In medical practice, along with a description of the pathologies of the oral cavity, the concept of Vincent's symptom is often encountered. What kind of condition is this, in what inflammatory process does Vincent's symptom occur and what is fertile ground for the occurrence of such a pathology - we will deal with these questions in our article today.
What is this symptom?
Vincent's symptom is a condition in which a person loses sensation in the chin area, more precisely in the area of the lower lip.
The symptom is a consequence of various disease states of the body, such as osteomyelitis of the jaw and acute apical periodontitis. This pathology is also mentioned in ulcerative membranous angina, the second name of which is Simanovsky-Vincent's angina (the symptoms of the pathology are quite diverse).
Let's take a closer look at each of the pathologies that lead to the manifestation of the above symptom.
Ulcerative membranous angina is a disease that leads to inflammation of the palatine tonsils. The cause of the pathologyis the activity in the body of the fusiform rod of Plaut - Vincent together with Vincent's spirochete. With angina, ulcers form with a characteristic dirty green coating. The breath of the patient is accompanied by a putrid odor. It must be said that such bacteria are constantly present in the oral cavity of a he althy person, however, under the influence of various factors, for example, with caries of molars, with foci of necrosis in the oral cavity, as well as with a general weakening of immunity, microorganisms are activated, and their activity leads to the development of pathological states.
Angina Vincent. Symptoms and treatment
Ulcerative membranous angina is manifested by a whole complex of characteristic symptoms. These include:
- Increased affected tonsil. Mostly the disease affects one of the parties.
- Enlargement and moderate soreness of regional lymph nodes.
- Formation of a grayish-yellow plaque on the mucous membrane of the palatine tonsils, which can cause the formation of superficial, painless ulcers with a gray bottom. If the pathology progresses, ulcers occur in other parts of the pharynx, as well as on the mucous membrane of the cheeks or gums. Sometimes ulcers can heal without leaving any defects.
- When eating (when swallowing), there are painful sensations, while patients note increased salivation, bad breath.
- Body temperature in pathology in rare cases exceeds normal limits, although sometimes the disease can begin withhigh fever and chills.
- Numbness and loss of sensation in the chin area.
Treatment of pathology is aimed at eliminating inflammation of the mucous membrane of the throat. Often, otolaryngologists prescribe means for rinsing or lubricating the affected area. In the case of a protracted course of the disease, antibiotic therapy is used. Patients with ulcerative membranous tonsillitis are always isolated, in severe forms of pathology they are hospitalized. The main principle of disease prevention is to strengthen the protective functions of the body and increase immunity.
Vincent's symptom in dentistry. Periodontitis
Periodontitis is a pathology caused by infection from the carious cavity into the bone tissue through the root apex. The disease causes inflammation of the shell of the tooth root. If left untreated, periodontitis is manifested by various signs, including Vincent's symptom. The reversibility of the disease depends on many factors: the timeliness of seeking medical help, the general condition of the human body, etc. Let's consider the mechanism of the pathology.
Deep caries leads to pulpitis - inflammation of the pulp, as a result of which microorganisms enter the periodontium through the root canal.
There are also other ways of penetration of bacteria into bone tissue, for example, due to trauma, with sepsis, but pulpitis is the most common cause of inflammatory processes in the bone. Inflammation causes sweating of the liquid, and the periodontium is a tissue saturatedreceptors, - reacts to an increase in pressure. In this case, inflammation causes pain.
A characteristic feature of periodontitis is the growing throbbing pain, which is strictly localized. Sometimes, when teeth are closed, pain is difficult to endure, patients cannot eat. It hurts a person just to touch the edge of the tooth, which also becomes mobile, the gums around the tooth, as well as the lip and cheek, swell, the body temperature rises sharply. A concomitant sign of periodontitis may be a symptom of Vincent. Signs of it have already been noted earlier: numbness and loss of tissue sensitivity in the chin area.
Forms of periodontitis
Distinguish between acute and chronic form of periodontitis. If, during inflammation, the resulting fluid leaves through the root canal of the tooth, periodontitis becomes chronic. The pain syndrome is not very pronounced, and the pathological processes in the apex of the tooth flow slowly. Bacteria, multiplying in the area of the affected bone, release toxins that “poison” the human body and lead to the development of diseases of various organs and systems (joints, heart, kidneys).
Otherwise, an acute form of periodontitis develops, which over time, if not properly treated, can go into a purulent stage.
The above forms of periodontitis require a long and highly qualified treatment. The main goal of therapy is to ensure the outflow of pus from the site of inflammation. In the process of treatment, the inflammatory process is first stopped, then the pulp is treated with antiseptic treatment, thenplace a temporary filling. During the period of therapeutic measures, the condition of the bone tissue is monitored by X-ray.
Treatment
In the treatment of chronic periodontitis, medications are used that stimulate the restoration of periodontal disease. Concomitant methods of treatment can be physiotherapy: electrophoresis, UHF, microwave, laser therapy, magnetotherapy. In some cases, antibiotic treatment is used.
Antibiotics can be used topically in case of deep periodontal pockets. Root canal filling is performed with materials that are selected individually in each case.
If inflammation affects large areas of tissue, or conservative therapy does not lead to the desired result, surgical intervention is performed. The purpose of the manipulation is resection of the apex of the tooth root. A small incision is made in the gum in order to gain access to the bone tissue. Next, the affected structure is removed, the top of the canal is sealed. Bone regeneration is a long process. If the treatment does not lead to positive dynamics, the tooth may be removed.
In order to avoid the development of such a disease, it is necessary to carefully monitor oral hygiene.
This implies a mandatory daily brushing twice a day. At the same time, the toothbrush should be changed periodically, scrupulously approach the choice of toothpaste. Visit your dentist at least once a yearprofessional tartar removal.
Emptiness of the dentition leads to the fact that an increased load falls on the remaining teeth in the mouth. The molars become vulnerable, an inflammatory process may develop in the oral cavity, which in the future will lead to periodontitis.
Periodontitis is a rather insidious disease, because it causes many complications, including acute sepsis, inflammation of the soft tissues of the face, osteomyelitis of the jaw.
What is osteomyelitis?
Another reason why Vincent's symptom occurs is osteomyelitis. This pathology, regardless of which part of the human skeleton manifests itself, belongs to the group of infectious diseases of an inflammatory nature.
When osteomyelitis of the jaw affects all tissues: periosteum, bone substance, bone marrow. Pathology occurs mainly in people not older than forty years. However, there are cases of the development of the disease in children, as well as in the elderly. It all depends on how badly the person's teeth are affected by caries. Equally, osteomyelitis worries both men and women. Vincent's symptom with osteomyelitis affects the chin area, and this is primarily due to the fact that the pathology more often affects the lower jaw than the upper.
Earlier, when oral hygiene was not given due attention, osteomyelitis of the jaw occupied about 40% of the pathology of other bones. Not so long ago, the situation has changed for the better.
Today, thanks to the widespread planned sanitation of the oral cavity in both children and adultsof the population, the percentage of patients with osteomyelitis of the jaw has decreased, and the use of antibiotics has made the course of the disease less severe.
Classification of osteomyelitis
In most cases, osteomyelitis of the jaw is a consequence of caries, as well as a complication after periodontal disease.
This group of osteomyelitis is called odontogenic (stomatogenic). The infection enters the bone structures through caries-affected molars. In the foci of inflammation there is a diverse microflora. These are streptococcus, and staphylococcus aureus (white and golden), pneumococcus and other bacteria.
Contact osteomyelitis is a pathology that occurs as a result of infection of the skin or mucous membrane (for example, with a facial boil). Here are specific osteomyelitis:
- tuberculous,
- syphilitic,
- actinomycotic.
Sometimes damage to the bone marrow of the jaw occurs through the ingestion of bacteria with the blood stream. This condition is classified as hematogenous osteomyelitis, which occurs after infections such as influenza, typhoid fever, scarlet fever, measles.
A separate group is osteomyelitis resulting from trauma (fracture, severe contusion). Vincent's symptom in fractures, when sensitivity is disturbed in the area of the mental nerve and patients note numbness of the lower lip, occurs due to compression of the lower alveolar nerve, formed during inflammation by exudate.
Course of illness
The course of the disease can be different, and most often itdepends on the state of the body as a whole, on the magnitude of circulatory disorders in the affected area. In some cases, the scale of bone necrosis is small, due only to the primary focus. In such cases, we are talking about limited osteomyelitis. If the disease progresses, the inflammatory process is transferred to the soft tissues surrounding the jaw. This condition can manifest itself in the form of periostitis or phlegmon. Phlegmon is an acute purulent inflammation of spaces (often soft tissues), which is diffuse and does not have clear boundaries, such as an abscess. By the way, Vincent's symptom can often be observed with phlegmon, patients note a loss of sensitivity in the affected area.
At the beginning of the pathological process, the bone marrow at the point of inflammation acquires a brown, dark red color. Later, purulent foci are formed, which merge into entire cavities. Pus enters the periosteum, gums and causes necrosis of the jaw areas. Sequesters are formed. Thrombi form in small blood vessels, which undergo melting. Areas of bone necrosis appear in the bone, its blood supply gradually decreases, which leads to an increase in the scale of necrosis of the bone structure. The size of sequesters is determined by the size of thrombosed vessels. In particularly difficult cases, necrosis of the entire jaw may occur. Similar conditions are associated with diffuse (diffuse) osteomyelitis.
Symptomatics
There are several forms of pathology. During the period of subacute osteomyelitis, a so-called shaft appears between a he althy bone and a dead one. In some cases, there is resorptionsequester. Regeneration processes can occur - a new bone structure is formed around the affected area. In reverse cases, rejection of sequesters is observed. The subacute form is borderline between acute and chronic osteomyelitis.
During the acute form of osteomyelitis, an active development of the inflammatory process occurs. Patients note severe pain in the jaw (drilling, shooting), which develop against the background of high fever, chills, rapid breathing and pulse. In addition to pain in the jaw, the sensitivity of the lower lip may disappear - this is how Vincent's symptom manifests itself in osteomyelitis. After a few days from the onset of the disease, the teeth adjacent to the diseased tooth become mobile.
Palpation of the jaw reveals swelling and is accompanied by painful sensations. There is inflammation and swelling of the gums, cheeks or other areas on the face. During the period of illness, an increase in lymph nodes occurs. Subsequently, all these symptoms may be accompanied by trismus - reduction of the jaw muscles, numbness (Vincent's symptom). The reversibility of the disease depends on the timeliness of diagnosis and further treatment.
The general condition of the patient is classified into conditionally mild, moderate and severe. Unfortunately, sometimes the disease ends in death within a few days from the onset of the pathological process.
It is well known that at first, patients may seem cheerful, but soon the state of euphoria is replaced by a breakdown with a sharp drop in blood pressure and an increase in heart rate. The appearance of a person sharplychanging.
Diffuse osteomyelitis is a gradual inflammation of new areas of the bone. The patient's condition can be described as unstable, with temporary improvements and deterioration of he alth, during which the body temperature may first return to normal, and then rise again and be accompanied by recurring chills.
The stage of acute diffuse osteomyelitis can last up to four weeks. At the same time, there is a sharp decrease in the content of lymphocytes in the blood (up to 15%–18%), protein is present in the urine.
The chronic form of the disease, in the absence of therapeutic measures, can last for months, and sometimes even years, and lead to various complications: lung abscesses, suppuration in the cranial sinuses, acute and chronic kidney damage.
Diagnosis and treatment
X-ray is one of the methods in the diagnosis of osteomyelitis and helps to determine the extent of damage to bone structures. However, the initial changes in the bone can only be seen on the 7-10th day from the onset of the disease.
The first thing that is determined using a snapshot is the area of rarefaction in bone structures. Further, if the course of the disease can be stopped, the radiograph reveals the resulting boundaries between he althy and dead tissue. Based on the size of this border, conclusions can be drawn about the size and localization of sequesters. In addition to radiography, it helps to identify the diseasea general picture of the state of the human body and an analysis of accompanying signs, including Vincent's symptom.
Treatment of osteomyelitis involves the combined use of antibiotics and surgery. Often, penicillin injections, streptomycin, or biomycin are prescribed as conservative treatment. With antibiotic therapy, however, it is important to be mindful of the bacteria's ability to become addictive.
Drug treatment is important to continue for 7-10 days even after the temperature drops to normal levels. Otherwise, the disease will be hidden. Often the fate of the tooth, due to the disease of which inflammation has arisen, is decided unambiguously - it must be removed. Although there are exceptions to the rule.
Neighboring teeth are trying to save, restoring their functionality. For this, wire tires are used, which are installed on the entire dentition. In addition, inflammation of the pulp in the teeth is also eliminated if possible. Movable sequesters are subject to surgical removal, which is carried out no earlier than 4-6 weeks after the onset of the disease. This is primarily due to the fact that only after the specified period, the boundaries of the sequestration are clearly distinguishable.
Thus, Vincent's symptom is one of the main signs of the development of serious inflammatory diseases in the human body, including osteomyelitis, periodontitis, Simanovsky-Vincent's tonsillitis (the symptoms of this particular form of the disease are distinguishable from the general symptoms of angina due to the manifestation of Vincent's symptom).
