Stomatitis

Role of salivary glands in the development of stomatitis

Salivary gland pathologies have a direct impact on the condition of the oral mucosa. The most important clinical syndromes here are xerostomia and sialorrhea.

• Xerostomia ("dry mouth syndrome") is caused by a drastic reduction or complete cessation of saliva production. This particular condition is a powerful predisposing factor for the development of stomatitis, as well as dental caries, periodontitis, glossitis, and generalized atrophy of the oral mucosa.
• Sialorrhea (hypersalivation), by contrast, is characterized by excessive saliva secretion. It can accompany acute inflammation of the mucosa, teeth eruption, the use of ill-fitting dentures, and may also occur during pregnancy and in a number of psychiatric or neurological disorders (epilepsy, schizophrenia).

Salivary gland diseases are divided into primary (tumors, sialolithiasis) and secondary (manifestations of systemic infections such as cytomegalovirus or tuberculosis). By etiology, they are classified into infectious, traumatic, obstructive, autoimmune, and neoplastic lesions.

Cystic lesions of the jawbones

For the differential diagnosis of oral diseases, it is important to know the morphology of jaw cysts. They are divided into odontogenic (of tooth origin) and non-odontogenic, and can also be true (with epithelial lining) and false.

Odontogenic dysembryogenetic cysts: They arise as developmental anomalies from epithelial remnants. These include:

1. Follicular cyst (dentigerous cyst). Most frequently affects the premolar and third molar areas. It develops from the enamel organ. Radiologically, it appears as a radiolucent focus, often with the crown of an unerupted tooth inside. The cyst wall consists of three layers, the inner of which is represented by a thin non-keratinizing stratified squamous epithelium.
2. Lateral periodontal cyst, gingival cyst, and eruption cyst. They share a similar microscopic picture—lined with stratified squamous epithelium with varying degrees of keratinization.

Acquired cysts (of inflammatory origin): Radicular (periapical) cyst—the most common pathology in this group. It is morphogenetically associated with chronic granulomatous periodontitis. The wall consists of a fibrous capsule, a layer of granulation tissue (with cholesterol crystals), and an inner non-keratinizing epithelium. During an exacerbation of inflammation, the epithelium forms characteristic reticular outgrowths, and the cavity fills with pus. Complications may include osteomyelitis, fistula formation, and, in the maxilla, the development of odontogenic maxillary sinusitis.

Tumor-like lesions: dysplasia and cherubism

A special group of jawbone pathologies consists of tumor-like formations based on impaired normal osteogenesis.

Fibrous dysplasia The basis of the disease is a developmental defect of the odontogenic mesenchyme, which loses the ability to form healthy bone, replacing it with fibrous connective tissue. Monostotic and polyostotic forms are distinguished.

• Pathomorphology: the phenomenon of incomplete osteogenesis is observed. Immature bone trabeculae have bizarre shapes resembling "Chinese characters".
• Radiodiagnostics: the "ground-glass" sign is characteristic.

Cherubism This is a rare hereditary variant of fibrous dysplasia manifested in early childhood. It is characterized by bilateral symmetrical enlargement of the jaws. Externally, this leads to the mechanical pulling down of the lower eyelids, exposing the sclera and giving the child's face a specific expression (resembling a cherub). Radiologically, multiple cyst-like areas are identified, formed due to active osteoclast activity. By puberty, the process usually stabilizes.

Giant cell tumor and granuloma

Formations rich in multinucleated osteoclast-like cells are frequently diagnosed in the jaws.

Giant cell tumor (osteoblastoclastoma): Frequently occurs in young women (in 30% of cases, it is localized in the jaws). It grows intraosseously in the mandibular premolar zone. Macroscopically, it is a node with a variegated cut surface (alternating brown, red, and gray areas with cysts). Microscopically, the tissue is richly vascularized, containing spindle-shaped cells and evenly distributed giant multinucleated cells. The tumor is prone to recurrence and sometimes metastasizes to the lungs.

Reparative giant cell granuloma: Divided into central and peripheral forms. The central granuloma manifests as bone tissue destruction with clear margins. At the microscopic level, unlike a true giant cell tumor, it contains a smaller number and size of osteoclasts, which group perivascularly against a background of fibrous tissue.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Morphology of rare malignant odontogenic tumors (intraosseous carcinoma, sarcomas)
• Differences between true fissural cysts and false bone (traumatic) cysts
• Differential diagnosis of peripheral giant cell granuloma and epulis
• Complications of cystic lesions of the maxilla (odontogenic maxillary sinusitis)

Other Topics in "Chapter 27. Diseases of the Dentofacial System and Oral Cavity"

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