Why does stomatitis appear on the cheek? Cheek biting - causes and treatment Inner cheek disease

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In this group, studies were carried out in 12 (11.3%) patients with locally advanced malignant processes of the buccal mucosa.

Of the 12 patients operated on, operations only on the primary lesion were performed in 6, while in the rest - combined operations with simultaneous removal of neck tissue.

Among the features of surgical interventions, it should be noted the need for wide electrical excision of the tumor with a deviation of 5 cm from its edge and inclusion of the skin and mucous membrane of the cheek in the block to be removed.

After such operations, through cheek defects of various shapes and sizes are formed.

For defects up to 4 cm in diameter, plastic surgery was performed with local tissues. Closure of large defects was performed using a Filatov stem, as well as skin flaps on a feeding pedicle formed on the lateral surface of the neck. An example of a successful combined operation for locally advanced cancer of the buccal mucosa is the following clinical observation.

Clinical example

Patient G., 52 years old, was in the department of head and neck tumors of the Oncology Research Institute from January 16 to March 18, 1975 for cancer of the mucous membrane of the right cheek with metastases to the lymph nodes of the neck on the right, stage IIIb, T4N1M0. He has been ill since April 1974, when, after an injury, an ulcer appeared on the mucous membrane of the right cheek, which quickly increased in size. For five months I treated myself with ointments, but without effect. When the tumor grew into the skin of the cheek, he went to the oncology clinic at his place of residence and was sent to the Scientific Research Institute.

Upon admission to the department, the patient had a large tumor ulcer on the mucous membrane of the right cheek, starting from the 4th tooth to the corner of the mouth, growing into all layers and skin up to 8 cm in diameter. On the right neck, enlarged lymph nodes were detected, dense, displaceable, up to 1.5 cm in diameter. Histologically, No. 112206-14 is squamous cell keratinizing carcinoma. The result of a cytological examination of enlarged lymph nodes No. 60425 - the picture is suspicious for cancer.

In terms of the combined method of treatment, from October 21 to November 15, 1974, a course of preoperative remote gamma therapy was carried out on the area of ​​the primary lesion and the area of ​​regional metastasis at a dose of 47.4 Gy with a slight reduction in the tumor.

At the 2nd stage of treatment, on January 28, 1975, a wide electrical excision of the tumor was performed on the right cheek with marginal resection of the alveolar process of the lower jaw, and fascial-sheath excision of the tissue of the right cheek. Tracheostomy.

Operation description. After appropriate treatment of the skin of the right half of the face and neck, a T-shaped incision was made in the skin of the neck. Skin flaps are separated to the sides. The sternocleidomastoid muscle was separated from the case. Then - the release of tissue with enlarged lymph nodes of the lateral triangle of the neck along the neurovascular bundle, accessory zone, submandibular and mental triangles along with the submandibular salivary gland.

The accessory nerve is traced and preserved along its entire length. The tissue of the neck on the right with enlarged lymph nodes was removed. Hemostasis. The wound was treated with antibiotics and tightly sutured in layers. An active rubber drainage was introduced into the supraclavicular area. Then - surgery on the primary lesion.

Having retreated 5 cm from the edge of the tumor, a wide electrical excision of the tissues of the right cheek was performed with marginal resection of the alveolar edge of the lower jaw at the level of 8-4 teeth. As a result, a through defect up to 5 cm in diameter was formed. The mucous membrane was restored with local tissues, and the skin defect was restored with a flap on the feeding pedicle from the lateral surface or on the right.

Silk sutures are placed on the skin and mucous membrane. A tracheostomy was performed with the introduction of tracheotomy tube No. 6. Aseptic dressing.

Histological examination No. 11420-1-21 - squamous cell keratinizing cancer of the mucous membrane with invasion of all layers to the skin. In the lymph nodes there are cancer metastases of the same structure. The postoperative course is smooth. Healing by first intention. Currently, there are no signs of relapse or metastases (Fig. 25).

Rice. 25. Patient G. 11 years after combined surgery for locally advanced cancer of the mucous membrane of the right cheek

Postoperative period

In the early postoperative period, two patients died (one from arrosive bleeding from the carotid artery, the other from pulmonary embolism). As observations have shown, patients die in the first year after surgery. Thus, three patients died within 6 to 14 months after surgery from progression of the malignant process with spread to the pterygomaxillary fossa at the base of the skull.

Therefore, the spread of the process to this area, grade III trismus, should be considered a contraindication to performing extended surgery for advanced cheek cancer. Of the 6 combined operations, neck lymph nodes were removed for prophylactic purposes in three patients.

Metastases were not found in any case. Of the 12 patients, 6 lived from 1 to 11 years, 2-5 years or more, which is 40% in relation to the observed patients, therefore extended and combined operations for locally advanced cancer of the buccal mucosa should be considered justified.

The effectiveness of surgical treatment of cancer patients is usually judged by 5-year survival after surgery. Let us first consider the life expectancy of patients depending on the volume and location of the surgical intervention (Table 19).

Table 19. Life expectancy of patients with cancer of the oral mucosa depending on the location of the process

The worst results were obtained when the malignant process was localized in the area of ​​the alveolar process of the mandible and the floor of the mouth. The highest mortality rate from disease progression occurs in the first year after surgery.

Thus, out of 41 patients who died from disease progression, 29 died in the first year after extended operations. The main percentage was made up of people with cancer of the root of the tongue and the mucous membrane of the floor of the mouth (19 patients) (Fig. 26).

Rice. 26. Survival of patients with locally advanced cancer of the oral mucosa depending on the location of the process: 1 - tongue; 2 - mucous membrane of the floor of the mouth; 3 - alveolar process of the lower jaw; 4 - cheek

However, despite the extensive scope of surgical intervention, the overall life expectancy of patients on average was quite encouraging. These results coincide with the literature data (Gremilov V. A., 1966; Paches A. I., 1971; Lyubaev V. L., 1971; Falileev G. V., Krugovoy B. A., 1979).

Studying the features of extended and combined operations in 106 patients with locally advanced cancer of the oral mucosa allows us to clarify the indications for their use, improve their implementation, develop a number of our own methods and approaches, as well as plastic surgeries to restore tissue defects. Thus, in case of tongue cancer (47 patients), it is always necessary to include the corresponding half of the lower jaw with disarticulation in the block of tissue to be removed.

This allows the operation to be performed ablastically and radically. We have proposed and introduced a new approach for surgical removal of advanced lingual root cancer through lateral pharyngotomy with temporary resection of a segment of the horizontal ramus of the mandible.

This access allows for a good view of the root of the tongue, contributes to a more radical operation, and skin and subsequent bone grafting accelerates the rehabilitation of this severe category of patients.

The use of a deltopectoral flap for primary plastic surgery and formation of the floor of the mouth in 7 out of 28 patients operated on for advanced cancer of the mucous membrane of the floor of the mouth allows for immediate closure of extensive tissue defects and significantly facilitates rehabilitation.

A study of the results of extended operations in 19 patients with locally advanced cancer of the mucous membrane of the alveolar process of the mandible suggests the advisability of performing through resection of the mandible with disarticulation, since the surgical intervention takes place in more ablastic conditions.

14 patients died in the hospital from various causes, which is 13.2% in relation to all operated patients. This is due to the severe general condition of the patients before surgery and the expanded scope of surgical interventions.

Analysis of the causes of relapses in 30 patients (27.7%) made it possible to determine contraindications to performing extended and combined operations for locally advanced cancer of the oral mucosa. These are: spread of the tumor to 2/3 of the tongue or its total damage, to the lateral wall of the pharynx to the base of the skull, intimate attachment or germination of metastatic nodes into the wall of the common carotid artery.

Features of metastasis

The study of the characteristics of metastasis in 47 patients (44.3%) made it possible to determine tactics in relation to regional metastases. Thus, if regional metastases are clinically determined before surgery, it is necessary to perform a combined operation, i.e., simultaneous removal of the primary lesion and areas of regional metastasis.

In the absence of clinical metastases in the neck, the operation can be performed in two stages: first, an extended operation is performed on the primary lesion, and then, 3-4 weeks after its healing, a fascial-sheath excision of the neck tissue is performed.

The exception is cancer of the root of the tongue and body of the tongue, where in all cases it is necessary to perform a simultaneous operation on the primary lesion and areas of regional metastasis. The main factor determining the prognosis after radical surgery is the stage of the disease.

The differences in long-term results by stage of the disease can be judged from the data in Table. 20. Thus, the lowest of them were noted for relapses of cancer of the oral mucosa after radiation therapy, confirming the aggressiveness of radioresistant forms of cancer of the oral mucosa.

Table 20. Life expectancy of patients with cancer of the oral mucosa depending on the extent of the tumor process

Analysis of long-term results showed that 16 patients lived 5 years or more. This allows us to talk about the justification for performing extended and combined operations for locally advanced mucosal cancer

In the process of diagnosing cheek cancer, photos show that the main provocateur of the disease is tobacco. Most often it affects older men. Women get sick about five times less often. In exceptional cases, it can be seen among sick young children.

Who is susceptible to the disease?

The lifestyle of a modern person increases the likelihood of cancer. Drinking alcohol, smoking, and chewing tobacco can provoke various formations on the mucous membrane.

No one can give an exact answer to the question of what provokes the growth and development of cancer cells. But modern developments allow us to draw some conclusions and take preventive measures.

Attention! Changes in the structure of the oral epithelium may be benign. Constant monitoring of the condition of the tumor will allow timely diagnosis of the degeneration of such a tumor into a malignant one and prescribe treatment.

Symptoms of the disease

The first symptoms of the disease are very easy to miss. Small formations, lumps or sores do not cause obvious discomfort. Over time, the inconvenience becomes greater. They grow and increase in size. A person may experience constant pain in the mouth. Very often the disease occurs with thickening and numbness of the tongue.

A person’s teeth begin to fall out for no apparent reason, the gums are in a deplorable state, the jaw swells, the voice changes or disappears altogether, the lymph nodes are enlarged - this is a reason to immediately seek advice from a doctor.

It is worth remembering that the course of cancer is always accompanied by rapid weight loss.

Of course, all these signs could be a manifestation of some other illness. But you need to pay attention to them.

Tumor forms

Mucosal cancer at the initial stage, as a rule, does not attract much attention. Often, a person only learns that he may have a malignant tumor when he visits the dentist.

The following forms of the disease are distinguished:

The most common form of oncology of the mucous membranes is ulcerative. It consists of small ulcers that do not heal for a very long time and cause a lot of inconvenience to the patient. The main danger is that the cancerous node is localized in close proximity to blood vessels and spreads very quickly throughout the body.

The papillary form is considered the easiest to treat. The growths hanging towards the gums can be effectively treated and do not allow the disease to go beyond the boundaries of the formation.

The ulcerative form of cheek cancer, the photo of which shows small compactions on the mucous membrane, is characterized by rapid growth. At the same time, the surface of the cheek itself may not change its color or become just a little whitish.

Phases of cancer tumor development

The life cycle of malignant tumors consists of several phases:

• Primary;
• Active;
• Launched.

At the initial stage, small lumps or ulcers appear on the cheek. They cause a certain discomfort to a person. As a rule, no one pays much attention to the first signs. However, diagnosing the disease in this phase significantly increases the success of treatment measures.

The active phase is characterized by the appearance of painful formations. The ulcers turn into cracks. The person becomes lethargic, suffers from severe headaches, and rapid weight loss occurs. At this stage, mucosal cancer becomes obvious, and any qualified dentist will pay attention to this.

In the advanced phase, the disease may have already metastasized and damaged other organs and tissues. The likelihood of successful treatment in this case is significantly reduced.

Stages of the disease

A tumor at different stages of its development has certain symptoms. Doctors evaluate it by size, degree of damage to the body and general behavior of cancer cells.

Modern medicine distinguishes several stages of disease development:

The lower the stage of the diagnosed disease, the more successful the recovery will be. Therefore, it is very important to consult a doctor and undergo an examination at the slightest suspicious change in the mucous membrane of the cheek.

Primary diagnosis

In order to identify the problem at the initial stage of development, it is very important to conduct self-diagnosis. A careful examination of the mucous membrane will allow you to notice changes on the inner surface of the cheek in time and seek medical help.

The specialist will conduct a visual examination and assessment of the condition of the oral cavity. The first examination is carried out by a dentist, who, if a malignant tumor is suspected, refers to a consultation with an oncologist.

The oncologist uses palpation to determine the degree of penetration of the disease into the soft tissues. Next, a cytological examination of the affected tissue is performed - a biopsy. A biopsy also allows you to determine the stage of the disease and the affected area.

Attention! Only based on the results of this study can a diagnosis of cheek cancer be made.

To clarify the diagnosis, a number of other studies are carried out.

Additional diagnostic methods

To get a complete picture of the disease and determine the method of therapy, a certain number of other examinations are carried out. Among them are:

• Radiography;
• Ultrasound diagnostics;
• Computed tomography.

X-rays allow you to assess the extent of tumor damage to surrounding bone tissue. Since the bones of the skull are in close proximity to the sites of the disease, they are affected first. Radiography allows you to see metastases and assess the extent of damage to the body.

The ultrasound diagnostic method evaluates the cancerous node, its structure and area of ​​damage.

Using computed tomography, it is possible to assess the nature of the tumor: malignant or benign. Computed tomography data are decisive when prescribing a therapy method.

How to get rid of a tumor?

Modern medicine uses an integrated approach in the fight against cancer. There are several basic methods:

Surgical treatment is still the main way to combat cancer cells. Removal of formations on the mucous membrane almost always entails plastic surgery. Therefore, surgeons carefully remove the formations, trying not to capture anything unnecessary.

Depending on the stage of the disease and the extent of damage to the body, it may also be necessary to remove part of the bone tissue. This significantly complicates the rehabilitation period. Skull reconstruction is a very complex operation, both technically and aesthetically.

In the development of cheek cancer, the photo will almost always show damage to the lymph nodes. Therefore, the question of removing them is not even worth it. But this may have its own difficulties: a large number of nerve endings are localized in these areas, and their damage can lead to unpredictable consequences.

Malignant tumors are very sensitive to ionizing radiation. They accumulate a certain dose of radiation and die.

Radiation therapy cannot be used as the only treatment. Most often it comes as an addition to surgical removal.

When treating cheek tumors, the following irradiation methods are used:

• Remote;
• Contact;
• Internal (brachytherapy).

In the first case, irradiation is carried out at a certain distance from the location of the disease. With the contact method, the device is directly applied to the skin of the cheek. In rare cases, brachytherapy is used - radioactive elements are injected directly into cancer cells.

Radiation therapy has some side effects. Therefore, they approach its purpose very scrupulously.

In simple terms, chemotherapy is taking certain medications. All of them are toxic and can kill cancer cells. The main disadvantage is that healthy cells also die. This leads to a very unpleasant side effect.

Doctors have developed a certain combination of drugs that are used in treatment. For patients, chemotherapy is divided into the following types:

• Red;
• Yellow;
• Blue;
• White.

The red scheme is the most toxic. It contains the most potent drugs. Taking such medications can significantly worsen the patient's condition. But the treatment regimen in this case is not canceled.

When treating mucosal cancer, chemotherapy is carried out before preparing for surgery, as well as after it, to prevent relapse.

Any of the above treatment methods has its side effects.

So, during surgical intervention it is necessary to carry out plastic restoration of appearance. When lymph nodes are removed and nerve endings are damaged, facial numbness and disruption in the functioning of certain muscles may occur.

When using radiation therapy, the voice may disappear, pain may appear when swallowing, and appetite may be impaired. To alleviate the condition, the patient is advised to follow a diet and drink as much liquid as possible.

Chemotherapy has the most powerful effect on the body. It can be accompanied by loss of almost all hair, loss of eyelashes and eyebrows, nausea, vomiting, numbness of the limbs, etc. Some of them appear after a while.

Causes of oncology

Doctors have proven that cancer of the oral mucosa is more likely to occur in smokers. It makes little difference whether a person smokes a pipe or a cigar. Or maybe he chews tobacco. These factors can only influence the location of the tumor: cigarette lovers are more likely to develop lip cancer, and those who like to chew tobacco suffer mainly from cheek cancer.

Smoking regular cigarettes is the lesser of two evils. In this case, there is no direct contact of carcinogenic substances with the mucous membrane, and they do not cause damage to it.

Despite the fact that smoking is the basis for the growth and development of cancer cells on the mucous membrane, there are a number of factors that can also provoke and stimulate this process:

• Excessive drinking;
• Failure to comply with hygiene rules when caring for the oral cavity;
• Malocclusion;
• Dental injuries, sharp edges of fillings, poor quality prosthesis (when diagnosing cheek cancer, the photo shows all the traumatic factors);
• Herpes and papilloma viruses;
• Harmful working conditions (constant contact with asbestos is especially dangerous);
• Poor diet, lack of vitamins and macroelements;
• Weakened immunity;
• Hereditary factors.

Measures to prevent cancer

Treating the consequences can be very difficult. It is much easier to prevent mucosal cancer. In order to do this, it is recommended:

• Carefully monitor the condition of the oral mucosa;
• Periodically visit a dentist for preventative purposes;
• Carry out dental treatment in a timely manner;
• Eliminate factors of trauma to the oral cavity;
• Stop smoking or chewing tobacco;
• Minimize the consumption of alcoholic beverages;
• Do not stay in direct sunlight for a long time. If such a need arises, it is necessary to use protective equipment;
• Balance and diversify your diet.

These rules will not provide one hundred percent protection against the occurrence of a malignant tumor, but will significantly reduce the chances of its development.

Morsicatio buccarum, morsicatio labiorum, cheek and lip biting, linea alba

Version: MedElement Disease Directory

Cheek and lip biting (K13.1)

Gastroenterology, Dentistry

general information

Short description

- a type of self-induced chronic mechanical injury to the mucous membrane of the cheeks and lips that occurs when exposed to teeth and/or dentures due to many reasons.

Notes

Other changes in the gingiva and edentulous alveolar margin - K06.-

Stomatitis and related lesions - K12.-

Diseases of the tongue - K14.-

If necessary, the following codes can be used to clarify the cause:
- Mental and behavioral disorders caused by alcohol consumption - F10.-

Mental and behavioral disorders caused by tobacco use - F17.-

Other codes indicating alcohol consumption, use of or exposure to tobacco (tobacco smoke)
- Neurotic disorder, unspecified - F48.9

Reaction to severe stress and adaptation disorders - F43.-

Classification

There is no uniform classification.
It is recommended to use general clinical description parameters, including localization, extent, number, size and shape of pathomorphological changes, as well as the phase of the disease (exacerbation, remission) and the presence of complications.

Etiology and pathogenesis

Cheek biting
The most common reasons:
- anatomical and morphological features of the structure of the dental system (malocclusion - teeth located outside the dentition; expansion of the upper and lower dental arches, buccal or lingual crossbite);

Sharp cusps of chewing teeth;

Sharp edges of carious and decayed teeth;

Poorly placed fillings;

Incorrectly manufactured dentures;

A bad habit that manifests itself during nervous tension;
- mental disorders (the issue of defining such disorders as obsessive-compulsive is being discussed);
- hereditary sensory and autonomic neuropathy (Riley-Day syndrome Riley-Day syndrome is a hereditary syndrome: a combination of hypersalivation, decreased lacrimation, erythema, mental lability, hyporeflexia and decreased pain sensitivity; inherited in an autosomal recessive manner
);

Deficiency of the enzyme hypoxanthine-guanine phosphoribosyltransferase (Lesch-Nyhan syndrome Hyperuricemia (syn. Lesch-Nyhan syndrome) is a hereditary metabolic disease caused by a deficiency of the enzyme hypoxanthine phosphoribosyltransferase (EC 2.4.2.8), manifested by mental retardation, choreoathetosis, attacks of aggressive behavior with self-harm, and increased uric acid in the urine. Inherited in an autosomal recessive manner
).

Lip biting
Additional reasons to the reasons given for cheek biting:
- orthodontic pathology (bite disorders): protrusion Protrusion (in dentistry) - 1) Moving forward of the lower jaw; 2) Malocclusion, characterized by the location of part of the teeth in front of the rest
anterior teeth, mesial bite Mesial occlusion is an anomaly characterized by an anterior position of the lower jaw
, distal bite Prognathic bite (syn. distal bite) - a bite in which the incisors and canines of the upper jaw are located in front of the corresponding teeth of the lower jaw
;

Overhanging edges of fillings;

Elements of orthopedic structures.

The process of biting is similar to the formation of callus on the skin and refers to the so-called “oral keratoses”. Constant mechanical irritation stimulates the production of excessive amounts of keratin, with a subsequent change in the thickness and color of the affected mucous membrane.
Histology reveals uneven hyperplasia of the epithelium with foci of proliferation of epithelial cells in the upper layer with focal para- and hyperkeratosis and basophilic infiltration of the surface layer of the epithelium.
Microscopy and bacteriological examination reveal various microorganisms (mainly staphylococcus, streptococcus, and much less frequently - candida).

Epidemiology

Age: mostly adults

Sign of prevalence: Very common

Sex ratio(m/f): 0.5

The incidence among women is approximately twice as high as among men.
Approximately 60-75% of patients are over 35 years of age.
In general, prevalence varies significantly by geography and averages 2.2-5.5% in the adult population, although individual population-based studies indicate a prevalence ranging from 0.8-1.8% (USA) to 7-8% (Spain, India). ).

Risk factors and groups

Risk groups correspond to the etiology and include:
- malocclusion;
- dental prosthetics;
- caries;
- treatment (filling) of teeth;
- piercing.

Clinical picture

Clinical diagnostic criteria

Change in psychological status; malocclusion; presence of seals; presence of prostheses; pain; burning; discomfort; White spots; white stripes; white scales; symmetrical lesion; desquamation of the mucous membrane; swelling of the lips; swelling of the cheeks; roughness of the affected area; minor mucosal erosions

Symptoms, course

Anamnesis. When biting the cheek and lips, there is evidence of a corresponding habit in the anamnesis. There is a connection with manipulations in the oral cavity, prosthetics, and for infants - with increased, difficult sucking.
Lip biting may be a habit that relieves discomfort from temporomandibular disorder or glossodynia. Glossodynia - paresthesia in the form of burning sensations, tingling, itching in the tongue and a feeling of dry mouth; observed in diseases of the gastrointestinal tract, some lesions of the nervous system, etc.
.

Complaints. Most patients may not have any complaints. Patients with aggressive cheek and lip biting may complain of pain, burning, or swelling.
Patients may notice a sensation of thickening or roughness at the site of the lesion. Desquamation of the mucous membrane from the affected areas forces some patients to frequently spit and mechanically remove fragments of the altered mucous membrane with their teeth or tongue.

During examination the oral cavity reveals an inflamed mucous membrane with an uneven surface. The affected area appears as a spot or plaque with ragged, furry edges. Sometimes small superficial erosions are observed on the mucosa, alternating with white scales. Most often, such changes are characteristic of the mucous membrane along the line of closure of the teeth (the so-called “linea alba”).
Examination of the lips reveals swollen and hyperemic mucosa, with the lower lip most often affected. The lesions are usually symmetrical.

Conclude the presence of hyperkeratosis Hyperkeratosis - excessive thickening of the stratum corneum of the epidermis
allows the absence of changes in the lesion when wiping it with a dry sterile cloth.

A number of patients experience changes in psychological status.

Diagnostics

The diagnosis of cheek and lip biting is usually made clinically.

1. Biopsy indicated in atypical cases, as well as in cases resistant to therapy for more than 1-3 weeks.
When processing a biopsy specimen, it is mandatory to use PAS (to identify fungal infections).
The most acceptable method is to take a biopsy using tissue excision. Brush biopsy and exfoliative biopsy are not sufficiently suitable methods.

2. For differential diagnosis, some optical instruments can be used that allow you to examine and photograph the mucous membrane with high magnification. These devices use various principles for the preliminary diagnosis of cancer and other lesions of the oral mucosa. Often, the mucosal area requires pre-treatment with some reagents (for example, acetic acid).

Laboratory diagnostics

There are no specific tests to confirm or refute the diagnosis.
Bacteriological examination of the mucosa is useful due to the high degree of colonization of the damaged mucosa by staphylococcus, streptococcus and candida.

Differential diagnosis

Biting the cheeks and lips is differentiated from the following diseases and conditions:
1. Mechanical injuries of a different etiology (for example, improper brushing of teeth).
2. Chemical and thermal burns of the lips.
3. Mucosal tuberculosis. Tuberculous ulcers have undermined edges, sharp pain on palpation is noted, and small yellow dots (Trill grains) are also identified.
4. Cancer. Ulcers observed in cancer have a dense base and dense edges; elements of the lesion may be slightly painful. Such ulcers do not heal long enough (more than 2-3 weeks).
5. Contact stomatitis.
6. Leukoplakia.
7. Candidal lesions of the oral cavity.
8. Stomatitis associated with smoking.
9. Congenital dyskeratosis.
10. Lichen planus.

Clinical features of mechanical hyperkeratosis in comparison with other whitish lesions of the lip mucosa:
1. The resulting spots and plaques are described as “rough, shaggy, often flaky.”
2. Lip damage is usually bilateral. The lesions are located in the part of the mucosa that may come into contact with the teeth.
Proliferative leukoplakia may also have bilateral lesions (sometimes symmetrical), but leukoplakia will often affect areas that do not have contact with the teeth (for example, the gums).

Complications

Biting the cheeks and lips has a benign course.
Complications include the formation of decubital ulcers and their infection with the development of stomatitis.
Risk of developing leukoplakia Leukoplakia is a dystrophic change in the mucous membrane, accompanied to varying degrees by keratinization of the epithelium; refers to precancer
is under discussion and does not yet have a good evidence base.

Treatment abroad

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Treatment

Diet. No special diet is required if the condition of the teeth and the absence of pain allows you to chew fairly coarse food. Reasonable restrictions include avoiding irritating ingredients and excessively rough foods that can increase pain and/or discomfort during chewing.

The most important therapy activity is identification and elimination of the traumatic factor:
- bite correction;
- correction of new dentures or replacement of old ones;
- replacement of fillings;
- grinding of cutting edges of teeth that injure the mucous membrane.

Of particular importance is the manufacture and installation of acrylic prostheses (mouth guards), which cover the teeth and protect the cheek mucosa from injury. At a minimum, wearing them is indicated during sleep, when the patient does not control the movement of the jaws.

There is no clear evidence of the effectiveness of psychological correction methods in the treatment of cheek and lip biting, however, several studies show their effectiveness for 3 months in the treatment of such conditions.

In case of bacteriological confirmation of colonization of damaged areas, local antiseptics are indicated.

Forecast

The prognosis is favorable. The changes disappear or decrease within 1-3 weeks from the start of full therapy. In the absence of dynamics, a set of measures is indicated to exclude a malignant neoplasm (biopsy) or other causes of parakeratosis Parakeratosis is a disorder of the process of keratinization of epidermal cells, characterized by the presence of cells containing nuclei in the stratum corneum and the absence of a granular layer
and ulceration (eg, infection, AIDS).

Hospitalization

No hospitalization required.

Prevention

Getting rid of the habit of biting lips or cheeks.

Information

Sources and literature

1. "Morsicatio buccarum et labiorum (excessive cheek and lip biting)" Glass LF, Maize JC, The American Journal of Dermatopathology, No. 13(3), 1991
2. "Oral Frictional Hyperkeratosis" Catherine M Flaitz, Chief Editor: William D James, 2012
   1. http://emedicine.medscape.com -
3. "Oral frictional hyperkeratosis (morsicatio buccarum): an entity to be considered in the differential diagnosis of white oral mucosal lesions" Cam K, Santoro A, Lee JB, Skinmed journal, No. 10(2), 2012
4. "Three cases of "morsicatio labiorum" Kang HS, Lee HE, Ro YS, Lee CW., Annals of Dermatology journal, No. 24(4), 2012
5. http://o-stom.ru
6. wikipedia.org (Wikipedia)

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Cheek biting is a fairly common occurrence that is rarely considered a disease. It not only causes pain and discomfort, but also reduces the patient’s quality of life. It affects both children and adults equally.

Note:Regular trauma to the mucous membrane of the cheeks during sleep, eating or talking can have serious causes and consequences.

Table of contents:

Causes of cheek biting from the inside

A number of factors contribute to the development of this pathology. It should be noted that in the absence of treatment and the disease becomes chronic, the risk of the formation of precancerous conditions and even oral cancer increases.

Injury to the buccal mucosa is possible as a result of the following reasons:

Features of the anatomical and morphological structure of teeth and jaws that lead to cheek biting include:

• incorrectly placed with overhanging edges;
• sharp bumps on the chewing surfaces of the teeth;
• dystopic teeth, which are located in the mouth outside the dentition;
• expansion of dental arches (lower, upper);
• poorly made;
• (congenital, acquired, lingual, buccal);
• tilted to the side;
• sharp edges of damaged teeth.

Symptoms when biting the cheek

Upon examination, the patient will present the following complaints:

• pain at the site of biting the cheek mucosa;
• difficulty in daily oral hygiene;
• wound formation;
• pain when eating;
• pain while talking.

Objectively, the doctor detects a local inflammatory process at the site of injury and an uneven surface of the mucous membrane. The typical location of the wound is the line where the teeth meet on the side of the cheek. If the biting is constant and does not have time to heal, then the disease enters the chronic stage. As a result, ulcerative and erosive processes form.

Important:Some of the long-term consequences of cheek biting are decubital (bedsore) ulcers and leukoplakia.

A decubital ulcer forms at the site of regular injury to the buccal mucosa. It requires mandatory consultation with a dentist and selection of treatment. L Eikoplakia is a chronic pathology in which keratinization of the oral mucosa and inflammation in the stroma occur against the background of exogenous irritation.

Diagnostics

The main attention is paid to differential diagnosis. The wound surface resulting from biting the cheek should be distinguished from tuberculous ulcers, leukoplakia and cancer.

Tuberculosis ulcer is very painful if you touch it. It has uneven, undermined edges and yellow grain. A cancerous ulcer does not heal for a long time, more than a month. It is distinguished by the presence of a seal in the center and along the edges. in this case, it allows you to accurately determine the diagnosis.

Note:In any case, if a wound appears as a result of biting your cheek, you should first seek medical help from a dentist.

Treatment for cheek biting

To eliminate cheek biting, either as a physiological problem or as a bad habit, the patient should first consult a professional dentist. The doctor selects treatment taking into account the cause, and, if necessary, refers to other specialists (oncologist, neurologist, otolaryngologist, psychotherapist).

First aid

Before visiting a doctor, you can rinse your mouth with cold water at home.. This will help eliminate bleeding, if any, and relieve pain. Rinsing with decoctions of St. John's wort is also allowed. If you have pain, you can take a painkiller.

Basic principles of treatment for cheek biting:

If the patient is in constant pain, experiences negative emotions and bites his cheek because of this, then therapy must also include psychological help.

If the cause of the pathology is improper prosthetics, fillings, or teething, then you should visit a dentist. He will eliminate the bite of the cheek when the jaws are closed by grinding down sharp bumps or removing a tooth, making new dentures and fillings.

If you have a congenital type of malocclusion, you must contact an orthodontist. He will select the right treatment and, if necessary, install braces that will help change the position of the teeth.

For bruxism, it is sometimes recommended to make protective mouth guards for the teeth, which are used only at night.. Such devices do not allow the patient to clench his jaw very tightly during sleep and bite the mucous membrane.

Note:When biting your cheek, you should not lubricate the wound in your mouth with brilliant green or iodine, touch it with dirty hands, drink hot drinks, or self-medicate without a doctor’s prescription.

If healing of the mucous membrane is not observed during the treatment process, the wound increases in size, a hematoma appears, the pathological process has spread to the tongue, then an additional examination should be performed and a visit to the oncologist.

Betsik Yulia, medical consultant

At a dental appointment, diseases of the oral mucosa are often diagnosed. Often lesions of the oral mucosa are localized on the lateral surface of the tongue and the distal cheeks.

Most dental patients have cheeks. The cheeks have functional, anatomical and social significance. Functionally, the owners of the cheeks use them to hold food and liquid during meals, to help produce speech sounds and moisturize the oral cavity, and also use them as a sucking membrane. The anatomical cheeks consist of buccal muscles covered on the outside with skin and mucous membrane on the inside. Within these layers are located numerous minor salivary glands, sebaceous glands, neurovascular structures, buccal fat pads, and the duct of the major salivary gland opens. Socially, you can say about an arrogant person that he has “big cheeks” (play on words: cheek - impudence colloquially, approx. transl.).

This article discusses several common benign lesions that occur on the intraoral and buccal surfaces. The cheeks are also a potential site for intraoral malignancy. The purpose of the material presented is to increase the awareness of dentists and dental hygienists regarding the presentation of selected benign, precancerous and cancerous cheek lesions.

Chemical burns

Chemical burns to the buccal mucosa often occur following the application of local anesthetics in an attempt to relieve toothache. Aspirin, acetaminophen, and various medical mixtures can cause chemical burns. Chemical burns can be classified by severity depending on the area of ​​edema and redness in relation to the dense white scab, sloughing off the necrotic mucosal surface (Fig. 1).

Rice. 1. Chemical burn.

Most chemical burns heal without consequences.

Tobacco stain (leukoplakia)

A tobacco spot or tobacco descending lesion is a wrinkled, white or pink, diffuse lesion of the oral vestibule. These lesions are often observed in the mandibular junctional fold, the site where smokeless tobacco is typically placed (Fig. 2).

Rice. 2 Tobacco stain.

Nitrosonornicotine in snuff or chewing tobacco has been declared carcinogenic. Thus, the use of a local carcinogen predisposes to the appearance of squamous cell carcinoma at the site of tobacco application, especially in the transitional fold of the mandible. (Fig. 3).

Rice. 3. Tobacco stain.

Initial lesions from topical tobacco use can be eradicated in most cases by stopping the use of tobacco products. Clinical lesions can disappear by stopping tobacco use for about two weeks. If, however, lesions persist after a two-week tobacco avoidance period, the remaining lesions should be completely excised and submitted to a pathologist for microscopic evaluation.

Squamous cell carcinoma

Squamous cell carcinoma is the most common malignant tumor found in the oral cavity. The buccal mucosa is a place where cancer can be found relatively easily. Squamous cell tumor lesions are usually painless, however, the patient may be aware of a persistent ulcer, fullness in the cheek, or a spot that ulcerates repeatedly.

Squamous cell carcinoma may appear as a flat area; in the form of an ulcerated surface; in the form of a hardened (donut-like) area; surface, like a washboard or like an exophytic swelling (Fig. 4).

Rice. 4. Squamous cell carcinoma.

Most dentists, dental hygienists and doctors are more suspicious of cancer if the lesion is white in color. For many years, practitioners have been trained to examine the mucosa for leukoplakia (white plaques). In fact, erythroplasia is the earliest clinical manifestation of squamous cell carcinoma 2 . Reddened tissue should sharply raise the level of suspicion for cancer (Figure 5).

Rice. 5. Squamous cell carcinoma.

Squamous cell carcinoma of the cheek is more easily seen than malignant tumors of many other anatomical areas of the mouth and upper pharynx. The buccal mucosa is easily examined, especially when a standard examination of the oral cavity and teeth is performed. All cheek tissue abnormalities should be carefully assessed. When a malignant tumor of the buccal mucosa occurs, the disease is very aggressive and difficult to control. Approximately half of all cases of squamous cell carcinoma of the cheeks metastasize to regional lymph nodes in the neck. The prognosis for cure for cheek cancer is poor.

Lichen planus

Most pathologists would agree that lichen planus (LP) and lesions that resemble lichen planus (lichenoids) are common diseases of the oral mucosa. Despite this, oral pathologists have expressed varying opinions regarding lichen planus and lichen planus-like lesions.

The most important points of view are the following:

Lichen planus should not be ignored; and it is extremely difficult to make a definitive diagnosis of lichen planus through clinical examination. Lichen planus is most often found on the buccal mucosa (Figure 6), but can also be found on the gums, tongue, palate, lips, floor of the mouth, or skin.

Rice. 6. Lichen planus.

This chronic process is characteristic of women, especially after 40. Lichen planus can be exclusively on the skin, exclusively on the mucous membrane, or simultaneously on both tissues. Lichen planus lesions may be associated with past trauma to the affected area, such as a skin scratch or dental injection. This observation is known as the "Koebner Phenomenon".

Typical lesions occur bilaterally on the buccal or gingival mucosa, appearing as lace, white streaks, or keratotic rings on an erythematous base (Fig. 7).

Rice. 7. Lichen planus.

These lesions are usually asymptomatic, with the exception of the ulcerative and bullous forms of lichen planus (Fig. 8).

Rice. 8. Erosive lichen planus.

Symptomatic lesions cycle between asymptomatic periods and painful episodes lasting several weeks. The lesions are routinely amenable to symptomatic application of topical steroids, especially 0.05% fluocinonide (Lidex).

Some researchers classify lichen planus as a precancerous condition.4 Other researchers question the relationship between lichen planus and oral cancer.5 However, other scientists suggest that in patients with long-standing lichen planus, both lichen planus and a malignant tumor may co-occur , especially in cases of erosive lichen planus.6 In addition, the dysplastic process, clinically accepted as “lichenoid dysplasia,” has similarities with lichen planus. But in contrast to lichen planus, lichenoid dysplasia tends to occur in areas of the mouth that are the most common sites for oral cancer: the floor of the mouth, the ventrolateral area of ​​the tongue, the lingual mucosa of the alveolar ridge, the tonsil folds, and the soft palate.

Somewhere between lichen planus of unknown origin and lichen dysplasia (with its malignant potential), another group of lichenoid lesions exists. Nonspecific lichenoid reactions - microscopic varieties - also have an unknown etiology. Similar to lichen planus, drug reactions are quite commonly diagnosed. In particular, patients taking phenothiazines, angiotensin converting enzyme inhibitors and thriazides are more likely to experience lichen planus-like reactions than other drugs. Oral lichenoid mucositis may also occur secondary to consumption of foods containing cinnamon, such as cinnamon sweets, chewing gum, mouth rinses, and toothpastes. Systemic or discoid lupus erythematosus may also be accompanied by oral lesions similar to lichen planus.

When a patient has any type of lichen planus lesion, it is important to make a specific diagnosis. A complete medical history of this lesion should include its onset, symptoms, medications, use of products containing cinnamon, tobacco use, alcohol use, history of trauma (such as dental treatment), and known systemic diseases. The most useful diagnostic tool is microscopic examination of biopsy tissue.

Once a diagnosis has been made, lichen planus can be treated with a topical corticosteroid, which often reduces unpleasant symptoms. Although clinical symptoms can be controlled, lichen planus lesions may persist for a long time. It is the duty of the dentist, dental hygienist and dental surgeon who can diagnose lichen planus to carefully examine the mucosa of patients with lichen planus for suspicious lesions. Despite disagreement among pathologists, it is true that cancer co-occurs with lichen planus, and lichen dysplasia is potentially malignant.

Fibroma

Irritation fibroids are a common benign lesion that occurs on the mucous membranes of the cheeks, tongue, lips and other areas of the oral cavity. Fibroids are raised nodules that are approximately the same color as the surrounding tissue or slightly paler (Fig. 9).

Rice. 9. Fibroids.

Most fibroids are a few millimeters in size, but can become quite large (Figure 10).

Rice. 10. Fibroma.

They may be single, or may appear as a group of lesions. Fibroids can be surgically removed and submitted for histological examination. Typically, lesions do not recur if the cause of the irritation has been removed and the lesion has been completely excised.

Hemangioma

Blood vessels can form tumor-like lesions, especially in the cheeks, tongue and lips. These benign lesions often appear as blue, ovoid, soft nodules (Figure 11).

Rice. 11. Hemangioma.

These shrinking nodules may turn pale during palpation due to temporary disruption of blood flow to the affected area. Hemangiomas can be removed surgically and submitted for histological examination, especially if they are large or their location causes functional problems (Fig. 12).

Rice. 12. Hemangioma.

Recurrence of hemangioma is possible and depends on the configuration of the lesion and the completeness of removal.

Hematoma

Hematomas are an accumulation of blood in soft tissues secondary to injury (Fig. 13).

Rice. 13. Hematoma.

Traces of spontaneous biting are often found on the buccal mucosa, leading to the formation of a hematoma (Fig. 14).

Rice. 14. Hematoma.

These lesions are usually self-limiting, self-healing and rarely require treatment.

This article presents several lesions of the buccal mucosa that are commonly encountered in dentistry. Because the cheeks are a potential site of aggressive oral malignancy, all lesions should be examined with suspicion until a definitive diagnosis is made. Lesions similar to lichen planus should also not be carelessly overlooked, since a cancerous tumor may arise or already exists, at least in association with lichenoid dysplasia or lichen planus lesions. It must be emphasized that visual examination is not sufficient to make a diagnosis and/or develop a treatment plan for lichen planus or lichenoid dysplasia.

Dentists and dental hygienists are the only ones and the most qualified in their field who can detect cheek lesions at an early, treatable stage. Every visit to the dentist should include a “cheek check.”

Bibliography:

1. Silverman, Sol, Jr. Oral Cancer, Third Edition. The American Cancer Society. 1990. P. 10.

2. Mashburg, A., Samit, A. "Early Diagnosis of Asymptomatic Oral and Oropharyngeal Squamous Cancers." CA: A Journal of Clinicians. Vol. 45, No. 6., pp. 328-51.

3. Weigand, D.A., Zeigler, T.R. Lichen Planus. In Jorden, R.E. (Editor) "Immunologic Diseases of the Skin." Norwalk: Appleton and Lange, 1991, pp. 623-629.

4. Holmstrup, P. "The Controversy of a Premalignant Potential of Lichen Planus is Over." OralSurg, OralMed, OralPath, 1992. 73:704 -706.

5. Eisenberg, E. "Clinicopathologic Patterns of Oral Lichoid Lesions." Oral and Maxillofacial Surgery Clinics of North America. August 1994. Vol.6

The article is based on the translation of the original article A check of cheeks. Rothstein J. Dent Today. 1996 Aug;15(8):60, 62, 64-5. PMID: 9567793 - Translation: Ukhanov M.M. Save on social networks: