Американский Научный Журнал FEATURES OF THE CLINICAL COURSE OF LICHEN PLANUS WITH LOCALIZATION ON THE ORAL MUCOSA

Abstract. The clinical picture and course of lichen planus (CPL) on the oral mucosa have significant differences from its manifestation on the skin. The variety of clinical manifestations and the low effectiveness of the treatment are of certain difficulties and interest not only for dentists, but also for dermatologists in terms of diagnosing and treating CPL of the oral mucosa. The purpose of the work is to identify the clinical features of the manifestation of various forms of CPL with localization on the oral mucosa. [16-19] The study was carried out with the participation of 147 patients with various forms of CPL of the oral mucosa from the age of 24 to 70 years. Results. The results of the study show that the largest number of patients were aged 40 years and older, and women accounted for the vast majority - 95%. Of all forms, erosive-ulcerative were detected more often than others - in 49 (33%) patients. In addition, all examined patients had a combination of CPL of the oral mucosa with another somatic pathology, which requires consultation of appropriate specialists to prescribe adequate treatment. Скачать в формате PDF
American Scientific Journal № ( 31) / 2019 17

FEATURES OF THE CLIN ICAL COURSE OF LICHE N PLANUS WITH LOCALI ZATION ON THE
ORAL MUCOSA
Akmalova Guzel Maratovna
Chuikin Oleg Sergeevich
Akateva Galina Grigoryevna
Makusheva Natalya Vyacheslavovna
Department of Pediatric Dentistry and Orthodont ics,
Bashkir State Medical University , Ufa

Abstract . The clinical picture and cou rse of lichen planus (CPL) on the oral mucosa have significant
differences from its manifestation on the skin. The variety of clinical manifestations and the low effectivene ss of
the treatment are of certain difficulties and interest not only for dentists, but also for dermatologists in terms of
diagnosing and treating CPL of the oral mucosa. The purpose of the work is to identify the clinical features of the
manifestation of various forms of CPL with localization on the oral mucosa. [16 -19] The study was c arried out
with the participation of 147 patients with various forms of CPL of the oral mucosa from the age of 24 to 70 years.
Results. The results of the study show that th e largest number of patients were aged 40 years and older, and women
accounted for the vast majority - 95%. Of all forms, erosive -ulcerative were detected more often than others - in
49 (33%) patients. In addition, all examined patients had a combination o f CPL of the oral mucosa with another
somatic pathology, which requires consultatio n of appropriate specialists to prescribe adequate treatment.
Key words : lichen planus, oral mucosa, clinical course.

Red lichen planus (CPL) is a chronic, long -lasting
dermatosis of a multifactorial nature with diverse
clinical manifestations and invol vement of the skin, its
appendages (hair, nails) and mucous membranes in the
process [1 -7]. Damage to the oral mucosa (MOP) in
CPL can be combined with skin lesions, but it i s often
of an isolated nature [3, 4]. Most often, the process
develops on the muco us membrane of the cheeks,
tongue, in the retro -molar region, gum, lips, less often
in the area of the bottom of the mouth and palate.
Mostly women aged 40 and over are aff ected [5 –7].
There are six clinical forms of KPL of the red border of
the lips and SOPR: typical, hyperkeratotic, exudative -
hyperemic, erosive -ulcerative, bullous and atypical [3].
The clinical picture and the course of CPL on MOP has
significant differenc es from its manifestation on the
skin, in particular, greater resistance to treatm ent,
which is due to the structural features of the mucous
membrane, as well as the specificity of biological and
physicochemical processes in the oral cavity. A variety
of c linical manifestations and low treatment efficacy
present certain difficulties and interest not only for
dentists, but also for dermatologists in terms of
diagnostics and treatment of SOPL CPR. [8 -15]
The purpose of this work is to identify the clinical
features of the manifestation of various forms of CPL
with localization on the oral mucosa.
Material and methods. The study was carried out
with the participation of 147 patients with various
forms of CPR MOP at the age of 24 to 70 years, who
sought advice f rom a dentistry clinic at the Ural State
Medical University and Bashkir State Medi cal
University. The examination of patients with CPR of
SOPR included a careful collection of the anamnesis of
this disease, clarification of the hereditary
predisposition ta king into account previous diseases,
identification of comorbid conditions and the ir
relationship with the main one, the stage -by -stage
manifestation of clinical symptoms of CPL (periods of
exacerbation and remission), an allergic factor, and, if
necessary , cytological and histological research. When
examining SOPR, the tongue and lips, they paid
attention to the presence of signs of inflammation,
elements of the lesion, and their localization. The
presence of an isomorphic reaction (Kebner symptom)
in CPL, manifested by the appearance of fresh primary
elements characteristic of this dis ease at the site of skin
or mucous membrane irritation by any exogenous
factor, is of important diagnostic value.
Results and discussion. Of the 147 patients
included in the study, 140 (95%) were women and 7
(5%) were men. The median age at diagnosis was 4 8.4
years for women and 47.05 years for men. The duration
of the disease was less than 1 year in 3 men and 47
women, the duration of the disease was 1 –5 years in 3
men and 53 women, more than 5 years in 1 man and 40
women. No somatically preserved person w as found
among patients with CPR of SOPR - all patients had
concomitant somatic pathology. Most often, the
following groups of diseases were noted in the
anamnesis: - gastroi ntestinal tract (77%): chronic
gastritis, gastric ulcer, duodenal ulcer, gastroint estinal
dysbiosis, viral and toxic hepatitis, chronic
cholecystitis, biliary dyskinesia; - cardiovascular
system (67%): hypertension, arrhythmia, coronary
artery disease, var icose veins, atherosclerosis,
vegetovascular dystonia; - endocrine system (39%):
diabetes mellitus, hormonal imbalance in women,
pathology of the thyroid gland, adrenal glands; - the
immune system (43%). A family history of the disease
was noted only in 3 patients. A typical form of SOPR
CPL lesion was detected in 27 cases. Patients
com plained of a feeling of tightness, roughness of the
SOP. In 43% of cases, the disease was asymptomatic
and was accidentally detected upon examination by a
dentist. Most often , the process was localized on the
mucous membrane of the cheeks along the line of
closure of the teeth, the back of the tongue and its
lateral surfaces, transition folds of the anterior teeth of
the upper and lower jaws, and the retromolar region.
The pri mary morphological element is the miliary
papule of a polygonal shape, towering ab ove the
surrounding mucous membranes, with a shiny surface.
Merging, papules form patterns in the form of lace, fern

18 American Scientific Journal № ( 31) / 20 19
leaves, rings, strips on unchanged SRS. In smokers,
papul es are more pronounced and larger. On the red
border of the lips, the papules can merge, forming a
strip of whitish color, in some cases taking a star shape.
In 40 patients, an exudative -hyperemic form was
revealed, which is characterized by typical CPL
papules in the presence of chronic catarrhal
inflammation in a limited area of the mucous
membrane. This form is accompanied by more
pronounced pain: burning, pain, aggravated by eating
spicy food, talking. Against the background of an
inflamed hyperemic m ucous membrane, the pattern of
papules can lose its clarity and even partially disappear,
but in the process of reverse development, when edema
and hyperemia of the mucous membrane decrease, the
pattern of papules reappears. Erosive -ulcerative form
was det ected in 49 patients. This is the most severe of
all forms, which occurs as a complication of a typical
or exudative -hyperemic form. With this form, there are
erosions, sometimes ulcers, on the hyperemic and
edematous SOP, around which, against the backgro und
of pronounced inflammation, papules typical for CPL
are located in the form of a pattern. Erosions or ulcers
of irregular shape are covered with fibrinous plaque,
after which bleeding easily occurs. In 11 cases, erosion
and ulcers were single, small, s lightly painful, in other
cases, multiple with sharply expressed soreness.
Sometimes at the site of long -existing erosions and
ulcers, patches of atrophy of the mucous membrane
appeared. Kebner's symptom was observed in seven
patients. A hyperkeratotic for m was detected in 14
patients, while on the background of typical papular
rashes there were continuous foci of keratinization with
sharp boundaries. Patients complained of an unusual
appearance and a feeling of unevenness of the SRO. It
should be noted tha t erosive -ulcerative and
hyperkeratotic forms belong to the optional precancer.
So, in 0.4 to 5% of cases, the disease can become
malignant [8, 9], this requires dynamic monitoring not
only by the dentist, but also by the oncologist. In 17
patients, an aty pical form was revealed, which
appeared on the mucous membrane of the upper lip and
on the gum in contact with it, characterized by the
appearance of a section of congestive hyperemia with
clear boundaries, since the primary elements of lichen
planus (papu les) are barely noticeable. Patients
complained of burning, soreness, bleeding gums in the
region of the anterior teeth of the upper jaw, especially
when brushing teeth. This form is often diagnosed by
dentists as an inflammatory periodontal disease [10].
With a bullous form of CPL MOP, patients complain of
the periodic formation of blisters, as a result of the
opening of which there are constant pains that intensify
under the influence of stimuli. Erosion after opening
the blisters can epithelize within a few days. The
histological picture of CPL in half of the patients is
characterized by uneven acanthosis and granulosis.
Hyper - and parakeratosis are usually determined. The
sawtooth lengthening of the interventricular processes
of the epithelium in the muc ous membrane (acanthosis)
is significantly less pronounced than in the skin. Often
observed vacuole degeneration of the cells of the
prickly and basal layer of the epithelium. Immediately
below the epithelium is a diffuse, less often strip -like
infiltrate, consisting mainly of lymphocytes and plasma
cells. Infiltrate almost never penetrates into the lower
edematous layers of the connective tissue, it closely
approaches the epithelium, as if supports it, and some
cells of the infiltrate penetrate the epithel ium
(exocytosis), so in some places the border between the
basal layer and the connective tissue is poorly visible.
Thus, our studies show that the majority of
patients are people aged 40 years and older, most of
whom are women (95%). In addition, in all the
examined patients, a combination of SOPR CPL with
another somatic pathology was noted. This fact
underlines the importance of the joint management of
patients with CPL with clinicians of other specialties.
Experience will allow dentists to familiarize
themselves with the features of the clinical
manifestations of various forms of CPL MOP and will
facilitate timely diagnosis and adequate treatment.

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FEATURES OF ORTHODON TIC TREATMENT OF CHI LDREN WITH NON -CARIO US LESIONS
OF H ARD TISSUES OF TEETH

Chuikin Oleg Sergeevich
Snetkova Tatyana Vladimirovna
Fardutdinova Alia Omarovna
Sharafutdinova Guzel Khakimovna
Muradyan Shushanik Artakovna
Mansurova Sofia Marsovna
Department of Pediatric Dentistry and Orthodontics,
Bashkir State Medical University , Ufa

Abstract . According to the epidemiological survey in the Republic of Bashkortostan, a high prevalence of
dentoalveolar anomalies and non -carious lesions of hard den tal tissues in children was revealed. Non -carious
lesions of the teeth limit the use of metal elements in orthod ontic appliances. Orthodontic treatment was performed
for 26 children aged 7 -11 years with dentoalveolar anomalies in combination with non -cario us lesions of the hard
tissues of the teeth. The authors evaluated the effectiveness of the use of LM activator in orthodontic treatment of
children of the observed group. The scheme of complex dental treatment of this category of patients is presented.
Key words : dentoalveolar anomalies, non -carious lesions of hard tooth tissues, LM activator, remineralizing
thera py, complex dental treatment regimen.

According to an epidemiological survey
conducted by the Department of Pediatric Dentistry and
Orthodonti cs, the prevalence of dentoalveolar
anomalies in Ufa, which is the center of the
petrochemical industry of the R epublic of Belarus,
during the period of a milk bite is 35.2%, in the early
shift bite - 72.5%, in the late interchangeable bite -
78.4%. Anomal ies in the structure of the hard tissue of
teeth were detected in 18.4% of the examined children,
enamel hypopla sia of temporary teeth in 17.8% of
preschool children, and permanent teeth in 10.9% of
schoolchildren. In the structure of tooth enamel
hypoplas ia, a large part falls on systemic enamel
hypoplasia, which is 64.7%. This indicator is six times
higher than th e data on the prevalence of enamel
hypoplasia in children living in areas with more
favorable environmental conditions [1 -6]. The
formation of e namel of permanent teeth begins at the
end of fetal development, but the main part of the
histogenesis of hard t issues of permanent teeth
proceeds after birth. Hypoplasia of permanent teeth
mainly reflects the condition of the child in the first