Disorders of tongue, lips, salaivary glands and teeth
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This document discusses several oral disorders including oral hairy leukoplakia, hairy tongue, ankyloglossia, squamous cell carcinoma of the tongue, salivary gland diseases, diseases of the lips, periodontitis, dental caries, and periapical abscess. It covers the pathogenesis, clinical presentation, diagnosis and management of these conditions.
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Disorders of tongue, lips, salaivary glands and teeth
- 1. Disorders oftongue, salivary glands, tongue, lips and teeth Prepared By: Justin V Sebastian, MSc N, RN, PhD Scholar
- 2. Oral hairy leukoplakia ▪ OHL – corrugated white lesion seen on ventral and lateralsurfaces of tongue ▪ Commonlyassociated with HIV ▪ EBV – causative agent ▪ Lesions are shaggy and frayed ▪ Plaque likeand often bilateral ▪ Microscopy – reveals viral nuclear inclusions with a rim of chromatin
- 4. Treatment ▪ No treatment is required ▪ Resolves with- zidovudine.Acyclovir, gancyclovir ▪ Topically application of- podophyllin resin andtretinion ▪ OHL is highly predictive ofAIDS development
- 5. Hairy tongue/ lingua villosa/Lingua nigra ▪ Defective desquamation of filiform papillae ▪ Accumulation of excess keratin on filiform papillae of the dorsal part of tongue ▪ Dark color results from trapping of debris and bacteria ▪ Radiation therapy ▪ Seen in smokers and persons with poor oral hygiene ▪ Increased coffee and tea drinking
- 6. Treatment ▪ Notreatment is required ▪ Gentle tongue scrapping and removal of etiology ▪ Surgical removal of papillae- laser ,electrodesication Filiform papillae attains 15 mmlength
- 7. Ankyloglossia/ tongue tie ▪ Inferior frenulum attaches to the bottom of tongue ▪ Restricts freemovement of tongue ▪ Frenulectomy isrecommended
- 9. Squamous cell carcinoma of the tongue
- 10. SCC of tongue ▪ Smoking,alcohol abuse are risk factors for SCC of tongue ▪ HPV is implicated in tonguecancer ▪ Seen in anterior two thirds of tongue ▪ Usually painless ▪ Presents as a non healing ulcer ▪ Nodal metastasis is common due to lymphatic drainage of tongue
- 11. ▪ Symptomsof tongue cancer ▪ A red or white patch on the tongue, that willnot go away ▪ sore throat ▪ A sore spot (ulcer)or lump ▪ Pain whenswallowing ▪ Numbnessin the mouth ▪ Unexplained bleeding from the tongue (that is not caused by biting your tongue or other injury)
- 12. Treatment ▪ Hemiglossectomy ▪ Totalglossectomy ▪ Radiation therapy ▪ Chemotherapy Hemiglossectomy
- 14. Salivary Gland Diseases ● Functional disorders ● Obstructive disorders ● Non-neoplastic disorders ● Neoplastic disorders
- 15. Functional Disorders ● Sialorrhea (Increase in saliva flow) – Psychosis, mental retardation, certain neurological diseases, rabies, – mercury poisoning ● Xerostomia (Decrease in saliva flow) – Mumps, sarcoidosis
- 16. Obstructive Disorders ● Sialolithiasis – 92% occur in submandibular gland – 6% in parotid gland – Multiple occurrence in same gland is common
- 17. Submandibular Gland Lithiasis ● Diagnosis – Pain and sudden enlargement of gland while eating – Palpation of stone submandibular duct – Occlusal radiograph (80%)
- 18. Submandibular Gland Lithiasis ● Treatment – Can be removed transorally if in duct and easily palpable – If in gland and gland is damaged, then gland should be removed
- 19. Parotid Lithiasis ● Diagnosis – Based on history – Swelling during meals – Bimanual palpation of painful gland – 40% non-radiopaque – Most parotid stones are multiple
- 20. Parotid Lithiasis ● Treatment – Stones in extra-glandular portion of duct can be removed transorally – Intraglandular stones removed from extra- oral approach
- 22. Acute Sialadentis ● Etiology – Viral - ( Mumps) – Bacterial
- 23. Acute Sialadentis ● Bacterial - swelling and dehydration, xerostomia, failure of secretion with ascending infection – (Staph aureus, Strep progenies, most common infective organism) ● Painful swelling parotid gland, overlying skin red, pus from parotid duct
- 24. Acute Sialadentis ● Treatment – Culture pus – Appropriate antibiotic – Supportive therapy • Fluids • Heat • Salivary stimulants
- 25. Chronic Sialadentis ● Chronic recurrent parotitis – Age 3-6 – Caused by Strep viridian – May spontaneously heal during puberty
- 26. Necrotising Sialometaplasis ● Benign inflammatory condition ● Usually involves in minor salivary gland of hard palate ● Will often simulate a malignant condition ● No definite etiology ● 1-3 cm ulcer heals spontaneously
- 28. Salivary Gland Tumors ● Adenomas (Epithelial) – Pleomorphic adenoma – Monomorphic adenoma – Adenolymphoma
- 29. Salivary Gland Tumors ● Carcinomas – Adenoid cystic carcinoma – Adenocarcinoma
- 30. Diseases OF Lips?? Any Idea??...
- 31. Swelling Of Lips? Swelling of lips It May be 1. Generalised/Diffuse 2. Localised Usually involves Perioral area of skin Usually patients of Orofacial Granulomatosis and angioedema present with lipswelling.
- 32. Causes Of lip Swelling DIffuse Localized 1. Angioedema 2. Oedema 3. Crohn’s Disease 4. Haemengioma 5. Lymphangioma 1. Mucocele 2. Abscess 3. Haematoma 4. Salivary adenoma 5. Basal Cell Carcinoma 6. Squamous cell carcinoma
- 36. Angular Cheilitis Angular Cheilitis is the Inflammation of one or both corners of mouth Multifactorial disease with 1. Local 2. Systemic factors
- 37. Inadequate Dentures • Skin creasing with sliva leakage and maceration at corners of the mouth • Host Defences Compromised Systemic Diseases or Deficiencies • Anemia • Iron Deficiency, B12or Folate Deficiency • HIV • Diabetes Mallitus Trauma • S. Aureus Species • Candida Species
- 38. Diagnosis? 1. Complete Medical, social, Dental History 2. Complete Examinations Especially for anaemia, ill fitting denture, denture and candidial infections. 3. Investigations? Microbiological: Blood Tests: Complete Blood Count Serum B12,ferritin, serum and red cell folate levels
- 39. Management Elimination of local factors Denture Hygiene Instruct patient to leave denture atnight Referral to medical specialist for underlying medical cause Provision of antimicrobial therapy 1. Local 2. Systemic
- 40. Antimicrobial therapy Candida isolated 1. Nystatin pastilles (intraoral) 2. Nystatin ointment (corners) S. aureus isolated 1. Fusidic acid cream (angles) 2. Mupirocine cream/fusidic acid cream (anterior nares) Mixed infection 1. Miconazole gel/cream Chlorhexidine mouthwash
- 41. Lip Fissures Less common Midline of lower lip Majority of these is due to Infections which may be S.aureus or candidaalbicans Treatment principle is based on elimination of secondary cause of infection and then topical steroid Creams application. Recurrence is common Commonly seen in patients of down syndrome along with angular cheilitis
- 43. Allergic Cheilitis Irritation and scaling of lips caused by allergy due to 1. Lipsticks 2. Ointments 3. Foods 4. Moisturises 5. Tooth pastes 6. Lipstick allergy may also be caused by straw sharingand kissing Mangement: 1. Identification and removal of the cause of irritation 2. Topical steroids cream can be used for short term management
- 45. Actinic Cheilitis Solar keratosis Predominantly male patients Prolonged exposure to sunlight either occupational or recreational may result this Long exposure to sunlight Lower lip more effected May progress to carcinoma Biopsy is necessary for completeassessment
- 46. Crusting and induration is due to fibrotic reaction of the connective tissues. Treatment : 1. Excision by either lip shaveoperation 2. Laser treatment
- 47. Exfoliative Cheilitis Production of excess amount of keratin Brown scales are formed which may be removed by the patientor may persist Reported to be exclusively in females Histology is simply hyper parakeratosis Not a malignantcondition May be related to stress, no definite cause isknown Various treatments have been used like local and systemic steroids, cautery, cryosurgery and many others but all withoutsuccess. Antidepressants have also been used with some successreported. Resolves itself usually.
- 51. Lick Eczema Young children Zone of irritable scaly skinaround the mouth Treatment is to stop the habit of licking
- 55. It is a gluey, gelatine - like substance that adheres to the teeth.
- 56. Dental caries or tooth decay is an erosive process that begins with the action of bacteria on fermentable carbohydrates in the mouth, which produces acids that dissolve tooth enamel.
- 57. PATHOPHYSIOLOGY Poor dental hygiene A small hole, usually in a fissure or in an area that is hard to clean The decay penetrates the enamel into the dentin and pulp Exposure of blood vessels, lymph vessels and nerves to the decaying area Infection and abscess formation
- 58. Clinical manifestation • Pulsating pain • Abscess formation • Swollen face
- 59. Prevention • Mouth care. • Diet. • Fluoridation. • Pit and fissure sealants.
- 64. PERIODONTITIS
- 65. PATHOPHYSIOLOGY • EARLY LESION • MODERATE LESION • ADVANCED LESION
- 66. DEEP CLEANING (SCALING AND ROOT PLANNING) Management
- 68. DEFINITION PERIAPICAL ABSCESS REFERRED TO AS AN ABSCESSED TOOTH, INVOLVES THE COLLECTION OF PUS IN THE APICAL DENTAL PERIOSTEUM (FIBROUS MEMBRANE SUPPORTING THE TOOTH STRUCTURE) AND THE TISSUE SURROUNDING THE APEX OF THE TOOTH (WHERE IT IS SUSPENDED IN THE JAW BONE).
- 69. TYPES • ACUTE PERIAPICAL ABSCESS • CHRONIC PERIAPICAL ABSCESS
- 70. Signs and symptoms of a dental abscess include: • pain in the affected area when biting or when touching the affected area • sensitivity to cold or hot food and liquids • a foul taste in the mouth • fever • a generally unwell feeling • difficulties opening the mouth • swallowing difficulties • insomnia
- 71. Treatments • Root canal treatment will be used to remove the abscess. A drill is used to bore a hole into the dead tooth so that the pus can come out. Any damaged tissue will be removed from the pulp. • Over the counter (OTC) painkillers may help reduce the pain while an individual is waiting for treatment • Antibiotics may be prescribed to prevent the infection from spreading and may be taken together with painkillers. Examples of antibiotics include amoxicillin or metronidazole.