Transcript DISEASES-OF-ORAL-CAVITY

DISEASES OF ORAL
CAVITY
SYSTEMIC DISEASES
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HIV (AIDS)
Leukaemia
Crohn’s disease
Diabetes mellitus
Down syndrome
Sarcoidosis
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Chediak Higashi syndrome
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Normal defense Mechanisms of oral
mucosa :
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2.
3.
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Competitive suppression ; by organisms of low
virulence
Secretory Ig A
Other immunoglobulins ; sub mucosal collection of
lymphocytes and plasma cells.
Antibacterial effect of saliva
Irrigation/Cleansing effect of food and drinks
Herpes simplex viral infection
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Type : HSV -1, HSV -2 (genital herpes)
Age : Children 2 -4 years of age
Presentation:
- Usually asymptomatic
- Gingivostomatitis ; abrupt onset of
vesicles/ ulcers
- Fever, anorexia, lymphadenopathy
Gross :
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Vesicles ; few mm – large bullae
Filled with clear fluid
Ruptures to form shallow ulcer
Histology :
Intracellular and intercellular edema
Intranuclear inclusions
Multinucleated giant cells
Course of the disease :
Spontaneous resolution in 3-4 weeks time.
Remain dormant in the ganglion ; trigeminal
Reactivation:
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Trauma
Allergies
Exposure of UV light
URTI
Pregnancy
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Menstruation
Extremes of temperature
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COMMON SITES OF RECURRENT
LESION :
 Lips
 Nasal Orifices
 Buccal mucosa
 Gingiva
 Hard palate
Disorders of the Lips
 Actinic cheilitis
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Premalignant condition
due to chronic UVR
exposure
Affects lower lip, initially
edematous &
erythematous, later
atrophic, white, scaly
plaque, may obliterate
vermillion border
Ulceration or induration biopsy to rule out
malignant transformation
Disorders of the Lips…
 Angular cheilitis (perleche)
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Inflammatory reactionerythema and maceration
at the angles of mouth,
fissuring and crusting may
be present
Predisposing factorsadvanced age, ill-fitting
dentures, thumb-sucking
in children, oral
Candidiasis, bacterial
infections
Disorders of the Lips…
 Cheilitis glandularis
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Inflammatory painless enlargement of lower lip,
usually in elderly men
Triggered by actinic damage, bacterial infection,
tobacco exposure, chronic irritation
 Cheilitis glandularis apostematosa
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Painful enlargement, eversion of lip with erosions
and recurrent bacterial infections or malignant
transformation
Disorders of the Lips…
 Exfoliative cheilitis
(factitious cheilitis)
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Chronic superficial
inflammation of
vermilion borders of
the lips
Characterized by
persistent scaling
Attributed to
repeated lip sucking,
chewing or other
manipulation of lips
Granulomatous cheilitis (cheilitis
granulomatosa)
 Granulomatous inflammation,
acute onset of asymmetric
swelling of the upper lip or lower
lip
 Erythema, scaling, fissuring and
erosions may develop
 Prolonged and recurrent course
with eventual fixed swelling
 May be associated with
constitutional symptoms,
regional lymph node
enlargement
Granulomatous cheilitis
 Melkersson-rosenthal syndrome- triad of lingua
plicata ( fissured or furrowed tongue), facial paralysis
and granulomatous cheilitis
 Other cranial nerves (olfactory, auditory,
glossopharyngeal, hypoglossal) may be involved
 Biopsy- oedema, perivascular lymphocytic infiltrate,
focal granulomas resembling sarcoidosis or Crohn’s
disease
Disorders of Tongue
 Glossodynia (burning mouth syndrome)- spontaneous
burning, discomfort, pain, irritation, or rawness of the
tongue, has no identifiable etiology most of the time
 Etiology
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Idiopathic, Infection, Allergic/contact
hypersensitivity, Mechanical trauma
Xerostomia, Geographic tongue/ Fissured tongue
Vesiculobullous disease, temporomandibular
dysfunction
Referred pain from teeth or tonsils
Drugs- Antibiotics, psychiatric medications,
chemotherapy
Etiology of Glossodynia
 Neurologic
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Peripheral nerve
damage
Diabetic neuropathy
Trigeminal neuralgia
Acoustic neuroma
 Systemic disorders
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 Psychiatric
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Depression
Anxiety
Cancerophobia
Somatoform disorder
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Anemia (iron
deficiency,
pernicious)
Nutritional deficiency
Gastroesophageal
reflux disease
Sjogren syndrome
Hypothyroidism
Acquired
immunodeficiency
syndrome
GLOSSITIS:
Definition: Inflammation of the tongue
Causes:
- Vitamin B12 deficiency (Pernicious anemia)
- Deficiency of riboflavin, niacin, pyridoxine
- Sprue-----Vitamin B deficiency
- Iron deficiency anaemia -----Vitamin B
deficiency
- Plummer Vinson syndrome;
Combination of iron deficiency anemia,
Glossitis and Esophageal dysphagia
OTHER CAUSES:
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Carious tooth
Ill - fitting dentures
Syphilis
Inhalation burns
Ingestion of corrosive chemicals
Disorders of Tongue…
 Glossitis- presents as pain, irritation or burning,
hypogeusia, or dysgeusia
 Atrophic glossitis
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Due to filiform de-papillation
Mild patchy erythema to a completely smooth,
atrophic, beefy-red surface
Etiology - pernicious anemia, protein and other
nutritional deficiencies, chemical irritants, drug
reactions, amyloidosis, sarcoidosis,
vesiculobullous diseases, oral candidiasis and
systemic infections
Moeller or Hunter glossitis of pernicious
anemia affects the lateral aspects and tip of the
tongue respectively
-
Presentation :
Large beefy tongue
Mechanism:
Atrophy of papillae ----- Thinning of mucosa
---- Exposure of underlying blood vessels.
Disorders of Tongue…
 Median rhomboid
glossitis - atrophic
disorder of the tongue
secondary to chronic
candidiasis
Disorders of Tongue…
 Geographic tongue- benign
inflammatory condition, due to
Loss of filiform papillae
 Erythematous plaques with an
annular or serpiginous well
demarcated white border
 Etiology- Psoriasis, Reiter
syndrome, atopic dermatitis,
diabetes mellitus, anemia,
hormonal disturbances, Down
syndrome, lithium therapy
Disorders of Tongue…
 Fissured tongue (furrowed
tongue, scrotal tongue,
grooved tongue)
 normal variant seen in 5-11%
individuals
 Numerous small irregular
fissures oriented laterally on
the dorsal tongue
 Also seen in - MelkerssonRosenthal syndrome,
Psoriasis, Down syndrome,
Acromegaly, Sjogren
syndrome
Disorders of Tongue…
 Herpetic geometric
glossitis - rare cause of
fissuring of tongue,
presents with acute onset
of pain and deep
longitudinal grooves with
smaller lateral fissures
Disorders of Tongue…
 Hairy tongue (white or black
hairy tongue) - hypertrophy of
filiform papillae resembling hairlike projections
 Associated with - heavy tobacco
use, mouth breathing, antibiotic
therapy, poor oral hygiene,
general debilitation, radiation
therapy, chronic use of bismuth
containing antacids, lack of
dietary roughage
 White, yellow green, brown, or
black color is due to
chromogenic bacteria or staining
from exog source
Disorders of Tongue…
 Oral hairy leukoplakia-
caused by Epstein-Barr
virus, presents as
asymptomatic,
corrugated, white plaques
with accentuation of
vertical folds along the
lateral borders
 .Predominantly seen in
HIV infection, organ
transplant recipients and
patients on chemotherapy
Disorders of Tongue…
 Macroglossia- congenital or acquired process, tongue is
disproportionately large relative to the patient’s jaw size
 Difficulty with mastication and speech and accidental
tongue biting are common
 Differential- Down syndrome, hypothyroidism, BeckwithWiedemann syndrome, neurofibromatosis, infection by
mycobacteria, filamentous bacteria or fungus,
amyloidosis
Disorders of Salivary Glands
 Xerostomia (dry mouth) - decreased saliva
production
 Women are twice as affected as men
 Signs and symptoms - diminished or altered taste
and smell, halitosis, heavy plaque accumulation,
difficulty in wearing dentures, recurrent yeast
infections, burning sensation, difficulty swallowing,
dry or cracked lips, salivary calculi and increased
thirst
Causes of xerostomia
 Medications - Antidepressants, antihistamines, diuretics
 Medical conditions - Parkinson disease, diabetes,
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anemia, cystic fibrosis, rheumatoid arthritis
Granulomatous inflammation - tuberculosis, sarcoid,
Sjögren syndrome, HIV, amyloid
Dehydration - Fever, excessive sweating, vomiting,
diarrhea, blood loss, burns, smoking, consumption of
tea, coffee
Radiation therapy of head and neck
Surgical removal of the salivary glands
Old Age
Disorders of Salivary Glands
 Mucocele (mucous retention
cysts)- benign, painless, domeshaped fluctuant papules, due to
trauma or obstruction of minor
salivary gland ducts
 Multiple mucoceles - graft vs
host disease, lichen planus,
cicatricial pemphigoid
Disorders of Salivary Glands
 Ranula - large, bluish,
translucent fluctuant mass in the
floor of the mouth due to
obstruction of the submandibular
and or sublingual duct
 Diffuse parotid gland
enlargement - acute
mononucleosis, HIV infection
Disorders of Gingiva & Periodontium
 Gingivitis - erythema, edema, and blunting of the
interdental papillae, without bone loss
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Predisposing factors - poor oral hygiene, tobacco
use, diabetes
 Periodontitis -chronic infection of connective tissue,
periodontal ligament and alveolar bone
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Long-term periodontitis is associated with
increased risk of diabetes, heart disease, stroke
and preterm birth
birth control pills, diabetes, steroids, Down
syndrome, Langerhans cell histiocytosis, HIV
predispose to periodontitis
Juvenile periodontitis is associated with genetic
defects in leukocyte chemotaxis
 Papillon-Lefevre syndrome - severe and destructive
periodontal disease, teeth exfoliation
Disorders of Gingiva & Periodontium
 Erosive gingivostomatitis (desquamative gingivitis)-
inflammation and erythema of the gingiva, nonspecific
reaction pattern, may be due to viral infection,
autoimmune, inflammatory and blistering disorders
 Lichen planus - painful or asymptomatic lacy white
patches, plaques or papules, often with erosions and
ulcerations
 Lichenoid mucositis - NSAIDS, antihypertensive
medications, contact allergy, graft-versus-host disease
GINGIVITIS
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Gingiva: Soft tissue mucosal lining in
between the teeth comprising of stratified
squamous epithelium.
Its inflammation is called gingivitisPathogenesis :
lack of oral hygiene----dental plaque
beneath the gumline----mineralisation---calculus (Tartar)----Release of acidic end
product----Inflammation.
Prevalence :Higher in Adolescence
Treatment :
Aimed at prevention of the disease and reducing
the accumulation of plaque/ calculus formation :
1. Brushing
2. Flossing
3. Regular dental visits
4. Maintenance of good oral hygiene
PERIODONTITIS :
Inflammation of the supporting structures
of the teeth
(Periodontal ligament, alveolar bone)
- Severe persistent infection----loss of
tooth.
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PATHOGENESIS
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Poor oral hygiene
Shift in bacterial flora; 300 different org
Facultative gram positive organism – Healthy
site
Anaerobic gram negative microaerophilic
organisms – Diseased site.
Actinobacillus, Porphyromonas gingivalis,
Provotella intermedia
Disorders of Gingiva & Periodontium
 Acute necrotizing ulcerative
gingivitis (trench mouth,
vincent disease)
 Punched- out ulcers of the
interdental papillae, gingival
hemorrhage, severe pain, foul
odor
 Fever and lymphadenopathy
are common
Disorders of Gingiva & Periodontium
 Precipitating factors- poor
oral hygiene, nutritional
deficiency, alcohol and
tobacco use,
Immunosuppression
 Etiologic agents- Treponema,
Selenomonas, Bacteroides,
Prevotella and Borrelia
vincentii
Aphthous ulceration
 Acute, recurrent, painful ulcers on nonkeratinized
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mucosa
Most common cause of oral ulcerations
Effect up to 40-50 % of the population
Ulcers with a gray or yellow pseudomembrane and
erythematous margin
Potential triggers - heredity, food and medication allergy,
decreased mucosal barrier integrity, hematologic and
immunologic disorders, emotional stress, and trauma
Aphthous Ulcers…..
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Superficial ulceration of oral mucosa
Age : First two decades
Presentation: Extremely painful recurrent
lesion
Gross: single or multiple ,shallow ulcer
surrounded by hyperaemia
HISTOLOGY:
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Predominant monuclear cells, scattered
neutrophils
CLINICAL COURSE :
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Spontaneous resolution (7-10days)
Persists for weeks
ETIOLOGY : Unknown
TREATMENT : Symptomatic
Aphthous ulceration
Minor aphthae
(90 -95 %)
Major aphthae
(5-10%)
Herpetiform
ulcers
(1-5%)
Age of onset
Childhood or
adolescence
Childhood or
adolescence
Young adult
Ulcer size
2–4 mm
10 mm or larger
Initially tiny, but
ulcers coalesce
Number of ulcers
Up to about 6
Up to about 6
10–100
Sites affected
Mainly vestibule,
labial, buccal
mucosa &
floor of mouth
Any site
Any site but often
on ventrum of
tongue
Duration of each
ulcer
Up to 10 days
Up to 1 month
Up to 1 month
Aphthous ulceration
 Systemic Conditions Associated
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Hematinic deficiency (up to 20%)- iron, folic acid
or vitamin B12 deficiency
Gastrointestinal malabsorption (3%) - Celiac
disease, dermatitis herpetiformis, gluten-sensitive
enteropathy, Crohn disease, pernicious anemia
Systemic lupus erythematosus, reactive arthritis
HIV
Behcet disease
PFAPA (periodic fever, aphthous stomatitis,
pharyngitis, and cervical adenitis)
MAGIC(mouth and genital ulcers inflam cartil)
Behcet’s disease
 Major criteria
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Oral Aphthae
Genital Ulcers
 Ocular- Iridocyclitis, Retinal
vasculitis,Optic atrophy
 CNS lesionsMeningoencephalitis,
cerebral infarction,
psychosis, cranial nerve
palsies, cerebellar and spinal
cord lesions
 Dermatological
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Pustules
Erythema nodosum
 Minor criteria
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Proteinuria and
haematuria
Thrombophlebitis
Aneurysms
Arthralgias
Non-aphthous erosions & ulcers
 Pemphigus vulgaris, paraneoplastic pemphigus, bullous
pemphigoid, cicatricial pemphigoid, EB acquisita
 Epidermolysis bullosa simplex, junctional EB &
dystrophic EB demonstrate the most severe
 Discoid and SLE- oral discoid lupus is characterized by
“sunburst” erythematous plaques surrounded by white
radiating striations
 Erythema multiforme and stevens-johnson
syndrome/toxic epidermonecrolysis
Non-aphthous erosions & ulcers…
 Chronic ulcerative stomatitis - autoimmune
mucosal erosive disorder
 Resemble erosive LP
 Direct immunofluorescence- IgG bound to nuclei of
keratinocytes of basal and lower epithelial layers
 Responsive to Hydroxychloroquine
Iatrogenic mucositis
 Complications of systemic chemotherapy
and head and neck radiation, occurs due to
direct tissue injury of the mucosal epithelium
Disorders of mucosal pigmentation
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Localized
Amalgam, tattoo
Ephelis / Naevus
Malignant melanoma
Kaposi’s sarcoma
Peutz–Jegher syndrome
Laugier–Hunziker syndrome
Melanotic macules
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Generalized
Racial
Localized irritation, e.g. smoking
Drugs, e.g. phenothiazines,
antimalarials, minocycline,
contraceptives, mephenytoin
 Addison’s disease/ Nelson’s
syndrome
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Ectopic adrenocorticotrophic hormone
(e.g. bronchogenic carcinoma)
Albright’s syndrome
Haemochromatosis
Neurofibromatosis, incontinentia
pigmenti
Malignant acanthosis nigricans
DISORDERS OF TEETH
A – INFLAMMATORY LESIONS
CARIES (TOOTH DECAY) :
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Commonest cause of loss of tooth
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Focal degradation of tooth structure
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Pathogenesis :
 Impaction of food
Bacteria in the
oral cavity
Fermentation of
sugars
Acidic metabolic end
products
Degradation of tooth
structure
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Processed food containing large amounts of
carbohydrates
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Incidence declined in most countries;
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Improved oral hygiene
Fluoridation of drinking water
(Flouride + enamel structure
flouro
apatite
resistance to degradation)
Disorders of Teeth
DISORDER
FINDINGS
Bulimia
Erosion of enamel and loss of dentin
Congenital
cytomegalovirus
Yellow dentin and hypoplastic pitted enamel
Congenital
erythropoietic
porphyria
Erythrodontia of canine teeth and molars and brown
discoloration of incisors
Congenital syphilis
Hutchinson teeth, mulberry molars
Ectodermal dysplasia
Hypodontia/anodontia/microdontia, peg-shaped
teeth, supernumerary teeth, enamel defects
Gardner syndrome
Supernumerary teeth
Goltz syndrome
Anodontia and enamel defects
Disorders of Teeth…
Incontinentia pigmenti
Hypodontia, conical-shaped teeth
Lepromatous leprosy
Reddening of upper teeth (pink spots) due to
infection of dentin
Primary biliary
cirrhosis
Green pigment deposits
Sjogren syndrome
Caries, increased plaque accumulation, poor
oral hygiene
Reflux
Erosion of enamel due to repeated exposure to
gastric acid
Tetracycline staining
Permanent gray discoloration
Tuberous sclerosis
Pitted enamel of the permanent teeth
Benign Tumors
 Pyogenic granuloma (pregnancy tumor) - an
exaggerated, reactive proliferation of granulation and
vascular tissue triggered by minor trauma or medication,
classically during pregnancy
 Pulp polyp- exaggerated reactive proliferation of the
dental pulp (neurovascular bundle), results when gross
caries destroys the enamel crown
 Verruciform xanthoma - minute white or yellow
verrucous papules on the gingiva, alveolar mucosa, or
hard palate. Foamy, lipid-laden macrophages in biopsy
 Mucosal lipomas - present as asymptomatic, soft,
yellow nodules on the buccal or vestibular mucosa,
tongue, floor of the mouth or lips of middle-aged adults
Benign Tumors…
 Traumatic neuroma - occur around mental foramen,
alveolar ridge, lip or tongue
 Neurofibromas and Schwannomas (neurilemmoma) on the tongue or buccal mucosa
 Sipple syndrome - multiple mucosal neuromas,
associated with pheochromocytoma, parafollicular
thyroid cysts secreting calcitonin, medullary thyroid
carcinoma and opaque nerve fibers on the cornea
 Granular cell tumor (Abrikosov tumor) - reactive
process of Schwann cell origin, appears on the dorsal
tongue as single or multiple asymptomatic firm, illdefined papule
REACTIVE / TUMOR –LIKE LESIONS:
FIBROUS PROLIFERATIVE LESION
1. Irritation Fibroma:
Site: buccal mucosa, gingivo-dental margin
Gross: smooth pink exophytic nodule
Histology:
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Fibrous tissue nodule covered by squamous
epithelium
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Few inflammatory cells
- Treatment: Surgical excision
Pyogenic granuloma:
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Site : Gingiva
Age/Sex :Children/young adult; esp pregnant
women (Pregnancy tumor)
Gross: Erythematous, haemorrhagic,
exophytic mass showing surface ulceration.
Histology :
Highly vascular tissue resembling granulation
tissue (? Capillary Hemangioma)
Course of disease:
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Regress completely (especially after
pregnancy)
Fibrous maturation
Peripheral ossifying fibroma
Peripheral ossifying fibroma
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Common reactive lesion
Etiology : unknown ; pyogenic granuloma
Age/Sex : young teenage females
Gross:
Red, ulcerated nodule (like pyogenic
granuloma)
Treatment :
Complete surgical excision upto the
periosteum ; high recurrence rate.
Peripheral giant cell granuloma
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Common lesion
Site : Gingival mucosa
Gross:
Bluish purple ulcerated nodule
Histology :
. Numerous multinucleated foreign body type
giant cells
. Fibrovascular stroma
Differential diagnosis :
.Central giant cell granuloma
.Brown tumours
Varicosities
 Asymptomatic, blue, soft nodules on the lips and
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ventrolateral tongue
Not associated with any known systemic disease
Caliber-persistent labial artery - raised pulsatile
tortuous, blue rubbery bleb, appreciation of lateral
pulsation is diagnostic
Mucosal hemangiomas - benign vascular tumors of
infancy, erythematous or bluish vascular nodules,
sometimes with associated thromboses and
phleboliths, spontaneous regression usual
Petechiae, ecchymoses, hematomas, and
spontaneous gingival hemorrhage in
thrombocytopenia, hemolytic anemia, von willebrand
disease, anticoagulant therapy
Pre-Malignant Lesions
 Leukoplakia - chronic, white, verrucous plaque
with histologic atypia
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Severity linked to the duration and quantity of
tobacco and alcohol use
Occur anywhere in the oral cavity; Lip, tongue, or
floor of the mouth
Lesions are prone for progression to SCC
 Erythroplakia - non-inflammatory erythematous
plaque
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Analagous to intra-oral erythroplasia of Queyrat
or SCC in situ
Histology: - severe dysplasia and areas of frank
invasion
Pre-Malignant Lesions…
 Submucous fibrosis
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Generalized white discoloration of oral mucosa with
progressive fibrosis, painful mucosal atrophy and
restrictive fibrotic bands
Individuals who chew betel quid, a concoction of
tobacco, lime, areca nut and betel leaves
Ultimately leads to trismus, dysphagia and severe
xerostomia
5 - 10 % progress to SCC
Malignant Lesions
 Squamous cell carcinoma - present as leukoplakia,
erythroplakia, erythroleukoplakia, irregular endophytic
masses with ulceration or exophytic nodules
- High-risk anatomic sites ; ventrolateral tongue, floor
of the mouth, and the vermillion border of the lip
 Verrucous carcinoma - locally aggressive SCC in
older adults presents as a hyperkeratotic, verrucous,
exophytic white mass on the vestibules or mandibular
gingiva, floor of the mouth, palate, and lip. Risk
factors - smokeless tobacco and infections with HPV(
16 and 18)
Malignant Lesions…
 Proliferative verrucous leukoplakia - rare
progressive multifocal leukoplakia, with white,
hyperkeratotic, verrucous plaques involve large areas
of mucosa
 Women are affected four times as men
 More than 90 % undergo malignant transformation
 Smoking is not associated, HPV may be etiologic
factor
 Melanoma - irregular pigmented macule, patch or
papule on the hard palate or maxillary gingiva
 in older than 50 years
 advanced lesions may ulcerate or bleed
 Breslow depth - most important prognostic factor
Malignant Lesions…
 Lymphoma : Hodgkin, Non-Hodgkin Lymphoma
(Cutaneous T Cell, and Burkitt lymphoma) - Nonspecific, indurated, painless masses
- Burkitt lymphoma is associated with alveolar
bone destruction
 Langerhans cell histiocytosis - ulcerative gingivitis,
periodontitis, ulceration and bony destruction, may be
initial or sole manifestation of disease
Multicentric reticulohistiocytosis - flesh-colored to
reddish-brown nodules on oral or nasal mucosa, in
addition to classic cutaneous lesions and associated
arthropathy
 Kaposi sarcoma - single or multiple hemorrhagic
patches or exophytic nodules, most often on gingiva
or palate
Salivary Gland Tumors
 Occur most commonly on the palate and on
the retromolar pad distal to the third molar
 Erythematous papules or ulcerated papules
and nodules
Medication-Related Oral Changes
Teeth Discoloration
Tetracyclines, Chlorhexidine
Gingiva Swelling
Phenytoin, Ciclosporin, Nifedipine, Diltiazem
Dry mouth
Tricyclic antidepressants, Phenothiazines,
Antihypertensives, Lithium
Disturbed Taste
Metronidazole, Penicillamine
Ulcers
Cytotoxic drugs, Non-steroidal anti-inflammatory agents
Lichenoid lesions
Non-steroidal anti-inflammatory agents
Mucosa Thrush
Broad-spectrum antimicrobials, Corticosteroids
Cytotoxic drugs
Hyper pigmentation
Minocydine, antimalarials, clofazimine,
amiodarone, ketoconazole, and zidovudine
Physical and Chemical Trauma
 Chronic biting and manipulation of lips in and buccal mucosa in
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nervous habit- ragged, irregular, white plaque at the site of
trauma
Frictional keratosis - thickened white plaque (sharp tooth or
overextended denture)
Irritation fibroma - sessile nodule at site of chronic mucosal
irritation
Smoker’s palate or nicotine stomatitis - thermal injury to the
hard palate of pipe smokers
Appears as a diffusely white palate studded with 2-5mm
erythematous umbilicated papules
Physical and Chemical Trauma
 Epulis fissuratum
 Develops beneath poorly fitting dentures, painless,
elongated ridges of hypertrophic mucosa along the
anterior labial alveolar ridge
 Giant cell epulis
 A reactive hyperplastic proliferation, appears as a deep red
papule on the interdental papillae
 Many multinucleated giant cells are seen histologically is a
vascular proliferation
Chemical burn
 Aspirin burns
 Mucosa in direct contact with aspirin becomes necrotic
and painful, also with Medications containing phenol
 Contact stomatitis
 Intra-oral erythema, ulceration or a lichenoid mucositis
 Dental amalgams, Cinnamate, flavorings, food
additives, spices, toothpaste, mouthwash, dental epoxy
resins, cosmetic lip products
Oral Manifestations of Viral Infections
Herpes
(HHV-l and HHV-2)
Lip edema with erythematous, grouped vesicles, erosions,
intra-oral hemorrhagic ulcers. Tongue involvement in
immunocompromised patients
Chickenpox (HHV-3)
Oral ulcers on palate or buccal mucosa
Herpes zoster (HHV-3)
Painful, unilateral, aphthous-like ulcers in second and
third trigeminal nerve branch
Infectious mononucleosis
Epstein-Barr virus (HHV-4)
Exudative tonsillitis, uvular edema, palatal petechiae, and,
uncommonly, necrotizing ulcerative gingivitis
Oral hairy leukoplakia
Epstein-Barr virus (HHV-4)
White plaques with prominent vertical folds on lateral
tongue> dorsal tongue > buccal mucosa and vestibule in
immunocompromised individuals
Congenital Cytomegalovirus
(HHV-5)
Yellow dentin and hypoplastic puffed enamel of the teeth,
Aphthous-like ulcers
Roseola infantum (HHV-6)
(exanthem subitum)
Erythematous macules on soft palate
Oral Manifestations of Viral Infections
Kaposi sarcoma HHV-8
Erythematous to violaceous macules on palate,
gingiva, tongue. Evolve into painful, ulcerated nodules
Herpangina
Group A coxsackievirus
Acute onset, 1- to 2-mm erythematous macules on palate
and uvula. Lesions vesiculate and ulcerate, leaving painful
superficial erosions
Hand-foot-and- mouth
disease (Coxsackie A-l6)
Many small, painful ulcers with surrounding erythema
on the tongue, buccal mucosa, palate
Acute lymphonodular
pharyngitis (Gp A Cox)
White or yellow papules with an erythematous base on uvula,
tonsils, oropharynx
Measles (rubeola)
Koplik spots - brightly erythematous macules with white
centers on buccal mucosa adjacent to posterior teeth
Rubella (German
measles)
Forschheimer spots—small erythematous macules on
palate
Acute sero-conversion of
HIV
Erythema, ulcerations, and secondary candidiasis
Oral Manifestations of Viral Infections
Squamous papilloma (HPV)
Solitary, exophytic, pedunculated, mucosa
colored papule, occurs on the palate or tongue
Verruca vulgaris (HPV)
Solitary or clusters of verruciform papules on the
Buccal mucosa, lips, or perioral skin
Condyloma
acuminatum (HPV)
Resemble verruca vulgaris but are larger. Oral
Involvement of the labia, lingual frenum, soft
palate, and gingiva
Focal epithelial
hyperplasia (Heck
disease) (HPV)
Benign, soft, painless 1- to 4-mm papules on the
labial, buccal, or lingual mucosae
Kawasaki disease
Beefy red oropharynx, strawberry tongue
(inflammation and papillary enlargement),
severe hemorrhagic cheilitis
Oral Manifestations of bacterial
Infections
Scarlet fever (Group B
Streptococcus)
Erythema of hard palate and a white-coated
Tongue with erythematous, edematous,
fungiform papillae. Later the tongue becomes
beefy red (strawberry tongue)
Diphtheria (Corynebacterium
diphtheriae)
Thick, gray pseudomembrane with erythematous
Halo on tonsils, pharynx, gingiva, tongue,
buccal mucosa
Tularemia (Francisella
tularensis)
Painful, necrotic oral ulcers or diffuse stomatitis
Lepromatous leprosy
Firm yellow-pink ulcerative nodules (lepromas)
on the palate or tongue. Macroglossia due to
tongue infiltration, Reddening of upper teeth
(pink spots) due to infection of dental pulp
Granuloma inguinale
Painful hemorrhagic ulcers or vegetative nodules,
Severe scarring
Oral Manifestations of bacterial
Infections
Primary syphilis
Chancre—painless ulceration with indurated borders
on the lip, tongue, buccal mucosa, or oropharynx with
lymphadenopathy
Secondary
syphilis
Mucous patches—oval plaques on the tongue with a
white or gray pseudomembrane. Split papules, macerated, flat-topped papules at the oral commissures
(condyloma lata). chronic oral ulcerations
Tertiary syphilis
Interstitial glossitis with atrophy of filiform
and fungiform papillae and fissuring of the tongue, Premalignant leukoplakia, gummas involve palate
Congenital
syphilis
Hutchinson teeth in 50%—peg shaped with crescentic
notches along incisal edge of incisors. Mulberry or Moon’s
molars—rounded or crenated occlusal cusps of first molars
Oral Manifestations of fungal
Infections
Primary oral Aspergillus
aspergillosis
Necrotic, violaceous ulcerations with black eschar on
gingiva and palate
Maxillary sinus Aspergilus
aspergillosis
Untreated maxillary infection can progress to necrotic
palatal perforation with a yellow and black palatal ulcer
and facial edema
Zygomycosis, Mucor and
Rhizopus
black, necrotic palatal ulceration
Histoplasmosis
Blastomycosis
Cryptococcus
Coccidioidomycosis
Para coccidioidomycosis
Chronic verrucous or necrotic mucosal ulceration
Oral Manifestations of fungal
Infections
 Oral candidiasis
 Acute pseudomembranous, Acute atrophic, Chronic
atrophic, Chronic hyperplastic, Median rhomboid
glossitis
 Predisposing factors- dry mouth, antimicrobials,
corticosteroids, leukaemia, HIV inf, tobacco smoking,
denture wearing, endocrinopathy
Oral manifestations of Endocrine
disorders
Pituitary dwarfism
Microdontia, Retarded tooth eruption
Congenital
hypothyroidism
Macroglossia, Retarded tooth eruption
Gigantism/acromegal
y
Spaced teeth, Mandibular prognathism,
Macroglossia, Megadontia
Hyperparathyroidism
Bone rarefaction, Brown tumours
Addison’s disease
Mucosal hyperpigmentation
Diabetes mellitus
Periodontal disease, Xerostomia,
Candidiasis,
Sialosis, Lichen planus
Pregnancy
Gingivitis, Epulis
Oral manifestations of Liver diseases
Alcoholic cirrhosis Bleeding tendency, Sialosis
Chronic active
hepatitis
Lichen planus
Primary biliary
cirrhosis
Sjögren’s syndrome, Lichen planus
Hepatitis C
Lichen planus, Sjogren’s syndrome
Oral manifestations of
Gastrointestinal diseases
Pernicious anaemia
Ulcers, Glossitis, Angular stomatitis, Erythema
Any malabsorption
Ulcers, Glossitis, Angular stomatitis
Chronic regurgitation
Tooth erosion, Halitosis
Crohn’s disease
Mucosal tags, Gingival hyperplasia, Cobbleston
of mucosa, Ulcers, Glossitis, Angular stomatitis
Coeliac disease
Ulcers, Glossitis, Angular stomatitis, Dental
hypoplasia
Chronic pancreatitis
Sialosis
Cystic fibrosis
Salivary gland swelling
Gardner’s syndrome
(familial colonic
Osteomas
Oral manifestations of Renal diseases
Chronic renal
failure
Post renal
transplant
Renal rickets
(vitamin D
resistant)
NephroticSyndro
Xerostomia, Halitosis/taste
disturbance, Leukoplakia
Dental hypoplasia, Bleeding
tendency
Infections( herpetic, candidal),
Bleeding tendency,
Gingival hyperplasia, Kaposi’s
sarcoma
Hairy leukoplakia
Delayed tooth eruption, Dental
hypoplasia, Enlarged
pulp
Dental hypoplasia
Oral manifestations Haematological
diseases
Deficiency of haematinics
(iron, folic acid or vitamin
B12)
Burning sensation, Ulcers, Glossitis,
Angular stomatitis
Sickle-cell anaemia
Jaw deformities, Osteomyelitis
Aplastic anaemia
Ulcers, Bleeding tendency
Leukaemia/lymphoma
Infections, Ulcers, Bleeding tendency,
purpura, Gingival swelling
Multiple myeloma
Bone pain, Tooth mobility, Amyloidosis
Amyloid disease
Enlarged tongue, Purpura