diseases of the oral cavity

8/7/2019 Diseases of the Oral Cavity

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DISEASES OF THE

ORAL CAVITYCSA Espina, MD, DPBO



How to examine

the oral cavity



What do you need for

a proper examination? a directed history and a good clinical eyea directed history and a good clinical eye

a good source of lighta good source of light

tongue depressor(s)tongue depressor(s) ± ± preferably 2preferably 2 clean gauzeclean gauze

clean examining glovesclean examining gloves

face maskface mask

measuring apparatusmeasuring apparatus

examining mirror (sometimes needed)examining mirror (sometimes needed)



What do you need to perform?

InspectionInspection

PalpationPalpation ± ± bimanual palpationbimanual palpation



ANDBIMANUAL

PALPATION OF

LESIONS THATMAY BE

TUMORS!!

EXAMINATION OF THE ORAL CAVITY

USING A TONGUE DEPRESSOR



What do you need to watch out for?

Be conscious if you are causing any pain or Be conscious if you are causing any pain or discomfort when examining the patientdiscomfort when examining the patient

Protect yourself from infection (WEAR A MASK)Protect yourself from infection (WEAR A MASK)

When dealing with tumors, (especially malignantWhen dealing with tumors, (especially malignantones, or those for surgery), seek out the extent of ones, or those for surgery), seek out the extent of

the lesionthe lesion Always check the neck for enlarged nodes when Always check the neck for enlarged nodes when

dealing with tumors suspicious for malignancydealing with tumors suspicious for malignancy



trigone

(anterior

2/3)



BENIGN CONDITIONS



APHTHOUS ULCERS

³singaw´



APHTHOUS ULCERS A common and very painful affliction. A common and very painful affliction.

Often simply caused by trauma and heal quickly on their Often simply caused by trauma and heal quickly on their own.own.

The recurrent, bothersome form is known as recurrentThe recurrent, bothersome form is known as recurrentaphthous stomatitis.aphthous stomatitis.

Cause is unknown, though it is believed to be some sort of Cause is unknown, though it is believed to be some sort of immune mediated condition.immune mediated condition.

At this time it is believed that aphthous stomatitis is not At this time it is believed that aphthous stomatitis is notcaused by any infectious agent (viruses or bacteria) andcaused by any infectious agent (viruses or bacteria) andthese ulcers are not contagious.these ulcers are not contagious.



APHTHOUS ULCERS

Almost always found on the "loose" tissues of the Almost always found on the "loose" tissues of the

mouth; i.e. the cheek, inner lip, tongue, soft palate,mouth; i.e. the cheek, inner lip, tongue, soft palate,

floor of mouth, and sometimes the throat.floor of mouth, and sometimes the throat.

A reddish halo usually surrounds them A reddish halo usually surrounds them

Usually small, less than one half centimeter inUsually small, less than one half centimeter in

diameter. A less common form, major aphthae, candiameter. A less common form, major aphthae, can

get quite large and take very long to heal.get quite large and take very long to heal.



APHTHOUS ULCERS

Triggers are usually difficult to pin down.Triggers are usually difficult to pin down.

Stress, acidic foods, specific foods for theStress, acidic foods, specific foods for the

individual, trauma, chemical sensitivities all play aindividual, trauma, chemical sensitivities all play arole.role.

There is no cure for There is no cure for aphthousaphthous stomatitisstomatitis..

Usually, these are self Usually, these are self--limiting.limiting.



APHTHOUS ULCERS Laser treatments are the most effective, giving immediateare the most effective, giving immediate

pain relief and causing the ulcer to heal in 24pain relief and causing the ulcer to heal in 24--72 hours.72 hours.Pain relief is immediate and lasting; the ulcers heal in twoPain relief is immediate and lasting; the ulcers heal in twoto four days.to four days.

Avoiding known triggers and reducing stress is helpful. Avoiding known triggers and reducing stress is helpful. A healthy diet with vitamin supplementation is A healthy diet with vitamin supplementation is

recommended.recommended.

Excellent oral hygiene, including use of antibacterialExcellent oral hygiene, including use of antibacterial

rinses has been shown to reduce frequency of attacks.rinses has been shown to reduce frequency of attacks. Topical steroid treatments (Kenalog, Lidex gel, DecadronTopical steroid treatments (Kenalog, Lidex gel, Decadron

rinses) are quite useful, reducing the pain and duration of rinses) are quite useful, reducing the pain and duration of the lesions.the lesions.



SYSTEMIC DISEASE

PRESENTING AS ULCERS



SYSTEMIC DISEASE

PRESENTING AS ULCERS Aphthae can also be manifestations of various Aphthae can also be manifestations of various

systemic diseases such as Behcet's syndrome, HIV,systemic diseases such as Behcet's syndrome, HIV,autoimmune disorders, Crohn's disease, and theautoimmune disorders, Crohn's disease, and the

like.like.



CANDIDIASIS OR ORAL THRUSH




An overgrowth of yeast fungus, An overgrowth of yeast fungus, Candida albicansCandida albicans in thein themucous membranes of the mouth.mucous membranes of the mouth.

Oral thrushOral thrush refers to temporary candidiasis in the mouths of refers to temporary candidiasis in the mouths of babies, whilst if occurring in the mouth or throat of adults itbabies, whilst if occurring in the mouth or throat of adults itmay also be termedmay also be termed candidosiscandidosis or or moniliasismoniliasis..

Appear as thick white or cream Appear as thick white or cream--colour deposits. Underlyingcolour deposits. Underlyingthe deposits the mucosa of the mouth may appear inflamedthe deposits the mucosa of the mouth may appear inflamed(red and possibly slightly raised).(red and possibly slightly raised).

In babies the condition is termed thrush and is usuallyIn babies the condition is termed thrush and is usuallypainless and causes no discomfort. Adults may experiencepainless and causes no discomfort. Adults may experiencediscomfort or burning.discomfort or burning.




THOSE AT RISK:THOSE AT RISK:

NeonatesNeonates

Denture usersDenture users

Poorly controlled diabeticsPoorly controlled diabetics Those taking strong antibioticsThose taking strong antibiotics

or inhaled steroids for or inhaled steroids for

treatment of lung conditionstreatment of lung conditions

(may be reduced by regularly(may be reduced by regularlyrinsing the mouth with water rinsing the mouth with water

after taking the medication)after taking the medication)

Those undergoingThose undergoing

chemotherapychemotherapy

ImmunocompromisedImmunocompromised peoplepeople

Poorly nourished patientsPoorly nourished patients(specifically those with vitamin(specifically those with vitamin

A, iron and A, iron and folatefolate deficiencies)deficiencies)

Women undergoing hormonalWomen undergoing hormonal

changes, like pregnancy or changes, like pregnancy or

those on birth control pillsthose on birth control pills




Any underlying cause should be addressed. Any underlying cause should be addressed.

Treatment with topical antifungal drugs, such asTreatment with topical antifungal drugs, such as

NystatinNystatin ((MycostatinMycostatin),), MiconazoleMiconazole.. Patients who arePatients who are immunocompromisedimmunocompromised, either with, either with

HIV/AIDS or as a result of chemotherapy, mayHIV/AIDS or as a result of chemotherapy, may

require systemic treatment with oral or intravenousrequire systemic treatment with oral or intravenous

administered antiadministered anti--fungalsfungals, like, like Amphotericin Amphotericin B.B.



DENTAL INFECTIONS



DENTAL INFECTIONS

Not a lifeNot a life--threatening disease; however, if anthreatening disease; however, if an

odontogenic infection spreads through fascialodontogenic infection spreads through fascial

planes, patients are at risk for sepsis and airwayplanes, patients are at risk for sepsis and airway

compromise.compromise.

Neutropenic patients undergoing chemotherapy areNeutropenic patients undergoing chemotherapy are

at risk for certain pathogenic oral microorganismsat risk for certain pathogenic oral microorganisms

causing bloodstream infections, which increase thecausing bloodstream infections, which increase thechance of morbidity and mortality.chance of morbidity and mortality.



DENTAL INFECTIONS Local infectionsLocal infections

Grossly decayed tooth that are tender to percussion andGrossly decayed tooth that are tender to percussion andtemperature.temperature.

Swollen erythematous or hemorrhagic gingiva.Swollen erythematous or hemorrhagic gingiva.

Dentoalveolar ridge edema is evidenced by a periodontal,Dentoalveolar ridge edema is evidenced by a periodontal,periapical, and subperiosteal abscess.periapical, and subperiosteal abscess.

With further invasion, the infection may elevate the periosteumWith further invasion, the infection may elevate the periosteumand penetrate adjacent tissues.and penetrate adjacent tissues.

An abscess may form and require incision and drainage. An abscess may form and require incision and drainage.

Deeper infections or abscesses that have spread along theDeeper infections or abscesses that have spread along thefascial planes may complain of fever and difficultyfascial planes may complain of fever and difficultyswallowing, breathing, and opening the mouth.swallowing, breathing, and opening the mouth.



DENTAL INFECTIONS Mandibular infectionsMandibular infections

Infections from the mandibular teeth may result in spread to several spaces of Infections from the mandibular teeth may result in spread to several spaces of the neck including the submental space, sublingual space, submandibular the neck including the submental space, sublingual space, submandibular space and retropharyngeal spacespace and retropharyngeal space

Submental space infection is characterized by a firm midline swelling beneathSubmental space infection is characterized by a firm midline swelling beneaththe chinthe chin

Sublingual space infection is indicated by swelling of the mouth's floor withSublingual space infection is indicated by swelling of the mouth's floor withpossible tongue elevation, pain, and dysphagiapossible tongue elevation, pain, and dysphagia

Submandibular space infection is identified by swelling of the submandibular Submandibular space infection is identified by swelling of the submandibular triangle of the neck around the angle of the jaw.triangle of the neck around the angle of the jaw.

Retropharyngeal space infection is identified by stiff neck, sore throat,Retropharyngeal space infection is identified by stiff neck, sore throat,dysphagia, hot potato voice, and stridor with possible spread to thedysphagia, hot potato voice, and stridor with possible spread to themediastinum.mediastinum.



DENTAL INFECTIONS Ludwig¶s anginaLudwig¶s angina is characterized by brawnyis characterized by brawny boardlikeboardlike

swelling from a rapidly spreadingswelling from a rapidly spreading cellulitiscellulitis of theof thesublingual,sublingual, submentalsubmental, and, and submandibular submandibular spaces withspaces with

elevation and edema of the tongue, drooling, and airwayelevation and edema of the tongue, drooling, and airwayobstruction.obstruction.

The condition isThe condition is odontogenicodontogenic in 90% of cases and arisesin 90% of cases and arisesfrom the second and thirdfrom the second and third mandibular mandibular molars in 75% of molars in 75% of cases.cases.

Potential exists for adjacent retropharyngeal andPotential exists for adjacent retropharyngeal andmediastinalmediastinal infection.infection.



DENTAL INFECTIONS

Ludwig¶s angina ± watch out for

Aiway Obstruction!

nasopharyngeal airway tube



DENTAL INFECTIONS

Causes:Causes:

Infections through theInfections through the fascialfascial planes usually areplanes usually are

polymicrobialpolymicrobial (average 4(average 4--6 organisms).6 organisms).

Dominant isolates are anaerobic bacteria.Dominant isolates are anaerobic bacteria.

Anaerobes (75%) Anaerobes (75%) -- PeptostreptococciPeptostreptococci,, BacteroidesBacteroides

andand PrevotellaPrevotella organisms, andorganisms, and FusobacteriumFusobacterium

nucleatumnucleatum Aerobes (25%) Aerobes (25%) -- Alpha Alpha--hemolytic streptococcihemolytic streptococci



ANKYLOGLOSSIA

Also known as Persistent Lingual Frenulum



ANKYLOGLOSSIA

Persistent lingualPersistent lingual frenulumfrenulum is ais a congenitalcongenital

persistence of tissue which binds the tongue to thepersistence of tissue which binds the tongue to the

floor of the mouth.floor of the mouth.

When severe, theWhen severe, the frenulumfrenulum should be cut toshould be cut to

mobilize the tongue to prevent articulation problemsmobilize the tongue to prevent articulation problems

for the child.for the child.



GEOGRAPHIC TONGUE



GEOGRAPHIC TONGUE Also known as Also known as Benign MigratoryBenign Migratory GlossitisGlossitis

Benign, nonBenign, non--painful, and fairlypainful, and fairly--common condition of common condition of unknown etiology.unknown etiology.

Caused by the absence of taste bud papilla manifesting asCaused by the absence of taste bud papilla manifesting asmultiple, irregular, flat red and white lesions of the dorsummultiple, irregular, flat red and white lesions of the dorsumof the tongue.of the tongue.

Glassy patches move around the tongue and changeGlassy patches move around the tongue and changeshape.shape.

Cause of this condition is unknown and does not requireCause of this condition is unknown and does not requiretreatment.treatment.



BLACK HAIRY TONGUE



BLACK HAIRY TONGUE Also known as Also known as LinguaLingua VillosaVillosa NigraNigra

Commonly observed condition of defectiveCommonly observed condition of defectivedesquamation of thedesquamation of the filiformfiliform papillae or elongationpapillae or elongation

of the taste buds.of the taste buds.

Results from a variety of precipitating factors: poor Results from a variety of precipitating factors: poor oral hygiene, chronic oral irritation or smoking.oral hygiene, chronic oral irritation or smoking.

Treatment involves good oral hygiene, brushing of Treatment involves good oral hygiene, brushing of the tongue, mouth rinses and sometimes thethe tongue, mouth rinses and sometimes thetrimming of the elongated papilla.trimming of the elongated papilla.



SCROTAL TONGUE



SCROTAL TONGUE Also called Also called Fissured Tongue or LinguaFissured Tongue or Lingua PlicataPlicata..

Harmless and asymptomatic condition in which fissuresHarmless and asymptomatic condition in which fissuresdevelop in the tongue, making it look wrinkled.develop in the tongue, making it look wrinkled.

Familial, but not always a congenital condition.Familial, but not always a congenital condition. Asymptomatic condition, unless food particles and debris Asymptomatic condition, unless food particles and debris

lodging in the depths of the fissures cause a mildlodging in the depths of the fissures cause a mild glossitisglossitis..Deep fissures may harbor colonies of bacteria or debrisDeep fissures may harbor colonies of bacteria or debrisfrom food, leading to bad breath or fungal infections of thefrom food, leading to bad breath or fungal infections of the

tongue.tongue. There is no treatment for scrotal tongue, except for goodThere is no treatment for scrotal tongue, except for good

oral hygiene if the above condition occurs.oral hygiene if the above condition occurs.



BENIGN GROWTHS

SIMPLE RANULATONGUE HEMANGIOMA



BENIGN GROWTHS

ORAL FIBROMA

SIALOCOELE



BENIGN GROWTHS

TORUS PALATINUSTORUS MANDIBULARIS



BENIGN GROWTHS

Hard bony growth or Hard bony growth or exostosisexostosis in the center of thein the center of the

roof of the mouth or on the floor of mouth.roof of the mouth or on the floor of mouth.

NotNot a tumor or neoplasm.a tumor or neoplasm. Commonly occurs in females over the age of 30Commonly occurs in females over the age of 30

and rarely needs treatment.and rarely needs treatment.

Occasionally these bony growths are removed for Occasionally these bony growths are removed for the proper fitting of dentures.the proper fitting of dentures.



PRE-MALIGNANTLESIONS



LEUKOPLAKIADEFINITION:DEFINITION:

A condition of the mouth A condition of the mouththat involves the formationthat involves the formation

of of white leathery patcheswhite leathery patchesor spotsor spots on the mucouson the mucousmembranes of the oralmembranes of the oralcavity.cavity.

Often caused by chronicOften caused by chronicirritation, tobacco use or irritation, tobacco use or infection.infection.

It is not a specific disease entityIt is not a specific disease entityand is diagnosed by theand is diagnosed by theexclusion of diseases that mayexclusion of diseases that maycause similar white lesions.cause similar white lesions.



LEUKOPLAKIADEFINITION:DEFINITION:

Leukoplakia affects less than one percent of the population,Leukoplakia affects less than one percent of the population,and is most common in adults within the 50and is most common in adults within the 50--70 years age70 years agegroup.group.

A small proportion of cases is associated with a risk of A small proportion of cases is associated with a risk of cancer.cancer.

Treatment of leukoplakia mainly involves avoidance of Treatment of leukoplakia mainly involves avoidance of predisposing factors like smoking, tobacco and betel nutpredisposing factors like smoking, tobacco and betel nut

chewing, alcohol, and removal of chronic irritants like sharpchewing, alcohol, and removal of chronic irritants like sharpedges of teeth.edges of teeth.

In suspicious cases, a biopsy is warranted.In suspicious cases, a biopsy is warranted.



ERYTHROPLAKIADEFINITION:DEFINITION:

Flat red patch or lesion in theFlat red patch or lesion in themouth with a soft and velvetymouth with a soft and velvetytexturetexture that cannot bethat cannot be

attributed to any other attributed to any other pathology.pathology.

Many other conditions that areMany other conditions that aresimilar in appearance and mustsimilar in appearance and mustbe ruled out before a diagnosisbe ruled out before a diagnosisof of erythroplakiaerythroplakia is made.is made.

ErythroplakiaErythroplakia is moreis morefrequently is associated withfrequently is associated withdysplasia, and is thus a predysplasia, and is thus a pre--cancerous lesion.cancerous lesion.



ERYTHROPLAKIADEFINITION:DEFINITION:

Mostly found in elderly men around the ages of 65Mostly found in elderly men around the ages of 65 -- 74.74.

Commonly associated with smoking.Commonly associated with smoking.

Microscopically, the tissue exhibits severe epithelialMicroscopically, the tissue exhibits severe epithelialdysplasia, carcinomadysplasia, carcinoma--inin--situ, or invasive squamous cellsitu, or invasive squamous cellcarcinoma in 90% of cases.carcinoma in 90% of cases.

Treatment involves biopsy and complete excision of theTreatment involves biopsy and complete excision of the

lesion is sometimes advised.lesion is sometimes advised. Recurrence of the erythroplakia is common and longRecurrence of the erythroplakia is common and long--termterm

monitoring is needed.monitoring is needed.



MALIGNANT

TUMORS



SQUAMOUS CELL

CARCINOMA

W ARTY OR EXOPHYTIC TYPE

ULCERATIVE TYPE

INVASIVE TYPE

SCCA OF THE LOWER LIP



SQUAMOUS CELL

CARCINOMA Smoking and other tobacco use are associated withSmoking and other tobacco use are associated with

about 75 percent of oral cancer cases, caused byabout 75 percent of oral cancer cases, caused byirritation of the mucous membranes of the mouthirritation of the mucous membranes of the mouth

from smoke and heat of cigarettes, cigars, andfrom smoke and heat of cigarettes, cigars, and

pipes.pipes.



SQUAMOUS CELL

CARCINOMA

Tobacco containsTobacco containsover 19 knownover 19 known

carcinogens.carcinogens.



SQUAMOUS CELL

CARCINOMA In many Asian culturesIn many Asian cultures

chewing betel nut is knownchewing betel nut is known

to be a strong risk factor to be a strong risk factor

for developing oral cancer.for developing oral cancer. In India where suchIn India where such

practices are common,practices are common,

oral cancer represents uporal cancer represents up

to 40% of all cancers,to 40% of all cancers,compared to just 4% in thecompared to just 4% in the

UK.UK.



SQUAMOUS CELL

CARCINOMA HumanHuman papillomaviruspapillomavirus (HPV) types 16 and 18(HPV) types 16 and 18

exposureexposure is a known risk factor and independentis a known risk factor and independent

causative factor for oral cancer.causative factor for oral cancer.

Oral cancer in this group tends to occur on theOral cancer in this group tends to occur on the

tonsil andtonsil and tonsillar tonsillar pillars, base of the tongue, andpillars, base of the tongue, and

thethe oropharynxoropharynx..



SQUAMOUS CELL

CARCINOMASYMPTOMSSYMPTOMS

Lesion, lump, or ulcer onLesion, lump, or ulcer onthe tongue, lip, or other the tongue, lip, or other

areasareas Usually painless initiallyUsually painless initially

May develop poor nutritionMay develop poor nutritionand poor oral hygienceand poor oral hygience

due to feeding problemsdue to feeding problemswhen the tumor iswhen the tumor isadvancedadvanced

Additional symptoms that Additional symptoms thatmay be associated withmay be associated with

this disease:this disease: Tongue mobility problemsTongue mobility problems

Problems with mouthProblems with mouth--opening (opening (trismustrismus))

Swallowing difficultiesSwallowing difficulties

Articulation problems Articulation problems

Pain andPain and paresthesiaparesthesia arearelate symptomslate symptoms

SQ O S C



SQUAMOUS CELL

CARCINOMA While a dentist, physician or other medicalWhile a dentist, physician or other medical

professional may suspect a particular lesion isprofessional may suspect a particular lesion is

malignant, the only definitive method for malignant, the only definitive method for

determining this is throughdetermining this is through BIOPSYBIOPSY andand

microscopic evaluation of the cells.microscopic evaluation of the cells.

SQUAMOUS CELL



SQUAMOUS CELL

CARCINOMA Surgical excision of the tumor is usually recommended.Surgical excision of the tumor is usually recommended.

Radiation therapy is often used in conjunction with surgery,Radiation therapy is often used in conjunction with surgery,

or as the definitive radical treatment, especially if theor as the definitive radical treatment, especially if the

tumour is inoperable.tumour is inoperable. Owing to the vital nature of the structures in the head andOwing to the vital nature of the structures in the head and

neck area, surgery for larger cancers is technicallyneck area, surgery for larger cancers is technically

demanding.demanding.

Reconstructive surgery may be required to give anReconstructive surgery may be required to give an

acceptable cosmetic and functional result.acceptable cosmetic and functional result.

SQUAMOUS CELL



SQUAMOUS CELL

CARCINOMA Survival rates for oral cancer depend on the precise site,Survival rates for oral cancer depend on the precise site,

and the stage of the cancer at diagnosis.and the stage of the cancer at diagnosis.

Overall, survival is around 50% at five years when allOverall, survival is around 50% at five years when allstages of initial diagnosis are considered. Survival rates for stages of initial diagnosis are considered. Survival rates for

stage 1 cancers are 90%, hence the emphasis on earlystage 1 cancers are 90%, hence the emphasis on early

detection to increase survival outcome for patients.detection to increase survival outcome for patients.

Following treatment, rehabilitation may be necessary toFollowing treatment, rehabilitation may be necessary to

improve movement, chewing, swallowing, and speech.improve movement, chewing, swallowing, and speech.

SQUAMOUS CELL



SQUAMOUS CELL

CARCINOMA Chemotherapy is useful in oral cancers when used inChemotherapy is useful in oral cancers when used in

combination with radiation therapy.When cure is unlikely itcombination with radiation therapy.When cure is unlikely it

can also be used to extend life and can be consider can also be used to extend life and can be consider

palliative but not curative care.palliative but not curative care. Treatment of oral cancer will usually be by be aTreatment of oral cancer will usually be by be a

multidisciplinary team, with treatment professionals frommultidisciplinary team, with treatment professionals from

the realms of radiation, surgery, chemotherapy, nutrition,the realms of radiation, surgery, chemotherapy, nutrition,

dental professionals, and even psychologydental professionals, and even psychology all possiblyall possiblyinvolved with diagnosis, treatment, rehabilitation, andinvolved with diagnosis, treatment, rehabilitation, and

patient care.patient care.



Thank You

diseases of the oral cavity

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