Very important in the daily practice of a doctor is the classification of diseases associated with the oral mucosa. This allows the specialist to navigate the multitude of nosological types of pathologies, and hence it follows that the correct diagnosis will be made and reasonable therapy will be prescribed, as well as preventive measures (including annual medical examinations) will be provided.
About the classifications of the oral mucosa
At the moment there is no classification that would be generally accepted among diseases of the oral mucosa. Those that are based on diverse features are popular. These include localization of changes in pathology, severe course of the disease, clinical and morphological signs, etiology, pathogenesis, etc.
This article will consider the Supple classification.
Changes in the mucosa
Emerging changes that develop inof the oral cavity after the teeth have been removed, they begin to capture not only the alveolar processes, but also spread to the mucous membrane that covers them and the hard palate.
These changes can be expressed in the form of atrophy, folds can also form. This changes the location of the transitional fold relative to the crest of the alveolar process. The essence and stage of these modifications can be explained not only by the loss of teeth, but also by the reasons that became the basis for their removal.
What influences this?
Local diseases and pathologies of the whole organism, age-related changes also affect the nature of the modification of the mucous membrane, which takes place after the teeth have been removed. The doctor needs to know the characteristics of the tissues that cover the prosthetic bed, as this is of great importance when choosing a prosthetic method. To achieve good results, it is necessary to prevent the harmful effects of the prosthesis on the supporting tissues.
The following is the classification of the mucosa by Supple.
The author pays special attention to the condition of the mucous membrane of the prosthesis bed. In total, he distinguishes four classes of compliance.
First class
The first class is distinguished by the presence of well-defined alveolar processes on the upper and lower jaws, which are covered with a pliable mucous membrane. The palate is also covered with a uniform layer of mucous. Here it is also moderately pliable in its rear third.
From the top of the alveolar process toa sufficient distance removed the natural folds of the mucous membrane on the upper and lower jaws. With this class of mucous membrane, there is a convenience for supporting the prosthesis, including options with a metal base.
Second class of mucosal compliance
In the second class of the Supple classification, the appearance of a dead mucous membrane is observed, which covers the alveolar processes and the palate with a rather thin stretched layer. In this case, the places to which natural folds are attached are located a little closer to the top of the alveolar process, in contrast to the first class. Being dense and thinned, the mucous membrane does not seem to be convenient for supporting a removable prosthesis, especially with a metal base.
Third class
The third class according to the Supple classification is characterized by the fact that the alveolar processes and the posterior third of the hard palate are covered with a loose mucous membrane. In this condition, this condition of the tissues is often observed in combination with a low alveolar process.
Patients with similar mucosa rarely need prior treatment. After the installation of prostheses, these patients must strictly observe the regimen when using it and be sure to undergo an examination by the attending physician.
Fourth class of compliance of the oral mucosa
In the fourth grade, the difference lies in the presence of movable strands of the mucous membrane, which run longitudinally and caneasy to move with minimal pressure of the impression material. The bands have the ability to be restrained, making it difficult or almost impossible to use the prosthesis.
Similar folds can be observed, as a rule, on the lower jaw, mainly in the absolute absence of the alveolar process. This species also includes a process that has a dangling soft comb. In this case, prosthetics are often only possible after its removal.
Based on the conclusions drawn from the classification of the mucous membrane according to Supple, it can be seen that its compliance is of great practical importance.
Based on its varying degrees, Lund identified four zones in the hard palate.
Supple and Lund classifications are similar.
Classification of the oral mucosa according to Lund
In the first zone, the mucosa is thin, there is no submucosal layer. As for compliance, it is very small. This area according to Lund is called the median fibrous zone.
In the second zone, the alveolar process is captured. Here, too, there is a coating in the form of a mucous membrane, which is practically devoid of a submucosal layer. This area is called the peripheral fibrous zone.
As for the third zone (rugae palatinae), it is covered with a mucous membrane that has an average degree of compliance. In the fourth zone, which is the posterior third of the hard palate, there issubmucosal layer enriched with glands. It contains a small amount of adipose tissue. This area is quite soft, begins to spring in the vertical direction, has the highest degree of compliance and is called the "glandular zone".
How does Supple classification help in orthopedics?
As a rule, researchers for the most part associate the ability to pliability of the mucous membrane of the hard palate and alveolar processes with the composition of the submucosal layer, or rather, with the place where fatty tissue and mucous glands are located in it.
Sometimes they adhere to a different point of view, when the compliance of the vertical type of the mucous membrane of the jawbone is associated with the saturation of the vascular network of the submucosal layer. Only they can create conditions under which the volume of tissue decreases, due to their ability to quickly release and fill with blood.
Buffer zones are called areas of the mucous membrane of the hard palate, which have extensive vascular fields, and which, as a result, have a springy property.
Supple classification in orthopedic dentistry is used quite often.
Research by other scientists
almost nohas buffer properties.
In the areas of the mucous membranes, which are located in the middle of the base of the alveolar process and the middle zone, there are saturated vascular fields, the density of which begins to increase, heading towards the line "A". As a result of this process, the buffering properties of the mucous membrane of the hard palate are enhanced.
In addition to the Supple classification of the oral mucosa, other theories apply.
B. I. Kulazhenko devoted a lot of time to studying the compliance of the mucous membrane of the hard palate, the study of which was carried out using an electron-vacuum apparatus. According to the results of his research, its limits range from two to five mm. In the data obtained by V. I. Kulazhenko about the mucous membrane in multiple places of the hard palate and alveolar process, there are general coincidences according to the topography of the buffer zones made by E. I. Gavrilov.
During life, there is a significant change in the buffer properties of the mucous membrane of the field of the prosthesis of the upper jaw, due to the fact that the vessels change their characteristics with age, as well as as a result of metabolic disorders, possible infectious and other diseases. Their condition affects not only the compliance of the mucous membrane of the hard palate, but also its possible reaction when exposed to the prosthesis. In the appearance of various changes in the mucous membrane, necrosis of the alveolar process, which is often observed during prolonged use of the prosthesis,it is the vessels that play the fundamental role.
We have described the Supple classification in detail.
