Causes of formation of ulcers in the mouth on the palate, methods of their treatment and prevention. Abscess of the hard palate. Main sources and routes of infection and treatment

A palatal abscess is a formed abscess located under the mucous membrane of the hard palate. In essence, this is acute purulent periostitis from the palatal surface.

This pathology is extremely rare; with the development of purulent inflammation of the periosteum, the process most often spreads to the vestibular (buccal or labial) surface.

The main cause of palate abscess is odontogenic infection. At the same time, its foci are located in the area of ​​​​the palatal roots of the upper chewing teeth - the first and second premolar and molar.

Thus, previous diseases are serous, purulent, granulomatous or granulating periodontitis.

Clinical picture

Patients complain of severe throbbing pain in the palate, as well as its swelling, which appeared several days ago. Chewing food and touching the tongue causes increased pain, and discomfort when swallowing often occurs. At the same time, pain in the causative tooth is not always observed, which is explained by the release of infection from periodontal tissues under the mucous membrane of the palate.

The general condition of the patient is often not disturbed. Swelling of the soft tissues of the face is usually absent. Sometimes facial asymmetry is observed if the process is localized on both the vestibular and palatal surfaces.

Often the submandibular lymph nodes react to this pathology - they are enlarged and painful on palpation.

There is swelling on the palate, the mucous membrane is painful on palpation, swollen, and hyperemic. The smoothing of the palatal folds is determined; if they spread significantly, the mucous membrane of the soft palate and the palatine arches are involved in the process.

Treatment tactics

Despite the fact that a palatal abscess often opens spontaneously within 5-7 days, immediate treatment is necessary, which consists of:

• Opening the abscess with subsequent drainage of the wound to create a good outflow of purulent discharge. The patient should rinse the wound with a solution of salt water for several days and show up to the surgeon every day for dressings, where the doctor washes the wound and changes the drainage.
• Deciding the fate of the causative tooth. If the tooth is severely damaged, there are large foci of bone tissue destruction in the area of ​​the root apexes (according to the x-ray), it must be removed. Otherwise, therapists try to save the tooth and fill the canals in them (a few days after opening the abscess).
• Drug therapy – the use of antibiotics and antihistamines is mandatory. For pain, painkillers are prescribed. The patient should rinse the wound with antiseptics or saline solution for 4-5 days.

Prevention

In order to prevent the occurrence of this pathology, it is necessary to maintain oral hygiene, visit the dentist twice a year for examinations, and promptly treat caries and its complications.

The appearance of boils on the body is always accompanied by severe pain that lasts for several weeks. The most problematic is their appearance in the facial area - it is uncomfortable, painful and unsightly. Their formation in the nasolabial triangle or at the corners of the lips causes particular trouble. At the same time, complaints about a boil in the mouth are not quite correctly formulated.

The appearance of purulent pimples on the gums, on the tongue and, in general, in the oral cavity should not be considered as boils. Let's take a closer look at what this is connected with. A boil is a disease or problem in the functioning of the sebaceous gland.

Oral furuncle is an acute inflammatory disease of the oral cavity, which is characterized by focal accumulation of pus in the tissues

The purpose of the sebaceous glands in the human body is to produce sebum, providing natural bactericidal protection to the skin. When any situation arises that negatively affects the secretion of the sebaceous glands, failures in the process of secretion are observed:

• sebum increases;
• its structure changes;
• density increases.

The result of this process, when accompanying factors appear, can be inflammation of the hair follicle, accompanied by the appearance of a boil. The main conclusion from the above is that boils appear only in places with hair, therefore such phenomena as a boil in the mouth, a boil in the throat, a boil on the tonsil do not exist in nature. But on the Internet you can find dozens of photos depicting, for example, a boil in the throat. A logical question arises: what kind of purulent formations do people have in the throat, on the gums, in the inner oral cavity, and what are the reasons for their occurrence?

Furunculosis of the oral cavity is diagnosed by a dentist during an examination based on an assessment of the condition of the tissues

Oral infection

The appearance of various purulent formations in the mouth is called an oral abscess. This phenomenon is understood as an acute inflammatory process, characterized by the presence of focal accumulation of purulent masses in soft tissues. The described disease is the most common problem in dental surgery, manifesting itself absolutely regardless of the age category or gender of the patient. The causes of purulent infection of tissues in the mouth are varied:

• complicated dental pathology (periodontitis, advanced periodontal disease);
• entry of infectious pathogens into oral wounds - even as a result of conventional dental anesthesia;
• boils on the face - due to incorrect, ineffective therapy or as a result of lack of treatment;
• streptococcal or staphylococcal tonsillitis;
• complications of influenza and other infectious diseases - against the background of weakened immunity.

Infection of the oral cavity begins when contributing factors occur: the presence of bacterial flora, severely weakened immunity, prolonged antibiotic therapy.

This disease is one of the most common problems in dental surgery.

Classification of abscesses

Purulent formations of the oral cavity are usually classified according to the location (location):

• abscess on the gum is the most common disease. Occurs near a specific tooth. It can occur in a chronic form, characterized by periodic exacerbations, the presence of a rotting smell from the mouth and lead to intoxication of the body;
• abscess at the bottom of the mouth. Location: sublingual fossa. It manifests itself as severe pain with any movement of the tongue. It is very dangerous in case of spontaneous opening - purulent masses, entering the throat, can provoke the appearance of secondary inflamed foci in the pharynx;
• abscess on the palate. Often caused by periodontitis of the upper dentition. In case of untimely or poor-quality treatment, it is dangerous because the infection can spread from the affected area to neighboring tissues. Can act as a factor in the development of complications such as osteomyelitis of the palatine vault;
• an abscess on the cheek is one of the most dangerous types. The danger lies in the proximity of the surface of the skin and other soft tissues. When developing inside the mouth, it can flow to the outside;

Furunculosis of the oral cavity can form as a result of infection in the wound when the integrity of the mucous membrane is violated

• an abscess on the tongue is the most dangerous. Swelling of the tongue makes it difficult to eat, speak, and can make breathing difficult, even to the point of blocking it. The patient is subject to urgent hospitalization when primary symptoms appear.

Symptoms

A purulent infection of the mouth forms very quickly. First, a sensation of pain appears, similar to the pain symptoms of periodontitis. With an abscess on the gum, pain predominates at the location of a particular tooth, intensifying when biting. Then, in the area of ​​localization of inflammation, a small tumor of a dense structure appears, causing severe aching pain. The appearance of the formation is often round, it comes in different sizes - the largest is similar to the size of a walnut.

Infection of the tongue tissue is accompanied by the appearance of increasing pain, a rapid increase in the volume of the tongue (swelling), and difficulty in absorbing food. The localization of the source of infection close to the skin (cheeks) is characterized by the appearance of redness and swelling.

Regardless of the type of disease, its additional symptoms are always the following:

In most cases, oral furunculosis is caused by an infection involving more than 3-5 microorganisms

• deterioration of health;
• temperature increase;
• lack of appetite;
• sleep problems.

The progression of the disease leads to the release of purulent masses, and the patient’s condition is significantly improved: body temperature stabilizes, there is an improvement in well-being, and swelling decreases. In this case, there is a danger of continuation of the inflammatory process, its flow into a chronic abscess, and the spread of purulent infection to other parts of the mouth.

The described disease can have many serious consequences: loss of teeth, phlegmon (purulent inflammation affects fatty tissue, muscles, tendons), sepsis. As a result, when the first symptoms appear, you should immediately seek medical advice or, if necessary, help. Only proper therapy can help avoid negative consequences.

Treatment options

Based on all of the above, it should be concluded that even if you know perfectly well how to treat a boil and are completely confident in your abilities, never use your experience and knowledge for purulent formations of the oral cavity. Their nature is completely different and requires treatment accordingly.

Oral furunculosis is treated exclusively through surgery

The disease is usually diagnosed by a dentist and he also refers you to dental surgery. You should not contact a regular surgeon with this problem - it is better to immediately visit a specialist. You may need to consult an ENT specialist if a purulent inflammatory process has affected the larynx, throat, or tonsils. If symptoms of an abscess appear, go to see a doctor. When this cannot be done immediately, do not try to self-medicate, use a variety of antibacterial agents and, most importantly, do not wait until the purulent formation breaks through. It is better to take a pain reliever and rinse your mouth with warm antiseptic solutions.

Treatment for abscesses is always surgery. In order to eliminate the source of infection and prevent the spread of inflammation, the dental surgery department or maxillofacial surgeon opens the abscess, cleanses the oral cavity of pus and carries out antiseptic treatment. Sutures are not required for these surgical interventions due to the small size of the incisions. Removal of purulent masses leads to:

• improving the patient's condition;
• pain subsiding;
• tumor reduction;
• restoration of normal facial contours.

After removal of the pus, as a rule, the patient feels better, the pain subsides, and the swelling subsides

In addition to surgical intervention, drug therapy is also required: the prescription of antibiotics, antihistamines, immunostimulants, vitamin-mineral complexes.

If an advanced stage of the disease is observed, the process of medicinal postoperative treatment can be lengthy with the use of physiotherapeutic procedures:

• fluctuarization;
• UHF therapy.

When fluctuating, low voltage electric current is used for medicinal purposes. This procedure has an analgesic, anti-inflammatory and anti-edematous effect.

Ultrahigh-frequency therapy uses electromagnetic fields with ultra-high frequencies. This procedure helps to:

• wounds heal;
• swelling decreases;
• pain subsides;
• inflammatory processes subside.

Success in the treatment of an oral abscess is determined by two components: timely contact with specialists and the general condition of the patient. Therapy at the earliest stages of the disease always brings the fastest and most effective results - timely surgical intervention can reduce the healing period to 10-14 days.

In order to prevent the occurrence of infection, it is worth following the preventive recommendations:

• compliance with hygiene rules;
• avoidance of mucosal injuries;
• timely treatment of periodontal disease and periodontitis.

Abscess of the palate

Palate abscess is a limited accumulation of pus in the tissues of the soft and hard palate that occurs during inflammation.

It usually occurs as a complication of periodontitis of the teeth of the upper jaw. More often the cause is the second incisor, canine or second premolar. The disease begins with pain in the hard palate and redness of the mucous membrane. When it bulges, the pain becomes most intense.

Based on the site of formation, this type of tumor can be divided into two subtypes: inflammation of the hard palate and soft palate.

Abscess of the hard palate:

• the patient complains of a noticeable throbbing pain in the palate (upper jaw), which intensifies when talking and trying to chew food;
• foci of infection - periodontal pockets of maxillary teeth, wounds on the mucous membrane of the hard palate;
• may spread in the absence of timely treatment to the soft palate and peripharyngeal space.

Abscess of the soft palate:

• complaints of painful swallowing, sore throat, aggravated by talking. The affected area greatly increases in size;
• sources of infection - damaged lacunae of the tonsils in chronic tonsillitis, microcracks in the mucous membrane of the soft palate, places where local anesthesia was administered;
• further spread leads to damage to the peritonsillar and peripharyngeal space.

Symptoms

hard palate:

Complaints of severe throbbing pain in the upper jaw (palate), aggravated by eating and talking.

Objectively: in the area of ​​the hard palate there is a swelling or protrusion with clear contours. The mucous membrane over the source of inflammation is hyperemic, palpation causes pain. Fluctuation may be detected.

Characteristic local signs of an abscess soft palate:

Complaints of sore throat, worsening when swallowing or talking.

Objectively: asymmetry of the pharynx with a displacement of the uvula of the palate to the healthy side. The affected part of the soft palate is increased in volume due to inflammatory infiltration of its tissues, the mucous membrane covering it is hyperemic. Pressure on the infiltrate (with an instrument, during palpation) increases pain.

Treatment

Surgical

Abscess treatment hard palate:

1. Pain relief. When the abscess is localized in the anterior part of the hard palate, local infiltration anesthesia in combination with conduction anesthesia at the greater palatine foramen; when the abscess is localized in the posterior part of the hard palate - local infiltration anesthesia in combination with conduction anesthesia at the round opening according to S.N. Weisblat, or subtemporal anesthesia according to A.V. Vishnevsky against the background of premedication.

2. An incision in the mucous membrane of the hard palate through the inflammatory infiltrate along its entire length parallel to the course of the vascular bundle of the palate.

3. Opening a purulent focus and evacuation of pus by spreading the edges of the wound using a hemostatic clamp.

4. Excision of a strip of mucous membrane 2-3 mm wide along the edge of the wound to ensure good constant outflow of inflammatory exudate without introducing drainage into the wound. Hemostasis.

Abscess treatment soft palate:

1. Anesthesia - local infiltration anesthesia (preliminary application anesthesia with a 1% dicaine solution can be performed) against the background of premedication.

2. An incision in the mucous membrane through the top of the inflammatory infiltrate (swelling) along its entire length parallel to the palatine arch.

3. Separating the edges of the wound and moving towards the center of the purulent-inflammatory focus by tissue separation using a hemostatic clamp, evacuation of pus.

4. Since drainage in the wound of the soft palate is poorly maintained, in order to prevent premature adhesion of the edges of the wound, you can excise a strip of thinned mucous membrane along the edge of the wound 2-4 mm wide, or periodically spread the edges of the wound.

Apart from secondary abscesses in osteomyelitis of the palatine process of the upper jaw of specific (syphilis, tuberculosis) and nonspecific origin, the usual source of an abscess in the area of ​​the hard palate is an infection emanating from the upper lateral incisors and first upper premolars. This is facilitated by the often observed deviation of the apex of the root of the upper lateral incisor and the palatal root of the first premolar towards the palate.

Abscesses of the hard palate associated with inflammatory processes in the area of ​​the apexes of the palatal roots of molars are observed relatively less frequently.

Clinic. With abscesses of the hard palate, pus accumulates in the depths (under the periosteum). On the corresponding half of the hard palate, the mucous membrane appears swollen and hyperemic (Fig. 124).

Sometimes swelling and redness spread to the soft palate. There are pains, both spontaneous and when touching the swelling even with the tongue, difficulty eating, temperature within 38°, but more often subfebrile. Due to the absence of loose tissue in the anterior part of the hard palate, fluctuation is usually determined only after 2-3 days from the beginning of the process. A protracted course of an abscess of the hard palate, exfoliating soft tissue from the bone, can result in necrosis of the bone area (cortical osteomyelitis) within the location of the abscess.

Essentially, in cases of abscess of the hard palate, one most often has to deal with either purulent periostitis or osteomyelitis of the palatine process of the upper jaw.

When making a diagnosis, it is necessary to keep in mind ulcers on the palatal surface of the alveolar process of the upper jaw, caused by the presence of deep bone-gingival pockets due to periodontal disease, ulcers in the middle of the hard palate, formed as a result of osteomyelitis of the nasal septum, as well as a suppurating cyst of the lateral incisor, which caused melting of the bone walls of the hard palate.

Treatment. Surgical treatment of a hard palate abscess involves an early incision down to the bone. The incision is made along the palate, sparing the palatine and incisive arteries (parallel to the alveolar edge). For successful treatment, it is necessary to keep the edges of the incision gaping by introducing gauze turundas into the wound. Otherwise, when the edges stick together, the outflow of pus is disrupted, which leads to a protracted course of the process (Fig. 125).

If conservative treatment of the tooth is ineffective, a root apex resection operation is performed; in extreme cases, the tooth is removed.

The sublingual space is located between the inferolateral surface of the tongue and the body of the mandible on both sides. Only abscesses of such areas of this area as the maxillo-lingual groove and sublingual ridges have “their own” clinic. In other cases, clinical manifestations associated with inflammation of the sublingual space are observed mainly with phlegmon affecting the floor of the mouth.

Limited abscesses of the sublingual space as a result of infection of certain parts of the area (for example, when injured by a fish bone, etc.) do not differ in features (abscesses caused by salivary stones).

The topic of today's article is extremely unappetizing, because it will talk about abscesses in the oral cavity.

To put it quite simply, an abscess is the accumulation of pus in an organic space, which is associated with the body’s fight against a point infection in a specific place.

This accumulation is not, to put it mildly, good, so any abscess is dangerous for the entire body, primarily for the heart.

Below is a more detailed story about this type of mouth problem. Unfortunately, oral abscesses can come in several types depending on where the inflammation occurs.

If we recall the academic formulation used by specialists, then “an abscess is a limited accumulation of pus in tissues that occurs during various inflammations.” That is, it can develop in many places in the maxillofacial region in general and the oral cavity in particular.

Moreover, an abscess generally has free localization and is able to develop in any part of our body. In this case, the tissues seem to “melt”, forming a capsule with pus.

Encapsulation of the abscess is one of the most radical reactions of the body to the infectious-inflammatory process, which is why it is said about “limited accumulation of pus in the tissues.”

But today we will only talk about the oral cavity.

What are the causes of an abscess in the mouth? This may be the banal presence of a slight wound on the mucous membrane, where the infection enters.

There is also a more exotic option - the introduction of bacteria, fungi or other microorganisms during injections for pain relief.

The second case is not as rare as it might seem. But there is always a huge amount of microflora in the mouth, which, even with a sterile injection, can get from the surface of the mucous membrane under it.

The third way of abscess formation is a consequence of purely internal problems. For example, in case of a tooth root abscess or other similar infections (sore throat, boils), when the infection is carried with blood or lymph from the source of inflammation to a completely different place.

Variety of abscesses

The classification of oral abscesses is quite clear and depends on where exactly the source of inflammation has formed. Therefore, everything here is simple and unambiguous, especially in cases of initial abscess.

In this regard, the typification of abscesses in the area under consideration is as follows (a partial list of the main types and a brief description).

Abscess of the floor of the mouth

The sublingual area turns red and thickens. The latter is extremely painful when touched, including when eating and swallowing movements.

Gradually, the mobility of the tongue is limited; it is constantly in an elevated state due to the presence of a volumetric compaction under it, which also becomes larger.

The general condition becomes unimportant, to put it mildly. When the abscess is fully “ripe,” it can burst, after which the patient’s condition improves.

But poisonous pus does not bring anything good to the pharynx, esophagus and stomach. Therefore, such spontaneous opening should not be allowed - you must consult a doctor.

Abscess of the upper or soft palate

It is almost always an infectious continuation of periodontitis of one or more teeth of the upper jaw. The first manifestations are soreness of the palate, redness of the mucous membrane. Eating becomes painful. Spontaneous opening carries the same dangers as those described earlier.

Cheek abscess

We can talk about external and internal lesions, which depends on its location closer to the skin or closer to the mucous membrane. The pain syndrome is weaker than in previous cases, but increases significantly when opening the mouth and especially when yawning.

There is a very high risk of the abscess spreading beyond the cheek. Nothing new can be said about the danger of an independent breakthrough, because it has already been said.

Tongue abscess

The lesion is located directly on the tongue, as a result of which the tongue swells quite noticeably, becomes less mobile and raised.

The pain is strong and reaches a particular peak when swallowing. Eating food is practically impossible - it is martyrdom, only drinking is possible.

One of the most dangerous types of abscess, which is characterized by a maximum rate of development. In the most severe cases, there may even be signs of suffocation, because the trachea may be almost completely blocked.

A feature of a lingual abscess is panic excitement and severe fear of the patient. The intervention of specialists must be extremely prompt.

Abscesses periodontal and in the root zone of teeth

They are dangerous because they can destroy gum tissue and lead to the loss of one or more teeth. A periodontal abscess is the most clearly localized of all types and appears as a small, painful ball under the skin of the gums. Occurs when the crevice space between the tooth and the soft tissue covering the gum becomes infected.

An abscess of the root zone of a tooth is a consequence of a long-term disease of the tooth and its local destruction to the internal core - the pulp. Gradually, the inflammation moves to the very base of the tooth.

A very interesting fact is that our smaller brothers - dogs - have abscesses in the oral cavity almost the same as in humans. However, this disease manifests itself equally in all higher animals.

Treatment and prevention

Only one thing can be said about the treatment: extremely light surgical intervention. It consists of opening the capsule, pumping out the pus and washing the cavity (drainage) - the procedure is completely worked out and is nothing complicated for the doctor.

As soon as the maxillofacial surgeon finishes his work, relief immediately sets in and all syndromes, including general poor health, fever and sleep disturbances, disappear.

Exactly the same thing happens when a lesion spontaneously opens, but the consequences can be extremely unpleasant. The unwashed capsule continues to fester little by little, and through the fistula it all constantly enters the esophagus and stomach.

The pleasure is not the most pleasant, and if you add bad breath, then it’s not good at all. In addition, if the surgeon does not intervene, complications such as phlegmon, extensive inflammation and even general blood poisoning are possible.

And this, you understand, is a more serious problem. The chronic form of an abscess ultimately seriously damages the heart muscle, without adding health to other organs and tissues. And if you also take into account that the brain is nearby, then... So joking with an abscess is more expensive for yourself.

As for prevention, there is not much to say. Good immunity with normal functioning of the body's defense systems is necessary. How lucky is anyone: someone, for example, only theoretically knows that boils exist, while others suffer from them almost constantly. “Rotten blood,” as people say. Sharp, but accurate. All these general considerations also apply to abscesses in the oral cavity.