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COMMON DISORDERS OF THE ORAL CAVITY

COMMON DISORDERS OF THE ORAL CAVITY. - DR SUBHODH H R. ULCERS OF ORAL CAVITY. VIRAL INFECTION. HERPANGINA : COXSACKIE VIRUS MOSTLY AFFECTING CHILDREN HERPETIC GINGIVOSTOMATITIS : PRIMARY : AFFECTS CHILDREN SECONDARY OR RECURRENT : AFFECTS ADULTS (HERPES LABIALIS ) HAND FOOT & MOUTH DISEASE.

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COMMON DISORDERS OF THE ORAL CAVITY

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  1. COMMON DISORDERS OF THE ORAL CAVITY - DR SUBHODH H R

  2. ULCERS OF ORAL CAVITY

  3. VIRAL INFECTION • HERPANGINA : COXSACKIE VIRUS MOSTLY AFFECTING CHILDREN • HERPETIC GINGIVOSTOMATITIS : • PRIMARY : AFFECTS CHILDREN • SECONDARY OR RECURRENT : AFFECTS ADULTS (HERPES LABIALIS ) • HAND FOOT & MOUTH DISEASE

  4. BACTERIAL INFECTIONS • VINCENT’S INFECTION (ACUTE NECROTISING ULCERATIVE GINGIVITIS ) • BY FUSIFORM BACILLUS & BORRELIA VICENTII • YOUNG ADULTS • DIAGNOSIS BY SMEAR

  5. FUNGAL INFECTIONS • CANDIDIASIS : ( CANDIDIA ALBICANS ) • THRUSH : • WHITE GREY PATCHES, WHEN WIPED LEAVE RED MUCOSA • IMMUNOSUPRESSED STATES • CHRONIC HYPERTROPHIC CANDIDIASIS : • CANDIDAL LEUKOPLAKIA • CAN’T BE WIPED OFF • TREATED BY TOPICAL CLOTRIMAZOLE AND OCCASIONALLY EXCISION

  6. APHTHOUS ULCERS • MINOR FORM • SMALLER (2-10MM), HEAL WITHOUT SCAR • MAJOR FORM • LARGER (2-4CM), WITH SCAR, RECURRENCE • ETIOLOGY : • AUTOIMMUNE, DEFICIENCY STATES, INFECTIONS, ALLERGIES, STRESS

  7. CAN BE DIFFERENTIATED BY ABSENCE OF CONSTITUTONAL SYMPTOMS, RECURRENCE AND MOVABLE MUCOSA INVOLVEMENT • TREATMENT : • TOPICAL OR SYSTEMIC STEROIDS • TOPICAL CHEMICAL CAUTERIASATION • TOPICAL LIGNOCAINE VISCOUS • BEHCET’S DISEASE ( ORO-OCULO-GENITAL SYNDROME )

  8. TRAUMATIC ULCER • JAGGED TEETH • ILL FITTING DENTURES • INJURY WITH FOREIGN OBJECTS • ACID OR ALKALI INJURY • ASPIRIN BURN

  9. SKIN DISORDERS • ERYTHEMA MULTIFORMAE • PEMPHIGUS VULGARIS • BENIGN MUCOUS MEMBRANE PEMPHIGOID ( BMMP ) • LICHEN PLANUS • CHRONIC DISCOID LUPUS

  10. BLOOD DISORDERS • ACUTE LEUKEMIAS : • ACUTE LYMPHOBLASTIC- KIDS • ACUTE MYELOBLASTIC- ADULTS • AGRANULOCYTOSIS • CYCLIC NEUTROPENIA • PANCYTOPENIA

  11. NEOPLASMS : • SQUAMOUS CELL CARCINOMA • MINOR SALIVARY GLAND TUMOURS • NON-HODGKIN’S LYMPHOMA • DRUG ALLERGY : • PENICILLINS • TETRACYCLINES • SULPHA DRUGS • PHENYTOIN • BARBITURATES • POST CHEMOTHERAPY AND RADIATION MUCOSITIS • VITAMIN DEFICIENCIES

  12. MISCELLANEOUS LESIONS

  13. MEDIAN RHOMBOID GLOSSITIS • IN FRONT OF FOR.CAECUM • PERSISTENCE OF TUBERCULUM IMPAR • ALSO DUE TO CHRONIC CANDIDA INFECTION • ASYMPTOMATIC

  14. GEOGRAPHIC TONGUE • MIGRATORY GLOSSITIS • KEEP CHANGING THEIR SHAPE • DEVOID OF PAPILLAE, RED FLAT AREAS WITH WHITE KERATOTIC RIM • ASYMPTOMATIC

  15. HAIRY TONGUE • EXCESSIVE KERATIN FORMATION ON FILIFORM PAPILLAE • SMOKERS • EXCISION AND DILUTE H2O2 MOUTH WASHES • GOOD ORAL HYGIENE

  16. FISSURED TONGUE : • VITAMIN DEFICIENCY • SYPHILIS • MELKERSON ROSENTHAL SYNDROME • FORDYCE’S SPOTS : • ABERRANT SEBACEOUS GLANDS • YELLOWISH SPOTS

  17. ANKYLOGLOSSIA • TONGUE TIE • RARELY CAUSES SPEECH DEFECTS • SURGICAL RELEASE OF TONGUE TIE

  18. ORAL SUBMUCOUS FIBROSIS

  19. CHRONIC INFLAMMATORY PROCESS WITH JUXTA-EPITHELIAL DEPOSITION OF FIBROUS TISSUE IN THE ORAL CAVITY AND PHARYNX • DESCRIBED BY JOSHI (INDIA) IN 1953 • COMMON IN ORIENTAL COUNTRIES

  20. ETIOLOGY • SOCIO-ECONOMIC STATUS • TOBACCO CHEWING • ARECA NUTS • ALCOHOL • NUTRITIONAL • IMMUNE PROCESS • MULTIFACTORIAL

  21. CLINICAL FEATURES • MALIGNANT TRANSFORMATION IN 3-7.6% • MOSTLY YOUNG ADULTS • SYMPTOMS : • INTOLERANCE TO SPICES • SORE MOUTH • VESICULAR ERUPTIONS • DIFFICULTY IN OPENING THE MOUTH • DIFFICULT PROTRUSION OF THE TONGUE

  22. SIGNS : • INVOLVES – SOFT PALATE, FAUCIAL PILLARS, BUCCAL MUCOSA • EARLY CHANGES – PATCHY REDNESS • LATER CHANGES – BLANCHING WITH FIBROTIC BANDS • PROGRESSIVE TRISMUS • RESTRICTIVE MOBILITY OF SOFT PALATE AND TONGUE • ASSOCIATED PREMALIGNANT LESIONS • POOR ORODENTAL HYGIENE

  23. TREATMENT • MEDICAL : • STEROIDS+HYLASE INTRALESIONAL INJECTIONS • AVOID IRRITANT FACTORS • MULTIVITAMINS AND ANTI OXIDANTS • JAW OPENING EXERCISES

  24. SURGICAL : • SIMPLE RELEASE AND SKIN GRAFTING • B/L TONGUE FLAPS • NASOLABIAL FLAPS • ISLAND PALATAL MUCOPERIOSTEAL FLAPS • B/L RADIAL FOREARM FREE FLAP • CORONOIDECTOMY AND TEMPORAL MUSCLE MYOTOMY

  25. TRISMUS

  26. Normal mouth opening • The normal range of mouth opening varies from patient to patient, within a range of 40- 60 mm, although some authors place the lower limit at 35 mm. • The width of the index finger at the nail bed is between 17 and 19 mm.

  27. TREATMENT • When a patient reports mild pain and dysfunction, an appointment for examination should be arranged. • In the interim, the practitioner should prescribe the following to manage the initial phase of muscle spasm : • Heat therapy consists of placing moist hot towels on the affected area for 15-20 minutes every hour • analgesics; muscle relaxants • a soft diet;

  28. Treatment for trismus should be directed at eliminating its cause. • Diagnostic assessment should be made before any type of therapy is applied. • If trismus is suspected to be associated with infection, appropriate antibiotics should be prescribed.

  29. When the acute phase is over the patient should be advised to initiate physiotherapy for opening and closing the jaws and to perform lateral excursions of the mandible for 5 minutes every 3-4 hours. • Sugarless chewing gum is another means of providing lateral movement of the TMJ.

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