Pain in the gums and jaw: causes and solutions

Why does pain occur in the gums and jaw?

One of the most common causes of pain at the end of the jaw is the eruption of wisdom teeth. This problem is most often encountered by patients aged 17-25 years. When the third molars grow abnormally, the symptoms are most pronounced. The clinical picture is also characterized by redness and enlargement of the gums, swelling of the cheeks, and inflammation of the cervical lymph nodes.

Possible causes of pain in the gums also include the following diseases.

• Gingivitis. Inflammation of the mucous membrane of the gums, accompanied by redness and bleeding. Occurs due to poor oral hygiene. Tends to be chronic. Increases the risk of developing more serious gum problems.
• Periodontitis. Periodontal inflammation with subsequent destruction of the periodontal junction. Develops with untreated gingivitis. Characterized by the formation of periodontal pockets and ulcers. Leads to loosening and loss of teeth.
• Stomatitis. Inflammation of the oral mucosa. Appears as blisters on the gums. Develops as a result of a burn of the mucous membrane, herpetic or candida infection.
• Tooth cyst. Formation of a dense capsule near the root of the tooth. Experts include jaw injuries and mechanical damage to the gums, acute respiratory diseases, advanced caries or pulpitis as the causes of this problem.

Pain in the gums can occur after complex treatment or tooth extraction. Normally, the discomfort goes away after 3-7 days. If discomfort persists for more than a week, you should consult your doctor.

"Dental" sinusitis

Surely everyone has heard that you need to visit the dentist at least twice a year, otherwise fleeting preventive meetings with the dentist can turn into long and painful therapeutic appointments for both parties.

Moreover, often an otolaryngologist also joins this idyll. “What does he have to do with it?” - you ask. The answer is simple: an ENT doctor treats odontogenic or, more simply put, “dental” sinusitis, which quite often occurs as a complication of dental diseases.

How are bad teeth and sinusitis related?

And the connection here is purely anatomical. Sinusitis itself is an inflammation of the mucous membrane of the air sinus, which is located in the thickness of the upper jaw. The bottom or lower wall of this sinus is a layer of bone that separates the sinus from the roots of the upper teeth (molars and premolars, sometimes canines).

Associated symptoms

Not only pain syndrome can indicate the development of diseases of teeth and gums. Warning signs are also:

• bad breath,
• bleeding gums,
• swelling of the cheek or lip,
• redness and swelling of the gums,
• mobility of teeth,
• local temperature increase.

Have you noticed several of the listed signs at once? Make an appointment with a dentist. An experienced doctor will help eliminate the problem and maintain dental health.

Diagnosis and treatment

To determine the cause of pain, dentists conduct a visual and instrumental examination of the oral cavity. To confirm the diagnosis you may need:

• overview x-ray of the upper or lower jaw,
• results of a general blood test and a smear from the oral mucosa,
• cytological examination of the contents of periodontal pockets.

The treatment regimen is drawn up individually for each patient, taking into account the diagnosis and clinical picture.

Sore throat: possible causes, diagnosis and treatment

Sore throat is a common complaint of patients when visiting an otolaryngologist, therapist, pediatrician and general practitioner. The causes of sore throat can be infectious and inflammatory diseases of bacterial and viral etiology, inflammatory processes in the pharynx, larynx and surrounding organs caused by non-infectious factors, and non-infectious pathology (

). Before proceeding with pharyngoscopy, it is necessary to carefully detail the patient’s complaints and collect an anamnesis. The patient can call a sore throat the unpleasant sensations of scratching, burning, soreness, rawness, the feeling of a “foreign body,” the intensity of which is conveniently assessed on a 10-point scale, where the maximum manifestation of pain is rated at 10 points, the minimum at 1 point.

It is important to determine what, in the patient’s opinion, preceded the onset of pain and what other symptoms it is accompanied by. If there is hyperthermia, then the inflammatory nature of the disease is most likely: pharyngitis, tonsillitis (tonsillitis) [16]. Refusal of food and water can provoke severe pain in aphthous stomatitis (Fig. 2), tonsillitis of the lingual tonsil, paratonsillar and retropharyngeal abscess, Ludwig's angina (phlegmon of the floor of the mouth). With these diseases, drooling is possible, and inflammation of the paramygdaloid tissue and tissues of the floor of the mouth leads to trismus of the masticatory muscles (inability to open the mouth), a forced position of the head tilted to the painful side.

The occurrence of such a condition requires immediate contact with a medical specialist to sanitize the area of ​​inflammation. Epiglottitis, an inflammation of the epiglottis caused by Haemophilus influenzae (more common in young children), gives similar symptoms. Along with refusal to eat, salivation, pain and hyperthermic symptoms, epiglottitis is accompanied by voice disturbance (it becomes dull, hoarse) and difficulty breathing. There is a forced position of the patient in a sniffing position, as if holding porridge in the mouth, the mouth opens freely, but a rough examination of the pharynx with a spatula can lead to laryngospasm and death. Therefore, with the above symptoms, pharyngoscopy is performed carefully; during it, you can see a hyperemic, edematous epiglottis behind the root of the tongue.

Other causes of sore throat accompanied by sore throat and cough can be in children and young people: drainage of discharge from the nasopharynx due to adenoiditis or sinusitis; irritation of the respiratory tract by dry air, smoke, including active and passive smoking; childhood infectious diseases [9]. In adults, a common cause of such complaints, often with a feeling of a lump in the throat, a “foreign body,” is an exacerbation of chronic pharyngitis associated with pathology of the gastrointestinal tract: gastritis, esophagitis, gastroesophageal reflux, cholecystitis, gastric ulcer. Severe dysphagia, regurgitation and pain when swallowing can be caused by esophageal varices [14].

A carefully collected anamnesis allows us to find out the dynamics of complaints, the time of their appearance, the connection with a previous injury or medical examination (gastroscopy), foreign body entry, contact with an infectious patient, hypothermia (drinking cold beer, ice cream), occupational or household hazards (irritants, dust , hot air, taking concentrated solutions of vinegar, spices, medications: corticosteroids, antibiotics, diuretics, local decongestants and others). Sore throat can occur as a manifestation of sexually transmitted diseases: gonococcal pharyngitis, syphilis, chlamydia of the respiratory tract. Infection with the human immunodeficiency virus contributes to the formation of inflammatory viral, tumor and mycotic lesions of the mucous membranes [3].

Chronic pathology of the kidneys, endocrine system, blood, previous radiation and chemotherapy can lead to the formation of a chronic inflammatory and atrophic process in the pharynx. The first manifestation of hyperglycemia [5] may be thirst and dry mouth, accompanied by catarrhal changes in the pharynx. Similar complaints occur with Itsenko–Cushing syndrome [5]. In patients with hypothyroidism, swallowing is often impaired, speech becomes slurred due to swelling and dryness of the tongue and lips, and it is difficult to perform pharyngoscopy.

Non-infectious pathology of the organs of the neck and chest cavity - angina pectoris, myocardial infarction - can manifest itself as intense pain in the pharynx and behind the sternum. Long-lasting dysphagia and unpleasant sensations in the form of a lump or foreign body in the throat, which are not amenable to anti-inflammatory therapy, can cause [14] tumors of the larynx, laryngopharynx, thyroid gland, and pharyngoesophageal (Zencker) diverticula. Many days of fasting, dieting, dyspepsia and heavy menstruation lead to a deficiency of vitamins and minerals. Vitamin A deficiency [5] causes dryness and erosion of the mucous membranes.

Vitamin B2 deficiency produces a triad of symptoms: dermatitis, cheilitis and glossitis (bright red, smooth and shiny dry tongue), accompanied by burning and pain in the mouth when talking and eating. Vitamin C hypovitaminosis occurs with dietary deficiency of ascorbic acid, inflammatory processes in the intestines and is manifested by pain, hemorrhagic and ulcerative-necrotic manifestations in the oral cavity and in the area of ​​the palatine tonsils, mobility and tooth loss. Similar changes in the oral cavity and pharynx give rise to blood diseases (leukemia). Against the background of iron loss (with hyperpolymenorrhea), Plammer-Vinson syndrome is formed, characterized by superficial glossitis, dysphagia, cracks in the corners of the mouth, nail dystrophy, seborrheic dermatitis of the face, blepharitis, conjunctivitis, and decreased vision at dusk. B12 deficiency anemia associated with impaired absorption of this vitamin in the stomach due to anacid gastritis, tapeworm infestation, or increased consumption in pregnant women, manifested by Möller-Gunter glossitis (bright red tongue with smoothed papillae) and atrophy of the pharyngeal mucosa, burning pain in the tongue, weakness, crawling sensation in the limbs. A blood test reveals macrocytes, megalocytes, hyperchromic anemia, leukopenia.

Diseases of the spine [2] (cervical osteochondrosis, tuberculous spondylitis, radiculitis) can cause pain in the pharynx. Neuralgia of the glossopharyngeal nerve manifests itself as intense pain in the pharynx, especially against the background of chronic stress in anxious and suspicious patients. Metabolic disorders, intoxication, and trauma contribute to its occurrence. Characterized by unilateral pain in the root of the tongue, tonsil, lasting several minutes, accompanied by dry throat and subsequent hypersalivation. The therapeutic effect is achieved by lubricating the root of the tongue and pharynx with local anesthetics. Neuralgia of the superior laryngeal nerve [1, 6] gives similar symptoms, but also includes a painful dry cough and spasm of the vocal folds during inspiration [6].

Pain in the pharynx can be caused by an odontogenic process: periodontitis, teething pathology, galvanism [4, 17]. Rarely, unilateral pain in the pharynx occurs, the cause of which is the long styloid process (Eagle syndrome), accessible to palpation in the area of ​​the palatine tonsil [15].

Rare causes of pain in the pharynx are ulcerations on the mucous membrane of tuberculous etiology [14]. In this case, there is a prolonged cough, weight loss, and swollen lymph nodes.

A final diagnosis is possible based on oropharyngoscopy. The main differential diagnosis for pain in the pharynx is between its most common causes - acute (or exacerbation of chronic) pharyngitis and sore throats caused by streptococcal infection (group A beta-hemolytic streptococcus - GABHS).

Acute pharyngitis is a viral infection of the pharynx in 90% of cases. Its main symptoms are: increased body temperature, sore throat when the throat is empty, when eating, soreness and a dry cough that does not bring relief. Patients indicate the localization of unpleasant sensations on the back wall of the pharynx. In the pharynx (Fig. 3), hyperemia of all parts is detected: the posterior wall, arches, tonsils, and there may be vesicular rashes (herpes, enterovirus). Plaques are not typical, there is often a runny nose and other catarrhal phenomena - nasal congestion, sneezing. If a rash is detected on the skin and mucous membranes, it is necessary to exclude an infectious disease - measles, scarlet fever, rubella [8]. Adenoviral infection manifests itself in the form of conjunctivitis, enlarged lymph nodes, fever, runny nose, and there may be plaque in the throat.

The disease progresses in waves: on the 7th–10th day of illness, a repeated increase in body temperature and a return of symptoms are possible. Enterovirus infection (“summer flu”) manifests itself in the form of dyspeptic, myalgic, and meningeal syndromes. Pharyngoscopy reveals bubbles on the mucous membrane of the oropharynx. In making the diagnosis of viral pharyngitis, the following help: knowledge of the epidemiological situation, dynamic observation of the patient, a variety of clinical manifestations (abdominal pain, vomiting, eye damage, meningeal symptoms, myalgia), lymphocytosis in the blood with normal ESR, lack of effect from antibacterial therapy, serological data research, polymerase chain reaction and others.

Sore throat is a general infectious disease with local manifestations in the form of acute inflammation of one or more components of the lymphadenoid pharyngeal ring, most often the palatine tonsils (tonsillitis), pharyngeal tonsil (adenoiditis), lingual tonsil, lateral ridges of the pharynx and larynx.

The classification of acute tonsillitis (according to I.B. Soldatov, 1975) involves the division into primary tonsillitis: catarrhal, lacunar, follicular, ulcerative-membranous; and secondary: for acute infectious diseases (diphtheria, scarlet fever, measles, tularemia, typhoid fever, infectious mononucleosis) and diseases of the blood system (agranulocytosis, alimentary-toxic aleukia, leukemia). There are special forms of tonsillitis [10]: viral, fungal, syphilitic.

With catarrhal tonsillitis, there is hyperemia and enlargement of the palatine tonsils, regional lymphadenitis, no plaque, a blood test shows slight leukocytosis, increased ESR. Catarrhal sore throat often has to be differentiated from viral pharyngitis, in which there is a cough, there may be a runny nose, and there is no enlargement or tenderness of the lymph nodes.

Follicular tonsillitis is manifested by bright hyperemia and swelling of the tonsils, subepithelial rounded yellowish elevations (follicles).

With lacunar tonsillitis, white-yellow plaques appear at the mouths of the lacunae of the tonsils (Fig. 4), which can merge with each other and cover the entire surface without going beyond the tonsils, being removed without leaving a bleeding surface, rubbing between two spatulas, dissolving in the vessel with water.

It is important to determine the streptococcal etiology of acute tonsillitis. This can be done using the McIsaac screening scale [12], which includes symptoms and their assessment in points (

).

A patient’s symptoms with a score of 3 means the probability of streptococcal etiology is 30%, and a score of 4 means about 70%. If the clinical picture is determined to be 0–1 points, then systemic antibiotic therapy is not indicated. At 2–3 points, antibiotics are necessary only if the infection is bacteriologically confirmed. Antibiotics should be prescribed when symptoms of 4–5 points are detected.

Diphtheria of the pharynx occurs in the form of localized, widespread, toxic I, II, III degrees and hypertoxic forms. With it, gray plaques are detected on the surface of the tonsils, tightly fused with the underlying tissues, they may spread to the arches, the mucous membrane of the posterior pharyngeal wall, the uvula (Fig. 5), and when you try to remove them, the mucous membrane bleeds. Plaques do not rub down and do not dissolve in water. In the toxic form, the neck is noticeably thickened due to swelling of the subcutaneous fat, pressure is painless and does not leave pits.

Infectious mononucleosis is an acute infectious disease caused by the Epstein-Barr virus, characterized by fever, sore throat, enlarged lymph nodes, pharyngeal tonsil, liver, and spleen. Plaques on the tonsils, as in lacunar tonsillitis (Fig. 6), but can spread beyond them. A general blood test (the appearance of atypical mononuclear cells), serological research methods (enzyme-linked immunosorbent assay (ELISA), Paul-Bunnel-Davidson reaction) help in diagnosing the disease.

Fungal infections of the pharynx in the form of curdled films, easily removed when scraped with a spatula, are caused mainly by yeast-like fungi of the genus Candida (about 90% of cases); less commonly, there are mold fungi of the genus Aspergillus, Penicillium [7]. C. albicans permanently or temporarily lives on human mucous membranes, skin and intestines. Factors contributing to the development of mycoses are: treatment with broad-spectrum antibacterial drugs, cytostatics and corticosteroids, diabetes mellitus, blood diseases, tumors, gastrointestinal diseases, vitamin imbalance. Candidiasis of the oral cavity, pharynx and esophagus occurs in more than 90% of AIDS patients (Fig. 7) [3].

Diagnosis of sore throats should include throat and nasal swabs for diphtheria (BL). Express determination of streptococcal antigen using test strips from the surface of the tonsils makes it possible to justify antibacterial therapy. A general blood test facilitates the differential diagnosis of primary and secondary acute tonsillitis. Opinions on the question “Should I do a smear?” controversial. It is needed to confirm the GABHS etiology of the disease in doubtful cases [16].

Therapeutic tactics for pain in the pharynx can be presented in the form of a diagram ().

For the treatment of acute pharyngitis, a gentle diet, hot foot baths, warm compresses on the front surface of the neck, warm alkaline drink (mineral water, milk with honey), steam inhalations, and smoking cessation are recommended. The attitude towards gargling is ambiguous [16]. Fresh infusions of mint, chamomile, calendula, eucalyptus, sage, and caragana are effective for relieving sore throat. Antiseptics of artificial origin (dichlorobenzene, metacresol, hexethidine, benzalkonium, thymol, ambazone, chlorhexidine) are bactericidal in their mechanism of action, which can lead to suppression of the normal microflora of the oral cavity, so they should be used with caution in children under 6 years of age [9]. For the treatment of sore throat, the most important painkillers are those containing menthol, tetracaine, lidocaine or flurbiprofen. Children from 6 months of age can use the herbal preparation Tonsilgon, which has an antiseptic and analgesic effect, but does not contain either menthol or lidocaine.

Menthol preparations and any sprays cannot be used before 3 years of age due to the possible development of laryngospasm.

Local combination drugs (antiseptics and painkillers) in the form of finished dosage forms are the most popular for the treatment of sore throat. One of them is TheraFlu LAR, a universal and highly effective local drug with an antiseptic and analgesic effect. TheraFlu LAR contains benzoxonium chloride and lidocaine. Available in the form of a spray and tablets, the content of lidocaine in which is 0–75 mg and 1 mg, respectively.

Recent in vitro and in vivo studies confirm the broad antiseptic spectrum of benzoxonium chloride and its activity against the main pathogens of the most common diseases of the oral cavity and pharynx. At the same time, the balance of the bacterial flora in the mouth is not disturbed, even with prolonged use of benzoxonium chloride.

Benzoxonium chloride has:

• bactericidal effect against aerobic and anaerobic gram-positive and gram-negative bacteria;
• fungicidal effect against Candida albicans, Aspergillus spp. and yeast fungi;
• antiviral activity against membrane viruses, including herpes virus, influenza virus, parainfluenza viruses, the causative agent of vesicular stomatitis.

Lidocaine is a local anesthetic that reduces pain in the throat when swallowing.

Adults should take the drug 1 lozenge every 2–3 hours (no more than 10 tablets per day) or as a spray, 4 sprays 3–6 times a day. Children aged 4 years and older are prescribed 1 lozenge every 2-3 hours (no more than 6 tablets per day) or as a spray, 2-3 sprays 3-6 times a day. The required duration of treatment, as a rule, does not exceed five days. The drug is well tolerated by patients, side effects are recorded extremely rarely. Possible short-term local irritation of the mucous membrane, allergic reactions.

Indications for its use are: pharyngitis, laryngitis, catarrhal tonsillitis, stomatitis, ulcerative gingivitis. Contraindications to the use of TheraFlu LAR: pregnancy (first trimester), breastfeeding, hypersensitivity to lidocaine, children under 4 years of age. TheraFlu LAR can be used by people with diabetes, as it does not contain sugar. Thanks to the combined effect - antibacterial and analgesic, TeraFlu LAR can relieve all symptoms of viral pharyngitis and be used in the complex therapy of bacterial sore throats.

Systemic antibiotic therapy in the treatment of patients with “sore throat” is indicated mainly for acute tonsillitis (angina) of suspected or established streptococcal etiology (GABHS) and is carried out with penicillins, and if they are intolerant, with macrolides; cefuroxime (Axetin) is effective. Clindamycin and lincomycin are reserve drugs [11]. Epiglottitis caused by Haemophilus influenzae is effectively treated with protected penicillins.

Literature

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M. V. Subbotina , Candidate of Medical Sciences Irkutsk State Medical University , Irkutsk

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