Role of Salivary Glands in the Development of Stomatitis
Salivary gland disorders directly affect the condition of the oral mucosa. The most critical clinical syndromes here are xerostomia and sialorrhea.
- Xerostomia ("dry mouth syndrome") is caused by a drastic reduction or complete cessation of saliva production. This condition serves as a major predisposing factor for stomatitis, as well as dental caries, periodontitis, glossitis, and generalized atrophy of the oral mucosa.
- Sialorrhea (hypersalivation), in contrast, is characterized by excessive saliva production. It can accompany acute mucosal inflammation, tooth eruption, ill-fitting dentures, and may also occur during pregnancy and in various psychiatric or neurologic disorders (e.g., epilepsy, schizophrenia).
Salivary gland diseases are divided into primary/independent disorders (e.g., tumors, sialolithiasis) and secondary disorders (manifestations of systemic infections such as cytomegalovirus or tuberculosis). Etiologically, they are classified into infectious, traumatic, obstructive, autoimmune, and neoplastic lesions.
Cystic Lesions of the Jaw Bones
For the differential diagnosis of oral cavity diseases, understanding the morphology of jaw cysts is essential. They are divided into odontogenic (of dental origin) and non-odontogenic, and can be true cysts (possessing an epithelial lining) or pseudocysts.
Odontogenic developmental (dysembryogenetic) cysts: Arise as developmental defects from epithelial remnants. These include:
- Follicular cyst (dentigerous cyst). Most commonly affects the premolar and third molar regions. It develops from the enamel organ. Radiographically, it appears as a radiolucent lesion, frequently enclosing the crown of an unerupted tooth. The cyst wall consists of three layers, with the innermost layer lined by thin, non-keratinizing stratified squamous epithelium.
- Lateral periodontal cyst, gingival cyst, and eruption cyst. They share a similar microscopic picture—lined by stratified squamous epithelium with varying degrees of keratinization.
Acquired cysts (inflammatory origin): Radicular (periapical) cyst — the most common pathology in this group. Morphogenetically, it is linked to chronic granulomatous periodontitis. The wall consists of a fibrous capsule, a layer of granulation tissue (containing cholesterol clefts), and an inner non-keratinizing epithelium. During acute inflammation, the epithelium forms characteristic reticular extensions, and the lumen becomes filled with pus. Complications may include osteomyelitis, sinus tract (fistula) formation, and, in the maxilla, the development of odontogenic maxillary sinusitis.
Tumor-like Lesions: Dysplasia and Cherubism
A special group of jaw bone pathologies comprises tumor-like lesions based on impaired normal osteogenesis.
Fibrous Dysplasia The condition is rooted in a developmental defect of odontogenic mesenchyme, which loses its ability to form normal bone and replaces it with fibrous connective tissue. Monostotic and polyostotic forms are distinguished.
- Pathomorphology: Features of arrested osteogenesis are observed. Immature bone trabeculae adopt bizarre shapes resembling "Chinese characters".
- Radiology: Characterized by the "ground-glass" sign.
Cherubism This is a rare inherited variant of fibrous dysplasia manifesting in early childhood. It is characterized by bilateral, symmetrical enlargement of the jaws. Externally, this results in the mechanical downward pulling of the lower eyelids, exposing the sclera and giving the child's face a specific appearance resembling a cherub. Radiographs reveal multiple cyst-like zones formed due to active osteoclast resorption. The process typically stabilizes by puberty.
Giant Cell Tumor and Granuloma
Lesions rich in multinucleated osteoclast-like giant cells are frequently diagnosed in the jaws.
Giant Cell Tumor (Osteoblastoclastoma): Frequently occurs in young women (30% of cases are localized to the jaws). It grows intraosseously in the mandibular premolar region. Macroscopically, it is a variegated mass on cross-section (alternating brown, red, and gray areas with cystic spaces). Microscopically, the tissue is highly vascularized, containing spindle-shaped cells and evenly distributed multinucleated giant cells. The tumor is prone to recurrence and occasionally metastasizes to the lungs.
Reparative Giant Cell Granuloma: Divided into central and peripheral forms. The central granuloma manifests as bone destruction with well-defined margins. Microscopically, unlike a true giant cell tumor, it contains fewer and smaller osteoclasts grouped perivascularly against a background of fibrous tissue.