic: The acute catarrhalis, acute herpetic and the acute aphthous stomatitis belong to infectious deseases it is (according to the Classification NMU) or a group of primary autoinfectious deseases of oral mucosa (according to the classification of Maximenko P.Т.). Main part of microflora of oral mucosa is cocci (85-90%). The detection of specific to the named in the serum of blood tells about the constant presense of the herpes simplex virus, 80-90% of people. Primary stomatitis are inflammatory diseases, the etiological factor of which acts directly on the oral mucosa. Auto-infectious diseases arise due to the action of opportunistic microorganisms that vegetate in the oral cavity. This occurs with a decrease in the reactivity of the oral mucosa and the organism as a whole. Contributing factors for the occurrence of autoinfectious stomatitis (acute catarrhal, acute aphthous and herpetic, acute ulcerative necrotic stomatitis of Vincent) are insufficient , , trauma, difficult wisdom teeth, hypothermia of the patient’s body, etc. Acute catarrhal stomatitis is exudative inflammation of the oral mucosa, which is characterized by hyperemia, increased desquamation of epithelial cells, enhanced release of leukocytes and serous exudate through oral mucosa, and an increase in the amount of mucus in the oral fluid.

Acute herpetic stomatitis. Herpes simplex virus after entry into the body through the oral mucosa and the nasal part of the since early childhood, still persist in the body predominantly in latent form, without causing any clinical signs of disease. Under the influence of provocative factors under adverse conditions (reduction in immunological reactivity) the virus can enter the active state and can cause the damage mucous membranes. Disease begins acutely with a general , fervescence to 37- 40°C. These symptoms within 24-48 hours joins , in the oral cavity which is enhanced during a talk and eating. The mucosa is hyperemic, edematous. The primary element in acute herpetic stomatitis — vesicle. The vesicles are arranged in groups, filled with a clear liquid, which eventually becomes turbid. After 2-3 days they burst, forming erosions which have bright red color, with finely scalloped with borders which are covered with plaque. The flow of saliva increases, it becomes viscous . The location of the lesion is - lip area, mucosa hard , cheek, . On the extent of the process the reaction of temperature and intoxication usually underline easy moderate and severe forms of the disease After the undergoing of primary herpes , virus will stay in human`s organism during the whole life, disease becomes a long latent phase of virus infection which is often accompanied by relapses. In relapses diseases of typical location of the of vesicles is transition of oral mucosa to the skin around the orifices (vermilion border, wing of the nose, nasolabial fold, eyes, genitals). of herpetic stomatitis: - viral lesions of the oral mucosa (, foot and disease, ); - allergic lesions of oral mucosa; - multiforme; - acute aphthous stomatitis; - acute necrotizing ulcerative stomatitis.

To confirm the diagnosis usually use such laboratory methods: - In cytogramme in the first 2-3 days of illness usually find: - polynuclear giant cells; - polymorphonuclear at different stages of necrobiosis. In the analysis of peripheral blood: leukopenia, accelerated erythrocyte sedimentation rate. In the immunogram: increasing virus of neutralizing antibodies.

Treatment of herpetic stomatitis depends on the severity of the disease, includes both local and general measures. Local treatment: •Anesthesia (10% spray, 5% anesthesia emulsion, Deep Freeze Spray); • processing RBCU (0,01% р-р Dimexidum, 0,1% sol etoniya, 0,06% sol , sol potassium permanganate 1:2000); • The antiviral ointment for the first 2-3 days of illness (Zovirax, Gerpevir, Anciclovir, Fladex); •Applications of enzymes (lysozyme, deoxyribonuclease; • Keratoplasty since 3-4 day of the disease (Karotolin, Vinilin, rosehip oil, Aevit; Solcoseril ointment, spray Livian, Gipozol, panthenol, olazol ) •Physiotherapy (UVR from 3 to 5 treatments, laser therapy). General treatment: Antiviral therapy for severe forms (Acyclovir, Herpevir); Desensitization therapy (Tavegil, Fenkarol, calcium gluconate, Claritin, Supradin, Telfast, Tsetrin); Anti-inflammatory and antipyretic therapy (Aspirin, , Amizon, Nimesil etc); Restorative therapy (ascorbic acid, multivitamins, high-calorie, bland diet with plenty of fluids); immunomodulatory therapy (Cyclopheron, Dekaris, Immunal, Interferon). Acute aphthous stomatitis - auto-infection desease, which occurs under the influence of conditionally streptococcus-staphylococcus microflora in oral cavity with the reduction in reactivity in the organism. Sensitization of the organism is development from the streptococcus- staphylococcus microflora (prof. PT Maksimenko) and trauma of oral mucosa (PhD. R.I. Anishenko). As a consequence develops an immune reaction of delayed-type (the type of Artyuse`s Phenomenon ) with the formation of aphthae. The disease begins with a general malaise, body temperature rises to 39- 40°C, headache, sore throat . During the development of the disease against the background of diffuse hyperemia appear many elements of destruction - aphthae, which are rounded, covered with fibrinous coating. Surrounded by a whisk (strip) of hyperemia and are located on the mucous membranes of the lips, chics, , lateral surface of the . Apthae are very painful. Differential diagnosis: - viral lesions of the oral mucosa (acute herpetic stomatitis, gerpangina, foot and mouth disease, shingles) - allergic lesions oral mucosa, - , - acute necrotizing ulcerative stomatitis. In cytogramme can be found: strepto staphylococci, strands of fibrin, destroyed and white blood cells. In the analysis of peripheral blood: - leukocytosis, accelerated erythrocyte sedimentation rate. In the immunogram: -increase in titer antistreptococcic antibodies ,appearance of plasma cells. Treatment of acute aphthous stomatitisis made by the scheme, which was introduced for the treatment of acute herpetic stomatitis with the primary purpose of antibacterial drugs (antibiotics, sulfonamides). In association with viral infection additionally prescribe antiviral drugs. At the Department of Therapeutic Dentistry Candidate of Medical Sciences Anischenko RI. developed a method for the treatment of acute aphthous stomatitis.moderate and severe degrees of severity antibacterial medicine «Hlorofillipt» together with enzymes (trypsin, chymotrypsin, himopsin), .what allowed to increase the effectiveness of local treatment.

6. Material for self-control: Test tasks: 1. What are the modes of transmission of herpes infection? A Contact A. Parenteral B. Airborne route C. Alimentary D. Genital

2. The primary element of the lesion in acute aphthous stomatitis is: A. B. Erosion C. Aphtha D. Vesicle E.

3. Elements of lesions in acute herpetic stomatitis: A. , erosion B. Erythema, erosion C. Aphthas, D. Vesicles, erosions E. , scars

4. In herpetic stomatitis in the cytologic tests can be found such cells: A. Acantholytic B. Big multicore C. Atypical D. Pirogov - Langhans E. Monocytes

5. The results of bacteriological tests for acute herpetic stomatitis: A. The fungus of the genus Candida B. Treponema pallidum C. Strepto-staphylococci D. Koch's bacillus E. Fusospirillary symbiosis

6. The localization of elements of lesions in acute herpetic stomatitis: A. The mucosa of the nose, lips, cheeks B. The mucosa of the nose, cheeks C. The mucosa palate, gums, lips D. The mucosa of the larynx E. The mucosa of the tongue, cheeks

7. The localization of elements of lesions in acute aphthous stomatitis A. The mucosa of the nose, lips, cheeks B. Buccal mucosa, lips, floor of the mouth, soft palate C. The mucosa of the soft palate , cheeks, lips, gums D. The mucosa of the larynx, the palate E. The mucosa of the tongue, cheeks, nose, palate

8. What is gum disease in acute aphthous stomatitis? A. Parodontitis B. Ulcerous C. Hypertrophic gingivitis D. Catarrhal gingivitis E. Without any changes

9. Possible manifestations on the face while person has acute aphthous stomatitis: A. Erosion B. Pustules C. Ulcers D. Erythema E. Bubbles

10. The results of bacteriological tests in acute aphthous stomatitis: A. The fungus of the genus Candida B. Treponema pallidum C. Strepto-staphylococci D. Koch's bacillus E. Fusospirillary symbiosis

Situational tasks: 1. The patient E. who is 16 years old, came to the hospital with complaints of pain in the mouth, with appearance of ulcers, and high body temperature 38°С, headache. On examination: oral mucosa is hyperemic, edematous. On the palate, gums, lips numerous erosion with scalloped edges, covered with grayish-white plaque. What is the most likely diagnosis? A. Acute herpetic stomatitis B. Erythema multiforme C. Acute aphthous stomatitis D. Foot and mouth disease E. Allergic stomatitis

2. The patient M., 27 years old, has a and the appearance of vesicles .which are located on the boundary of skin and mucous membranes. Which methods of examination can confirm the presence of herpes simplex virus in patients organism? A. Microbiological and allergic B. Virological and biological C. Biological and serological D. Microbiological and serological E. Virological and serological

3. The young man 17 years old, complains of pain in the mouth, which makes it difficult to use food, headache, fever. Got ill 3 days ago after hypothermia. Objectively: on the red border of the lower lip on the right against the background of hyperemia are crusts. On the oral mucosa of the lips, palate against the background of diffuse hyperemia, marked isolated and fused with each other erosions covered with plaque, painful when touch. What kind of additional methods of examination will give an opportunity to confirm the diagnosis? A. B. Luminescent C. Smear microscopy D. Cytology E. General analysis of blood

4. The patient M, who is 25 years old, came to dentist complaining of pain in the mouth and the appearance of unclers on the mucosa. The doctor came to the conclusion that mucosal lesions are herpetic nature and designated drug which inhibits the synthesis of viral nucleic acid. What drug is it? A. Acyclovir B. Rimantadine C. Furazolidone D. Biseptol E. Oksolin

5. The patient D., who is 23 years old complaining of pain in the mouth,On examination of the oral mucosa were found multiple areas of necrotic epithelium round or oval in shape up to 5 mm surrounded by a rim of hyperemia,The bottom elements lesions covered with fibrinous plaque which is difficult and painful to be removed. Which diagnosis meets the clinical picture? A. Acute herpetic stomatitis B. Acute aphthous stomatitis C. Acute ulcerative stomatitis D. Foot and mouth disease E. Erythema multiforme

6. The patient B suffered a severe form of acute herpetic stomatitis and is in a period of extinction of the disease. What should be supplemented with treatment during this period? A. Protein degrading enzyme B. drugs C. Weak D. Viricide drugs E. Keratoplastic drugs

7. During the cytological examination of the contents of the bubbles was found neutrophils, with varying degrees of destrophy and resident as well as layers of epithelial cells with the phenomena of polymorphism and polynuclear giant cells- ballooning distrophy cells. What this characterizes? A. Acute aphthous stomatitis B. Acute ulcerative stomatitis C. Acute herpetic stomatitis D. Chronic recurrent aphthous stomatitis E. Erythema multiforme

8. The girl who is 18 years old, after hypothermia was observed malaise fever, pain during the using of food. She is a worker on chemical factory. The patient has enterocolitis. Objectively: on hyperemia, edema oral mucosa are located numerous and erosions which were formed after the disclosure of bubbles. There is multiple caries.How do you think what was the cause of the disease? A. Bacterial B. Unhealthy working conditions C. Oral hygiene D. Pathology of the gastrointestinal tract E. Herpes simplex virus

9. The patient С., 27 лет, after hypothermia complaining of general weakness, fever to 38,5 ° C, cough, runny nose, pain on swallowing. Objectively: by edema and hyperemia of the oral mucosa noted increased vascular pattern, hemorrhage , plaque on the tongue, numerous bubbles, that contain a clear exudate. Which of the following drugs is etiotropic? A. B. Antihistamines C. Antibiotics D. Sulfa drugs E. Antivirals 10. The patient I,who is 23 years old came to dentist the second day after the beginning of the desease.the diagnose is acute aphthous stomatitis modrate degree of suverity What are the ways for the processing elements of destruction which should be assigned at first? A. Ointment with , antiseptics B. Ointment with antibiotics, C. Ointment antiviral, D. Ointment with sulfonamides, enzymes E. Ointment with proteolytic enzymes

7. Literature: Basic sources 1. Oral mucosa diseases: Textbook / M. Yu. Antonenko, O.F. Nesyn, S. A. Shnayder [et al.]; by ed. A. V. Borysenko. — Odesa: Print house, 2015, - 328 p. 2. Prof. Nikolishin A.K., prof. Kindij D.E., doc. Litovtshenko I.U., doc. Ilenko N.N., as. Geranin S.I. Academic Case History of Therapevtic Stomatology. – Poltava 2009. – 59 р. 3. Nikolishin A.K., Ilenko N.N., Geranin S.I. Oral mucosa diseases: methodical recommendations for self-work V-yeas students. – Poltava 2009. – 228 р 4. Petrushanko T.O. Academic case history of therapeutic stomatology/ T.O. Petrushanko, I.Y. Lytovchenko, I.Y. Popovich - Poltava, 2015. – 60 p. Additional sources 1. Application of Different Medicinal Forms in Dental Practice / І. Hrynovets, A. Mahlovanyy, I. Deneha O.Ripetska, V. Hrynovets, A. Buchkovska / Danylo Halytsky National Medical University in Lviv. – Lviv: Monograph, 2016. – 105 s. 2. Ruocco V., Gombos F. Sintesi dermatostomatologica.- Padova, 1988. – 359 p. 3. Strasburg M., Knolls G. Diseases of the Oral Mucosa a color atlas. – Chicago, 1994. – 803 p. 4. Sturdevant C.M. The Art and the Science of Operative Dentistry. – Mosby. – New-York. – 1995. Еlectronic resources: 1. Electronic resource [http://dental-ss.org.ua/load /kniga_stomatologia /terapevticheskaja/8] 2. Electronic resource [http://www.stomatkniga.ru/index.php?start=48] 3. Electronic resource [http://stomatbook.blogspot.com/p/blog- page_14.html] 4. Electronic resource [http://www.mosdental.ru/Pages/Page28.1.html] 5. Electronic resource [http://mirknig.com/knigi/nauka_ucheba/ 1181309066-terapevticheskaya-stomatologiya-uchebnik.html

Methodical guidelines prepared assistant of the department N.V. Kotelevskaya