Transcript Disorders of oral cavity

Disorders of oral cavity
Disorders of the Lips
• Actinic cheilitis
– 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)
– 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
– Inflammatory painless enlargement of lower lip,
usually in elderly men
– Triggered by actinic damage, bacterial infection,
tobacco exposure, chronic irritation
• Chelitis glandularis apostematosa
– Painful enlargement, eversion of lip with erosions and
recurrent bacterial infections or malignant
transformation
Disorders of the Lips…
• Exfoliative cheilitis
(factitious cheilitis)
– 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– 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
• psychiatric
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Depression
Anxiety
Cancerophobia
Somatoform disorder
OCD
• Systemic disorders
– Anemia (iron deficiency,
pernicious)
– Nutritional deficiency
– Gastroesophageal reflux
disease
– Sjogren syndrome
– Hypothyroidism
– Acquired immunodeficiency
syndrome
Disorders of Tongue…
• Glossitis- presents as pain, irritation or burning,
hypogeusia, or dysgeusia
• Atrophic glossitis
– 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
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 hair-like 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 exogenous sources
Disorders of Tongue…
• Orai hairy leukoplakiacaused by Epstein-Barr
virus, presents as
asymptomatic,
corrugated, white plaques
with accentuation of
vertical folds along the
lateral borders of tongue
• 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,
anemia, cysticfibrosis, 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, dome- shaped
fluctuant papules, due to trauma or
obstruction of minor salivary gland
ducts
• Multiple mucoceles - graft vs host
disease, lichen planus, cicatricial
pemphigoid
• 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
– Predisposing factors - poor oral hygiene, tobacco use, diabetes
• Periodontitis -chronic infection of connective tissue,
periodontal ligament and alveolar bone
– Long-term penodontitis 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, with exfoliation of the deciduous
and permanent teeth
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
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
• 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
mucosa
• Most common cause of oral ulcerations
• Effect up to 30 % 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 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
– 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 with inflamed
cartilage)
Behcet’s disease
• Major criteria
– Oral Aphthae
– Genital Ulcers
• Ocular- Iridocyclitis, Retinal
vasculitis,Optic atrophy
• CNS lesionsMeningoencephalitis, cerebral
infarction, psychosis, cranial nerve
palsies, cerebellar and spinal cord
lesions
• Dermatological
– Pustules
– Erythema nodosum
– Pathergy
• Minor criteria
– 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
• Localized
• Generalized
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• Racial
• Localized irritation, e.g.
smoking
• Drugs, e.g. phenothiazines,
antimalarials, minocycline,
contraceptives, mephenytoin
• Addison’s disease/ Nelson’s
syndrome
• Ectopic adrenocorticotrophic
hormone (e.g. bronchogenic
carcinoma)
• Albright’s syndrome
• Haemochromatosis
• Neurofibromatosis,
incontinentia pigmenti
• Malignant acanthosis nigricans
Amalgam, tattoo
Ephelis / Naevus
Malignant melanoma
Kaposi’s sarcoma
Peutz–Jegher syndrome
Laugier–Hunziker syndrome
Melanotic macules
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, medullaiy 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
Pre-Malignant Lesions
• Leukoplakia - chronic, white, verrucous plaque with
histologic atypia
– 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
– Analagous to intra-oral erythroplasia of Queyrat or SCC in situ
– Biopsies - severe dysplasia and areas of frank invasion
Pre-Malignant Lesions…
• Submucous fibrosis
– 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…
• Hodgkin, non-Hodgkin, cutaneous Tcell, and Burkitt
lymphoma - non-specific, 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
Varicosities
• Asymptomatic, blue, soft nodules on the lips and
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, coagulation,
hemolytic anemia, von willebrand disease, anticoagulant
therapy
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 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 in 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 soff 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 cheilits
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,
Pre-malignant 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 Untreated maxillary infection can progress to
aspergillosis
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/acromegaly
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, Cobblestoning
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 polyposis)
Osteomas
Oral manifestations of Renal
diseases
Chronic renal failure
Xerostomia, Halitosis/taste disturbance, Leukoplakia
Dental hypoplasia, Bleeding tendency
Post renal transplant
Infections( herpetic, candidal), Bleeding tendency,
Gingival hyperplasia, Kaposi’s sarcoma
Hairy leukoplakia
Renal rickets
(vitamin D resistant)
Delayed tooth eruption, Dental hypoplasia, Enlarged
pulp
Nephrotic syndrome
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
References
• Fitzpatrick,s dermatology in general
medicine 7th edition
• Rook’s text book of dermatology 7th edition