Changes in the uterus and ovaries in the secretion phase. Phase of desquamation, regeneration of the uterine cycle

- an inflammatory-dystrophic lesion of the mucous membrane of the tongue, characterized by the formation of smooth, bright red foci with a whitish border, cracks and furrows due to uneven exfoliation of the epithelium. Desquamative glossitis may be accompanied by a burning sensation, tingling of the tongue, irritation when eating, a violation of taste sensations. The diagnosis of desquamative glossitis is based on clinical picture, data from a visual examination of the oral cavity, morphological, biochemical, microbiological, immunological studies, ultrasound. With desquamative glossitis, treatment is aimed at eliminating causally significant factors.

General information

Desquamative glossitis (“geographical” tongue) is a pronounced focal rejection of the epithelium of the mucous membrane of the tongue, associated with a violation of the keratinization process and degenerative changes in the filiform papillae. Against the background of the normal mucosa of the tongue, desquamation foci of various sizes and shapes appear, resembling a geographical map with their outlines. Foci of desquamative glossitis appear very quickly, mutate or disappear, usually migrating from one area of the tongue to another. Desquamative glossitis is relatively common in children, mainly in preschoolers and schoolchildren, but can often be detected in adult patients. Desquamative glossitis is more common in females.

Causes of desquamative glossitis

The causes of desquamative glossitis have not been clearly defined. It is assumed that the changes in the mucous membrane of the tongue are based on trophic disorders. Desquamative glossitis can be an independent disease (primary) or occur against the background of an existing pathology (secondary). Primary desquamative glossitis can develop as a result of trauma to the tongue with sharp edges of the teeth or improperly fitted dentures, thermal and chemical burns of the oral cavity. In young children, desquamative glossitis may be due to eruption of milk teeth.

Since the mucous membrane of the tongue is extremely sensitive to all functional changes occurring in the body, the development of secondary desquamative glossitis may be due to various pathological processes. Desquamative glossitis may be accompanied by chronic diseases of the gastrointestinal tract, liver and gallbladder, malnutrition and vitamin and mineral metabolism (hypovitaminosis B1, B3, B6, pantothenic and folic acids, iron imbalance).

Desquamative glossitis occurs in diseases of the hematopoietic system, endocrine changes (during pregnancy), vegetative disorders, autoimmune pathology (systemic lupus erythematosus, systemic scleroderma, rheumatism), chronic dermatoses (exudative diathesis, psoriasis).

In the occurrence of desquamative glossitis, a certain role is played by acute infections(influenza, scarlet fever, typhoid fever, etc.), helminthic invasions, dysbacteriosis. Cases of desquamative glossitis are detected with drug intoxication - uncontrolled intake antibiotics and strong drugs. Desquamative glossitis can be hereditary (family) in nature.

Classification of desquamative glossitis

Initially, small areas appear on the surface of the tongue with a whitish-gray coating, which gradually swells and exfoliates to form a smooth patch of bright pink or red color that stands out against the background of the surrounding epithelium. The process of deepithelialization spreads along the periphery of the focus, which rapidly increases in size. In its center, atrophy of the filiform papillae is noted, but usually after 1-3 days there is a rapid regeneration of the epithelium and their restoration.

Foci of desquamative glossitis are often multiple, of different shapes and sizes, and can cover a significant area of the mucosa of the back and side surfaces of the tongue. Along the edge of the focus of desquamation, a mild inflammatory reaction is visible. Due to the change in the processes of keratinization and exfoliation, the "geographical pattern" in the language is constantly changing.

In most patients, desquamative glossitis is not accompanied by complaints, but is detected by chance during examination of the oral cavity by a dentist or otolaryngologist. Sometimes there may be discomfort and unpleasant pain on the tongue, aggravated by eating; violation of taste sensations, problems with diction; the unnatural appearance of the tongue may be disturbing.

The course of desquamative glossitis is long, chronic, its foci may disappear for a short time and reappear on the same or another part of the tongue. Exacerbation of desquamative glossitis is observed with emotional stress or relapses of somatic pathology, against which it developed. The absence of normal mucosa in the foci of desquamative glossitis contributes to the penetration of infection with the development of cracks, pain, general malaise, and enlargement of regional lymph nodes.

Diagnosis of desquamative glossitis

The diagnosis of desquamative glossitis is established by the dentist according to the history and complaints of the patient, visual examination of the oral cavity, examination of the lymph nodes and additional laboratory examination, including morphological, biochemical, microbiological, immunological, serological methods.

Desquamative glossitis is characterized by a decrease in the keratinization index by 20-50% and an increase in the number of epithelial cells ready for apoptosis by several times. With desquamative glossitis, there is a decrease in the level of serum IgA and the activity of lysozyme involved in local immunity. Exceeding the level of norepinephrine in saliva several times with desquamative glossitis indicates a spasm of the capillaries of the mucous membrane of the tongue, which contributes to the formation of dystrophic foci. An increase in the level of histamine in saliva may indicate an allergic form of desquamative glossitis.

Ultrasound of the vessels allows you to establish a decrease in the level of capillary blood flow in the tongue by 20-30%. Differential Diagnosis desquamative glossitis is carried out with secondary syphilis, lichenoid form, elimination of traumatic factors), sparing diet, if necessary - psychotherapy.

With desquamative glossitis, sedative, antihistamine, vascular, anti-inflammatory drugs, vitamin-mineral complexes, biostimulants can be used. When feeling burning and pain, antiseptic rinses are recommended with solutions of citral, soda, chlorhexidine; applications on the affected areas of keratoplastic agents (oil solution of vitamin A, rosehip oil,), local analgesics (anesthesin in glycerin, pyromecaine). If necessary, apply antibacterial, antifungal drugs, immunomodulators. With severe pain, novocaine blockades are prescribed in the region of the lingual nerve. Physiotherapy of desquamative glossitis includes drug electrophoresis, ultraphonophoresis, SMT therapy, ultrasound therapy.

Prediction and prevention of desquamative glossitis

Desquamative glossitis does not pose a threat to the patient's health, the likelihood of malignancy of the foci is excluded. To prevent primary desquamative glossitis, it is necessary to eliminate traumatic factors (grinding fillings, fitting dentures), avoiding smoking, drinking alcohol, and irritating food. Prevention of secondary desquamative glossitis consists in the treatment of the underlying diseases of which it is a manifestation.

Inflammation of the tongue, accompanied by keratinization and rejection of the papillae of the mucous membrane (desquamation), is called desquamative glossitis. The diagnosis is not difficult, since the tongue has a characteristic appearance.

But in order to effectively treat the disease, it is necessary to identify its underlying cause. It was found that women and children are more susceptible to pathology. In adulthood, desquamative glossitis is rare.

What language changes characterize the disease?

The normal appearance of the tongue is pale pink in color and has a velvety surface on the back and edges. This is due to the formation of numerous papillae from the cells of the mucous membrane. They are outgrowths, covered with stratified squamous epithelium, differ in shape, size and functional purpose. Vessels, sensitive nerve endings are suitable for them.

Filiform papillae are the most numerous. They occupy the entire front surface of the tongue and the marginal part. The height of protrusions of keratinizing type cells is within 0.6–2.5 mm (they are longer closer to the tip). Desquamated scales form on the surface of the cells. They give the tongue a whitish color. The process is ongoing.

In case of violations, the rejection of keratinized cells is delayed, which is manifested by a white coating (doctors say "coated tongue"). The filiform papillae do not have taste buds and are not involved in determining the taste of food. Their main function is to touch and hold food on the tongue so that other papillae can evaluate.

Desquamative glossitis is associated with degenerative changes in the filiform papillae. The process of keratinization and rejection of the epithelium is disrupted. The appearance of the tongue is characteristic: against the background of the usual mucosa, foci of desquamation of various shapes and sizes appear. They resemble a geographical atlas or map. Thus, the name of the feature was formed - "geographical" language.

Causes of the disease

The search for the causes of desquamative glossitis is still ongoing. Most authors agree that dystrophic changes caused by vascular disorders. There is a decrease in cell nutrition. Pathology can occur both primary (independent disease) and as a result of another disease (secondary).

Changes do not cover the entire shell, but separate areas, foci appear and disappear quickly, it seems that they migrate from one zone to another

Primary desquamative glossitis is caused by:

injury to the tongue with a sharp edge of destroyed teeth;
in children, improper eruption of milk teeth;
uncomfortable prosthesis or filling;
burns from hot food or chemicals.

Secondary glossitis appears due to the increased sensitivity of the mucous membrane of the tongue to any dysfunction in the body, pathological processes. Desquamation of the epithelium is disturbed:

with chronic diseases of the gastrointestinal tract;
pathology of the liver and gallbladder;
violation of the quality of nutrition, hunger;
changes in the vitamin and mineral composition of tissues (with a lack of vitamins B 3, B 1, B 6, folic and pantothenic acid, an impaired iron balance);
diseases of the blood and blood-forming organs;
autoimmune systemic pathology (lupus erythematosus, scleroderma, rheumatism);
endocrine disorders and functional imbalance of hormones during pregnancy;
vegetative disorder nervous system;
chronic skin diseases(psoriasis, exudative diathesis).

Less often, cases of desquamative glossitis are found in acute infectious diseases (scarlet fever, influenza, typhoid fever), helminthic invasion in children, severe dysbacteriosis, as a negative effect. medicines(antibiotics).

The baby grows a molar in the second row, this creates problems for the tongue

Special attention it is given a hereditary form if desquamative glossitis is detected in members of the same family.

Classification

Depending on the relief of the mucous membrane of the tongue and the degree of damage to the papillary layer, dentists distinguish 3 forms of desquamative glossitis. Superficial - a clear pattern of smooth bright red stripes and spots is visible on the tongue, there is a healthy mucosa around. Patients experience mild burning and itching.

Hyperplastic - characterized by foci of compaction formed by hypertrophied filiform papillae, on the tongue there is a dense coating of gray-white or yellow color. Patients feel foreign body in oral cavity, discomfort.

Lichenoid - foci of desquamation are distinguished by migration, an increase in mushroom-shaped papillae in the desquamation zone, they are surrounded by an accumulation of filiform forms. Every day the "geographical" picture is changing. People feel a burning sensation. It is more common in dental prosthetics due to the increased sensitivity of the mucous membrane of the tongue to metals that are used in dentistry.

According to morphological changes in tissues with the calculation of the keratinization index (percentage of keratinized epithelium), biochemical changes and immunological tests, the readiness of cells for apoptosis (the normal process of destruction of dying cells by tissue phagocytes), clinical types desquamative glossitis.

Microbial

Another name - dysbiotic (caused by a change in conditionally pathogenic flora) - is detected in individuals with infectious diseases respiratory and digestive systems. Morphology shows a decrease in the keratinization index by 20%, an increase in the number of cells ready for destruction by 5 times.

Bacteriological examinations from the oral cavity reveal pathogenic microorganisms ( Staphylococcus aureus, β-hemolytic streptococcus) and conditionally pathogenic (clostridium, staphylococcus, corynebacterium). Immunological analysis indicates reduced level immunoglobulin A (IgA), which provides local immunity, and lysozyme activity in saliva.

Biochemical tests provide information about a decrease in the hormone norepinephrine. The study of blood flow using the Doppler type of ultrasound diagnostics shows a decrease in the volume of blood passing through the capillaries of the tongue by 20–30% of normal level.

candida

It is usually considered a concomitant symptom of inflammation of the oral cavity, pharynx, ears, intestinal dysbacteriosis. Plaque and areas of desquamation do not migrate, the epithelium grows according to the hyperplastic type, blast forms of fungi, pseudomycelium are detected in it, exceeding the norm by almost 9 times.

Tissue morphology shows a decrease in the keratinization index by 30% (this is attributed to the toxic effect of fungi), the number of epithelial cells prepared for lysis.
Immunologically, a 3-fold decrease in the level of immunoglobulin A, with a decrease in lysozyme activity, has been proven.

neurogenic

Glossitis of the neurogenic type is distinguished by the presence in the patient neurological symptoms or mental disorders. Usually a person is observed about:

asthenoneurotic or hypochondriacal syndrome;
neurasthenia;
various phobias (fears).

Phobias in appearance healthy person not advertised, but cause an unexpected reaction

In such patients, the content of norepinephrine in the blood is increased by 7 times. A study of the blood flow of the tongue shows spasms of capillaries and foci of dystrophy. The conclusion causes carcinophobia (fear of cancer) in patients. The keratinization index is reduced by half, and the mass of epithelial cells prepared for apoptosis is increased by 3 times. There is usually a decrease in saliva production.

Allergic

According to the name, pathology accompanies chronic allergic diseases:

urticaria;
diathesis;
vasomotor rhinitis;
medicinal and food allergies;
a pronounced reaction to the pollen of plants and flowers.

At the same time, the content of histamine in the oral cavity increases by 2 times. The index of keratinization is reduced slightly. The number of cells ready for apoptosis is increased by 2 times.

Mixed

It is expressed in a combination of signs of candidal and allergic desquamative glossitis.

How does the disease manifest itself?

Symptoms of desquamative glossitis often occur without obvious causes. Less commonly, a person first experiences vague pain in the tongue (glossalgia), numbness in the mouth. Almost 50% of patients have a combination with folding of the tongue. Not everyone has complaints. In most cases, the desquamative process is detected by chance at an appointment with a dentist or an otolaryngologist.

Sometimes patients report discomfort, especially when eating, some have problems with pronunciation of words and a violation of taste. Usually worried about the abnormal appearance of the tongue. First, small areas appear on the surface irregular shape covered with a whitish-gray coating.

Penetration of infection into the deep layers can cause abscessing, as seen in the photo

Then the top layer swells and flakes off, and in its place remains a smooth, bright spot of pink or red. It stands out sharply against the background of the surrounding white-pink hue. The process of disappearance of epithelial cells begins from the periphery of the focus. Due to this, in the central part, the filiform papillae atrophy, the inflammatory zone is visible along the edges, and the focus itself increases in size.

Recovery occurs in 2-3 days. Desquamation foci are multiple and located on the back and sides of the tongue. The mucosal picture is constantly changing due to non-simultaneous transformations in different foci. The disease is long-term chronic course. The "geographical" pattern may temporarily disappear, then reappear in the same place or nearby.

Characterized by exacerbations after stress, against the background of relapses of other chronic diseases.

It is important that there is no normal mucosa in the foci. This means that an infection penetrates through them much faster, a local reaction appears in the form of cracks, painful inflammation. Possible increase submandibular lymph nodes and general malaise.

How is the diagnosis carried out?

Suspicion of the diagnosis arises after questioning the patient about sensations in the mouth and examination appearance language. For reliable confirmation, dentists use laboratory methods and study of morphological structure, blood circulation, local immunity. To establish the type of desquamative glossitis, the keratinization (keratinization) index is calculated. With the disease, it decreases by 20-50%.

According to the morphological composition of cells, the mass of epitheliocytes ready for apoptosis matters. Immunity is characterized by a drop in the level of serum IgA and salivary lysozyme. The biochemical method determines the content of norepinephrine in saliva. Enhanced level indicates spastic contraction of capillaries and malnutrition of the papillae with cell degeneration.

Visual inspection - the first stage of diagnosis

Another important biochemical indicator- histamine level. Exceeding the norm indicates the allergic origin of glossitis. Bacteriological analysis by sowing a smear from the surface of the tongue allows you to establish the pathogenic flora that caused or joined. For exact definition use linked immunosorbent assay, polymerase technique chain reaction.

Desquamative glossitis must be differentiated:

with secondary changes in syphilis;
lichen planus in lichenoid form;
flat form of leukoplakia;
scleroderma;
Addison-Birmer disease;
exudative erythema;
vitamin A deficiency;
galvanization.

In case of difficulties in diagnosis, the participation of specialists of various profiles is necessary: a dentist, a gastroenterologist, an otolaryngologist, an infectious disease specialist, a dermatologist, a neurologist, and a psychiatrist.

How is the desquamative form of glossitis treated?

The treatment of desquamative glossitis necessarily includes general and local measures. Treatment of exacerbations of chronic diseases of the stomach and intestines, liver and gallbladder is carried out.

A sparing diet is associated with a restriction of fatty and fried foods, smoked, hot spices and pickles, acidic foods. Nutrition should exclude fast food, canned food, hard crackers, nuts.

Children may need a course of deworming with special preparations. Be sure to prescribe complexes of vitamins and minerals to eliminate hypovitaminosis, probiotics and prebiotics to restore the balance of intestinal microflora. May be needed antihistamines, soothing. To stimulate the immune system, immunomodulators are shown (aloe, zamanihi extract, lemongrass, transfer factor).

Rosehip oil enhances healing, has a bactericidal property

Local procedures begin with a complete sanitation of the teeth, replacement of irritating dentures. To relieve sensations of pain and burning, it is recommended:

rinsing with antiseptic solutions (soda, Chlorhexidine, Furacilin);
imposition of applications on the foci with oil solutions of Retinol, rosehip, glycerin solution of Anestezin Pyromecaine;
if the pain does not disappear, do novocaine blockade of the lingual nerve.

Treatment may require antibiotics and antifungals. Effective physiotherapy treatment methods of drug electrophoresis, ultraphonophoresis, ultrasound therapy.

Desquamative glossitis usually does not cause trouble to patients, it is safe for health. Practically no transformation into a cancerous tumor of the tongue is observed. For prevention, it is necessary to normalize nutrition, stop smoking and alcohol, timely eliminate uncomfortable factors of trauma after filling teeth, installing crowns.

The state of the tongue depends on the overall functioning of the digestive organs. Therefore, in addition to daily hygienic local procedures, patients with chronic diseases digestive tract must comply with all the recommendations of the gastroenterologist and treat the underlying disease.

Desquamative glossitis is an inflammatory-dystrophic lesion of the mucous membrane of the tongue with areas of desquamation, which are the area of epithelial detachment. The disease may take various forms, and the affected areas can be located both on the back of the tongue and on the side surfaces. Treatment of the disease includes local and general therapy. A set of drugs is selected depending on the form of glossitis. Note that even after treatment, you need to monitor hygiene, it is recommended to carry out a complete sanitation of the oral cavity and exclude irritating food.

Description of the disease

Most often, the tongue contains several affected areas, less often one area is affected.

The onset of the disease is characterized by the formation of areas with a gray-white coating, which exfoliates over time and forms an area of red tint with a smooth surface, devoid of papillae. Around the desquamation are white stripes - the area of keratosis. Read more about why white spots appear in the mouth.

Very often, the course of the disease is accompanied by a folded tongue, which has several folds on the mucous membrane, which makes the inflamed area even more like a geographical map.

Causes

There are several factors that can provoke the development of desquamative glossitis. These include:

mechanical effects on the mucous membrane of the tongue during fractures and, the operation of dental structures and devices, unprofessionally installed crowns or sharp edges of the filling;
chemical or thermal burns of the mucous membrane of the tongue;
teething (including in the wrong place or direction), as a rule, these are wisdom teeth.

Desquamative glossitis can develop against the background of another disease. Most often this occurs with the following ailments:

chronic diseases of the gastrointestinal tract;
problems with the liver and gallbladder;
disorders of the autonomic and endocrine systems;
rheumatic ailments;
lack of trace elements and vitamins in the body - hypovitaminosis of vitamins B1, B3, B6, lack of pantothenic, folic acids, low level iron index);
diseases associated with the hematopoietic process;
autoimmune diseases;
some types of chronic dermatitis.

The disease can also be formed with the participation of infectious processes occurring in the body, such as scarlet fever, helminthic invasion, viral infections, influenza. Intoxication due to the use of potent antibiotics can also provoke desquamative glossitis and stomatitis. For details on the treatment of stomatitis after antibiotics, see.

Kinds

Desquamative glossitis can have the following forms of the disease:

surface form looks in the form of spots and stripes of red color with a clear border surrounding a healthy mucous membrane. After the epithelium is rejected, the back becomes smooth due to the absence of papillae. Symptoms of this form are itching and slight burning;
hyperplastic form differs from the previous one in more dense lesions, the magnitude of which is associated with hypertrophy of the filiform papillae of the tongue. The symptoms of this form are as follows: discomfort and a touch of yellow, white or gray shades;

Often with a hyperplastic form, there is a feeling of finding a foreign object in the oral cavity.

lichenoid form It is characterized by formations of affected areas of various sizes and shapes that do not have a permanent localization site and can migrate. The filiform papillae of the mucosa are distributed around the inflamed areas, and in the desquamation zones themselves, hypertrophy of the fungiform papillae can be observed.

Diagnostics

Recognition of the disease does not present any particular difficulties, since its clinical symptoms are very characteristic. Desquamative glossitis should be distinguished from diseases such as:

Lichen planus can affect not only the tongue, but also the mucous membrane of the mouth.

leukoplakia;
plaques in secondary syphilis;
hypovitaminosis B2, B6, B.2;
candidiasis.

Histological changes are characterized by thinning of the epithelium and flattening of the filiform papillae at the site of desquamation, parakeratosis and moderate hyperkeratosis in the epithelium of the surrounding areas of the lesion. In the mucosal layer itself there is a slight edema and an inflammatory infiltrate.

Treatment

Treatment of desquamative glossitis may include local and general therapy, as well as professional advice from doctors such as a gastroenterologist, endocrinologist, allergist, psychologist, psychotherapist, dermatologist. In the case of treatment of the disease, therapy of the main somatic diseases, normalization of the function of the gastrointestinal tract, sanitation of the oral cavity, including oral hygiene by a professional dentist, elimination of traumatic moments, the prescribed diet, and, if necessary, psychotherapy.

When desquamative glossitis is detected, antihistamine, vascular, anti-inflammatory, sedative medications, as well as vitamin and mineral complexes and biostimulants are used.

If burning and pain are clearly felt, the following are recommended:

applications on the affected area of preparations containing vitamin A in the composition;
local anesthetics;
antiseptic rinses with chlorhexidine, soda, citral.

If necessary, antifungal and antibacterial drugs, as well as immunomodulators, can be used. If there is severe pain, novocaine blockade can be prescribed at the site of the lingual nerve.

Physiotherapy can also be used, which includes ultraphonoresis, ultrasound therapy, SMT therapy and drug electrophoresis.

Prevention

Desquamative glossitis may pose no danger to the patient, and there is no possibility of malignancy of lesions. To warn primary symptoms diseases, eliminate all kinds of traumatic contacts with the oral cavity (for example, grind the sharp edges of fillings), exclude the use of cigarettes and alcoholic beverages, as well as irritating food.

Secondary desquamative glossitis can occur due to existing diseases in the body, of which it can be a symptom.

Video

For more details on identifying desquamative glossitis, see the video

What language changes characterize the disease?

Causes of the disease

The search for the causes of desquamative glossitis is still ongoing. Most authors agree that dystrophic changes are caused by vascular disorders. There is a decrease in cell nutrition. Pathology can occur both primary (independent disease) and as a result of another disease (secondary).

Changes do not cover the entire shell, but separate areas, foci appear and disappear quickly, it seems that they migrate from one zone to another

Primary desquamative glossitis is caused by:

injury to the tongue with a sharp edge of destroyed teeth;
in children, improper eruption of milk teeth;
uncomfortable prosthesis or filling;
burns from hot food or chemicals.

Secondary glossitis appears due to the increased sensitivity of the mucous membrane of the tongue to any dysfunction in the body, pathological processes. Desquamation of the epithelium is disturbed:

with chronic diseases of the gastrointestinal tract;
pathology of the liver and gallbladder;
violation of the quality of nutrition, hunger;
changes in the vitamin and mineral composition of tissues (with a lack of vitamins B 3, B 1, B 6, folic and pantothenic acid, an impaired iron balance);
diseases of the blood and blood-forming organs;
autoimmune systemic pathology (lupus erythematosus, scleroderma, rheumatism);
endocrine disorders and functional imbalance of hormones during pregnancy;
disorder of the autonomic part of the nervous system;
chronic skin diseases (psoriasis, exudative diathesis).

The baby grows a molar in the second row, this creates problems for the tongue

Particular attention is paid to the hereditary form if desquamative glossitis is detected in members of the same family.

Classification

Hyperplastic - characterized by foci of compaction, formed by hypertrophied filiform papillae, on the tongue there is a dense coating of gray-white or yellow color. Patients have a sensation of a foreign body in the oral cavity, discomfort.

Microbial

Another name - dysbiotic (caused by a change in conditionally pathogenic flora) - is detected in individuals with infectious diseases of the respiratory and digestive systems. Morphology shows a decrease in the keratinization index by 20%, an increase in the number of cells ready for destruction by 5 times.

Bacteriological studies from the oral cavity reveal pathogenic microorganisms (Staphylococcus aureus, β-hemolytic streptococcus) and conditionally pathogenic (Clostridia, Staphylococcus, Corynebacterium). Immunological analysis indicates a reduced level of immunoglobulin A (IgA), which provides local immunity, and lysozyme activity in saliva.

Biochemical tests provide information about a decrease in the hormone norepinephrine. The study of blood flow using a Doppler type of ultrasound diagnostics shows a decrease in the volume of blood passing through the capillaries of the tongue by 20–30% of the normal level.

candida

Tissue morphology shows a decrease in the keratinization index by 30% (this is attributed to the toxic effect of fungi), the number of epithelial cells prepared for lysis is 1.5 times increased.
Immunologically, a 3-fold decrease in the level of immunoglobulin A, with a decrease in lysozyme activity, has been proven.

neurogenic

Glossitis of the neurogenic type is distinguished by the presence of neurological symptoms or mental disorders in the patient. Usually a person is observed about:

asthenoneurotic or hypochondriacal syndrome;
neurasthenia;
various phobias (fears).

Phobias in an apparently healthy person are not advertised, but they cause an unexpected reaction.

Allergic

According to the name, the pathology accompanies chronic allergic diseases:

urticaria;
diathesis;
vasomotor rhinitis;
drug and food allergies;
a pronounced reaction to the pollen of plants and flowers.

At the same time, the content of histamine in the oral cavity increases by 2 times. The index of keratinization is reduced slightly. The number of cells ready for apoptosis is increased by 2 times.

Mixed

It is expressed in a combination of signs of candidal and allergic desquamative glossitis.

How does the disease manifest itself?

Sometimes patients report discomfort, especially when eating, some have problems with pronunciation of words and a violation of taste. Usually worried about the abnormal appearance of the tongue. First, small irregularly shaped areas appear on the surface, covered with a whitish-gray bloom.

Penetration of infection into the deep layers can cause abscessing, as seen in the photo

Recovery occurs in 2-3 days. Desquamation foci are multiple and located on the back and sides of the tongue. The mucosal picture is constantly changing due to non-simultaneous transformations in different foci. The disease is characterized by a long, chronic course. The "geographical" pattern may temporarily disappear, then reappear in the same place or nearby.

Characterized by exacerbations after stress, against the background of relapses of other chronic diseases.

It is important that there is no normal mucosa in the foci. This means that an infection penetrates through them much faster, a local reaction appears in the form of cracks, painful inflammation. Perhaps an increase in the submandibular lymph nodes and general malaise.

How is the diagnosis carried out?

Suspicion of the diagnosis arises after asking the patient about sensations in the mouth and examining the appearance of the tongue. For reliable confirmation, dentists use laboratory methods and the study of the morphological structure, blood circulation, and local immunity. To establish the type of desquamative glossitis, the keratinization (keratinization) index is calculated. With the disease, it decreases by 20-50%.

According to the morphological composition of cells, the mass of epitheliocytes ready for apoptosis matters. Immunity is characterized by a drop in the level of serum IgA and salivary lysozyme. The biochemical method determines the content of norepinephrine in saliva. An elevated level indicates spastic contraction of capillaries and malnutrition of the papillae with cell degeneration.

Visual inspection - the first stage of diagnosis

Another important biochemical indicator is the level of histamine. Exceeding the norm indicates the allergic origin of glossitis. Bacteriological analysis by sowing a smear from the surface of the tongue allows you to establish the pathogenic flora that caused or joined. For an accurate determination, enzyme-linked immunosorbent assay, the polymerase chain reaction technique is used.

Desquamative glossitis must be differentiated:

with secondary changes in syphilis;
lichen planus in lichenoid form;
flat form of leukoplakia;
scleroderma;
Addison-Birmer disease;
exudative erythema;
vitamin A deficiency;
galvanization.

How is the desquamative form of glossitis treated?

A sparing diet is associated with a restriction of fatty and fried foods, smoked, hot spices and pickles, acidic foods. Nutrition should exclude fast food, canned food, hard crackers, nuts.

Children may need a course of deworming with special preparations. Be sure to prescribe complexes of vitamins and minerals to eliminate hypovitaminosis, probiotics and prebiotics to restore the balance of intestinal microflora. Antihistamines, sedatives may be needed. To stimulate the immune system, immunomodulators are shown (aloe, zamanihi extract, lemongrass, transfer factor).

Rosehip oil enhances healing, has a bactericidal property

Local procedures begin with a complete sanitation of the teeth, replacement of irritating dentures. To relieve sensations of pain and burning, it is recommended:

rinsing with antiseptic solutions (soda, Chlorhexidine, Furacilin);
imposition of applications on the foci with oil solutions of Retinol, rosehip, glycerin solution of Anestezin Pyromecaine;
if the pain does not disappear, do novocaine blockade of the lingual nerve.

Antibacterial and antifungal agents may be needed in therapy. Effective physiotherapy treatment methods of drug electrophoresis, ultraphonophoresis, ultrasound therapy.

The state of the tongue depends on the overall functioning of the digestive organs. Therefore, in addition to daily hygienic local procedures, patients with chronic diseases of the digestive tract must follow all the recommendations of a gastroenterologist and treat the underlying disease.

Desquamative glossitis is an inflammatory-dystrophic lesion of the mucous membrane of the tongue, characterized by the formation of smooth, bright red foci with a whitish border, cracks and furrows due to uneven detachment of the epithelium. Desquamative glossitis may be accompanied by a burning sensation, tingling of the tongue, irritation when eating, a violation of taste sensations.

The diagnosis of desquamative glossitis is based on the clinical picture, data from a visual examination of the oral cavity, morphological, biochemical, microbiological, immunological studies, ultrasound. With desquamative glossitis, treatment is aimed at eliminating causally significant factors.

Desquamative glossitis is a disease of the mucous membrane of the tongue, leading to the formation on its surface of areas of desquamation (desquamation, exfoliation) of the epithelium.

Desquamation sites can have different shapes, located both on the back of the tongue and on its lateral surfaces.

The disease is quite common, its appearance does not fundamentally depend on the sex and age of the person.

Classification of desquamative glossitis

In dentistry, there are three clinical forms desquamative glossitis.

For surface form diseases are characterized by well-defined smooth, shiny bright red stripes and spots, surrounded by healthy mucous membranes, accompanied by slight itching and burning.

At hyperplastic form desquamative glossitis, focal seals are determined due to hypertrophy of the filiform papillae of the tongue with a coating of white, yellow or gray. Patients experience a sensation of a foreign body in the mouth.

Lichenoid form desquamative glossitis with migrating desquamation lesions, enlarged fungiform papillae, and a burning sensation is commonly seen in hypersensitivity mucous membrane of the tongue to various metals used in dental prosthetics.

Causes of Desquamative glossitis

Etiology and pathogenesis have not been fully elucidated. Most often, desquamative glossitis (glossitis desquamativa, "geographical" tongue, exfoliative, or migrating, glossitis) occurs in diseases of the gastrointestinal tract, vegetative-endocrine disorders, rheumatic diseases (collagenosis).

It is also assumed that in the occurrence of desquamative glossitis, a certain role is played by viral infection, hyperergic state of the body, hereditary factors. The disease occurs equally often in different age groups, more often in women.

Symptoms of Desquamative Glossitis

The process begins with the appearance of a whitish-gray area of opacification of the epithelium with a diameter of several millimeters. Then this area swells and in its center the filiform papillae are exfoliated, exposing a bright pink or red area of a rounded shape, which stands out against the background of the slightly raised zone of epithelium opacification surrounding it. The area of desquamation rapidly increases, keeping even round outlines, but the intensity of desquamation decreases. The zone of desquamation of the epithelium can be of different shapes and sizes and is a reddish spot. Sometimes areas of desquamation are in the form of rings or half rings. In the area of desquamation, fungiform papillae are clearly visible in the form of bright red dots. When the focus of desquamation reaches a significant size, its boundaries blur in the surrounding mucous membrane, and in the center, after desquamation, normal keratinization of the filiform papillae begins to recover, while in the areas of keratinization, on the contrary, desquamation occurs.

The centers of a desquamation can be single; but more often they are multiple and, as a result of constantly changing processes of keratinization and desquamation, are layered on top of each other. Against the background of old foci, new ones are formed, as a result of which the shape of the desquamation sites and the color of the tongue are constantly changing, which gives the surface of the tongue a look reminiscent of a geographical map. This was the rationale for the names "geographic language", "migratory glossite". A rapid change in the outlines of desquamation foci is characteristic, the picture changes even when examined the next day. Desquamation foci are localized on the back and sides of the tongue, usually not extending to the lower surface.

In most patients, especially in children, changes in the tongue proceed without any subjective sensations and are detected by chance during an examination of the oral cavity. Only a few patients complain of burning, tingling, paresthesia, pain from irritating food. Patients are also concerned about the strange appearance of the tongue; carcinophobia may develop. Emotional stressful states contribute to a more difficult course of the process. Desquamative glossitis that occurs against the background of the pathology of the gastrointestinal tract and other systemic diseases can periodically worsen, which is often due to exacerbation of somatic diseases. Exacerbation of desquamative glossitis is accompanied by an increase in the intensity of desquamation of the epithelium of the mucous membrane of the tongue. Desquamative glossitis in about 50% of cases is combined with a folded tongue.

The disease lasts indefinitely, without causing concern to patients, sometimes disappears for a long time, then reappears in the same or other places. There are cases when desquamations occur predominantly in the same place.

Diagnosis of Desquamative glossitis

Recognition of the disease does not present any particular difficulties, since its clinical symptoms are very characteristic.

Desquamative glossitis should be differentiated from:
- red lichen planus;
- leukoplakia;
- plaques in secondary syphilis;
- hypovitaminosis B2, B6, B.2;
- allergic stomatitis;
- candidiasis.

Treatment of Desquamative glossitis

If there are no complaints and discomfort treatment is not carried out. When a burning sensation, pain occurs, sanitation and rational oral hygiene, elimination of various irritants is recommended. Hygienic recommendations are especially relevant in the case of a combination of desquamative glossitis with a folded tongue, in which anatomical features buildings create favorable conditions for the reproduction of microflora in the folds, which can cause inflammation, causing pain.

If there is a burning sensation, pain, light antiseptic rinses, irrigations and oral baths with a solution of citral (25-30 drops of 1% citral solution per half a glass of water), applications of 5-10% suspension of anesthesin in an oil solution of vitamin E, applications of keratoplastic agents ( oil solution vitamin A, rosehip oil, carotene, etc.).

Good results are obtained by calcium treatment with pantothenate (0.1-0.2 g 3 times a day orally for a month). In some patients, a positive effect is noted from the use of novocaine blockades in the region of the lingual nerve (for a course of 10 injections). With severe pain, it is advisable to prescribe local anesthetics. The identification and treatment of comorbidities is mandatory.

This treatment is symptomatic, it is aimed at eliminating or reducing pain, reducing the frequency of relapses. However, there are still no means of completely eliminating the recurrence of the disease, especially in the elderly. Often develops cancerophobia. Prevention of such conditions can be individual conversations with patients and the correct deontological tactics.

The prognosis of the disease for life is favorable, the possibility of malignancy of desquamative glossitis is excluded.

Prediction and prevention of desquamative glossitis

Desquamative glossitis does not pose a threat to the patient's health, the likelihood of malignancy of the foci is excluded.

To prevent primary desquamative glossitis, it is necessary to eliminate traumatic factors (grinding fillings, fitting dentures), avoiding smoking, drinking alcohol, and irritating food. Prevention of secondary desquamative glossitis consists in the treatment of the underlying diseases of which it is a manifestation.