I. Overview of Oral Mucosal Diseases
Oral mucosal diseases refer to the damage to the mucous membranes in the oral cavity. Specific symptoms include: ulceration of the mouth and tongue, dry and cracked tongue, hoarse voice, dry mouth and bitter taste. Subsequently, they may lead to oral disorders such as oral lichen planus, stomatitis, recurrent aphthous ulcers, and cheilitis, resulting in difficulty in eating and unbearable oral pain. A prominent feature of oral ulcers is their recurrent nature: the number of ulcers increases from a few to many, and the affected sites spread from the front to the back of the oral cavity. They mostly occur on the oral mucosa, gums, the upper and lower surfaces and sides of the tongue, and the pharynx. The size of the ulcerated areas ranges from that of a grain of rice to a soybean, with a layer of white necrotic membrane attached to the surface. In mild cases, ulcers may occur once every few months; in severe cases, the interval between episodes gradually shortens, and the condition worsens year by year. In some instances, ulcers may recur continuously for several years or even decades without healing, and can lead to various systemic complications, directly affecting the patient’s physical health, work, and daily life. Clinically, Western medicine is often used to control the symptoms of this disease, but it is difficult to completely cure it, so it is listed as one of the major challenges in oral medicine.
II. Types of Oral Mucosal Diseases
There are many types of oral mucosal diseases. In addition to diseases that occur exclusively on the oral mucosa, they also include systemic diseases that cause oral mucosal lesions. The specific types are as follows:
Infectious Oral Mucosal Diseases: Including herpetic gingivostomatitis, herpes zoster, hand-foot-mouth disease, oral candidiasis, oral tuberculosis, and coccal stomatitis.
Oral Mucosal Ulcerative Diseases: Including recurrent aphthous ulcers, Behçet’s syndrome, and traumatic ulcers.
Lip and Tongue Diseases: Including chronic nonspecific cheilitis, granulomatous cheilitis, glandular cheilitis, actinic cheilitis, angular cheilitis, migratory glossitis, fissured tongue, median rhomboid glossitis, and lingual papillitis.
Allergic Oral Mucosal Diseases: Including drug-induced allergic stomatitis and angioedema with erythema multiforme.
Blistering Oral Mucosal Diseases: Mainly pemphigus vulgaris and mucous membrane pemphigoid.
Oral Mucosal Lichenoid Diseases: Including oral leukoplakia, oral lichen planus, and oral submucous fibrosis.
Oral Manifestations of Other Systemic Diseases (sometimes even the first manifestations of these systemic diseases): Including AIDS, sexually transmitted diseases (such as syphilis, condyloma acuminatum), infectious diseases (tuberculosis), gastrointestinal diseases (such as inflammatory bowel disease), metabolic diseases (such as systemic amyloidosis), hematological diseases (such as anemia, leukemia, thrombocytopenic purpura), and genetic diseases (such as Peutz-Jeghers syndrome).
1. Herpetic Gingivostomatitis and Herpes Labialis
Both are caused by the herpes simplex virus. Herpetic gingivostomatitis is a primary infection, mostly occurring in infants and adolescents. It presents as acute stomatitis, with the formation of numerous blisters that rupture into ulcers. Systemic symptoms include fatigue, fever, and lymphadenopathy. Herpes labialis is a recurrence of herpes simplex virus infection, with mild symptoms limited to the skin of the lips and corners of the mouth. Before blisters form, there is a burning sensation. The blisters are small but may occur in clusters and merge to form a dark brown crust. They usually heal on their own within about 10 days but can recur. Generally, no treatment is required; for patients with systemic symptoms, antibiotics can be used to control secondary bacterial infections. Appropriate supplementation of vitamin C and compound vitamin B, as well as increased nutrition, can promote healing.
2. Recurrent Oral Ulcers
Diseases characterized by recurrent oral ulcers include: recurrent aphthous ulcers, recurrent necrotizing periadenitis, and Behçet’s syndrome.
Recurrent aphthous ulcers refer to recurrent, round or oval, shallow, small ulcers in the oral cavity. Unlike ulcers caused by herpes, there are no pre-ulcer blisters. The aphthous ulcers are light yellow in color, often surrounded by a red halo, with a diameter of less than 0.5 cm. They occur singly or in groups of several, causing significant pain. The cause is not yet clear; some believe it is related to Streptococcus viridans type L, while recent studies suggest an association with decreased cellular immune function. Some surveys also indicate a genetic predisposition. Predisposing factors include digestive disorders, ascariasis, mental stress, insufficient sleep, exposure to certain chemicals, vitamin B deficiency, iron deficiency, zinc deficiency, premenstrual tension syndrome, and minor bites. In patients with frequent and severe aphthous ulcers, serum zinc levels are often lower than those in normal people. After taking zinc sulfate, serum zinc levels return to normal and the condition improves. Low zinc levels can cause immune deficiency, reduced enzyme activity, and incomplete keratinization of the oral mucosal epithelium. The immunological examination of severe recurrent oral ulcers is similar to that of Behçet’s syndrome, and both are autoimmune diseases. Symptomatic treatment includes: holding 0.25% chlortetracycline in the mouth, applying corticosteroid ointment or powder, holding 1% procaine in the mouth for severe pain, or using various medicinal films attached to the ulcers. Corrosive treatment of the ulcer surface with silver nitrate can also relieve symptoms and promote healing. Topical application of the traditional Chinese medicine "Yangyin Shengji San" (Yin-Nourishing and Tissue-Regenerating Powder) has the effects of promoting tissue regeneration, relieving pain, reducing inflammation, and accelerating ulcer healing. This medicine has low irritancy and is widely used for recurrent aphthous ulcers, various types of stomatitis, and mucosal ulcers.
Recurrent necrotizing periadenitis is a type of large recurrent oral ulcer, often preceded by a history of aphthous ulcers. The ulcer surface is usually 0.5–2 cm in size, lasts for 1–2 months, and leaves a scar after healing. Corticosteroids can temporarily control the condition. Some female patients experience alleviation or even healing of symptoms during pregnancy, indicating that endocrine factors have an impact on this disease.
The three main signs of Behçet’s syndrome are recurrent oral ulcers, ocular uveitis, and genital ulcers; patients with only two of these signs have the incomplete type. Beyond these three signs, severe conditions such as gastrointestinal bleeding, thrombophlebitis, and central nervous system disorders may also occur.
3. Oral Leukoplakia
Oral mucosal leukoplakia is found in approximately 5% of the adult population, with an incidence rate of over 20% in smokers. Its occurrence is related to chronic irritation (especially long-term friction) or smoking. If the irritation is removed and smoking is ceased for 3 months, but the leukoplakia does not diminish or disappear, closer follow-up is necessary. Pathologically, leukoplakia is divided into two major categories: ① benign hyperkeratosis, which is a benign lesion; ② epithelial dysplastic leukoplakia, which is a precancerous lesion. Clinically, leukoplakia has two types: ① the homogeneous type, which appears as uniform white patches with a flat surface and generally requires no treatment; ② the non-homogeneous type, including the granular type, ulcerative type, verrucous type, and leukoplakia with red areas. Approximately 1/5 of cases in this type are precancerous lesions or early-stage cancer.
III. Prevention of Oral Mucosal Diseases
The prevention of oral mucosal diseases requires comprehensive measures including daily care, dietary adjustments, and lifestyle improvements, with a focus on maintaining oral hygiene, avoiding irritating factors, and enhancing immunity. The following is a detailed breakdown of preventive methods:
(I) Maintaining Oral Hygiene
Proper Oral Cleaning: Brush teeth with a soft-bristled toothbrush every morning and evening, avoiding excessive force to prevent mucosal damage. Rinse the mouth with warm water or dilute salt water after meals; if conditions permit, use Kangshiqiang Mouthwash to reduce food residue retention.
Auxiliary Cleaning Tools: Use dental floss or an oral irrigator to clean interdental spaces as needed, but be gentle to avoid damaging the gums and mucosa.
Regular Toothbrush Replacement: Replace toothbrushes every 3 months to prevent bacterial growth; if suffering from mucosal diseases such as oral ulcers, replace the toothbrush after recovery.
(II) Adjusting Dietary Structure
Avoid Irritating Foods: Reduce intake of spicy, overly hot, and hard foods (such as chili peppers, fried foods, and nut shells) to prevent physical or chemical irritation to the mucosa.
Balanced Nutrition: Increase intake of foods rich in B vitamins (e.g., whole grains, green leafy vegetables), vitamin C (e.g., citrus fruits), and zinc (e.g., fish, legumes) to promote mucosal repair.
Control Sugar and Acidic Beverages: Reduce intake of carbonated drinks, coffee, and alcohol to avoid disrupting the balance of the oral environment.
(III) Improving Lifestyle Habits
Quit Smoking and Limit Alcohol: Harmful substances in tobacco (such as tar and nicotine) and alcohol can cause dryness of the oral mucosa and abnormal keratinization, increasing the risk of lesions.
Regular Work and Rest: Ensure adequate sleep (7–8 hours per day for adults) and avoid staying up late to maintain stable endocrine function and immune system health.
Reduce Local Irritation: Correct bad habits such as lip-biting, cheek-biting, and tongue-biting; promptly address residual tooth roots, sharp tooth cusps, or ill-fitting dentures to prevent mechanical trauma.
(IV) Enhancing Immunity and Health Management
Moderate Exercise: Engage in aerobic exercise (such as brisk walking, swimming) 3–5 times a week to improve the body’s resistance.
Control Chronic Diseases: Chronic diseases such as diabetes, anemia, and digestive system diseases may induce oral mucosal problems; adhere to standardized treatment under medical guidance.
Mental Regulation: Long-term anxiety and excessive stress may lead to recurrent oral ulcers; relieve stress through meditation, social activities, and other methods.
(V) Regular Check-ups and Early Intervention
Professional Oral Examinations: Undergo an oral examination every 6–12 months. Especially when ulcers, leukoplakia, or erythema that do not heal for a long time appear, seek medical attention promptly to screen for precancerous lesions.
Avoid Misuse of Medications: Long-term use of antibiotics or hormone-containing mouthwashes may disrupt the balance of oral flora; use such medications under the guidance of a doctor.
VI. Precautions for Special Populations
Children and the Elderly: Prevent children from biting foreign objects; for the elderly, pay attention to denture cleaning and proper fit. Both groups need enhanced nutritional supplementation.
Pregnant Women and Immunocompromised Individuals: Hormonal changes during pregnancy can easily trigger mucosal inflammation; it is recommended to increase intake of folic acid and iron supplements. Immunocompromised individuals should be alert to fungal infections (such as oral candidiasis).
