Methods for diagnosing the formation of components of communicative competence. Diagnosis of communicative social competence (CSC)
Inflammatory diseases. The oral mucosa is highly resistant to a diverse local microbial flora. Among the many defense mechanisms that are implemented in the oral cavity, selective competitive suppression of potential pathogenic pathogens by a mass of representatives of the autoflora should be mentioned; production of secretory immunoglobulin (IgA) and other immunoglobulins by accumulations of lymphocytes and plasma cells present in the mucous membrane; antibacterial properties of saliva; liquefying and flushing action of food and drink. Nevertheless, the weakening of any of these mechanisms, occurring, for example, in immunodeficiency states or microbial imbalance during massive antibiotic therapy, contributes to the development of infection in the oral cavity. Further, local, nosologically distinct forms of inflammatory lesions of the oral cavity are described, but systemic diseases will not be affected, in which changes in the oral cavity are considered simultaneously with other data on these diseases in other chapters.
Herpes simplex virus (HSV) infections. In most cases, orofacial lesions of a herpetic nature are caused by type 1 virus (HSV-1); Type 2 - HSV-2 - more often affects the genitals (see Chapter 14). In addition, the herpes virus can cause keratoconjunctivitis and, in neonates and immunosuppressed individuals, severe keratitis or fatal encephalitis. Most primary oral HSV-1 infections result in a trivial herpetic eruption. In children aged 2-4 years, such lesions can be severe, become diffuse, with involvement in the process of the mucous membrane of the mouth, tongue, gums and pharynx. Fiery red hyperemia, edema, and after them clusters of vesicles appear. Acute herpetic gingivostomatitis develops. It is usually accompanied by systemic lesions.
Vesicles vary in diameter from a few millimeters to centimeters. For some time they remain, being filled with a light serous fluid, then they rupture, in their place there are very painful, superficial ulcers, surrounded by a red halo or roller. Under a microscope, acantholysis is visible in the spinous layer of the epithelium, i.e. intra- and intercellular edema, destruction of intercellular bridges and formation of blisters. In individual epitheliocytes located at the edges of the vesicles or floating in their serous fluid, oxyphilic intranuclear viral inclusions are visible. There are multinucleated giant cells. Superficial ulcers spontaneously clear and heal within 3-4 weeks. However, the virus migrates along the regional nerve trunks and goes into a latent state in the regional ganglia, in particular, the nodes of the trigeminal nerve. In the vast majority of adults, HSV-1 remains latent, but in some (especially young) individuals it can become activated and cause a herpetic sore. The factors provoking activation are not entirely clear. These include the influence of allergens, infections of the upper respiratory tract, being in a state of cooling, in a draft, in direct sunlight.
In contrast to acute gingivostomatitis, recurrent herpetic stomatitis manifests itself in lesions of the skin of the lips, less often the nasal openings or mucous membrane of the cheeks in the form of groups of small (1-3 mm) vesicles. The acute stage of the process, in this case of a milder degree, lasts for 4-6 days, and healing is noted after 8-10 days.
Aphthous stomatitis ("afta" - a grayish-white coating). It is an erosive lesion of the oral mucosa and is very common. In the US, it affects about 40% of the population. The disease most often occurs during the first 20 years of life and is characterized by morbidity, a tendency to relapse and predominance in members of the same family, it can be single or multiple. The main manifestation of aphthous stomatitis is superficial, hyperemic ulceration, covered with a thin layer of exudate and limited by a narrow strip of erythema. Inflammatory infiltrate in the bottom and edges of the erosive defect is represented mainly by mononuclear elements. The secondary microbic infection joining later is followed by plentiful leukocytic infiltration. Lesions may spontaneously heal within 1 week or persist stubbornly for several weeks. The causes of aphthous stomatitis are unclear. Sometimes it is associated with the presence of enteritis or Behcet's syndrome (N.Behcet; chronic recurrent septic-allergic condition with rheumatoid lesions, hemorrhages, in particular in the brain tissue, as well as aphthous-ulcerous lesions of the genitals, oral cavity). Hypersensitivity, stress, pregnancy, autoimmune cellular and humoral reactivity, Streptococcus sanguis infections can act as etiological factors.
Candidal stomatitis (thrush). Various variants of candidiasis are described in chapter 14. Suffice it to recall that oral lesions usually appear as grayish-white membranous plaques, sometimes plaques. Under the microscope, in the masses of fibrinous-purulent exudate, hyphae of the fungus can be seen. The latter is part of the normal flora of the oral cavity and can manifest its pathogenic effect only in severe predisposing conditions: diabetes mellitus, neutropenia of various origins, disruption of microbial cooperation during antibiotic therapy, AIDS.
Glossitis (inflammation of the tongue). This name is used in relation to various processes in the tissue of the tongue. Atrophic glossitis is characterized by a decrease and even disappearance of the papillae and thinning of the mucous membrane and some decrease in the tongue. In some cases, atrophic changes are accompanied by inflammation and superficial ulceration. Atrophic glossitis occurs when there is a deficiency of vitamin B12 (pernicious anemia, see chapter 12), riboflavin (vitamin B2) \ niacin (vitamin PP) or pyridoxine (vitamin B6) (see chapter 9). Similar changes occur in malabsorption syndromes or iron deficiency anemia, especially complicated by a deficiency of one of the B vitamins mentioned. The combination of iron deficiency anemia, glossitis, esophageal dysphagia, skin hyperkeratosis, conjunctivitis, etc., occurring mainly in women, is known as the Plummer-Vinson syndrome (H.S. Plummer, P.P. Vinson). Glossitis, characterized by ulcerative changes that usually occur along the lateral edges of the tongue, may be associated with a carious, decaying tooth, ill-fitting dentures. Much less often it occurs with syphilis, inhalation burns and ingestion of caustic chemicals.
Xerostomia (dry mouth). It is one of the main signs of an autoimmune disease - Sjögren's syndrome (H.C. Sjoegren) - a chronic systemic disease with insufficiency of the endocrine glands (see Chapter 5). Lack of saliva secretion may be due to radiation therapy or drug treatment with various anticholinergic agents. When xerostomia is found primarily dry mucous membrane or atrophy of the papillae of the tongue. In addition, there may be fissures, erosions, or - in Sjögren's syndrome - an accompanying increase in inflamed salivary glands.
Reflection of systemic diseases on the oral mucosa. Many diseases of the digestive and other systems affect the condition of the mucous membrane of the tongue and oral cavity in general.
Pathological changes in the oral cavity systemic diseases
Hairy leukoplakia is a rare oral lesion that occurs only in HIV-infected individuals. Sometimes the recognition of an immunodeficiency state begins precisely with the detection of this lesion. Outwardly, hairy leukoplakia appears as white confluent patches or plaques with a fluffy (hairy) surface, localized anywhere in the oral cavity. Under the microscope, one can see how the surface layers of keratinocytes are raised and form piles, while acanthosis is observed in the basal layers of the epithelium. In some cases, superficial epitheliocytes that are not yet keratinized and therefore contain nuclei show koilocytosis (perinuclear vacuolization), indicating the presence of human papillomavirus (HPV). At the same time, studies with in situ hybridization, in addition to HPV, detected Epstein-Barr viruses (EBV) and sometimes HIV (HIV) in the foci of hairy leukoplakia. Finally, in some patients, a layering of candidal infection sometimes occurs. If the plaques of fleecy leukoplakia are the "habitat" of HIV infection, then within 2-3 years, patients will certainly show signs of AIDS.
reactive proliferates. Fibroma of irritation is a fibrous nodule, usually protruding in the gingivodental (marginal) zone of the gum, which is subject to chronic irritation. It is covered with hyperemic mucous membrane. In essence, it is an overly pronounced focus of inflammatory fibrosis, occurs in both men and women, and often accompanies pregnancy. Therefore, sometimes such a fibroma is called a tumor of pregnancy.
Epulis (supragingival; giant cell granuloma) is also an inflammatory lesion. This formation protrudes from the surface of the gums in the area of chronic inflammation and reaches 1.5 cm in diameter. It can also be covered with a hyperemic mucous membrane, on which, however, erosions occur. Under the microscope, attention is drawn to accumulations of multinuclear giant cells such as foreign bodies located in the fibrovascular stroma (Fig. 16.1). Epulis should be distinguished from true giant cell tumors of the maxilla and mandible, as well as from the histologically similar but usually multiple reparative giant cell "brown tumors" (osteoclastomas) in hyperparathyroidism (see Chapter 23). Although not encapsulated, the epulis is nevertheless easily husked by surgery. In addition to the giant cell epulis, there is an angiomatous (vascular) epulis, which in structure resembles a capillary hemangioma (Fig. 16.2).
Precancerous conditions and tumors. In the mucous membrane and soft tissues of the oral cavity, very common precancerous conditions occur, as well as benign and malignant tumors. Many tumors - hemangiomas, granular cell myoblastomas, lymphomas, etc. - are also found in other organs, so they are described in other chapters. Let us dwell on some of the most important precancerous processes (leukoplakia, erythroplakia, papillomas) and on squamous cell carcinoma of the oral cavity.
Rice. 16.1.
Giant cell gingival epulis of one of the premolars
On the right - hyperplastic gingival epithelium (preparation by M.G. Rybakova).
Rice. 16.2.
Vascular epulis
(preparation by M.G. Rybakova).
Leukoplakia and erythroplakia. Whitish spots and even plaques appear on the oral mucosa with intense and long-term smoking or snuffing, chronic biting of the buccal mucosa, lichen planus (one of the dermatoses, see Chapter 25), inflammation of the palatine mucosa in smokers, candidiasis, as well as in rarer conditions and impacts. According to modern ideas, true leukoplakia is characterized not only by hyperplasia and intense keratinization of the epithelium of the mucous membrane, it is an optional precancerous condition. The lesion occurs anywhere in the oral cavity, but more often on the buccal mucosa, floor of the mouth, ventral surface of the tongue and hard palate, it can be single or multiple. The boundaries of soft or more dense plaques are usually clear, less often blurred. Under the microscope, pronounced hyperkeratosis, the remaining zone structure of the stratified squamous epithelium, and acanthosis are noted. There may be signs of mild or moderate dysplasia. In this case, lymphomacrophage infiltration of the underlying connective tissue is more pronounced than in the absence of such signs.
Erythroplakia (leukoplakia with dysplasia) is a condition closely related to the previous one and is rarer and more threatening. This condition is characterized by the presence of red, velvety, sometimes eroded lesions on the oral mucosa. Compared with ordinary leukoplakia, there is a much more frequent malignancy. Under the microscope, as a rule, the disappearance of the zonal structure of the epithelium, signs of ulceration, severe dysplasia, foci of carcinoma in situ and foci of incipient cancer invasion are observed. In the underlying connective tissue, inflammation and especially hyperemia are expressed. The latter, through zones of erosive thinning of the lining, gives the lesion a red color, hence the name "erythroplakia".
Both leukoplakia and erythroplakia occur in adults of any age, but are more common between 40 and 70 years of age. Men are affected 2 times more often than women. Smoking and chewing tobacco are strong predisposing factors for these lesions. Other factors include alcoholism, constant consumption of very hot drinks and very hot food. In more than 50% of patients in the foci of leukoplakia and erythroplakia, sequences of the serotype 16 of the papillomavirus (HPV) were found. The appearance of carcinoma in situ, as well as invasive cancer, is noted in 5-6% of patients. External signs of malignancy are a spotty surface, have a warty appearance. Malignancy most commonly occurs in plaques on the floor of the mouth or the ventral surface of the tongue. Erythroplakia is characterized by malignancy in at least 50% of cases.
Squamous cell papilloma and genital warts. These relatively harmless benign growths are found on the skin and genitals in men and women (see chapters 7 and 21). They are of not only clinical but also theoretical interest due to the presence of HPV serotypes 6 and 11, which, however, are not characteristic of oral lesions.
Squamous cell carcinoma. At least 95% of all oral cavity carcinomas (including the palatine tonsils) are squamous cell carcinomas. The rest includes adenocarcinomas of the mucous glands, melanomas and other rarer tumors. Oral squamous cell carcinoma is a rare tumor, accounting for about 4% in men and approximately 2% in women of all malignant neoplasms [according to Cotran R.S., Kumar V., Collins T., 1998]. It occurs in the age range of 50-70 years. In about 50% of cases, this tumor leads to death.
It is believed that smoking and alcoholism play the greatest role in the origin of squamous cell carcinoma of the oral cavity. Compared with non-smokers and non-drinkers, smokers but not alcoholics have a 2-4 times higher risk of developing this type of cancer, and 6-15 times higher in people who abuse both. It has been proven that the amount of tobacco and alcohol consumed corresponds to the level of risk. Among other etiological factors, chewing of tobacco, betel (a mixture used for the purpose of excitement and consisting of spicy betel pepper leaves with pieces of areca palm seeds and a small amount of lime), marijuana use are noted. Prolonged irritation or focus of infection is no longer considered a predisposing carcinogenic factor, but it can lead to leukoplakia, which is capable of malignancy. Approximately 50% of patients with squamous cell carcinoma of the tongue and floor of the mouth had HPV serotype 16 and closely related serotypes identified in the tumor tissue. In relation to risk factors for cancer of the lower lip, the role of intense ultraviolet radiation (excessive sunbathing) and pipe smoking is also known. Perhaps all these and other factors affect the genetic apparatus of the oral cavity epithelium, in which, during malignancy, various changes are determined at the level of genes and karyotype. In particular, divisions were found in the regions of chromosomes 18q, Yur, 8p, and 3p. Mutations in p53 and overexpression of the mutant p53 protein, as well as amplifications of the oncogenes int-2 and bcl-/, were also detected. A large number of these changes indicates a multi-stage nature of carcinogenesis in the oral cavity.
According to the decreasing frequency of findings, the localization of squamous cell carcinoma of the oral cavity is distributed as follows: the bottom of the oral cavity - the tip of the tongue - the base of the tongue - the mucous membrane of the hard palate - the mucous membrane of the lips. In the early stages, this cancer looks like a slightly raised dense plaque or as an area of uneven and uneven warty thickening of the mucous membrane. The picture may resemble leukoplakia (see above). Sometimes malignancy occurs on the basis of leukoplakia or erythroplakia. As the tumor tissue progresses, it tends to grow exophytically, but quickly necrotic, forming bizarre ulcers with a rough bottom and raised, dense and rounded edges. Invasive oral cancer progresses from in situ carcinoma foci or areas of marked dysplasia. The period of such progression ranges from several months to several years. Histological variants of the tumor include the whole variety of differentiation, ranging from the most common highly differentiated (epidermoid) forms to the rarer anaplastic forms. All of them are distinguished by a tendency to local invasive growth, and then to lymphogenous or hematogenous metastasis. Time of occurrence and localization of metastases in to a large extent are determined by the localization of the primary tumor node in the oral cavity. Metastases are most commonly found in the mediastinal lymph nodes, lungs, liver, and bones. Early recognition of oral cancer is the most important prognostic factor. The best prognosis after complex treatment was noted for lip cancer. Within 5 years, 90% of patients do not have a relapse. The worst indicators for carcinoma of the floor of the mouth and the base of the tongue. Only 20-30% of such patients do not relapse within 5 years.
Diseases developing in the oral cavity often bring discomfort to a sick person and interfere with his full life. They appear at any age, but more often in weakened people. Diseases that occur in the mouth can be viral and infectious, not dangerous to health and precancerous, but they all require high-quality diagnosis and treatment.
Types of diseases of the oral cavity with a photo
When an infection enters the oral cavity, the mucous membrane first of all suffers. It becomes inflamed, thinner and becomes a breeding ground for infections. The disease can cover the tongue, gums, inner surface of the cheeks and tonsils. All diseases of the oral cavity are conditionally called stomatitis, but stomatitis is not the only disease affecting the oral mucosa.
Let's analyze the most common diseases in the mouth and mucous membranes, their symptoms and causes. General classification and the statistics of diseases of the oral cavity in adults can be seen in the photo with the names of the diseases:
Stomatitis and thrush
Stomatitis is an inflammatory reaction in the oral mucosa. It affects people with reduced immunity and thinned mucous membranes (infants and the elderly).
Stomatitis causes discomfort in the patient, can signal the presence of a pathological process in the body and be a harbinger of oncology. There are many varieties of this disease. For more information about the types of stomatitis, possible reasons the occurrence of the disease and symptoms can be found in the table.
Types of stomatitis | Symptoms | Causes of the disease |
Infectious | Various rashes turning into ulcers | Occurs against the background of the course of the underlying infectious disease |
Traumatic | It starts with a wound and its redness, turns into rashes and ulcers | Occurs after damage to the mucous membrane (scratches, burns with hot food or drinks) |
Bacterial | Yellowish crust on the lips, plaque and vesicles with pus in the mouth | The ingress of microbes and dirt on the mucous membrane |
Fungal (candidiasis, thrush) | Dense cheesy white coating covering the oral cavity | Low immunity, prolonged use of antibiotics, infection from mother to child during childbirth |
Allergic | Swelling and dryness of the mucosa, burning and itching, bright spots of white or red color | Individual reaction to food, medicines and hygiene products |
herpetic | Bubbly eruptions inside and on the lips, turning into ulcers. Increased body temperature, possible vomiting and diarrhea | Infection with the herpes virus transmitted by airborne droplets |
aphthous | Small round or oval rashes covered with a gray-yellow coating with a red border (we recommend reading: why is there a yellow coating on the tongue and what could it be?). Can be single or multiple | It occurs more often in adults in conditions of reduced immunity and beriberi |
Nicotinic | It begins with irritation of the soft or hard palate, turns into hardening of the palate, and multiple ulcers appear. | Occurs in smokers due to the irritating effect of tobacco smoke on the mucous membrane. Can turn into cancer |
Glossitis or inflammation of the tongue
The tongue is called the mirror of human health, because by its state it is possible to determine the presence of diseases in the body. The defeat of the tongue of an inflammatory nature in medicine is called glossitis, it can be acute or chronic.
According to the causes of the disease, glossitis is divided into primary (independent disease) and secondary (attached against the background of other diseases). According to the form of the lesion, glossitis can be deep and superficial. Glossitis often appears with stomatitis.
Common symptoms of glossitis:
In the chronic form, papillomas and warts may appear. Types of glossitis, its signs and causes are described in the table. You can see what rashes and ulcers are in the photo.
Kinds | signs | The reasons |
Desquamative | Uneven desquamation of the epithelium (light spots) in the form of a geographical pattern | Viral and infectious diseases, diseases of the gastrointestinal tract |
Gunterovsky | Lacquered surface and bright red tongue | Lack of vitamins and folic acid |
catarrhal | Superficial inflammation and increased sensitivity of the tongue in the initial stage | Stomatitis, teething in children |
candida | Curdled plaque with brown patches, swelling and burning, an unpleasant odor | Yeast fungus, thrush |
aphthous | Ulcerative lesions in the form of aphthae (purulent pimples with a red border) | Aphthous stomatitis |
Allergic | Swelling, itching and burning | Individual reaction to food or hygiene products |
atrophic | Death of the papillae and muscles of the tongue, reduced sensitivity | Deficiency of vitamins A and E, infections |
diamond shaped | Pathology of the basal part of the tongue in the form of a rhombus, does not cause pain and discomfort | Abnormal development, diseases of the gastrointestinal tract, has a chronic course |
Folded | The appearance of multidirectional stripes and folds | Abnormal language development |
interstitial | Increased density and limited mobility of the tongue | Syphilis |
herpes virus
The well-known "cold rash" on the lips can also appear in the oral cavity. The cause of such rashes is infection with the herpes virus, which can occur in acute and chronic form.
The most common type of herpetic eruptions in the oral cavity is acute herpetic stomatitis. It is characterized by a rapid spread and a sharp development of symptoms. It is most often transmitted by airborne droplets, but there are cases of infection through the blood and from mother to child during childbirth.
In the initial stage, a herpes infection manifests itself as soreness, burning and swelling of the mucous membrane. The mild form of the disease does not manifest itself as bright symptoms. A severe form of acute herpetic stomatitis manifests itself with pronounced symptoms:
The main symptoms of the disease are rashes in the form of vesicles with a yellowish-white coating, which, when ruptured, form ulcers. The rash can affect the tongue, gums, cheeks, and even the tonsils.
Herpetic stomatitis is not a dangerous disease, but it brings great discomfort to the sick person. With proper and timely treatment, the prognosis for recovery is favorable.
Gingivitis or gingivostomatitis
When we are talking about the inflammatory process localized mainly on the gums, without affecting the periodontal junction, gingivitis can be diagnosed. With damage to the gums and the appearance of ulcers on the inner surface of the cheeks, gingivostomatitis is diagnosed (more often children suffer from it).
Gingitis is often the result of poor dental care, occurs predominantly in men and depends on lifestyle and general condition organism. In the absence of proper treatment, the disease progresses and passes into periodontitis, which threatens with tooth loss.
With neglected care of the teeth and oral cavity, microorganisms accumulate, as a result of which dental plaques form and the inflammatory process begins. Gingivitis is acute, chronic and recurrent. There are several types of gingivitis:
- Ulcerative - the initial acute form. It is characterized by swelling of the gums, their redness and the appearance of foreign smell from the mouth.
- catarrhal. There is a pronounced swelling, pain in the gums and their slight bleeding. Gingival pockets are not affected in this form.
- Hypertrophic - advanced stage of the disease. At this stage, the gums and gingival papillae thicken and enlarge, the gingival pocket turns red. There are two forms of hypertrophic gingivitis - edematous, characterized by edematous, smooth red, bleeding gums, and fibrous - with this form, the gums are very dense, pain and bleeding are absent (not amenable to drug therapy, surgical treatment is used).
Other types of diseases
There are also less common diseases of the oral cavity, such as cheilitis, leukoplakia, xerostomia, lichen planus, glossalgia (more in the article: red gums and other oral diseases). Some of them are diagnosed only by experienced doctors.
Diagnosis and symptoms
If you have any unpleasant symptoms of oral diseases, you should contact your dentist. It will be easy for an experienced doctor to diagnose the disease when examining the oral mucosa. This may be enough to establish the correct diagnosis.
In some cases, examinations may be prescribed:
- scraping from the site of the lesion for examination under a microscope;
- bacterial culture to determine the sensitivity of the fungus to the drug;
- allergy tests;
- general examination of the body to detect a systemic disease.
When should you visit a dentist? If any general symptoms of diseases of the mucous membrane and mouth are found in the oral cavity:
- pain, swelling and burning;
- discoloration of the mucosa or the appearance of spots on it;
- increased or decreased work of the salivary glands;
- the appearance of any rashes, ulcerative lesions and wounds.
Treatment of oral diseases in adults
Due to the wide variety of diseases, there is no single treatment regimen. First of all, the cause of the disease and concomitant diseases are identified and treated. The treatment regimen is compiled individually for each patient.
Treatment is complex and includes drugs for internal and local use. Recovery can take a long time.
Medicines
Folk remedies
- Traditional treatment effectively complements folk remedies. For these purposes, decoctions of herbs, soda rinses and applications with natural oils are used.
- Rosehip, sea buckthorn or St. John's wort oil is used in the form of applications to the affected areas. Effectively heal wounds and damage. A gauze swab soaked in oil removes plaque with thrush.
- Flowers of calendula and chamomile, oak bark, eucalyptus leaf are used in the form of decoctions for rinsing. They have antibacterial and wound-healing effects.
- A weak solution of soda is used to treat oral candidiasis. Can be used as a rinse and as a mouthwash.
Prevention of oral diseases
Contact your dentist not only when symptoms of the disease appear, but also twice a year for a preventive examination. To prevent diseases in the mouth, it is necessary to know the main factors influencing their appearance and try to eliminate them:
DISEASES OF THE MUCOSA OF THE ORAL CAVITY
According to their manifestations, diseases of the mucous membranes of the oral cavity can basically be divided into three groups: 1) inflammatory lesions - stomatitis; 2) lesions similar to a number of dermatoses, dermatostomatitis, or stomatosis; 3) diseases of a tumor nature. Recognition of all these diseases requires, first of all, knowledge of the normal anatomy and physiology of the oral mucosa, the ability to investigate it, taking into account the state of the whole organism, directly connected in its existence with the external environment.
RESEARCH METHODS. GENERAL SYMPTOMATOLOGY
The structure of the oral mucosa. The mucous membrane of the oral cavity consists of three layers: 1) epithelium (epithelium); 2) proper mucous membrane (mucosa propria); 3) submucosa (submucosa).
epithelial layer formed by stratified squamous epithelium. In the epithelial layer there are cells of various shapes - from a cylindrical, cubic layer to a completely flat surface epithelium. As in the skin, the epithelial cover can be subdivided depending on the characteristics and function of its individual rows into four layers: 1) horny (stratum corneum), 2) transparent (stratum lucidum), 3) granular (stratum granulosum), 4) germinal (srtatum germinativum).
The germinal layer makes up a significant part of the mucosal epithelium. Its lower row consists of cylindrical, densely stained cells, with their narrow side facing their own shell. These cells are considered as the germinal layer of the germinal layer. This is followed by several rows of flatter cells, which are also well painted over and connected to each other by jumpers. Then come the layers of cells that are in various stages of keratinization: 1) the granular layer - the initial degree of keratinization, 2) the transparent layer - a more pronounced degree of keratinization, which is the transition to the last, clearly marked stratum corneum. The transparent layer of the epithelium on the oral mucosa is predominantly observed in those places where keratinization manifests itself with greater intensity.
Actually mucous membrane formed by dense connective tissue with a fibrillar structure. In the connective tissue of the shell itself, small blood vessels such as capillaries and nerves are laid. The membrane on the border with the epithelium forms papillary outgrowths. These papillae are of various sizes. Each papilla has its own feeding vessel.
submucosa also of a connective tissue structure, but it is looser than the shell itself, and contains fat and glands; it contains larger vascular and nerve branches.
The mucous membrane of the oral cavity is supplied with nerve fibers - sensory and motor. The cranial and spinal nerves, as well as the cervical sympathetic nerve, take part in the innervation of the mouth. Of the cranial nerves, the following are suitable for the walls of the oral cavity: trigeminal, facial, glossopharyngeal, hypoglossal, partly vagus.
To study the oral mucosa, we use a number of techniques, which, depending on the characteristics of the case, are used in various numbers and combinations. The main examination of the oral cavity is made up of the following points: 1) - a survey, 2) examination, 3) palpation - palpation, 4) microscopic examination. In addition, a study of the general condition of the body and individual systems and organs is carried out, and often additional serological, hematological and other laboratory tests.
Onpos. As always, in case of diseases of the mouth, general, indicative questions are first asked, and then questions of a particular nature. When questioning patients suffering from lesions of the mouth, the doctor often immediately detects a number of objective symptoms that are associated with a disorder in the act of speech (dyslalia). They appear as a result of damage to the tissues of the mouth by inflammatory processes or the presence of congenital or acquired defects in the oral cavity. Disorders are manifested in a change in the sonority of speech and the nature of the pronunciation of individual sounds - letters.
Inflammatory processes on the lips, which reduce the mobility or swelling of the latter due to pain, often distort the pronunciation for the most part labial sounds: "m", "f", "b", "p", "c" (dyslalia labialis).
Inflammatory processes in the tongue, especially peptic ulcers or other diseases leading to restriction of the mobility of this organ, make it difficult to pronounce almost all consonants, which leads to a lisping conversation (dyslalia labialis). With the defeat of the back of the tongue, the pronunciation of the sounds "g" and "k" is especially affected.
In case of violations of the integrity of the hard palate (syphilis, congenital fissured defects, injuries) and if the soft palate is damaged, even slightly, speech takes on a nasal tone: all consonants are pronounced nose. The pronunciation of the so-called closed consonants is especially disturbed: “p”, “b”, “t”, “d”, “s”. This speech disorder is called rhinolalia aperta as opposed to rhinolalia clausa (muffled sound). The last disorder is observed with infiltrating processes of the palatine sail.
The doctor draws attention to all these disorders already at the beginning of the conversation with the patient, thus introducing elements of the functional study of the mouth into the survey.
Of particular note are complaints of difficulty and soreness during meals, mainly with damage to the soft palate. Swelling of the palate and soreness interfere with the normal act of active swallowing. If the integrity of the palatine vault is violated, liquid food flows into the nose. Small abrasions on the hard palate often cause severe pain when eating solid food. Painful lesions of the tongue also cause difficulty in taking solid food, liquid food passes more easily. Complaints about painful eating can also occur with damage to the vestibule of the oral cavity. With stomatitis, ulcerative processes in the mouth, patients complain of bad breath (foetor ex ore).
It is important to establish the relationship of mucosal lesions with some other diseases. In the presence of stomatitis and stomatosis, it is necessary to pay special attention to common infectious diseases, diseases of the digestive system, and metabolism.
In acute cases, it is important to determine the presence of some acute general infection, such as influenza. Often, influenza infection may precede stomatitis. In some acute diseases, damage to the mucous membrane gives signs that are very valuable for diagnosis, for example, Filatov's spots in measles. Often stomatitis complicates some general debilitating illness or follows an illness, especially often after influenza. Acute as well as chronic lesions of the mucous membrane can be associated with skin diseases, general poisoning (drug, occupational, etc.), diseases of the gastrointestinal tract (anid and anacid gastritis, membranous colitis, etc.), helminthic invasion, malnutrition ( beriberi - scurvy, pellagra, etc.), blood diseases (anemia, leukemia, etc.). Specific infections - tuberculosis and syphilis - should be highlighted. Diseases of the endocrine glands, such as disorders of the thyroid gland, should also be noted during the interview.
Examination of the oral mucosa. The most valuable method of examining the mouth is examination. Inspection should be subjected, regardless of the alleged diagnosis, all parts of the mouth. It is necessary to examine the mouth in very good light, preferably daylight. Inspection is subject not only to the site of the lesion, but the entire mucous membrane of the oral cavity and the affected areas of the mucous membrane of the pharynx, skin, perioral region and face.
Lips and cheeks. The mucous membrane of the mouth mainly differs from the skin in the presence of a thin epithelial layer, very slight keratinization of the surface layers, abundant blood supply due to the presence of a dense vascular network, the absence of hair follicles and sweat glands, a small number of sebaceous glands, which are mainly located on the mucous membrane of the lips from the corners of the mouth to the free edge of the teeth. The skin, located at the site of transition to the mucous membrane in the region of the red border of the lips, also approaches the mucous membrane in its structure. These features of the latter, as well as the presence of bacteria and a moist warm environment in the form of oral fluid, cause a different manifestation of the same origin of lesions on the mucous membrane and skin.
Start the examination from the vestibule of the mouth. With a mirror, spatula or crochet, first the lip is pulled, then the cheek. On the inner surface of the lip, thin superficial veins shine through from under the mucous membrane and intertwining strands of loose connective tissue and the circular muscles of the mouth protrude. A closer examination reveals sparsely scattered small yellowish-white nodules. These are the sebaceous glands. In persons suffering from seborrhoea, the number of sebaceous glands in the oral cavity is often increased. On the lateral parts of the lips, especially the upper, small nodular protrusions are visible - mucous glands. On the mucous membrane of the cheeks, the sebaceous glands are sometimes found in significant numbers in the form of a scattering of yellowish-white or grayish tubercles, which are usually located along the bite line in the region of the molars and premolars. Meet on the mucous membrane of the cheeks and acinar glands. There are fewer of them here than on the lip, but they are larger in size. A particularly large gland is laid against the third upper molar (gianduia molaris). It should not be confused with pathological formation. In inflammatory processes of the mucous membrane, the number of visible glands usually increases.
On the buccal mucosa at the level of the second upper molar, if the cheek is pulled back, one can see a small protrusion of the papilla type, at the top of which the stenon duct opens - the excretory duct of the parotid gland. To determine the patency of the stenon duct, the examination can be supplemented with probing. The direction of the stenon duct in the thickness of the cheek is determined by a line drawn from the earlobe to the red border of the upper lip. Probing is performed using a thin blunt probe, while the cheek should be pulled outward as much as possible. The probe, however, cannot be passed into the gland. Usually the probe gets stuck in the place where the stenopathic duct passes through m. buccinator. Without extreme necessity, probing is not recommended to avoid the introduction of infection and injury. Is it easier and safer to examine the function of the gland by massage? massage the outside of the parotid gland; the doctor at the same time observes the opening of the duct; saliva flows normally. With inflammation of the gland or blockage of the duct, saliva is not secreted, but pus appears.
On the transitional fold, mainly at the point of transition of the mucous membrane of the cheek to the gum, in the region of the upper molars, blood vessels, especially veins, are sometimes sharply translucent. They should not be mistaken for pathological formations.
The normal mucous membrane of the lips and cheeks is mobile, especially on the lower lip; it is less mobile on the cheeks, where it is fixed by the fibers of the buccal muscle (m. buccinator). In the presence of inflammatory processes, deeply penetrating ulcers, the mucous membrane takes on an edematous, swollen appearance, teeth marks are sometimes visible on it, its mobility is sharply limited.
In addition to inflammatory processes, swelling of the mucous membrane is observed with heart and kidney suffering, with some diseases associated with dysfunction of the endocrine glands (myxedema, acromegaly).
After examining the vestibule of the mouth (lips and cheeks), the oral cavity is examined (Fig. 175).
The mucous membrane of the hard palate in appearance it differs significantly from that on the cheeks. It is paler, denser, motionless and has a different relief. In the anterior part, symmetrical, transverse elevations of the mucous membrane (plicae palatinae transversae) are noted, which smooth out with age. The relief of the palate mucosa is significantly distorted under the influence of wearing plastic prostheses. In the midline at the central incisors is a pear-shaped elevation - palatine papilla (papilla palatina). In some subjects, it may be pronounced, but it should not be mistaken for a pathological formation. The region of the palatine papilla corresponds to the location of the incisive canal of the upper jaw (canalis incivus). Sometimes in the middle of the hard palate there is a rather sharply protruding longitudinally located elevation (torus palatinus). This formation is a thickening of the palatine suture (raphe palatini), it also cannot be considered pathological. In the thickness of the mucous membrane covering the sky, numerous glands are laid. They are located mainly in the mucosa of the posterior third of the hard palate, closer to the soft palate. The excretory ducts of these glands open in the form of pinholes - depressions on the mucous membrane of the palate (foveae palatinae, fossae eribrosae).
The glands located under the mucous membrane of the hard palate also extend to the soft palate. The mucosa of the palate rarely looks like a uniformly colored cover. In smokers, it is almost always inflamed and colored deep red. With lesions of the liver and biliary tract, the color of the soft palate sometimes takes on a yellowish tint, with heart defects - cyanotic.
Language. When examining the tongue, a very complex picture is revealed. Its surface has a villous appearance due to the presence of various papillae. Usually the back of the tongue is painted pink with a matte tint. However, the tongue is often furred or coated, most often grey-brown. Any plaque should be regarded as a pathological phenomenon. Sometimes the tongue, even in its normal state, may appear coated with a white coating, which depends on the length of the filiform papillae (papillae filiformes) scattered over its upper surface - the back and root. This plaque may disappear with age, and sometimes change during the day (in the morning to be more pronounced, by the middle of the day, after eating, less).
The tongue, as a rule, is coated in cases where, due to inflammatory processes and soreness in the oral cavity or other reasons, its normal mobility is disturbed or speech, chewing, swallowing is difficult, there is a disease of the stomach, intestines. In such cases, plaque appears not only on the back and root of the tongue, but also on the tip and on the side surfaces. Plaque can also cover the palate and gums. Plaque, or deposit, is usually formed due to increased desquamation of the epithelium and mixing of desquamation products with bacteria, leukocytes, food debris and oral mucus. The presence of plaque on only one side of the tongue depends mostly on the limitation of the activity of this side of the tongue, which is observed in hemiplegia, trigeminal neuralgia, hysterical anesthesia, unilateral localization of ulcers. IP Pavlov believes that the basis of the occurrence of raids is the neuroreflex mechanism.
Behind the angle formed by large papillae, at the top of which there is a blind opening (foramen coecum), the posterior part of the tongue, devoid of papillae, begins. The follicular apparatus of the tongue is laid here and, due to the presence of a large number of crypts (bays), this part resembles the tonsil in appearance. Some even call it "lingual tonsil". The follicular apparatus often increases with inflammatory processes in the oral cavity and pharynx. An increase can also be observed in the normal state of these departments, with changes in the lymphatic system of the body.
When examining the lateral surface of the tongue at its root, rather thick venous plexuses are visible, which can sometimes mistakenly appear to be abnormally enlarged (Fig. 176).
In the lower part of the tongue, the mucous membrane becomes more mobile in the middle, passes into the frenulum of the tongue and into the cover of the floor of the oral cavity on the sides. Two sublingual folds (plicae sublinguales) depart from the frenulum on both sides, under which the sublingual glands are located. Closer to the middle, lateral from the intersection of the sublingual fold and the frenulum of the tongue, is the so-called sublingual meat (caruncula sublingualis), in which there are excretory openings of the sublingual and submandibular salivary glands. Inside from the sublingual fold, closer to the tip of the tongue, a thin, uneven, fringed process of the mucous membrane (plica fimbriata) is usually visible. In this fold there is an opening of the anterior lingual gland of Blandin-Nun (gl. Iingualis anterior), which is laid at the tip of the tongue or at the point of transition of the mucous membrane from the bottom to the lower surface of the tongue. With inflammatory processes that pass to the bottom of the oral cavity, the meat swells, rises, the mobility of the tongue is limited, and the tongue itself shifts upward.
Symptoms of inflammation. When examining the mucous membranes of the oral cavity, one should pay attention to a number of symptoms and take into account the degree and nature of their deviation from the normal appearance. The following features should be fixed first.
Firstly, type of mucous membrane: a) color, b) gloss, c) the nature of the surface.
Inflammatory processes cause a change in color a. In acute inflammation due to hyperemia, the mucosa takes on a bright pink color (gingivitis and stomatitis). The intensity of the color depends not only on the degree of overflow of the superficial vessels, but also on the tenderness of the mucous membrane. So, for example, on the lips, cheeks and soft palate, the color is brighter than on the tongue and gums. In chronic inflammation (congestive hyperemia), the mucous membrane takes on a dark red color, a bluish tint, and a purple color.
Changes in the normal mucosal luster depend on the defeat of the epithelial cover: keratinization or violation of integrity (inflammatory and blastomatous processes), or the appearance of fibrinous or other layers (aphthae).
Surface nature may vary depending on changes in the level of the mucosa. According to the depth of destruction of the latter, one should distinguish: 1) abrasions (erosion) - violation of the integrity of the surface layer of the epithelium (there is no scar during healing); 2) excoriation - violation of the integrity of the papillary layer (during healing, a scar is formed); 3) ulcers - a violation of the integrity of all layers of the mucous membrane (during healing, deep scars are formed). Violation of the integrity of the mucosa in abrasions and ulcers causes changes in the level of the mucosa - lowering it. Scars, on the contrary, for the most part give a limited increase in the level on the mucosal surface. However, atrophic scars (with lupus) are known, causing a decrease in the level of the mucous membrane. A decrease is also observed with retracted scars after deep destruction of the mucous membrane.
Hypertrophic productive forms of mucosal inflammation also noticeably change it. appearance.
Changes the relief of the surface of the mucous membranes and the presence of nodular and tubercular rashes. A nodule, or papule, is a small (from a pinhead to a pea) elevation of the mucous membrane in a limited area. The color of the mucous membrane above the papule is usually changed, since the papule is based on the proliferation of cellular elements in the papillary and subpapillary layers, accompanied by an expansion of the superficial vessels. Papular rashes on the mucous membrane are observed mainly in inflammatory processes [syphilis, lichen planus (lichen ruber planus)]. Large papules (plaques) are observed with aphthous stomatitis, sometimes with syphilis.
tubercle in appearance it resembles a papule, differing from it only anatomically. It captures all layers of the mucous membrane. Due to this, the tubercle, unlike the papule, leaves a trace in the form of an atrophic scar during reverse development. Typical manifestations of tuberculous lesions on the mucous membrane are lupus and tuberculous syphilis. The difference between the tuberculous eruptions in these two sufferings is that in syphilis the tubercle is sharply limited, while in lupus, on the contrary, the tubercle does not have a clear outline. Sometimes, as is the case, for example, with lupus, the presence of a tuberculous lesion of the mucous membrane is masked by secondary inflammatory phenomena. In this case, to identify tubercles, it is necessary to squeeze out blood from hyperemic tissue. This is achieved with the help of diascopy: a glass slide is pressed on the examined area of the mucosa until it turns pale, then the lupus tubercle, if any, is indicated as a small yellowish-brown formation.
A gross change in the level of the surface of the mucous membrane is caused by the presence of neoplasms (tumors).
Thus, studying the appearance of the mucosa can be valuable for diagnosis. The definition of color, gloss, level should be supplemented by data on the extent of the lesion and the location of its elements.
Banal stomatitis and gingivitis usually give diffuse lesions, some specific gingivitis, such as lupus, are limited for the most part strictly localized in the area of \u200b\u200bthe anterior upper teeth. Lupus erythematosus (lupus erythematodes) has a favorite localization on the oral mucosa - this is mainly the red border of the lips and the inner surface of the cheek in the region of the molars. Lichen planus is located mainly on the buccal mucosa, according to the bite line.
Further, it is necessary to distinguish a confluent lesion from a focal lesion, when the elements are located separately. In the oral cavity, the focal arrangement of the elements gives mainly syphilis. In tuberculous and banal inflammatory processes, a confluent arrangement of elements is observed. Almost always, when examining the oral cavity, the outer covers should also be examined.
Below is a diagram of the inspection.
Inspection scheme
1. Ascertaining damage to the mucous membrane.
2. The nature of the appearance and flow.
3. The main elements of the defeat.
4. Grouping elements
5. Growth of elements.
6. Stages of development of elements.
For the spot
1. Size.
3. Coloring.
4. Persistence.
5. Topography.
6. Flow.
7. The presence of other elements.
For papule and tubercle
1. Size.
3. Coloring.
4 stages of development.
5. Topography.
For an ulcer
1. Size.
5. Depth.
6. Secret.
7. Density.
8. Soreness.
9. Surrounding tissues
10. Development.
11. Current.
12. Topography.
For scars
1. Size.
4. Depth.
5. Coloring.
Having finished the morphological analysis of the lesion, the doctor supplements it, if necessary, with a palpation examination, palpation. This cannot be neglected.
Examination of the external integument aims to establish mainly a change in the color and appearance of the skin, the presence of swelling. Such an examination usually does not give solid indicative signs, since the appearance of the swelling often says little about its nature and origin. Swelling of the cheeks and chin can be caused by the presence of collateral edema, which is very often caused either by phlegmonous inflammation of the subcutaneous tissue, or by a tumor process. To establish the nature of the swelling, it is necessary to "perform a palpation examination.
To palpation examination lesions of the mouth have to be resorted to quite often. Palpation should be performed when examining neoplasms of the mouth, some ulcers, and in all cases of lesions of an unexplained nature.
When feeling the tumor, in addition to its consistency, one should determine the depth of the location, the mobility of the tumor itself and the mucous membrane above it, and the connection with the surrounding tissues and organs. When feeling the ulcer, the doctor should be interested in its density, edges and the nature of the infiltration around the ulcer. These data often provide valuable auxiliary information in the differential diagnosis between cancer, tuberculosis, syphilis, and nonspecific ulcers on the tongue, cheek, and lip.
A cancerous ulcer is characterized by the presence of a very dense cartilage in consistency, a rim around the ulceration. Feeling a cancerous ulcer is painless. On the contrary, palpation of a tuberculous ulcer often causes pain. The edges of the tuberculous ulcer are slightly compacted and do not give the sensation of a cartilaginous ring when palpated, which is so characteristic of cancer. Sometimes a hard chancre or a syphilitic ulcer on the lip or tongue, cheek, due to the presence of a dense, painless infiltrate, can be difficult to distinguish from a cancerous ulcer by touch.
Nonspecific ulcers of the oral mucosa, when palpated, are for the most part significantly different from those described above due to their superficial location. Here, however, one should keep in mind chronic ulcers of traumatic origin, especially those located on the lateral surface of the tongue, at its root. These ulcers, due to trauma constantly caused by a carious tooth or a poorly fitted prosthesis, are surrounded by a rather dense infiltrate. And yet they remain more superficial and less dense than in cancer.
Often, in order to examine dental patients, it is necessary to use palpation of the external tissues of the face and neck. This study is performed in search of inflammatory infiltrates, neoplasms, in the study of the lymphatic apparatus. Feeling the soft tissues of the face is recommended to be done with a well-fixed head.
Visible diffuse swelling of the soft tissues of the face, which is observed during inflammatory processes in the jaws, is mostly due to collateral edema. Palpation examination usually reveals the presence (or absence) of a compacted area, infiltrated tissue, or a fluctuating area of an abscess in the test mass of edematous tissue.
The lymph nodes. Especially often it is necessary to make a study of the lymph nodes. As is known, the study of nodes has great importance for clinical evaluation of inflammatory and blastomatous processes. Lymph from the soft and hard tissues of the mouth is drained through the following system of nodes. The first stage is the submandibular, mental, lingual and facial lymph nodes; the second is superficial and upper deep cervical nodes; the third is the lower deep cervical nodes. From the lower deep cervical nodes, lymph enters the truncus lymphaticus jugularis.
Separate areas of the mouth and the dental system are associated with the lymph nodes of the first stage in the following way. All teeth, with the exception of the lower incisors, give lymph directly to the group of submandibular nodes, the lower incisors - to the mental and then to the submandibular nodes. The floor of the mouth, cheeks (directly and through the superficial facial nodes), as well as the lips are connected with the submandibular lymph nodes, with the exception of the middle part of the lower lip, which first gives lymph to the mental nodes. The back of the gums of the lower jaw gives lymph to the submandibular nodes and deep cervical, and the front part - to the chin; gums of the upper jaw - only in the deep buccal, tongue - in the lingual and directly in the upper deep cervical. The sky is connected directly with the deep facial lymph nodes (Fig. 177, 178).
Palpation of the submental and submandibular lymph nodes is performed as follows. The doctor stands on the side and somewhat behind the patient. The patient relaxes the muscles of the neck, tilting his head slightly forward. With the tips of the three-middle fingers of both hands, the doctor penetrates the right and left into the submandibular region, pressing the soft tissues. The thumbs, while resting on the lower jaw, fixing the head. The submandibular nodes are located medially from the edge of the lower jaw in the following order. In front of the submandibular salivary gland - two groups of lymph nodes: 1) in front of the external maxillary artery and 2) behind the artery; behind the salivary gland is the third group of submandibular lymph nodes. The chin nodes are located along the midline of the chin between the chin-hyoid muscles (Fig. 177).
To feel the facial lymph nodes, it is more convenient to use a two-handed examination: one hand fixes and gives the cheek with inside, the other feels the glands from the outside. Sometimes a two-handed examination is also useful when palpating the submandibular and submental lymph nodes, for example, in very obese subjects with inflammatory infiltration of soft tissues, etc. The facial lymph nodes are located mainly on the buccal muscle in the space between the masticatory and circular muscles of the mouth. The cervical nodes run along the internal jugular vein.
When feeling the lymph nodes, it is important to establish their size, consistency, mobility and soreness. Normally, lymph nodes are not palpable at all or are not clearly palpable. Acute inflammatory processes in the mouth cause an increase in the corresponding nodes; the lymph nodes at the same time become painful when palpated. In these cases, acute perilymphadenitis may also appear, the nodes are palpated with a continuous package. In banal chronic inflammatory processes, the nodes are usually enlarged, mobile and slightly painful. The glands are especially dense in cancer and syphilis, they can also be palpated in separate packages. With cancer in the further stages of its existence, there may be a limitation of the mobility of the nodes due to metastases. Chronic perilymphadenitis is considered characteristic of tuberculous lesions of the lymph nodes.
This technique is intended to obtain a more complete picture of the individual, to make a probabilistic forecast of the success of her professional activity.
The questionnaire includes 100 statements arranged in a cyclic order in order to provide a convenient reference using a stencil. There are three alternative answers for each question. The methodology is designed to study individual personality factors in individuals with secondary and higher education.
Instructions for the test: You are offered a series of questions and three possible answers to each of them (a, b, c). You need to answer as follows:
- first read the question and the answers to it;
- choose one of the suggested answers that reflects your opinion, and put the corresponding letter (a, b or c) in the box on the answer sheet.
Remember the following rules:
- don't spend a lot of time thinking about answers; give the answer that comes to mind first;
- try not to resort too often to intermediate answers like "not sure", "something in between", etc. There should be as few such answers as possible;
- never skip anything. Each question must be answered;
- answer as sincerely as possible. No need to try to make good impression their answers, they must correspond to reality.
Now please get to work. Your answers in alphabetical form must be put down either in the questionnaire next to the question number, or in a special form.
Memo to the experimenter
Pay attention to whether the respondent understood the instructions, whether he is ready to sincerely answer the questions posed. Remember to answer all questions. It must be emphasized that it is undesirable to use intermediate answers often and to reflect on them for a long time. If there are several interviewees, they should not consult with each other.
test material
- I understood the instructions well and am ready to sincerely answer the questions:
- not sure;
- I would prefer to rent a cottage:
- in a busy holiday village;
- something in between;
- in a secluded place, in the forest.
- I prefer uncomplicated classical music to modern popular tunes:
- right;
- not sure;
- wrong.
- I think it's more interesting to be:
- design engineer;
- don't know;
- playwright.
- I would have achieved much more in life if people were not opposed to me:
- don't know;
- People would be happier if they spent more time with their friends:
- something in between is true;
- When planning for the future, I often rely on luck:
- find it difficult to answer;
- "Shovel" is to "dig" as "knife" is to:
- spicy;
- cut;
- sharpen.
- Almost all relatives treat me well:
- don't know;
- Sometimes some obsessive thought keeps me awake:
- Yes, it's true;
- not sure;
- I never get angry with anyone.
- find it difficult to answer;
- With equal working hours and the same salary, it would be more interesting for me to work:
- carpenter or cook;
- don't know what to choose;
- waiter in a good restaurant.
- Most of my acquaintances consider me a cheerful conversationalist:
- not sure;
- At school I preferred:
- music lessons (singing);
- Hard to say;
- workshops, manual labor.
- I'm definitely unlucky in life:
- something in between is true;
- When I was in grades 7-10, I participated in the sports life of the school:
- very rarely;
- from time to time;
- often.
- I keep order at home and always know what is where:
- something in between is true;
- "Tired" is to "work" as "proud" is to:
- smile;
- success;
- happy.
- I behave as is customary in the circle of people among whom I am:
- it depends;
- In my life, as a rule, I achieve the goals that I set for myself:
- not sure;
- Sometimes I enjoy listening to indecent jokes:
- find it difficult to answer;
- If I had to choose, I would rather be:
- forester;
- hard to choose;
- high school teacher.
- I would like to go to the cinema, to different performances and to other places where you can have fun:
- more than once a week (more often than most people);
- about once a week (like most);
- less than once a week (less than most).
- I am well oriented in unfamiliar terrain: I can easily tell where is north, south, east or west:
- something in between;
- I don't get offended when people make fun of me.
- it depends;
- I would like to work in a separate room, and not with colleagues:
- not sure;
- In many ways, I consider myself quite a mature person:
- It's right;
- not sure;
- this is not true.
- Which of the following words does not match the other two:
- candle;
- moon;
- lamp.
- Usually people misunderstand my actions:
- something in between is true;
- My friends:
- I was not let down;
- occasionally;
- often.
- Usually I cross the street where it is convenient for me, and not where it is supposed to:
- find it difficult to answer;
- If I were to make a useful invention, I would prefer:
- continue to work on it in the laboratory;
- hard to choose;
- take care of its practical use.
- I definitely have fewer friends than most people:
- something in between;
- I prefer to read:
- realistic descriptions of acute military or political conflicts;
- don't know what to choose;
- a novel that excites the imagination and the senses.
- My family does not like the specialty I have chosen:
- something in between is true;
- I find it easier to solve a difficult question or problem:
- if I discuss them with others;
- something in between is true;
- if I think about them alone.
- When doing any work, I do not rest until even the smallest details are taken into account.
- right;
- average;
- wrong.
- "Surprise" is to "unusual" as "fear" is to:
- brave;
- restless;
- horrible.
- It always angers me when someone cleverly manages to avoid a well-deserved punishment:
- differently;
- It seems to me that some people do not notice or avoid me, although I do not know why:
- right;
- not sure;
- wrong.
- Never in my life have I broken a promise:
- don't know;
- If I worked in the economic field, I would be interested in:
- to talk with customers, clients;
- something in between;
- maintain reports and other documentation.
- I think that:
- you need to live by the principle: “Time for business, hour for fun”;
- something between "a" and "b";
- you need to live cheerfully, not particularly caring about tomorrow.
- I would be interested in completely changing the scope of activity:
- not sure;
- I believe that my family life is no worse than that of most of my acquaintances:
- Hard to say;
- I hate it if people think that I am too unrestrained and neglect the rules of decency:
- very;
- a little;
- not worried at all.
- There are times when it's hard to resist feeling sorry for yourself:
- often;
- sometimes;
- never.
- Which of the following fractions does not match the other two:
- 3/11.
- I'm sure they talk about me behind my back:
- don't know;
- When people behave imprudently and recklessly:
- I take it easy;
- something in between;
- I feel contempt for them.
- Sometimes I really want to swear:
- find it difficult to answer;
- For the same salary, I would rather be:
- a lawyer;
- find it difficult to answer;
- navigator or pilot.
- I take pleasure in doing risky things just for fun:
- something in between;
- I love music:
- light, alive;
- something in between;
- emotionally rich, sentimental.
- The hardest thing for me is to cope with myself:
- right;
- not sure;
- wrong.
- I prefer to plan my affairs myself, without outside interference and other people's advice:
- something in between;
- Sometimes a feeling of envy affects my actions:
- something in between;
- "Size" is to "amount" as "dishonest" is to:
- prison;
- sinful;
- stole.
- Parents and family members often find fault with me:
- something in between is true;
- When I listen to music and people are talking loudly:
- it doesn't bother me, I can concentrate;
- something in between is true;
- it spoils my pleasure and angers me.
- From time to time such bad thoughts come to my mind that it is better not to talk about them:
- find it difficult to answer;
- I think it's more interesting to be:
- artist;
- don't know what to choose;
- director of a theater or film studio.
- I would rather dress modestly, like everyone else, than catchy and original:
- I agree;
- not sure;
- disagree.
- It is not always possible to accomplish something by gradual, moderate methods, sometimes it is necessary to apply force:
- I agree;
- something in between;
- I loved school
- Hard to say;
- I understand the material better
- reading a well-written book;
- something in between is true;
- participating in a group discussion.
- I prefer to go my own way instead of sticking to the generally accepted rules:
- I agree;
- not sure;
- disagree.
- AB is to GW as SR is to:
- Usually I am satisfied with my fate:
- don't know;
- When it comes time to do what I planned and expected in advance, I sometimes feel unable to do it:
- I agree;
- something in between;
- disagree.
- Not all my friends like me:
- find it difficult to answer;
- If I were asked to organize a fundraiser for a gift to someone or to participate in organizing an anniversary celebration:
- I would agree;
- I don't know what I would do;
- I would say that, unfortunately, I am very busy.
- An evening spent doing what I love attracts me more than a lively party:
- I agree;
- not sure;
- disagree.
- I am more attracted by the beauty of the verse than by the beauty and perfection of the weapon:
- not sure;
- I have more reason to be afraid of something than my friends:
- Hard to say;
- When working on something, I would rather do this:
- in a collective;
- don't know what to choose;
- on one's own.
- Before expressing my opinion, I prefer to wait until I am completely sure that I am right:
- always;
- usually;
- only if it is practically possible.
- "Best" is to "worst" as "slow" is to:
- ambulance;
- the best;
- fastest.
- I do a lot of things that I later regret:
- find it difficult to answer;
- I can usually concentrate on my work, not paying attention to the fact that people around me are making noise:
- something in between;
- I never put off until tomorrow what I have to do today:
- find it difficult to answer;
- I have had:
- very few elected offices;
- several;
- many elected positions.
- I spend a lot of free time talking with friends about the pleasant events that we once experienced together:
- something in between;
- On the street, I will stop to look at the work of an artist rather than a street quarrel or a traffic accident:
- not sure;
- Sometimes I really wanted to leave home:
- not sure;
- I would rather live quietly as I please than be admired by my friends:
- something in between is true;
- Speaking, I tend to:
- express your thoughts as soon as they come to mind;
- something in between is true;
- before you get your thoughts together.
- Which of the following combinations of characters should continue this series X0000XX000XXX:
- 0XXX;
- 00XX;
- X000.
- I don't care what others think of me:
- something in between;
- I have such disturbing dreams that I wake up:
- often;
- occasionally;
- almost never.
- I read the whole newspaper every day:
- Hard to say;
- For birthdays, for holidays:
- I love making gifts;
- find it difficult to answer;
- I think that buying gifts is a somewhat unpleasant duty.
- I really don't like being in a place where there is no one to talk to:
- right;
- not sure;
- wrong.
- At school I preferred:
- Russian language;
- Hard to say;
- mathematics.
- Someone harbored a grudge against me:
- don't know;
- I am willing to participate in public life, in the work of various commissions, etc.:
- something in between;
- I firmly believe that the boss may not always be right, but he always has the opportunity to insist on his own:
- not sure;
- Which of the following words does not match the other two:
- any;
- several;
- most of.
- In a cheerful company, it is sometimes uncomfortable for me to fool around with others:
- differently;
- If I made some mistake in society, I quickly forget about it:
- something in between;
Processing and interpretation of test results
The answers of the respondent must be compared with the key.
- If the letter specified in the key matches the letter of the answer chosen by the respondent, 2 points are awarded for this answer.
- An intermediate answer "b" is always awarded 1 point.
- If the letter of the answer and the letter of the key do not match, 0 points are awarded.
Processing for factor B (logical thinking) is somewhat different.
- If the letter of the answer matches the letter of the key, 2 points are assigned,
- In case of mismatch - 0 points.
Key to the test
I | 1c | 11a | 21c | 31c | 41a | 51c | 61c | 71c | 81a | 91a | L |
II | 2a | 12c | 22c | 32c | 42a | 52a | 62c | 72a | 82c | 92a | BUT |
III | 3a | 13a | 23a | 33c | 43c | 53a | 63c | 73c | 83a | 93c | D |
IV | 4c | 14a | 24c | 34c | 44a | 54c | 64a | 74a | 84a | 94a | To |
V | 5a | 15a | 25c | 35a | 45c | 55a | 65c | 75c | 85a | 95a | P |
VI | 6c | 16a | 26a | 36c | 46a | 56a | 66c | 76c | 86a | 96c | M |
VII | 7c | 17a | 27a | 37a | 47c | 57c | 67c | 77a | 87c | 97a | H |
VIII | 8b | 18b | 28b | 38c | 48b | 58c | 68b | 78c | 88b | 98a | AT |
IX | 9c | 19c | 29a | 39c | 49a | 59a | 69c | 79a | 89a | 99c | P |
X | 10c | 20a | 30a | 40c | 50a | 60a | 70c | 80a | 90c | 100a | FROM |
The scores thus obtained are summed up for each factor.
For factors A, B, C, D, K, M, H, L, the maximum number of points is 20.
For factor P - 40 points (add 5 and 9 lines).
The number of points from 16 to 20 (for factors A, B, C, D, K, M, N) is a high score for this factor, which means that the corresponding personality quality is clearly expressed (for example, sociability by factor A).
The number of points 13, 14, 15 indicates a certain predominance of a quality corresponding to a high rating (for example, sociability over isolation).
The number of points 5, 6, 7 indicates the predominance of a quality corresponding to a low score (for example, isolation over sociability).
The number of points 8-12 means an approximate balance between two opposite personal qualities (for example, moderately open, moderately closed).
If the respondent scored 12 or more points on the L scale, then the results of the survey must be recognized as unreliable.
If the respondent scored more than 20 (out of 40) points on the P scale (tendency to antisocial behavior), then this indicates certain personal problems in any area of life: in the family, in relationships with friends, at work, in relationships with others) . In this case, it is necessary to conduct an additional interview to determine how serious the problems are.
Factor a
- High score +A - open, easy, sociable.
- Low score -A - unsociable, withdrawn.
Factor B
- High score + B - with developed logical thinking, quick-witted.
- Low score -B - inattentive or with underdeveloped logical thinking.
Factor C
- High score +C - emotionally stable, mature, calm.
- Low score -C - emotionally unstable, changeable, amenable to feelings.
Factor D
- High score + D - cheerful, carefree, cheerful.
- Low score -D - sober, silent, serious.
K factor
- High score +K - sensitive, reaching out to others, with artistic thinking.
- Low score -K - self-reliant, realistic, rational.
Factor M
- High score + M - preferring his own decisions, independent, self-oriented.
- Low score -M - dependent on the group, sociable, follows public opinion.
Factor H
- High score + H - controlling himself, able to obey the rules.
- Low score -N - impulsive, disorganized.
In addition, this questionnaire allows us to identify a tendency to antisocial behavior (factor P), which may be characterized by disregard for accepted social norms, moral and ethical values, established rules of conduct and customs.
Included in the questionnaire and the scale of truthfulness (factor L), which allows you to judge the reliability of the results.
Level assessment of factors (in points):
- 16-20 - maximum level;
- 13-15 - the predominant severity of factors;
- 8-12 - average level;
- 5-7 - low level.
Society Sciences
Science of Society
ZUBAREV Sergey Nikolaevich, post-graduate student of the Department of Pedagogy and Psychology
METHODS FOR ASSESSING THE FORMATION OF COMMUNICATION COMPETENCE
In the article, the author describes various techniques evaluation communicative competence. In the context of the study, taking into account the specifics of communicative competence and the scope of professional activity of graduates of humanitarian universities, the author concludes about the methodology for demonstrating competencies. Further, the author provides methods for assessing the competence of graduates of humanitarian universities in the form of a detailed description of each method. At the end of the article, the author makes a conclusion about the choice of the best method.
Key words: communicative competencies, level of formation, assessment techniques, assessment methods.
ZUBAREV Sergey Nikolaevich, Postgraduate student, Chair for Pedagogy and Psychology,
METHODS OF ASSESSING THE COMMUNICATIVE COMPETENCE
The author describes various techniques of evaluating communicative competence. In the context of the study, taking into consideration the specificity of communicative competence and sphere of professional activities of graduates from humanitarian higher educational institutions, the author makes the conclusions related to the methods of demonstrating the competence. The author also presents methods of evaluating the competence of graduates from humanitarian higher educational institutions in the form of detailed description of each method. Finally, the author makes conclusions on choosing the best method.
Keywords: communicative competence, the level of development, technology assessment, evaluation methods.
The development of criteria for assessing the formation of communicative competencies among graduates requires, first of all, to determine the methods of assessment in their direct connection with the tasks of assessment.
To identify the level of formation of graduates' competencies, a fund of assessment tools (FOS) is being created, which is understood as a "set of methodological, control, measuring and evaluation materials" intended for assessing and studying the level of competencies.
According to the requirements of the Federal State Educational Standard of Higher Professional Education, the following competency assessment techniques are used that are relevant to the topic of our study:
Tests "for application" in determining subject and interdisciplinary competencies;
A monitoring model that provides for the creation of a "portfolio" of graduate achievements;
Discussion and discussion;
Writing texts of various kinds;
Presentation - representative data, skills public speaking, the ability to stay in front of an audience;
Situational-behavioral tests - brief standardized evaluation procedures;
Information processing efficiency tests;
Personality questionnaires as sets of standardized questionnaires with closed-type questions;
Interview as a tool that allows you to openly discuss strengths and weaknesses and explain your point of view;
Strategic interview method;
Observation - gathering information to establish facts;
The questionnaire is a tool for collecting information, and the respondents have time to find the required data/facts.
The competence-based approach is based on the activity component educational process, therefore, the methods of qualitative assessment of the student's activity are of the greatest importance. The teacher can assess the communicative competence of the student, either directly present in the process of his activity, or by organizing the work of the student in such a way that its results make it possible to determine the level of competencies with a sufficient degree of reliability.
Hilde Schaper and Kolya Bridis in the report on the project "Competences of university graduates, professional requirements and conclusions for the reform of higher education" raise a number of topical issues in the context of the competence-based approach. Speaking about the methods of evaluation, change
ISSN 2219-6048 Historical and socio-educational thought. Volume 7 No. 1, 2015 Historical and social educational idea "s Tom 7 # 1, 2015
competencies, they emphasize the manifestation of competencies in action, in the process of applying knowledge. “Therefore, preference should be given to objective methods of measurement, such as observation of task performance in natural or quasi-natural situations and when testing learning outcomes.” The most effective approaches, such as the Assessment Center (an assessment center using a set of interactive methods), are very resource-intensive, therefore, various options for surveys, questionnaires, and interviews are more common, which simultaneously provide a self-assessment of competencies, and also create a high motivation for students to develop them.
In the context of our study, taking into account the specifics of communicative competence and the scope of professional activity of graduates of humanitarian universities, the demonstration of competencies should take place in a specific subject (professional) situation, as close as possible to the conditions of their future professional activity. In this regard, along with surveys, such interactive methods and technologies as case analysis, participation in a role-playing game, work on a project, mutual review of essays and presentations, etc., will be optimal.
Let's consider the main methods for assessing the communicative competence of graduates of liberal arts universities.
1. Development of a survey/questionnaire/interview
Questionnaires and questionnaires allow you to collect reliable and valid data on the level of formed competence. This is indicated by V.I. Zvonnikov and M.B. Chelyshkova, noting the need to go through the following stages in the development of questionnaires and interview templates:
Formulating testable and null hypotheses, solving the problem of taking into account all the factors that affect the results of the survey;
Drawing up a research plan, including conducting a survey, processing data, analyzing and interpreting them in accordance with the survey plan;
Development of the structure of the questionnaire in strict accordance with the requirements of pedagogy, sociology and psychodiagnostics.
2. Case development
The case is problem situation from life, which reflects a real practical problem and does not have an unambiguous solution. In the process of solving the problem, which consists in analyzing the situation and choosing a solution, along with professional knowledge, a certain complex is updated. communication skills student. Case analysis "is a methodically organized process of analyzing specific professional situations" .
3. Group implementation of the project
The project method refers to complex integrative control tasks, including elements of professional activity. In contrast to the case, in the process of project implementation, a much wider range of student's communicative competencies is manifested. All members of the project team should take part in discussions, discussions, decision-making, resolving disputes and conflicts, etc. Such a project can be, for example, the development of an educational product that includes lesson planning documents, study materials independently compiled by students, an Internet service, a database data, etc.
To assess the student's competence in working on a project, not only observation and external control points can be used, but also writing an essay with reflections on the organization of the educational process and the process design work and with their comparison.
4. Writing essays and other texts of a problematic nature
Essay analysis allows you to identify and evaluate the level of formation of a whole group of graduate's communicative competencies. Depending on the assessment scheme and the depth of assessment, work on the text can be of varying degrees of complexity. So, if it is necessary to evaluate only one or two competencies, such as the ability to express one's thoughts in writing, not to make various kinds of mistakes, it is enough for an essay to formulate one problem for which the student will have to offer his solution.
With a more complex assessment scheme, it is necessary, when preparing a task, to think over the criteria for assessing the quality of the presentation of the text, its structure, style and other significant factors.
To identify the formation of communicative competence, a combination of several measurement methods or several data sources is often necessary. This will “increase validity and reduce possible bias when using a single
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method". Also, in the selection of certain methods and technologies for assessing competencies, it is necessary to take into account the degree of their reliability, for example: assessment centers (assessment centers) give - 0.65-0.68; case methodologies - 0.62; tests - 0.55-0.60; projects - 0.54; situational tests - 0.54; personality questionnaires- 0.42; unstructured interview - 0.15; questionnaire tests (professional) - 0.39; essay - 0.38; interviews (behavioral) - 0.48-0.61; structured interview - 0.33-0.63; interviews (standard) - 0.05-0.7.
Thus, each of the proposed assessment methods has its advantages and disadvantages, therefore, the optimal method for a particular category of competencies, a given specialty and a group of graduates will be the method that best suits the needs of the program, has adequate validity and is not burdensome in terms of time, effort and cost.
1. Portal of the Federal educational standards higher education. [Electronic resource] -http://www.fgosvo.ru/ 12/16/2014
2. Shaper H., Bridis K. Competences of university graduates, professional requirements and conclusions for the reform of higher education // The Bologna Process. - M., 2009. - S. 245.
3. Zvonnikov V.I., Chelyshkova M.B. Evaluation of the quality of training of students in the framework of the requirements of the Federal State Educational Standard of Higher Professional Education. -M., 2010. - S. 30-31.
4. Ibid. pp. 27-28.
5. Efremova N.F. Problems of assessing students' competencies in the implementation of competency-oriented BEP HPE / Presentation // Seminar "Peculiarities of the formation and use of measuring materials for assessing the quality of higher education" vocational education subject to the introduction of GEF
6. Krasnostanova M.V. Assessment Center for executives. Implementation experience in a Russian company, exercises, cases / M.V. Krasnostanova, N.V. Osetrova, N.V. Samara. - M.: Vershina, 2007. - S. 208.
1. Portal of the Federal educational standards of higher education. Available at: http://www.fgosvo.ru/ (accessed 12/16/2014)
2. Shaper H., Bridis K. Competence of graduates, professional requirements and implications for reform of the higher school, the Bologna process. Moscow, 2009. P. 245.
3. Svonnikov V.I., Chelyshkova M.B. Evaluation of training quality training which has occurred within the requirements of the GEF VPO. Moscow, 2010. P. 30-31.
4. Ibid. P. 27-28.
5. Ephremova N.F. Problems of assessment of students "competence of the implementation of competence-oriented OOP VPO / Presentation / Seminar "Peculiarities of formation and use of measurement tools for assessing the quality of higher professional education with regard to the introduction of the GEF VPO" in Moscow, nitu MISIS, 24-26 April 2012).
6. Krasnoshtanova M.V. Assessment Center for executives. The experience of implementation in the Russian company, exercises, case studies, Moscow: Vertex, 2007. P. 208.
Zubarev Sergey Nikolaevich, Postgraduate Student, Department of Pedagogy and Psychology, Russian International Academy of Tourism,
141420, st. Oktyabrskaya, 10, Moscow
Khimki, (Moscow region), Russia
Received: 7. 02.2015
Zubarev Sergey Nikolaevich, Postgraduate student, Chair for Pedagogy and Psychology, Russian International Academy of Tourism.
141420, Oktiabrskaya str. ten,
Khimki city, (Moscow region),
Russian Federation
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