Topic 157. "Changes in the oral mucosa in diseases of the cardiovascular system.

" Diseases of the cardiovascular system

SUBJECTIVE EXAMINATION

COMPLAINTS

MEDICAL HISTORY

LIVING HISTORY

OBJECTIVE ASSESSMENT

INSPECTION

PALPATION

PRELIMINARY DIAGNOSIS

ADDITIONAL METHOD

BACTERIOSCOPY

LABORATORY

CYTOLOGICALLY

DIAGNOSTIC SEARCH FINAL DIAGNOSIS ADVICE CARDIOLOGIST

TREATMENT

LOCAL PREVENTION

GENERAL CLINICAL EXAMINATION

1. Financial and methodological support classes: machinery and equipment dental office, an illustrative materal, methodical practice session for teachers, recording and reporting. 2. Materials for the lab: Some medical disorders are reflected in the morphofunctional condition of the mouth. The dentist should be aware of these clinical manifestations , to orient the choice of methods of patient examination and diagnosis. The defeat of the mucous membrane of the mouth often occurs before there will be other clinical signs of disease. In addition, the oral cavity is available for self-examination , which makes the initial application the patient to the dentist. A careful history , careful examination of the patient , the choice of adequate additional research methods and the correct assessment of the results can be suspected systemic disease , appoint expert advice appropriate profile .

Diseases of the cardiovascular system (atherosclerosis , hypertension , myocardial infarction, valvular heart disease , cardiovascular failure, etc. ) are very common. There is a relationship lesions of the oral mucosa with the cardiovascular system ( reflector , humoral , etc.). Changes in the mouth ( oral mucosa , tongue, periodontal ) have no specific signs of various clinical entities of diseases of the cardiovascular system, and are relatively rare diagnostic value since developed a second time, in cardiovascular disease, decompensation , and so etc. However, similar changes in the mucous membranes of the mouth in cardiovascular disease, traumatic injuries , diseases of the gastrointestinal tract require careful differential diagnosis. The dynamics of local changes in the mucous membranes of the mouth depends on the treatment of the underlying disease in the local use of symptomatic agents . Pathological changes of the oral mucosa in cardiovascular disease is diagnosed in 40-80 % of patients. However , like other common diseases of the body , cardio- vascular diseases do not cause changes typical for this particular group of patients. Changes in the oral mucosa in cardiovascular diseases are largely dependent on the degree of heart failure , the condition of the vascular wall , etc. In cardiovascular disease, mucous membrane of the blood circulation , there is a general puffiness , cyanosis of the oral mucosa and the vermilion border . Such a condition may be associated with dry CO and its swelling , resulting in the language increases in size , and on her cheeks and tongue prints appear teeth. Cyanosis of the oral mucosa , lips and bright red or crimson tongue characteristic of the acute period of myocardial infarction. In addition to the color change , there are other changes to the language , the severity of which depends on the severity of the overall disease. For example, when you change the language macrofocal myocardial often are destructive : the cracks , erosion, ulceration, hemorrhage and papillary tissue. With small focal infarction and angina occur only discoloration, swelling of the tongue , dry and seldom cracks. The interdependence of changes in the oral cavity and cardiovascular diseases Cardiovascular failure cyanosis mucosa cyanosis of the lips Dry Burning Ulcers Myocardial infarction cyanosis strawberry tongue cracks language dryness burning tongue Pain in the language Erosion and sore tongue Hypertonic disease Bubbles in the soft palate, the side surfaces of the language erosion sores Diagnosis of edematous states and change the color of the mucous membranes of the mouth

Complaints of the patient's mouth may be omitted. Swelling, discoloration of the mucous membrane of the mouth reveals a dentist . The discomfort in the mouth, tongue edema , feeling of larger first , biting buccal mucosa , language and other minor changes occur in the mouth in less severe diseases ( essential hypertension, atherosclerosis, etc. ) due to hemodynamic capillary network peripheral circulatory disorder , increase vascular permeability of the tissue . In the future, burning, pain when taking irritating foods , redness of the mucous membrane of the mouth ( cheeks, tongue ) , cyanosis caused by microcirculation disturbance , increased levels of histamine and other biologically active substances ( kinins , acetylcholine , etc.) that contribute to pain. When macrofocal infarction in the early days of the disease is determined by the violation of the integrity of the language (such as cracks , slight erosion) . At the core of vascular abnormalities in myocardial infarction are interrelated factors : hemodynamic , humoral and neuro- reflex . Most often reveal a history of such transferred and related diseases: childhood infections , frequent sore throats, rheumatic heart disease , hypertension , stress , violations of work and leisure , bad habits (smoking , alcohol , drugs ) . Ill mostly of middle- aged and elderly Children's infections reduce the overall resistance of the body , adversely affect the condition of the blood vessels. Stress, physical and nervous stress creates conditions for the development of pathology of the cardiovascular system . Bad habits contribute to the progression of cardiovascular disease . Important are genetic predisposition , comorbidities (diabetes mellitus , hyperthyroidism , etc.) Increased mucosal edema , discoloration associated with progression- cardio- vascular system, the development of the disease, the state of decompensation. Irregular treatment , nervous stress , bad habits , and to exacerbate the progression of hypertension and other diseases of the cardiovascular system . Growing phenomenon of peripheral circulatory disorders , increased levels of histamine reduces the activity of histaminase , there are other biochemical changes When viewed from the mouth - dentition , periodontal , oral mucosa , with cardiovascular disease reveal cyanosis of the lips and the surrounding skin areas , dental defects , carious teeth , chronic periodontitis , swelling of the mucous membrane of the cheeks , sides of the tongue , teeth imprints , hyperemia of the mucous membranes of the mouth , tongue, with symptoms of edema. In atherosclerosis mucosa pale, clearly defined vascular pattern of the palatine arches and soft palate. These symptoms are the result of heart failure and hypoxia. Contribute to the infection of the mouth, predispose to certain diseases of the cardiovascular system ( endocarditis , etc.). The sharp edges of the teeth are the cause mechanical injury edema of the mucous membrane of the mouth . There are marked hemodynamic disorders, circulatory disorders , which are a consequence of microcirculatory disorders with symptoms of stagnation in the capillary bed , raising the level of histamine and other biologically active substances ( bradykinin , etc.) Intensity of atherosclerotic vascular changes , ischemia, venous stasis depends on the duration and severity of the disease Diagnosis of venous disorders The emergence of trophic changes of the oral mucosa , including the formation of ulcers, observed mainly in patients with decompensated heart disease and circulatory disorders III, II degree sometimes . Trophic ulcers are located mainly in the posterior part of the mouth, on the buccal mucosa , alveolar bone , in the language of the mucous retromolar area and in other areas . Ulcers are of different sizes (2-5 mm or more) . They are covered with a pale gray patina with fetid odor, sharp pain when touched , and during the meal. Characterized by the absence of inflammatory reaction in the surrounding tissue . Ulcers, localized on the alveolar mucosa , can spread to the buccal mucosa , lips, cause partial necrosis of the alveolar bone and jaw. Because of the collapse , severe necrotizing bleeding.

Trophic disorders ( erosion , ulcers) are defined mainly in middle- aged and elderly people with cardiovascular disease . Development of trophic disorders in the oral cavity may contribute to a violation of diet ( eating spicy food), alcohol abuse , local traumatic factors . The prerequisites for the occurrence of venous disorders is to reduce the overall immunological resistance , marked atherosclerosis , emotional stress and other factors contribute to the progression of cardiovascular disease and the development of trophic lesions of the oral mucosa Trophic ulcer is vague outlines , sharply painful . The surrounding mucosa with no signs of hyperemia and infiltration ( areactive inflammation). Can propagate changes to the underlying tissues ( cheek perforation , bleeding , osteomyelitis , etc.) Trophic erosion , ulcers develop as a result of marked disorders of microcirculation, venous stasis , violations of general and peripheral circulation, metabolic changes with the release of inflammatory mediators in the necrotic tissue decay . The severity of the changes , their depth and length depends on the duration and severity of the underlying disease. What matters is poor oral hygiene due to difficult self-cleaning teeth ( reception gentle food because of pain) Cytology scraping material from the bottom of erosion or ulceration of the epithelial cells are defined by single surface and intermediate layers with signs of degeneration (resize cells , the lack of clear contours pycnosis and changing the shape of the nucleus) . Histiocytic cells are presented in a number or a small number of missing, which is characterized by inflammation of unresponsiveness Should consult a cardiologist for a diagnosis and plan of treatment. Diagnosis of venous ulcers often presents considerable difficulties. To differentiate them from cancer , tuberculosis ulcers and gummy ulcers. Diagnosis of vesico - vascular syndrome In patients with atherosclerosis and hypertension observed in the appearance of the oral mucosa of hemorrhagic blisters . Most often, the bubbles of different sizes with bloody contents appear on the soft palate, the side surfaces of the language, from his cheeks on the line between the teeth. A bubble occurs suddenly , often while eating increases, and then bursts ; formed erosion covered with a whitish bloom. Epithelialization erosion occurs spontaneously after 5-7 days depending on size. The bubble is a consequence of the enhanced permeability and fragility of blood vessels in patients suffering from hypertension . There is a thinning of the epithelium, degenerative changes in the mucous membrane of the actual nature of the age , impaired communication with the epithelial basement membrane A history revealed hypertension for years , irregular treatment. In the past, psycho-emotional stress. Sick of middle- aged and elderly With the progression of hypertensive disease, lack of adequate treatment increases the frequency of formation of hemorrhagic blisters (1 every 5 years to 4-5 per year, sometimes 2-3 times a month) Psycho-emotional , nervous tension , stress creates conditions for the development and progression of hypertension, and the lack of blood pressure control , regular treatment , along with agerelated changes create the conditions for the rupture of a blood vessel or the formation of extravasates , lift the epithelium , with the occurrence of hemorrhagic bladder. Visual inspection of these patients with no observable change . Regional lymph nodes were not palpable The mucosa is moderately moist. On the soft palate , the side surface of the tongue , floor of the mouth is usually determined by a single bubble with hemorrhagic content , after the opening of the bubble formed by erosion rounded slightly hyperemic background. Erosion is covered with fibrinous coating, epithelialized within 3-7 days, depending on the size of the bubble, without scar formation . Bubbles are often formed with an increase in blood pressure while eating , coughing movements mainly on the soft palate . This is due to the functional features of the soft palate, a good blood supply

and mobility of the soft palate , and increased permeability of blood vessels, easing communication epithelium with underlying connective tissue. Additional methods of research Symptom Nicol - negative : When you pull the remains of the tire bubble detachment apparently intact mucosa was observed. No events acantholysis . The bubble is subepithelial . Cytological examination of scrapings from the bottom of the material erosion - no acantholytic cells . Blood elements and features of the epithelium without Capillary resistance to vacuum ( sample Kulazhenko ) sample is positive. Education petechiae , bruising occurs after 10 seconds . (normally after 40-60 seconds. ) . Complete blood count : without deviation from the norm. Should consult a physician, cardiologist for diagnosis , severity of illness and treatment plan. Treatment of these changes of the oral mucosa provides for the elimination of heart failure in combination with local symptomatic treatment . Carry out rehabilitation of the oral cavity, treatment is prescribed antiseptic and anesthetic solutions. Sores should be cleaned of necrotic tissue enzyme preparations and assign funds to accelerate epithelialization : propotseum , ekteritsid , solkoseril , spedian , tsigerol , sea buckthorn oil , rosehip oil solutions of vitamins A and E, into drugs that normalize the condition of the vascular wall and metabolic disorders: Routine , vitamins C and P , potassium orotate , Riboxinum , carnitine chloride , etc. Basic principles of treatment of lesions of the mucous membranes of the mouth and tongue: Consultation and treatment by a cardiologist (GP); local effects depend on the clinical and morphological manifestations (edema, erosion, ulcers, etc.), after consultation with the cardiologist; - Oral hygiene: - Occupational health and correction of personal oral hygiene; - Treatment of caries and its complications; - Prostheses; - Periodontal treatment. Recommendations on specific symptoms 1. When edematous condition of the mucous membranes of the mouth and tongue topical treatment is not carried out, must be monitored and treated by a physician (cardiologist). 2. Catarrhal stomatitis does not require a local drug therapy (treatment of the underlying disease). 3. Violation of epithelial integrity (cracks on the tongue, cracks, erosion, and trophic ulcers) require anesthesia and careful antiseptic treatment, the use of proteolytic enzymes in necrotic processes, and tools that promote epithelialization (solkoserila gel, ointment aktovegina 5% ointment Radev, sea buckthorn oil , rosehip oil, etc.). All local interference in the oral cavity is carried out after consultation with the physician in parallel with the treatment of the underlying disease, symptomatic treatment of local changes in the mucous membranes of the mouth of the underlying disease without treatment ineffective. An important role is played by individual oral hygiene, vytsboru facilities and hygiene items. 1. Practical skills on the topic: be able to: 1) to work in the dental equipment; 2) Intended use dental tools; 3) The issue of accounting and reporting documents, to analyze quantitative and qualitative measures of the doctor - dentist;

4) conduct the clinical examination of the patient with abnormal cardiovascular system, develop a plan of examination; 5) Implement and evaluate health indicators oral health; 6) take the material for laboratory tests, analyze results; 7) put the dental diagnosis; 8) to make patient card dental patient; 9) to estimate the index oral health; 10) to irrigation, application of drugs to the oral mucosa; 11) write prescriptions drugs; 12) perform professional hyena mouth; 13) to give advice on the rational oral health, prevention of complications. 1. Terminology: circulatory failure, hypertension, and trophic ulcers, cystic-vascular syndrome. 2. Questions for Knowledge Control: 1) What are the changes of the oral mucosa and tongue are possible with cardiovascular disease. 2) Describe the sensitivity disorders in cardiovascular disease. 3) Changes in the oral mucosa in myocardial infarction. 4) lesions of the oral mucosa in hypertension. The concept of the vesico-vascular syndrome. 5) The trophic ulcer, its diagnosis. 6) The differential diagnosis with other trophic ulcers ulcers (tuberculosis, cancer, syphilis, radiation). 7) the treatment of venous ulcers. 8) What is the tactic of a dentist in the management of patients with disorders of the cardiovascular system. 9) The volume of dental procedures for diseases of the cardiovascular system. 10) The role of sanitation and hygiene of the oral cavity in patients with disorders of the cardiovascular system. Assignments to control the source of knowledge: 1. Patient 56 years old complains of discomfort in the throat when swallowing , the presence of bubbles in the mouth, which appeared two months ago. OBJECTIVE: on the gums of the upper jaw with pieces of bladder erosion . Nicholas positive symptom . What is the most likely diagnosis ? A. syphilitic sore throat B. Gerpangina C. acantholytic pemphigus D. Dermatitis herpetiformis Duhring E. Erythema multiforme 2 . A patient 49 years complains of pain in the mouth, difficulty eating . He suffers from coronary artery disease. OBJECTIVE: shortness of breath , swelling of the extremities. The oral cavity is not sanitized . On the right buccal mucosa ulcer with jagged edges , covered with grayish- white necrotic plaque. Bad breath . What is the most likely diagnosis ? A. traumatic ulcers B. Necrotizing ulcerative stomatitis C. tuberculous ulcer D. A cancerous ulcer E. trophic ulcer

3 . A patient 33 years complains of pain in the right language , increasing during the meal , conversation. Objectively: a first surface on a side closer to the top painful ulcers 0.6 cm in diameter. Bottom is covered with gray patina . The crown 47 is destroyed. What is the most likely diagnosis ? A. chancre B. trophic ulcer C. tuberculous ulcer D. A cancerous ulcer E. Dekubitalnaya ulcer 4 . During prosthetics patient 52 years old suffering from hypertension, complained of a headache. After a while , the patient developed dizziness , nausea, aching pain in the chest , worse eyesight ; increasing intensity of headache , vomiting appeared . Objective : Ps 64/min , regular, intense, blood pressure - 220/ 150 mm. Hg. Art. Heart sounds are sonorous, systolic murmur over the apex , the accent II tone of the aorta , and in the lungs - vesicular breathing. What is the most likely diagnosis ? A. Hypertensive heart disease is stage 2 . B. Heart disease. C. Myocardial infarction. D. Angina . E. Hypertensive crisis . 5 . A patient 55 years appealed to the dental surgeon with complaints about the presence of ulcers on the right side of the tongue . The appearance of sores connects with trauma to the tongue a sharp edge of the tooth. The ulcer is of the form of an oval, sharply outlined defect mucosa , soft-edged , red -bottomed rim and redness around her. What is the most likely diagnosis ? A. Ulcer , ulcerative in miliary tuberculosis. B. Cancer of the tongue . C. Trophic ulcer language. D. Gummy ulcer . E. Chancre . 6. The patient 65 years complains of choking , heart pain , palpitations after exercise . Three months ago, underwent macrofocal myocardial infarction. Objective : The skin is covered with cold sweat , acrocyanosis , neck veins bulging . Ps - 110/min , BP - 100/ 60 mm Hg. Art. Heart sounds are muffled . Breathing heavy , there is a distance. Released during coughing foamy sputum , painted in pink. What causes the development of this condition ? A. Acute left ventricular failure . B. Latency in the body of water and sodium. C. Increased release of catecholamine . D. Acute pulmonary heart . E. Acute vascular insufficiency . 7. Male 55 - year-old complains of the presence Chiyo bubble on the soft palate . Twice previously noted the emergence of such bubbles in the sky , after 1-2 days they burst and heal within a week . In the history of hypertension II Art. Objective: to the left of the soft

palate mucosa , against hyperemia , defined bubble diameter of 1 cm , with bloody content. What is the most likely diagnosis ? A. pemphigus only the mucous membranes of the mouth . B. Vesico - vascular syndrome C. Dermatitis herpetiformis Duhring D. Bullous pemphigoid Lever E. Bullous lichen planus 8. A patient 34 years appealed to the dentist complaining of the presence of ulcers on the hard palate , which appeared about a month ago. He was treated rinses decoction of herbs, but the ulcer gradually " creep ." Objectively: the mucous membrane of the hard palate is shallow painful ulcer with podrytymi jagged edges, soft consistency , the bottom contains granulation. On the periphery of the ulcer visible yellowish grain. What is the most likely diagnosis ? A. actinomycosis B. Primary syphilophyma C. trophic ulcer D. tuberculous ulcer E. A cancerous ulcer 9. A patient 66 years of age suffering from coronary heart disease, atherosclerosis, during dental reception there was a strong chest pain radiating to the left shoulder , which mucous membrane of the numbness of his left hand . OBJECTIVE: pale skin , sweat on his forehead . BP -140 /90 mm Hg , PS- 75ud./min , rhythmic . The pain is not removed validol , but began to decrease after administration of nitroglycerin . What a bout of illness led to a patient? A. paroxysmal tachycardia B. hypertensive crisis C. myocardial infarction D. Tahikardiya E. angina 10 . A patient 40 years after anesthesia noted the emergence of severe weakness , nausea , chest pain , which radiate in the scapular region and the left arm , heart palpitations . Tripling the use of nitroglycerin did not give a positive effect. Objectively : the patient is conscious, lethargic , forehead covered with cold sweat , pallor of the skin. BP - 100/ 60 mm Hg, heart sounds muffled , pulse weak filling , thready , aritmichen . What is the condition develops in a patient ? A. acute pancreatitis B. angina C. myocardial infarction D. Cardiogenic form of anaphylactic shock E. The aggravation of gastric ulcer 11. Go to the dentist asked the patient 38 years with complaints about the presence of ulcers on the lateral surface of the tongue . OBJECTIVE: on the left side of the tongue ulcer is defined round, painless on palpation , up to 1 cm in diameter, with a smooth and slightly
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raised above the surface of the mucous edges. At the base of its chondroid infiltrate. What is the most likely diagnosis ? A. tuberculosis B. trophic ulcer C. traumatic ulcers D. syphilis E. actinomycosis 12. An appointment with the dentist formation patient 60 years of age . Diagnosis: acute exacerbations of chronic periodontitis 37 tooth . From history : hypertension III penalties degree of severity, coronary heart disease. After the anesthesia patient suddenly felt ill , began to complain of a headache. Then came the vomiting and the patient lost consciousness. AD- 180/100 mm Hg , Ps- 95/min . Inspiratory dyspnea . What is the most likely diagnosis is a? A. hemorrhagic stroke B. myocardial infarction C. ischemic stroke D. epileptic seizure E. The attack of angina 13. The patient in the area of the lower lip IME - dense painless tumor size 2,5 x0, 8 cm , centered on the ulcer , its bottom is covered with active granulation . In the palpation of detecting a painless enlarged lymph node. Sick for the past 3 months . What is the preliminary diagnosis ? A. tuberculous ulcer B. trophic ulcer C. A cancerous ulcer D. actinomycosis E. Keratoacanthoma 14. A woman 64 years old , suffering from hypertension, complaining of blisters on the mucous membrane of the mouth . Objectively: the mucous membrane of the soft palate there is a bubble with bloody contents , and erosion , covered a whitish bloom, located on the hyperemic background. What is the most likely diagnosis ? A. Pemfigoidnaya form of lichen planus B. Vesico - vascular syndrome C. Erythema multiforme D. Erosive form of leukoplakia E. true pemphigus 15. Patient 28 + years 2 days ago injured person complains of soft tissue swelling of the parotid- chewing , pain and limitation of mouth opening to 1.0 cm , and the complication of the lateral movements of the lower jaw to the side of the injury . Diagnosis: fracture of the left zygomatic arch . At what radiological installation is most clearly defined fracture of the zygomatic arch ? A. Naso - chin B. according Pordesu
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C. according Geneshu D. Naso - frontal E. side 16. Male 65 years old suffering from hypertension for about 20 years. In the afternoon, during exercise , experience headache , nausea , vomiting, weakness of the right arm and leg , blood pressure , 220/100 mm Hg , after 2 hours - 240/190 mmHg What should be the tactics of the doctor ? A. Treatment in the outpatient clinic at B. Admission to intensive care C. Admission to the neurological department D. Hospitalization in the coronary care unit E. Outpatient treatment 17. A patient 44 years old, suffering from hypertension , there were headache , palpitations , fear . Objective : Ps- 100/min , BP -200 /100 mm Hg, the left border of cardiac dullness of 1.5 cm to the left, vesicular breathing . The ECG - sinus tachycardia, signs of left ventricular hypertrophy . What preparation is necessary to assign to the emergency room ? A. obzidan B. reserpine C. furosemide D. Dibazol E. magnesium sulfate 18. To the dentist asked the patient 46 years of age . When dissecting cavity patient complained of headache, dizziness, tinnitus, heat sensation , nausea , dry mouth , numbness of the limbs. Objective: asymmetrical face , nasolabial folds with one hand smoothed speech disorder . What is the most likely diagnosis ? A. vascular collapse B. Cerebrovascular accident C. anaphylactic shock D. hyperglycemic coma E. hypertensive crisis 19. The defeat of the oral mucosa is specific to the individual clinical entities pathology of the cardiovascular system : A. yes B. no 20. When cystic- vascular syndrome is a bubble : A. intraepithelial B. subepithelial 21. Swollen condition of the mucous membrane of the mouth is determined by: A. On palpation B. On prints of teeth on the mucosa of the cheeks and the sides of the tongue; C. Blister test of McClure -Aldrich

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22. Hemorrhagic blisters on the mucous membrane of the mouth are formed by : A. Cardiovascular disease B. Rheumatic Heart Disease C. hypertonic disease 23. When cyanosis of the mucous membranes of the mouth against cardiovascular disease topical treatment : A. Displaying B. not shown 24. Treatment of patients with trophic ulcers decompensated cardiovascular disease carried out in conjunction with : A. cardiologist B. endocrinologist C. neuropathy D. psychotherapist 25. Cyanosis of the oral mucosa and lips , dryness , burning, erosive and ulcerative lesions of the most characteristic : A. Cardiovascular disease B. myocardial infarction C. hypertonic disease 26. Bubbles in the soft palate and the lateral surface of the tongue , erosion , sores and indicate: A. myocardial infarction B. hypertonic disease C. circulatory failure 27. Overall puffiness , swelling and cyanosis of the oral mucosa and the vermilion border , an increase in language, teeth imprints on the cheeks and tongue are possible when : A. hypertonic disease B. myocardial infarction C. Cardiovascular disease 28. Cyanosis, dryness of the oral mucosa , " raspberry " form language , burning , cracking , erosion , pain in the language most likely to occur when : A. myocardial infarction B. hypertension C. circulatory failure

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