Classification of diseases of oral mucous membrane. Traumatic lesions of the oral mucous membrane.Etiology, pathogenesis, clinical picture, diagnosis and treatment.
Classification of diseases of oral mucous membrane.
By Borovsky E., Mushkyleison A.
(Moscow medical dental university)
I. Traumatic lesions (mechanical, chemical, physical)
II. Infectious lesions.
1.Virus diseases
2.Bacterial infections
3.Vincent’s stomatitis
4. Venereal diseases
5. Candidosis
III. Allergic lesions
IV. Medicament intoxications
V. Changes of oral mucous membrane in some systemic diseases.
1.hyper– and hypovitaminosis
2. endocrine diseases
3. alimentary tract diseases
4. cardio-vascular diseases
5. blood diseases
6. nervous system diseases
7. other
VI. Changes of oral mucous in dermatoses with an autoimmune component.
VII. Tongue anomalies and diseases.
VIII. Cheilitis.
IX. Precancer diseases.
Mechanical trauma
Can be:
1. Acute
2. Chronic
And caused by:
1. A sharp edge of a tooth
2. Accidental biting
3. Sharp, abrasive,or excessively salty food
4. Poorly fitting dentures
5. Dental braces
6. Trauma from a tooth brush
7. Patients bad habits
Acute trauma
n Single,
n can identify the cause
n should improve after removal
Traumatic ulcers on the tongue:
Clinical features of traumatic ulcers:
•They are clinically diverse, but usually appear as a single, painful ulcer with a smooth red or whitish-yellow surface and a thin erythematous halo.
•They are usually soft on palpation, and heal without scarring within 6–10 days, spontaneously or after removal of the cause.
•However, chronic traumatic ulcers may clinically mimic a carcinoma.
•The tongue, lip, and buccal mucosa are the sites of predilection.
•The diagnosis is based on the history and clinical features.
•However, if an ulcer persists over 10–12 days a biopsy must be taken to rule out cancer.
Treatment
1. Removing factors, caused trauma
2. Good hygiene of oral cavity
3. Antiseptic for 7-10 days
4. Analgetics if it is necessary
5. Topical steroids may be used for a short time.
6. Biopsy
Leukoplakia
Etiology:
-trauma from habitual biting, dental appliances
-tobacco use
-alcohol consumption
-oral sepsis
-local irritation
-syphilis
-vitamin deficiency
-endocrine disturbances
-dental galvanism
-actinic radiation (in the case of lip involvement).
Symptoms
– painless, fuzzy white patches on the side of the tongue or cheeks.
Clinical picture:
n -located on the tongue, mandibular alveolar ridge and buccal mucosa in ~50%.
-palate, maxillary alveolar ridge, lower lip, floor of the mouth and the retromolar regions are somewhat less frequently involved.
-may vary from nonpalpable, faintly translucent white areas to thick, fissured, papillomatous, indurated lesions.
-surface is often wrinkled or shriveled in appearance and may feel rough on palpation.
-color may be white, gray, yellowish-white, or even brownish-gray in patients with heavy tobacco use.
Physical:
-lesion cannot be wiped away with a gauze
Differential diagnosis:
1. Candidiasis and aspirin burn – can be wiped away with a gauze
2. Erythroplakia (a red plaque that does not rub off), is a dysplastic lesion (or worse) in 90 percent of cases.
Treatment
Treat dental causes such as rough teeth, irregular denture surface, or fillings as soon as possible.
Stopping tobacco or/and alcohol.
Removal of leukoplakic patches with using a scalpel, a laser or an extremely cold probe that freezes and destroys cancer cells (cryoprobe).
Chemical injures:
Chemicals such as aspirin or alcohol that are held or that come in contact with the oral mucosa may cause tissues to become necrotic and slough off creating an ulcerated surface.
Treatment:
1. Wash a mouth with lot of water
2. Analgetics (for 3-5 days )
3. Antiseptics ( for 7 – 10 days)
4. Keratolytics (after 5-7 days)
5. Keratoplastics (after 7-10 days)
Physical injures:
Electrical Burns to the Mouth–are most commonly caused when a child bites into a cord, touches the male ends of a “live” but improperly connected cord, or sucks on the female end of an extension cord that is plugged into the wall. The vast majority of the patients is younger than three years.
Treatment:
1. Conservative
Antiseptics
Antibiotics
Analgetic
2. Surgical (after the healing was completed and after the degree of functional and/or aesthetic deformity was established (usually 6 months post-injury)).
Stomatitis is an inflammation of the mucous lining of any of the structures in the mouth, which may involve the cheeks, gums, tongue, lips, throat, and roof or floor of the mouth. The inflammation can be caused by conditions in the mouth itself, such as poor oral hygiene, dietary protein deficiency, poorly fitted dentures, or from mouth burns from hot food or drinks, toxic plants, or by conditions that affect the entire body, such as medications, allergic reactions, radiation therapy, or infections.
Pathophysiology
Severe iron deficiency anemia can lead to stomatitis. Iron is necessary for the upregulation of transcriptional elements for cell replication and repair. Lack of iron can cause the genetic downregulation of these elements, leading to ineffective repair and regeneration of epithelial cells, especially in the mouth and lips. This condition is also prevalent in people who have a deficiency in vitamin B2 (Riboflavin), B3 (Niacin), B6 (Pyridoxine), B9 (folic acid) or B12 (Cyanocobalamine).When it also involves an inflammation of the gingiva, it is called gingivostomatitis.It may also be seen in ariboflavinosis (riboflavin deficiency) or neutropenia.
Angular stomatitis
Main article: Angular cheilitisIrritation and fissuring in the corners of the lips is termed angular stomatitis or angular cheilitis. In children a frequent cause is repeated lip-licking and in adults it may be a sign of underlying iron deficiency anemia, or vitamin B deficiencies (e.g. B2-riboflavin, B9-folate or B12-cobalamin, which in turn may be evidence of poor diets or malnutrition (e.g. celiac disease).Also, angular cheilitis can be caused by a patient’s jaws at rest being ‘overclosed’ due to edentulousness or tooth wear, causing the jaws to come to rest closer together than if the complete/unaffected dentition were present. This causes skin folds around the angle of the mouth which are kept moist by saliva which in turn favours infection; mostly by Candida albicans or similar species. Treatment usually involves the administration of topical nystatin or similar antifungal agents. Another treatment can be to correct the jaw relationship with dental treatment (e.g. dentures or occlusal adjustment).
Migratory stomatitis: Main article: Migratory stomatitis.Migratory stomatitis is a condition in which extensive areas in the oral cavity mucosa are affected by annular atrophic red lesions that surrounded by a thin white rim. This is a relatively uncommon form of the geographic tongue condition, that, in opposed to migratory stomatitis, is confined to the dorsal and lateral aspects of the tongue mucosa only.
Stomatitis –inflammation of the oral mucosa accompanied by degenerative changes in the oral cavity.
In humans, stomatitis may be caused by mechanical, thermal, chemical, or physical injury, hypovitaminosis, diabetes mellitus, diseases of the cardiovascular, nervous, hematopoietic, and digestive systems, acute infections (for example, measles, scarlet fever, and diphtheria), chronic infections (for example, tuberculosis), poisoning, and parasitic fungi (for example, thrush).The factors that cause traumatic stomatitis include deposits of dental calculus, decayed carious teeth, poorly made prostheses and fillings, foreign objects, burns produced by hot food, and the action of alkalies and acids.
A catarrhal process develops after short exposure to an injurious factor, with the mucous membrane becoming hyperemic and edematous and bleeding easily. Prolonged exposure results in the formation of ulcers, around which inflammatory phenomena develop.Stomatitis caused by systemic diseases is characterized by the appearance of aphthae on the oral mucosa; it may be acute or chronic. Acute stomatitis aphthosa usually occurs in children suffering from gastrointestinal diseases, diatheses, or viral diseases. The body temperature is high, and aphthae surrounded by a bright red border appear on the mucosa of the gums, lips, and palate.
There is profuse salivation, and the submaxillary lymph nodes become enlarged and tender. The disease lasts seven to ten days.
Chronic recurrent stomatitis aphthosa is characterized by the periodic appearance of solitary aphthae on the buccal mucosa, the lateral surface of the tongue, and the lower lip. The bottoms of the aphthae are covered with a grayish yellow coating. The lymph nodes are usually not enlarged. The disease lasts five to ten days, after which the aphthae epithelize or are transformed into ulcers.
Ulcerative stomatitis commonly accompanies acute enterocolitis, gastric ulcer, and mercury and bismuth poisoning. It may result from tonsillitis or influenza. Ulcers may appear over the entire mucosa. A disagreeable odor emanates from the mouth, and salivation is profuse. With blood diseases (leukemias), aphthae appear on the oral mucosa and tonsils; the aphthae are eventually transformed into ulcers. Radiation sickness is characterized by the same symptoms.Preventive and therapeutic measures include good oral hygiene, the elimination of the causes of the disease, rinsing of the mouth with a salt solution or boric acid (depending on the pH of the oral environment), physical therapy, and the application of sea-buckthorn oil.
A mouth or oral ulcer from Latin ulcus and that from Greek “ἕλκος” – elkos, “wound” is an open sore in the mouth, or rarely a break in the mucous membrane or the epithelium on the lips or surrounding the mouth. The types of mouth ulcers are diverse, with a multitude of associated causes including: physical abrasion, acidic fruit, infection, other medical conditions, medications, and cancerous and nonspecific processes. Once formed, the ulcer may be maintained by inflammation and/or secondary infection. Two common types are aphthous ulcers (“canker sores”) and cold sores (fever blisters, oral herpes). Cold sores around the lip are caused by viruses. Trauma to the mouth is a common cause of bacterial introduction.
A sharp edge of a tooth, accidental biting (this can be particularly common with sharp canine teeth, or Wisdom teeth), sharp, abrasive, or excessively salty food, hot drinks, poorly fitting dentures, dental braces or trauma from a toothbrush may injure the mucosal lining of the mouth resulting in an ulcer.
These ulcers usually heal at a moderate speed if the source of the injury is removed (for example, if poorly fitting dentures are removed or replaced). Chemicals such as aspirin or alcohol that are held or that come in contact with the oral mucosa may cause tissues to become necrotic and slough off creating an ulcerated surface. There is limited evidence to suggest that Sodium lauryl sulfate (SLS), one of the main ingredients in most toothpastes, is associated with an increased incidence of oral ulcers. These ulcers also commonly occur after dental work, when incidental abrasions to the soft tissues of the mouth are common. A dentist can apply a protective layer of petroleum jelly before carrying out dental work in order to minimize the number of incidental injuries to the soft mucosa tissues. Viral, fungal and bacterial processes can lead to oral ulceration. One way to contract pathogenic oral ulcerations is through the contact of chapped lips with unwashed hands. The reason for this is that bacteria sinks into the minuscule, open cuts caused by the chapped lips. The most common is Herpes simplex virus which causes recurrent herpetiform ulcerations preceded by usually painful multiple vesicles which burst. Varicella Zoster (chicken pox, shingles), Coxsackie A virus and its associated subtype presentations, are some of the other viral processes that can lead to oral ulceration. HIV creates immunodeficiencies which allow opportunistic infections or neoplasms to proliferate. Bacterial processes leading to ulceration can be caused by Mycobacterium tuberculosis (tuberculosis) and Treponema pallidum (syphilis). Opportunistic activity by combinations of other wise normal bacterial flora, such as aerobic streptococi, Neisseria, Actinomyces, spirochetes, and Bacteroides species can prolong the ulcerative process.
Symptomatic treatment is the primary approach to dealing with oral ulcers. If their cause is known, then treatment of that condition is also recommended. Adequate oral hygiene may also help in relieving symptoms. Topical antihistamines, antacids, corticosteroids or applications meant to soothe painful ulcers may be helpful, as may be oral analgesics such as paracetamol or ibuprofen [citatioeeded] and local anesthetic lozenges, paints or mouth rinses such as benzocaine[citatioeeded] and avoiding spicy or hot foods may reduce pain. Ulcers persisting longer than three weeks may require the attention of a medical practitioner. Symptomatic treatment is the primary approach to dealing with oral ulcers. If their cause is known, then treatment of that condition is also recommended. Adequate oral hygiene may also help in relieving symptoms. Topical antihistamines, antacids, corticosteroids or applications meant to soothe painful ulcers may be helpful, as may be oral analgesics such as paracetamol or ibuprofen[citatioeeded] and local anesthetic lozenges, paints or mouth rinses such as benzocaine[citatioeeded] and avoiding spicy or hot foods may reduce pain. Ulcers persisting longer than three weeks may require the attention of a medical practitioner.
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Information was prepared by Sukhovolets I.O.
