Diseases of the Mouth

Oral cavity extend from lips to pharynx contains tongue ,teeth and gum.
Stomatitis – inflammation in the mouth
Angular stomatitis –inflammation in the mouth corner
Burning mouth syndrome- Burning with normal looking oral mucosa occur in middle and
elderly With psychological upset
Halitosis- Bad odor from the mouth
Poor oral hygiene
Anxiety
Rare ( esophageal stricter ,pulmonary sepsis)

Oral Pigmentation
Non neoplastic causes
Peutz -Jegher
Addison disease
Lichen planus
Heavy metal
Neoplastic , e.g. melanoma
Diseases of the Tongue
Glossitis -red, smooth, sore tongue occurs in anemia, candidiasis ,riboflavin and
nicotinic acid deficiency
Black hairy tongue –proliferation of chromogenous microorganism causing brown staining
of filiform papillae .causes include smoking and use antiseptic washer
Geographical Tongue- idiopathic may be familial painless need reassurance
Gum Diseases

Gingiva is mucous membrane

Chronic gingivitis most common cause of bleeding gum
Acute gingivitis of Vincent caused by spirochete and fusiform bacteria treated by
metronidazole 200 mg TDS for 3 days
Desquamated Gingivitis usually caused by lichen planus or pemphigoid need biopsy
Gum Swelling – gingival hyperplasia
Drugs- phenytoin ,nifidipin
Scurvy
Pregnancy
Leukemia infiltration

The Teeth
Streptococcus mutuns organism cause papillitis
Necrosis ,abscess formation
Major HIV Manifestations :-
1.Candidiasis
2. Oral hairy Leukoplakia

3. Kaposi sarcoma
Ptyalism – excessive salivation preced vomiting
Occurs with intraoral pathology or psychological
SICCA Or XEROSIS
Sjogren syndrome
Drugs
Radiology
Dehydration and shock

Ulceration of the Mouth

Causes include
1.Infection/HSV,HZ,CMV,Candidiasis,Actinomycosis,histoplasmay,syphilis,
2.Autoimmune diseases /Lupus, pemphigoid ,chron disease ,aphthus ulceration,
Erythema multiform ,lichen planus ,Behcet disease
3.Trauma
4.Neoplastic ulceration
5.Malnutrition / Vit B deficiency ,vit C deficiency ,iron deficiency ,folic acid
deficiency
Erythema multiform
Causes include post infection ,autoimmune ,drugs
Types
1.Simple EM-
25% oral involvement
Less than 10% body involvement
Proceed by 1-2 weeks flue
Target lesion on skin
Self limited lesion with 1-2 weeks

2.Steven Johnson lesion /

60% oral involvement
More than 10%body involvement but Less than 30%
More mucosal involvement
More ulceration and hemmohage
Loss of fluid and bacterial infection may end with death

3.Toxic Epidermolysis Necrosis

Almost always affect the mouth
More than 30% body involvement
More hemorroge and mucosal skin involved
80% related to drugs

Management of EM
1.In simple EM minor no major intervention
Apart from topical antibiotic /topical steroid
2.In SJ - TEN admission to ICU /Systemic steroid/topical antibiotic or systemic
antibiotic
/fluid support and special care about airway

Pemphigus vulgaris
Important autoimmune disease ,40% affect mouth, Autoimmune antibodies affect the
interdigital membrane causing vesicles with gray membrane that easily rapture ,
diagnosis by biopsy or by immune florescent detecting the IgG and C3, without
treatment ,mortality within 2-5 years .The disease treated with high dose of
corticosteroid that associated with side effects ,plasmaphresis is a promising

Lichen Planus
Immune disease ,mouth involves in 70% ,associated with Hepatitis C, 5 Characters
Purple, pruritic, polygonal, planar and papule
Caused by T cell destruction to basement layer epidermis ,Features include reticular,
plague, bullous and erosive . Diagnosis by biopsy and the immune florescence
test, there is possible chance of malignancy in 1-5% ,
Usually the skin lesion resolved within 6 months ,the mouth lesion may need years.
Treatment /topical steroid with or without cyclosporine mouth wash

Behcet Disease
Theory / vasculitis related to the hypersensitivity to HSV or streptococcal antigen.
In US A incidence 1-5/100000 while in Middle East 1/10000 ,Male/female 20/1.
Manifestations /recurrence painful oral ulceration and genital ulceration ,skin
lesion like erythema nodosum ,polyartheritis , thrombosis ,the serious lesions include
CNS ,meningoencephalitis and uveitis
Treatment for ulceration of mouth includes Tetracycline solution or topical steroid .
Systemic steroids are used for uveitis and neurological manifestations, all types of
treatment not prevent the recurrences and the prognosis

Leukoplakia and Erythroplakia

Both are premalignant conditions
Leukoplakia histopathology shows hyperkeratosis and atypia
Risk of malignancy 5-20% and in special lesion of lower lip ,lateral side of tongue
and floor of the mouth