The first of the internal areas of the body that "meets" food is the oral cavity. Its structure is directly related to the processes of digestion. It performs many specific functions. Consider one of the components - the vestibule of the oral cavity, its structure, norms, features of the examination and correction of possible deviations.
Functions of the human oral cavity
The structure of the human oral cavity, which is in direct contact with food and is responsible for the processes of digestion, performs a number of basic functions. Namely:
- Crushing food. Separation of food into pieces, grinding of small and solid particles.
- Softening. That is, the maximum grinding of food, even soft. Everything is thoroughly chewed so that later the food is processed faster by saliva and gastric juice.
- Wetting food. Even a piece of soft bread will not pass just like that into the larynx. It is saliva that contains the necessary enzymes for the digestion of all substances.
- Analysis of food composition. This process involves the language, which contains various receptors that transmit information about food (temperature, taste) to the brain.
What is the vestibule of the mouth?
The oral cavity is the beginning of the alimentary canal. Many functions that are responsible for the process of food intake into the body depend on it.
It consists directly of the vestibule and the actual oral cavity. The vestibule is the space between the teeth and gums on the inside and the lips and cheeks on the outside. This is a soft tissue through which the mouth opens. There are a large number of small salivary glands and ducts of the parotid salivary glands.
Building
In the oral cavity, the excretory ducts of the salivary glands open: sublingual, submandibular and parotid. In addition, there are a large number of small glands. The glands that make up the vestibule of the oral cavity and the oral cavity itself can be of three types, depending on the nature of the secret: serous, mucous and mixed.
Large salivary glands that go beyond the mucosa, reaching large sizes, retain communication with the oral cavity through their excretory ducts. These include:
- Parotid gland (Glandula parotidea). It is the largest serous type gland, as well as a complex alveolar gland. It is located on the lateral side of the face in front andjust below the ear. It is covered with fascia and has a lobed structure.
- Submandibular gland (Glandula submandibularis). It has a mixed alveolar-tubular character and is the second largest.
- Sublingual gland (Glandula sublingualis). Complex alveolar-tubular mixed type of iron. It is located at the bottom of the mouth, forming a fold.
How the examination works
Specialists start examining the oral cavity from the vestibule, with the jaws closed and the lips relaxed. The doctor pulls the lower lip with a dental mirror and examines the corners of the mouth and the border of the lips first. The walls of the vestibule of the oral cavity should have a pinkish tint, there should be no crusts and scales. At the same time, the inner surface of the lip may be slightly bumpy, which is caused by the presence of small salivary glands.
Pinholes can also be seen, that is, excretory ducts with accumulation of secretion droplets. Next, with the help of a mirror, the inner surface of the cheeks is examined, the color and moisture are determined. On the mucosa, imprints of the teeth can be seen. Thus, a malocclusion can be diagnosed by a doctor.
Additionally, the oral cavity is examined by the nature of salivation (low or high), whether there is bad breath, whether the gums bleed. In the presence of diseases, the mucous membrane may be hyperemic, edematous, with rashes, which indicates the development of inflammation.
Dimensions and depth
The depth of the vestibule of the oral cavity can be shallow (less than 5 mm), medium (8-10 mm) and deep (more than 1 cm), which depends on the distance between the moving part and the fixed gum area. If the vestibule is shallow, it is fraught with the development of gingivitis or marginal periodontal disease. In this case, a kind of periodontal pockets can form, that is, a depression between the tooth and the gum. The cause of this condition can be a normal conversation, brushing your teeth or the process of eating food. With an increase in the mobility of the nipples, delaying the free end of the gums, periodontal disease may occur.
When the size of the vestibule deviates from the norm, operations are performed, which are called vestibuloplasty. They can be both open and closed and carried out in various ways.
Norm and reasons for deviation
Examination of the oral mucosa begins with an examination of the vestibule of the oral cavity, namely its depth. To determine this indicator, a graduated trowel or periodontal probe is used. The distance from the edge of the gum to the level of the transitional fold is measured. Normally, the depth should be 5-10 mm. If the indicator is less, the threshold is considered shallow, more - deep.
You can identify an anomaly by the following features:
- increase, narrowing or complete absence of the area to which the mucosa is attached;
- in the area of attachment of teeth and gums there is a tension of the gum tissue;
- bleeding and inflammation affecting the gums;
- Incisor hypersensitivity;
- anatomical deformities of the dental andgingival row;
- short bridle;
- problems with diction.
With a decrease in the size of the vestibule, there may be incomplete closure of the lips, malocclusion, partial immobility of the lips, or a slightly reduced size of the upper jaw compared to the lower dentition.
The consequences of deviations from the norm of the vestibule of the oral cavity include:
- marginal periodontium may be injured in the process of eating food;
- chin muscle tone increases;
- blood is poorly supplied to the gum tissue;
- malocclusion is formed;
- lip mobility decreases;
- upper jaw row slows down in growth;
- gum atrophy and inflammation;
- loose dentition;
- periodontitis develops.
Small oral vestibule
Gingival insertion height, especially in children, is variable. With the development of dental follicles, as well as teething (both milk and permanent), the size of the vestibule may change.
There are certain norms for deepening the vestibule of the oral cavity in children:
- 6-7 years - depth is 4-5mm;
- 8-9 years - 6mm to 8mm;
- by the age of 15 - up to 14 mm.
Small vestibule refers to anomalies in the development of the mucosa. This may lead first to catarrhal gingivitis affecting one or more teeth, to local periodontitis. The development of this process can be facilitated by a low leveloral hygiene and various orthodontic disorders.
The causes of the development of a small vestibule of the oral cavity can be:
- congenital pathology with a hereditary factor;
- consequences of surgical interventions;
- mechanical damage to soft tissues in the oral cavity.
The treatment is complex, including therapeutic, orthodontic and surgical procedures. In some cases, plastic surgery of the vestibule of the oral cavity is performed as a preventive measure.
Vestibuloplasty
Plasty of the vestibule of the oral cavity is often performed with its reduced size. Through open or closed surgery, the area is deepened, which in turn helps to avoid the development of problems with the dentition in the future.
Indications for vestibuloplasty are:
- lack of gum attachment;
- tension, displacement or blanching of the gingival margin when the lip is retracted;
- deep vestibule is less than 1mm;
- gingival tissue is very inflamed;
- preparation for orthodontic therapy;
- need for prosthetics;
- gum atrophy.
The operation is carried out in different ways, which can be divided into groups: open, closed, patchwork and the use of a plate. The open method involves dissection of the mucous membrane of the lower lip and displacement of soft tissues, after which the depth of the vestibule increases. ATas a result of this method, a wound is formed, which subsequently scars, and the recovery period lasts about 14 days.
With a closed operation, the mucosa is practically not damaged, the recovery period is short, but there is a big minus - the possibility of relapse. According to statistics, after a few years, the depth of the vestibule is almost halved.
Flap surgery is performed with a strong tension of the gum tissue, which can subsequently lead to loosening of the teeth and inflammation in the oral cavity. It is performed using vertical and horizontal incisions. The patches are fixed with suture materials. The use of a plate also makes it possible to deepen the vestibule of the oral cavity. This is a vestibular construction, which is superimposed on the site of the mucosal incision and fixed with sutures. To achieve the result, it should be worn for at least two months.
Other treatments:
- Vestibuloplasty according to Edlan-Meikher. A fairly effective way to eliminate a small vestibule. The incision of the mucosa and periosteum, as well as the transfer of the submucosa to the anterior and lateral parts of the vestibule, is performed under local anesthesia, the recovery period is up to two weeks.
- Vestibuloplasty according to Schmidt. The operation is similar to the previous one, but the periosteum is not peeled off. The method is applied to both the upper and lower jaws.
- Vestibuloplasty according to Clark. It is carried out with the pathology of the upper row of the jaw. Exfoliation of the mucosa is carried out with scissors, the depth of the incision is notexceeds 15 mm. Next is the movement of the detached area and fixation with sutures.
- Vestibuloplasty according to Glickman. It can be carried out both on the entire plane of the oral cavity, and on a specific area. The incision, transfer and suturing takes place under anesthesia.
- Tunnel vestibuloplasty. The least traumatic method, which is used for both the lower and upper jaw. The recovery period after cutting, moving the flap and fixing it, lasts no more than ten days.
But plastic, regardless of the method or method, is not carried out by everyone. There are a number of contraindications, namely:
- chronic diseases of the oral mucosa;
- caries affecting almost the entire dentition;
- inflammatory processes affecting the musculoskeletal tissue;
- disturbances in the functioning of the nervous system;
- poor blood clotting or other pathologies of the circulatory system;
- malignant neoplasms;
- radiotherapy given to the head or neck in the past.
Stages of vestibuloplasty and possible complications
Since the ducts of the salivary glands open in front of the oral cavity, it is important to conduct an examination from the determination of the height at which the gum is attached. If the specialist establishes that the vestibule is still small and vestibuloplasty is indicated, it is necessary to thoroughly prepare for the operation. This will reduce the possible risk of complications infuture.
Principles of preparation:
- complete oral hygiene;
- no solid food for at least six hours before surgery;
- do not take medicines except those prescribed by a doctor or necessary to maintain normal human life.
Also, experts note that the psychological attitude is important. In general, regardless of the method of vestibuloplasty, the operation is painless, as it is performed under local anesthesia and lasts about an hour.
Stages of vestibuloplasty:
- An anesthetic is injected after the doctor discusses with the patient the possible intolerance of certain drugs and excludes them. It is the choice of anesthesia that determines how a person will feel during and after the operation.
- Direct surgical intervention by one of the methods described above. Takes no more than an hour.
- Ice is applied to the site where the operation was performed for 15 minutes to remove swelling and minimize pain after surgery.
After the operation, swelling and redness of the skin is possible, which is considered normal. During the day after vestibuloplasty, the use of painkillers is indicated, but this depends on the patient's well-being.
Complications, which are extremely rare after deepening of the vestibule of the mouth, can develop due to non-compliance with the recommendations of a specialist and poor oral hygiene.
Possible side effectseffects:
- increased bleeding, especially at the suture site;
- tissue scarring;
- low sensitivity;
- severe gum swelling.
If this condition is observed within a few days after vestibuloplasty, this indicates the development of an inflammatory process. It is worth consulting a doctor for advice.
Conclusion
Examination of the vestibule of the oral cavity in the presence of problems with the dentition is mandatory. Determining its depth allows you to identify the causes of diseases associated with teeth, the development of malocclusion or speech disorders. Regardless of the form (small, medium or deep vestibule), as well as the nature of the pathology (congenital or acquired), it is amenable to therapy. Specialists perform vestibuloplasty with different methods to correct the situation.
