Diseases and Disorders of Oral Mucosa In

8/16/2019 Diseases and Disorders of Oral Mucosa In

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Disorder of the tongue



2. Macroglossia

- A tongue larger than normal

- Either congenital or aquired

Congenital macroglossia :

an overdevelopment of the lingualmusculature or vascular tissue !ecomesapparent as the child develops

An a!normall" large tongue h"poth"roidism ma" e#tent out of the mouth

a!normal gro$th pattern of themandi!le and malocclusion Angle class %%%

maloclussion



%n %nfant





&. An'"loglossia



An'"loglossia

Developmental anomal"





(. )issured *ongue





-



Median +hom!oid ,lossitis

Congenital anomal"





Appears



. enign Migrator" ,lossitis

- /n'no$n etiolog" - Migrating patches on the tongue surface

- Stress-related male: female 0 1:2

- to 13 "ears of age

- Multiple area of desquamation of 4lliformpapillae irregular pattern

-*he central portion is in5amed the outer part isthin and outlined !" a "ello$ish $hite !and

- *he desquamative areas sho$ 4lliform papillaeas red elevated remain for a short periodin one location heal then reappear at anotherlocation



-)requent recur after spontaneusl" healing - ectopic geographic tongue in the

!uccal mucosa gingiva lips etc





6. 7air" *ongue

- Etiolog" is attri!uted to candidiasisinfection

- Ma" not e#actl" !e a developmentalanomal"

- Characteristic !" h"pertroph" of 4lliformpapillae thic'l" e#tensive on thedorsal surface

- Dorsal surface of the tongue appearshair"

- *he color depends on e#trinsic factorsli'e to!acco !ecome !lac'ish

!ro$n

black hairy tongue



- *reatment : -'eeping the tongue clean$ith tooth !rush avoid foodaccumulation irritation





DISORDERS OF THE BUCCAL UCOSA

)ord"ce8s Spot ,ranules- developmental anomal" heterotropic9ectopic

collections of se!aceous glands on the oral mucosa

- during development of ma#illar" and mandi!ularprocess some portion of the ectoderm fromneig!ouring s'in get included in these site development of se!aceous glands inside the mouth

- "ello$ish-$hite papules

- !uccal mucosa vermillion !order of upper liptonsils etc

- as"mptomatic no treatment





eu'odema

- gre"sh-$hite mil'" opalescent appearance of

oral mucosa most on cheec' streched $hite patch disappear

- un'o$n etiolog"

- surface of the mucosa appears folded $rin'les

- cannot !e scraped o;

- !ilateral

e#tent on to the lip mucosa- not pre-malignant condition

- <o treatment





Disorders of the lips

)orms





Disorders of the lips







=eut>-?egher8s S"ndrome









%<)EC*%O<

A. acterial %nfection1. Diphtheria

- caused !" a gram @!acillus Cornebacteriumdiphtheri

- most frequent" in children - transmitted through droplet infection or direct contact - incu!ation period is a fe$ da"s - is manifested !" malaise headache fever and vomiting - associated $ith sore throat mild redness and edema of

the phar"n# - cervical l"mphadenopath"



%<)EC*%O<

acterial %nfection







2. *u!erculosis- is an infection granulomatous disease- caused !" !acillus Mycobacterium tuberculosis -

pulmonar" tu!erculosis

- ma" also occur !" $a" of the intestinal tract tonsilss'in

- tu!erculosis infection of su!ma#illar" and cervical nodes a tu!erculous l"mphadenitis tender or painful

- tu!erculosis of the oral cavit" secondar" to apulmonar" disease. *he organism are carried in thesputum enter the mucosal tissue through a small !rea'

in the surface- occur on the tongue mostl"B palate lips !uccal

mucosa gingiva frenula



- is an irregular super4cial or deep painfululcer $hich tends to increase slo$l" in si>e

- dentist ma" contract an infection from hiscontact $ith living tu!ercle

- tu!erculosis gingivitis a di;use h"peremicnodular or papillar" proliferation of thegingival tissue

- tu!erculosis osteom"elitis in the later stages

of the disease unfavoura!le prognosis- treatment of oral tu!erculosis is secondar" to

treatment of the pimar" lesions





&. Actinom"cosis

- is a chronic granulomatous suppurative and4!rosing disease

- caused !" anaero!ic gram-positive nonacid-

fast 4lamentous !acteri Actinomyces israeli,

A. Naeslun A. naeslundi, A. viscosus, A.odontolyticus , A. propionica

- the pattern of the disease the formation ofa!scesses $hich tend to drain !" the formationof sinus tracts pus

- pus is e#amined sho$s sulfur granulesor colonies of organism $hich appear in thesuppurative material as tin" "elo$ grains



- is classi4ed according to the location :

cer4cofacial the most common B a!dominal

pulmonar"

Cervicofacial actinom"cosis :

- involves the salivar" glands !one s'inof the face and nec' s$elling indurationof the tissue develop into one or morea!scess pus containing sulfur granules

- the s'in overl"ing the a!scess is purplishred indurated or 5uctuant

- rarel" mucosal surface



- ma" e#tent to involve the mandi!le and

ma#illa

speci4c osteom"elitisinvolve the cranium meninges !rainitself

- *reatment:

diFcult penicillin and tetrac"cline

the course of the disease isstill prolonged



(. S"philis

- %nfection of a spirochaeta Treponema pallidum- classi4ed : - acquired

- congenital

! Congenital Syphili" # is transmitted !" an infected mother

manifestation: - frontal !ossae

- short ma#illa

- high palatal arch - saddle nose

- Mul!err" molars



- rhagade

- 7utchinson8s trias: h"plopasia of the incisor

and molar mul!er" molarB

eight nerve deafness

interstitial 'eratitis

*reatment :

- adequate treatment of the

mother !efore 1th

$ee' ofgestation





. <OMA Cancrum Oris B

- %s rapidl" spreading gangraen of the oral andfacial tissue in deli!ated or nutritionall"

de4cient persons

- a secondar" complication of s"stemic disease- chie5" in children

- speci4c infection !" Gincent8s organism

- an acute necroti>ing gingivostomatitis is

complicated !" secondar" invasion of man"micro!ial forms streptococci staph"lococcidiphtheria !acilli B



- !egins as a small ulcer of the gingiva

rapidl" spread the surrounding tissuesof the Ha$s lips chee's !" gangrenousnecrosis

odor is e#tremel" foul- high temperature su;er secondar"

infection

die from to#emia or pneumonia

- mortalit" rate 6I !efore the a!ilit" ofanti!iotics

- the prognosis is !etter anti!iotics are

administered !efore 4nal





G%+A %<)EC*%O<

1. Herpes Simplex irus Type ! "n#ection primary herpetic gingivostomatitis - develops in !oth children and "oung adult

- rarel" !efore the age of months the pea' at 1(months

- characteri>ed !" fever irrita!ilit" headache

pain of s$allo$ing regional l"mphadenopth"

- a fe$ da"s the mouth !ecomes painful gingivaintensel" in5ammed

- lips tongue !uccal mucosa palate phar"n# tonsil "ello$ish 5uid-4lled vesicles rupture formshallo$ ragged e#tremel" painful ulcers covered !" agra" mem!rane surrounded !" an er"thematous margin



Diagnosis :

- clinical appearance and histor" - e#foliative c"tolog" : - multinucleated

giant cell

- viral inclusion

!od" -direct immuno5uorescence for viral

antigen

- viral culture

- c"tolog" and antigen detection



- heal $ithin 6 J 1( da"s leave no scar - treatment :

s"mptomatic topicalanaesthetic agents on the

ulcer

soft diet

adequate 5uids

hospitaladmission if necessar"

mouth$ashes forolder children chlorhe#idine

gluconate K2I 1K ml for (



)or "oung children $ith severe

ulceration chlorhe#idine ma" !es$a!!ed over a;ected areas $ithcotton $ool s$a!s. A mouth$ashchlorhe#idine K12I and !en>"damine

h"drochloride can !e used $ith goodresult antiviral chemotherap" acicloviroral suspension reserved for children

$ho are immunocompromisedpain control $ith paracetamol anti!iotics are unhelpful





2 H i d H d # t d



2. Herpangina and Hand, #oot andmouth disease

- is caused !" Co#sac'ie group A virus- most seen in "oung children

- a summer disease

- transmitted through contact multiple cases

in a sinlge household are common- incu!ation periode is 2-1K da"s

- clinical manifestations are mild shortduration sore throat lo$ grade fever

headache vomiting a!dominal pain- small vesicles short duration rupture

ulcer



- ulcer $ith a gra" !ase in5amedperipher"

- in 7erpangina on the anterior faucialpillars hard and soft palate posterior

phar"ngeal $all !uccal mucosa tongue a cluster of ( to vesicles

- in had foot and mouth disease up to 1Kvesicles occur in the mouth in addition to

the hand and feeton the palmar andplantar B

- heal $ithin a fe$ da"s to a $ee'

- self limiting

s"mptomatic care as for





&. Chic'enpo# Garicella B

- an acute viral infection in children-herpes-varicella->oster virus

- incu!ation 2 $ee's

- transmission is !" air!orne droplets ordirect contact

- portal of the entr" respirator" tract

- characteri>ed : prodormal of headache

nasopharingitis anore#ia

- follo$ed !" maculopapular or vesiculareruption of the s'in

!egin of the trun' spread to the face



- small !lister-li' er"themae lesions in theoral cavit" : !uccal mucosa

tongue gingiva palate phar"n#

- the lesion is a slightl" raised vesicle $ithsurrounding ruptures small eroded

ulcers $ith red marginManagement : - topical anaesthetic gel

- mouth rinses





(. 7erpes Loster SinglesB

- an acute viral infection- herpes-varicella->oster virus

- e#tremel" painful in5ammation of dorsal rootganglia or e#tra medullar" cranialnerve ganglia

vesicular eruption of the s'in or mucous mem!rane

primar" infection !" the G-L virus chic'enpo#$hile recurrent infection herpes Loster

- %nitiall" fever malaisepain tenderness along the

envolve sensor" nerve unilateral- a fe$ da"s a linear or vesicular eruption of the s'in or

mucous supplied !" the a;ected nerve



- triggering factors : - trauma

- maglinanc" 9 tumor - ocal -+a" radiation

- immunosuppressivetherap"

- infection oftrigeminal nerve



Mumps Epidemic



. Mumps Epidemic=arotitisB

- an acute viral infection disease - unilateral or !ilateral s$elling of the

salivar" gland usuall" parotid

- incu!ation 2 J & $ee's

- preceded !" headache chills fever vomiting pain !elo$ the ears

- are follo$ed !" a 4rm ru!!er" or elastic

s$elling of the salivar" glands elevatingthe ear last for one $ee'

- management includes : - adequate rest

- 5uid inta'e

6 Ac%uire& I''uno De(ciency



6$ Ac%uire& I''uno De(ciency Syn&ro'e ) AIDS *

- caused !" human immunode4cienc" virus 7%G B- 19& to 192 7%G positive !a!ies mother infected 7%G- virus transmission occurs to the fetus in pregnanc" in the4rst trisemester more common in perinatall"- infected children ma" not survive for a "ear- also get the infection from !lood transfusion or !loodproducts- A!normal N cell function :

*( helper cells is destro"ed !" direct or indirect

c"topathic mechanism of 7%G intefere in the production of interfer

-



opportunistic infection maglinanc"

throm!oc"topenia

- 7%G on C<S lead to progressive

encephalopath" !ehaviour and motorde4cit

- chronic diarrhoea l"mphadenopath" tu!erculosis opportunistic !acterial

infection- l"mphoc"tic interstitial pneumoni is

most common in childrenB

'aposis sarcoma to#oplasmosis



- t"pical 4ndings in children :

l"mphoid h"perplasia salivar" gland enlargement

p"ogenic !acterial infection

developmental dela"

d"smorphic craniofacial- Oral futures :

candidiasis

7SG infection

+A/9+AS

progresive periodontal disease



oral hair" leu'opla'ia

petechiae

linear gingival er"thema

cervical l"mphadenopath"

- Speci4c test: antigen detection

virus isolation

pol"merase chain reaction

anti!od" detection test E%SAB

- *reatment : s"mptomatic

antiviral drugs ac"clovir etc







)/<,A %<)EC*%O<

Acute Pseudomembranous Candidiasis( Thrush )

- occur in the de!ilitated or chronicall" ill and on the infant

- oral lesions : - soft $hite slightll" elevated plaques can !e

$iped a$a" leaving a normal or aner"thematous

area

- on the !uccal mucosa tongue palate

gingiva 5oor of the mouth

- treatment : application of antifungal medication

n"statin amphotericin etc B





Oral Thru"h

is a ver" common infection in infants thatcauses irritation in and around a !a!"Psmouth.

%t is caused !" the overgro$th of a "east

a t"pe of fungusB called Candida albicans.Most people including infantsB naturall"

have Candida in their mouths and digestivetracts $hich is considered normal gro$th.

*he amount of this fungus in the !od" iscontrolled !" a health" immune s"stem andsome RgoodR !acteri



%f the immune s"stem is $ea'ened due to anillness or medicines li'e chemotherap"B or if the

immune s"stem is not full" developed as is thecase in infants

the Candida in the digestive tract can overgro$and lead to an infection causes diaper rashand vaginal "eastB infections.

Candida overgro$th or candidiasisB can happenafter a !a!" has received anti!iotics for a !acterialinfection !ecause anti!iotics can 'ill o; the RgoodR!acteria that 'eep the Candida from gro$ing.

Similarl" it can happen after the use of steroidmedicines



S"mptoms

Oral thrush can a;ect an"one although itPs mostcommon in !a!ies "ounger than months ofage and in older adults.A !a!" $ith oral thrush might develop crac'ed

s'in in the corners of the mouth or $hitishpatches on the lips tongue or inside thechee'sScraping the $hite patches o; can cause some

!leeding.Man" !a!ies donPt feel an"thing at all !ut somema" !e uncomforta!le $hen suc'ing. Some!a!ies ma" not feed $ell !ecause their mouthfeels sore.a!ies can have oral thrush and a dia er rash

O*7E+eS



+EC/++E<* A=7*7O/S S*OMA*%*%S

- triggered to stress gastrointestinal distur!ance

nutritional de4cienc"

hormonal im!alance

infection

allerg" genetic etc

- & t"pes : minor commmonB ulcers up to mm "ello$ pseudomem!ranous slough $ith aner"thematous !orde

heal $ithin 1K-1( da"s $ithout scarring

maHor ulcers mm last longer heal $ithscarring

herpetiform



Management:

S"mptomatic care $ith mouthrinsees - chlorhe#idine gluconate K2I 1K ml

three times dail"

- tetrac"cline mouth$ash 2Kmg in 1K

ml $ater three times dail" for ( da"s forchildren 3 "ears

- !en>"damine h"drocloride 12I

- #"locain spra" ma" !e helpful for somepatient

*opical steroid

- triamcinolone in ora!ase ma"!e

diFcult to appl" in childrenB



S"stemic corticosteroids onl" in severecases of maHor ulceration

7erpetiform ulcertion seems to respond!est to tetrc"cline mouth$ash







ehcet8s S"ndrome

-Characteri>ed !" recurrent aphthous ulcerationtogether $ith genital and ocular lesions

- the s'in and other s"stems can also !e involved

ehcet8s s"ndrome can !e divided into four t"pes:

mucocutaneous form : involvement of oraland genital mucosa and conHunctiva

arthritic form : arthritis in association $ithmucutaneous lesions

neurological form : central nervous s"stem

involvement Ocular form $ith uveitis in addition to oral and

genital lesions



ehcet8s s"ndrome

Diagnosis : - clinical presentation and !iops"

Management :

- as for recurrent aphthous ulcerations"stemic treatment corticosteroidB isrequired

Er"thema multiforme Steven-



Er"thema multiforme Steven ?ohnson s"ndrome

- is an acute often recurrent h"persensitivit"reaction e;ecting mucocutaneous tissue

- 2KI of cases occur in children

- is more common in males

-EM a;ects the mouth $ith serousanguinouse#udate on the lips and $idespreadulceration

- =redisposing factors :- drugs : penicilin

sulfa !ar!iturat - herpes simple# infection



Clinical )eatures

EM ma" present from mild limited to a severe$idespread and life-threatening illnessOral esions: - di;use $idespread macules progress through

!lister

ulcerationon on the non-'eratini>ed mucosapronounced in the anterior mouth - lips !ecome s$ollen and crac'ed !leeding andcrusted - recur in a!out 2I from $ee's to "ears



Oral manifestation



7aemorrhagic crust



S'in esions : - a;ect the distal e#tremitas: the e#tensor surface ofthe arms legs el!o$s 'nees dorsum of hands and feet- macules that are s"mmetric round er"thematousslightl" pruritic or non-itch"- ring- shape target lesions $ell-demarcated centre ofthe papule forms a necrotic ulcer $hich result in adepressed $hite "ello$ or gre" area surrounded !" a red

edge and then a pale oedematous ringT a !right redmargin ma" surround this pale ringOther mucosae - e"e involvement ma" cause lacrimation photopho!ia - genital lesions are painful ma" result in urinar"

retention



Uhas pada 'ulit lesi targetB



Steven-?ohnson S"ndrome

Garian dari erithema multiforme "angparah

Meli!at'an 'ulit mu'osa mulut matadan genital

ife threatening dehidrasiB

=en"em!uhan lama

Memerlu'an penatala'sanaan dalam tim





THAN$ %&'



+eferences

1. +ao A. 2KK3 : (rinciples and (ractise o#(edodontics

2nd edB ?a"pee rothers Medical=u!lishers =B *D <e$

Delhi : (21- (&( 2. anglais +.=. at all 2KKV : Color Atlas o#

Common &ral

)iseases (th ed ippincott Williams XWil'ins =hilladelphia

&. Scull" C. 2KK3 : &ral and Maxillo#acialMedicine The *asis o#

Diseases and Disorders of Oral Mucosa In

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