Please note that the following is a general guideline only.
Outline
Traumatic
-Cheek biting/ dentures/ burns/ chemicals
Infective
-Viral -HSVI, HSVII, V Zoster, Coxsakie V,
-Bacterial- seconadry, Syphillis,
-Fungi- Candida
Inflammatory
-Immune-Behcets, Erythema multiforme, Lichen planus, Benign mucous membrane pemphigoid, Bullous pemphigoid,Pemphigus vulgaris , E Multiforme
-Granulomatous-wegners
Neoplastic
Idiopathic
-Apthous
Systemic
-Chron’s/ vitamine lack, coeliac
I INFECTIVE
Candida
Definition
Candia infection usually by Candida albicans-yeast like organism
Aetiology
Candida Albicans
Pathophysiology
Local factors-dehydration, sjogrens, XRT, dentures Systemic-reasons for immune suppression, antibiotics, diabetes etc
Clinical
I Acute Thrush (psedo membraneos Candidasis)
Easily wiped off
Leaves a raw bed
White plaque on mucosal surface
II Acute Atrophic Candidasis
Acute burning sensation Red patch or diffuse patch Painful
De keratinisation-de papillation-hence atrophic
III Chronic Hyperplastic candidasis
Resembles leukoplakia ie Cant be rubbed off
IV Angular cheilitis
V Median Rhomboid Glossitis
Treatment
-If non-responsive will require biopsy and PAS stain. Need to exclude dysplasia. -Chronic candida infection may lead to cancer development.
-Remove offending reason ie stop smoking/ stop antibiotic use/ check immune status etc
-If acute form Nylstatin topically- lozenges/ drops
-If Chronic form Myconazole gel until lesion disappears
-If non-responsive try oral fluconazole or itraconazole for at least 2 weeks
-Dentures soak in Chlorexidine
HSV types I and II
Definition
-Primary Infection By a DNA virus
Aetiology
Herpes -DNA virus types I and II
Epidemiology
Common, Young
Clinical
Primary
Herpetic gingivostomatitis
Often asymptomatic ie non-painful
May be associated with fever, chills, malaise Vesicles-ulcers-crusting
Anywhere in the oral cavity
Diagnosis, clinical, smears, a rising titre of antibodies
Secondary Infection
Reactivation of latent virus in 20 – 30% Not associated with systemic symptoms Small vesicles
Treatment
Aciclovir, peniciclovir cream, analgesia
II INFLAMMATORY/ IMMUNE
Lichen Planus
Definition
Lichen planus is an inflammatory muco-cutaneous condition
Epidemiology
Can occur in the buccal mucosa also finger nails Higher in older ager >40 yrs
F>M
Aetiology
Inflammatory disorder
T cells attacking the basal layer= autoimmune origin likely
Papular Plaque-like Atrophic/erosive
Clinical
Usually asymptomatic
Some ulcerate
If buccal may have restricted mouth opening Bilaterally symmetrical-buccal, lateral tongue Gingiva may have ulceration
Palate-unlikely
erosive risk of Cancer
Reticula -Common form
Papular
Plaque like- rare
Treatment
Asymptomatic non erosive forms (Reticular)-No treatment
Symptomatic
If Symptomatic
Medium potency - Topical corticosteroids Triamcinalone acetonide (0.1% Kenalog in Orabase) Betamethasone valerate (0,05% Betnovate cream) Systemic corticosteroids???? Not usually necessary Prednisone tablets (5mg)
Erosive- Malignant potential- Excise
III IDIOPATHIC
Geographic Tongue
Aetiology
unknown
uneven de keratinisation of tongue
may get secondary infection with candida
Hereditary ie allergic cause
Clinical
can be red and painful
Treatment
avoid irritants
miconazole / nylstatin if candida
Apthous Ulcers
Definition-Idiopathic painful reccurent ulcers in the oral cavity
Epidemiology V common (most common ulcer)
Aetiology
Unknown
Possibilities- Exaggerated response to trauma Infections
Immunologic Gastrointestinal disorders
Haematologic deficiencies
Hormonal disturbance Stress
Clinical
Minor aphthous ulcers
most common, small, round, or oval, and are less than 10 mm across. They look pale yellow, but the area around them may look swollen and red. Only one ulcer may develop, but up to five may appear at the same time. Each ulcer lasts 7-10 days, and then goes without leaving a scar. They are not usually very painful.
Major aphthous ulcers
occur in about 1 in 10 cases. They tend to be 10 mm or larger across. Usually only one or two appear at a time. Each ulcer lasts from two weeks to several months, but will heal leaving a scar. They can be very painful and eating may become difficult.
Herpetiform ulcers
occur in about 1 in 10 cases. These are tiny pinhead-sized ulcers, about 1-2 mm across. Multiple ulcers occur at the same time, but some may join together and form irregular shapes. Each ulcer lasts one week to two months. Despite the name, they have nothing to do with herpes or the herpes virus
Treatment
Analgesia- systemic and topicas Steroids-topical/ systemic Topic tetracycline
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