ATROFI MUKOSA,LIDAH

DAN KELENJAR LUDAH

Oleh : Atik Kurniawati dan
TIM DMF 2

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ATROFI

Pengurangan dr luar thd masa

organ atau jaringan yg disebabkan
krn penurunan jumlah dan ukuran
sel unsur-unsurnya (hipoplasia)
HIPOPLASIA :
ketidakmampuan/kegagalan organ
utk berkembang sampai ukuran
normal

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Atrofi ada 2: Fisiologik & Patologik

FISIOLOGIK: cont pd dinding uteri stl melahirkan,

senil atrofi--perub fisiologi yg berhub dg
meningkatnya usia & menurunnya aktivitas organ
endokrin.
PATOLOGIK ada 2:umum & lokal,
Umum, dihub dg kekurangan mak,peny kronis &
keganasan
Lokal,disuse atrofi pd otot yg jarang digunakan,krn
trauma,poliomielitis,r.artritis
Akumulasi sekresi pd duktus krn tersumbat batu
atrofi tekanan pd klj saliva,pankreas,ginjal

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MUKOSA & LIDAH

Oral mucosal lesions may be

classified according to different
characteristics.
This chapter describes disorders of
the oral mucosa that clinically
appear either red or white.

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Oral mucosal lesions may be classified

according to different characteristics.

The oral epithelium may be stimulated to

an increased production of keratin (hyperkeratosis,
Composition 1)

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an abnormal but benign thickening of

stratum spinosum (acanthosis, Composition 2)

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Intracellular-(Composition 3)

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Necrosis, may occur when the oral mucosa is exposed to toxic

chemicals. Microbes, particularly fungi, can produce whitish
pseudomembranes consisting of sloughed epithelial
cells,fungal mycelium, and neutrophils, which are loosely
attached to the oral mucosa (Composition 4)

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A red lesion of the oral mucosa may develop as the result

of atrophic epithelium (Composition 5

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characterized by a reduction in the number of epithelial cells

(Composition 6) or increased vascularization

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Oral Candidiasis

The most prevalent opportunistic

infection affecting the oral mucosa
The lesions are caused by the yeast
Candida albicans.
The pathogenesis is not fully
understood-- predisposing factors
from the normal commensal flora
(saprophytic stage) to a pathogenic
organism (parasitic stage).
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Local predisposing factors

Denture wearing
Smoking
Atopic constitution
Inhalation steroids
Topical steroids
Hyperkeratosis
Imbalance of the oral microflora
Quality and quantity of saliva
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General predisposing factors

Immunosuppressive diseases
Impaired health status
Immunosuppressive drugs
Chemotherapy
Endocrine disorders
Hematinic deficiencies

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Etiology and Pathogenesis

To invade the mucosal lining, the

microorganisms must adhere to the
epithelial surface; strains potential are
more pathogenic
The yeasts penetration is facilitated by
their production of lipases,for the yeasts to
remain within the epithelium, they must
overcome constant desquamation of
surface epithelial cells

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Classification of Oral Candidiasis :

Primary Oral Candidiasis Secondary

The local predisposing factor are

able to promote growth of Candida
or to affect the immune response of
the oral mucosa.
General predisposing factors are
often related to the patients
immune and endocrine status

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Classification of Oral Candidosis

Acute : Acute Pseudomembraneous

(thrush)
Acute Athropic candidosis
Antibiotic sore mouth
Chronic :Chr.Athropic candidosis
Denture stomatitis (denture
sore-mouth)
Angular cheilitis
Median rhomboid glossitis
Chr. hiperplastic candidosis
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Clinical Findings

The acute pseudomembranous

candidiasis (thrush)
The infection predominantly affects patients
medicated antibiotics,immunosuppressant
drugs, or a disease that suppresses the
immune system.
The infection typically presents with loosely
attached membranes comprising fungal
organisms and cellular debris,which leaves an
inflamed, sometimes bleeding area if the
pseudomembrane is removed
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Pseudomembranous candidiasis

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Erythematous Candidiasis.
The erythematous form of candidiasis was
previously referred to as atrophic oral candidiasis

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Chronic Plaque-Type and

Nodular Candidiasis.

candidal leukoplakia, the typical clinical

presentation is characterized by a white
plaque
positive correlation between oral candidiasis
and moderate to severe epithelial dysplasia
the chronic plaque-type and nodular
candidiasis have been associated with
malignant transformation,

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Chronic plaque-type candidiasis

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Chronic nodular candidiasis in the

left retrocommissural area

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Angular Cheilitis.
infected fissures of the commissures of the mouth,
often surrounded by erythema

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Median Rhomboid Glossitis

Atrophy of the filiform papillae.The etiology ? mixed

bacterial/fungal microflora

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Benign Migratory Glossitis (Geographic

Tongue) circumferentially migrating as erythematous area
reflecting atrophy of the filiform papillae.

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Kelenjar saliva

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Kelenjar saliva

There are three major salivary glands: the

parotid, submandibular, and sublingual.
These are paired glands The minor salivary
glands dispersed throughout the oral cavity
Symptoms in the patient with salivary gland
hypofunction are related to decreased fluid in
the oral cavity and the effects this has on
mucosal hydration and oral functions.
Dysfunction of the salivary glands, the most
common of complaints of dry mouth :
xerostomia
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Penyakit pada Kelenjar Saliva

INFEKSI
A. Infeksi Virus
B. Infeksi Bakteri
Infeksi Virus, contoh :
Mumps (epidemic parotitis)
disebabkan : paramyxovirus
Penularan : kontak langsung,
makanan dan minuman
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Menyerang : kelenjar saliva (primer

bisa mempengaruhi gonads, CNS,
kelenjar thyroid, pancreas dan
myocard.Bila menyerang gonad tjd
sterilitas
Insiden menurun sejak ditemukan
vaksin MMR (measles, mumps.
Rubella)

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Manifestasi klinis:

Pembengkakan mendadak dan tdk ditemukan pus pada

muara kelenjar, pembengkakan terus membesar selama
2-3 hari dan sembuh hari ke 7. Pembengkakan sakit bila
disentuh dan nyeri bila makan makanan asam. Kulit
sekitar, muara kelenjar parotis (stensen duct) inflamasi.
Gejalasistemik :demam, malaise, anoreksia, headache,
pada orang dewasa gejala sistemik ini lebih parah
daripada anak-anak.
Kebanyakan pada kelenjar parotis. Namun kelenjar
submandibular juga bisa namun tidak begitu sakit.
Biasa menyerang satu sisi lebih dahulu 24-48 jam
Penyakit ini self limiting.

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Komplikasi

Orchitis
Deafness:
Meningitis:
Oophoritis
(radangpadaovarium),pancreatitis,
myocarditis, penyakit syaraf spt
(bells palsy dan
Guillain-Barr syndrome)
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Infeksi virus yang lain yang dapat

menyebabkan pembengkakan pada
kelenjar saliva adalah Epstein-Barr
virus (EBV), cytomegalovirus (CMV
), Coxsackievirus, and the human
immunodeficiency virus (HIV).,

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B. Infeksibakteri: akut & kronis

Bacterial Sialadenitis

Acute suppurative parotitis.

Menyebabkan penurunan flow saliva pada
pasien yang lemah.
Pasien biasanya dewasa.Pada anak-anak
sering kembuhan dan sembuh pada usia 20
tahun

Penyebab : staphylococcus aureus yang

resisten terhadap penicillin.

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Acute bacterial sialadenitis and purulent

discharge from Stensens duct.

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ManifesitasiKlinis

Rasa sakit tiba2 pada sudut rahang yang

memburuk saat penderita membuka mulut
makan dan bicara. Rasa sakit yang sangat
bisa terjadi bila capsule parotis terkena.
Pemeriksaan klinis kelenjar membesar dan
peka.kulit diatasnya merah danhangat.
Diagnisis ditegakkan dg adanya pus yang
keluar melalui muara ductus stenoni bila
kelenjar ditekan.

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Xerostomia (dry mouth) is not a disease,

a symptom of
various medical conditions,
a side effect of a radiation to the head
and neck,
a side effect of a wide variety of
medications.

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It may or may not be associated with

decreased salivary gland function.
Xerostomia affecting approximately 20
percent of the elderly.
Xerotomia does not appear to be related
to age itself as much as to the potential
for elderly to be taking medications that
cause xerostomia as a side effect.

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Functions of saliva

Saliva possesses many important functions

including
antimicrobial activity,
mechanical cleansing action,
control of pH,
removal of food debris from the oral cavity,
lubrication of the oral cavity,
remineralization and
maintaining the integrity of the oral mucosa.

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Signs and symptoms

problems with eating, speaking,

swallowing and wearing dentures.
Dry, crumbly foods, such as cereals and
crackers, may be particularly difficult to
chew and swallow.
Denture wearers may have problems with
denture retention, denture sores and the
tongue sticking to the palate.

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Patients with xerostomia often complain

of
taste disorders (dysgeusia),
a painful tongue (glossodynia) and
an increased need to drink water,
especially at night

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Xerostomia can lead to

increased

dental caries,
parotid gland enlargement,
inflammation and fissuring of the lips
(cheilitis),
inflammation or ulcers of the tongue and
buccal mucosa,
oral candidiasis,
salivary gland infection (sialadenitis),
halitosis and
cracking and fissuring of the oral mucosa.
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Complications associated with

xerostomia

Xerostomia is often a contributing factor

for both minor and serious health
problems. It can affect nutrition and
dental, as well as psychological, health.
Some common problems include
a constant sore throat,
burning sensation,
difficulty speaking and swallowing,
hoarseness and/or dry nasal passages.

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Xerostomia is an original hidden cause of

gum disease and tooth loss in three out of
every 10 adults.
If left untreated, xerostomia decreases
the oral pH.

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Common causes of xerostomia :

1. Medications

The most prevalent cause

Affect the quantity and/or quality of saliva
Xerogenic drugs can be found in 42 drug
categories and 56 subcategories. More
than 400 commonly used drugs can cause
xerostomia.
The main are antihistamines,
antidepressants, anticholinergics,
anorexiants, antihypertensives,
antipsychotics, anti-Parkinson agents,
diuretics and sedatives.

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Other drug include antiemetics,

antianxiety agents, decongestants,
analgesics, antidiarrheals, bronchodilators
and skeletal muscle relaxants.
these effects are generally not
permanent.

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2. Diseases and other conditions

A. Sjgren's syndrome (SS),
a chronic inflammatory autoimmune disease
that occurs predominantly in postmenopausal
women.
It is estimated that as many as 3 percent of
Americans suffer from Sjgren's syndrome,
with 90 percent of these patients being
women with a mean age at diagnosis of 50
years.
SS is characterized by lymphocytic infiltration
of salivary and lacrimal glands, resulting in
xerostomia and xerophthalmia.
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This combination is called the sicca

complex.
Enlargement of major salivary glands
occurs in about one-third of patients with
SS. There is no cure for the disease. The
goal of therapy is to manage symptoms.

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Common symptoms associated with SS,

in addition to xerostomia and
xerophthalmia, include blurred vision,
recurrent eye and mouth infections,
dysphagia or difficulty swallowing, oral
soreness, smell and taste alternations,
fissures on the tongue and lips, fatigue,
dry nasal passages and throat,
constipation and vaginal dryness.

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B. Sarcoidosis and amyloidosis are other

chronic inflammatory diseases that cause
xerostomia. In sarcoidosis, granulomas in
salivary glands result in reduced salivary
flow. In amyloidosis, amyloid deposits in
the salivary glands result in development
of xerostomia.(2)

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c. HIV-salivary gland disease occurs in some

individuals infected with HIV, mainly in
children. This disease results in
enlargement of the parotid glands and,
occasionally, the submandibular glands,
resulting in xerostomia. The T-lymphocyte
infiltrate is mainly comprised of CD8+
cells, as compared with SS where CD4+
cells predominate.

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D. Other systemic diseases include

rheumatoid arthritis, systemic lupus
erythematosus, scleroderma, diabetes
mellitus, hypertension, cystic fibrosis, bone
marrow transplantation, endocrine disorders,
nutritional deficiencies, nephritis, thyroid
dysfunction and neurological diseases such
as Bell's palsy and cerebral palsy.
Hyposecretory conditions, such as primary
biliary cirrhosis, atrophic gastritis and
pancreatic insufficiency, may also cause
xerostomia.

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Dehydration resulting from impaired

water intake, emesis, diarrhea or
polyuria.
Psychogenic causes, such as
depression, anxiety, stress or fear,.
Alzheimer's disease or stroke may alter
the ability to perceive oral sensations.
hyperventilation, breathing through the
mouth, smoking or drinking alcohol.

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Trauma to the head and neck area can

damage the nerves supplying
sensation to the mouth, impairing the
normal function of the salivary glands.
Xerostomia may also occur during
graft-vs.-host disease. When donor
lymphocytes proliferate and infiltrate
the recipient's salivary glands and
other tissues, changes can occur in a
clinical pattern resembling those seen
in Sjgren's syndrome.2

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3. Cancer therapy

Xerostomia is the most common toxicity

associated with standard fractionated
radiation therapy to the head and neck.
Acute xerostomia from radiation is due to
an inflammatory reaction,
late xerostomia, which can occur up to
one year after radiation therapy, results
from fibrosis of the salivary gland and is
usually permanent.

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Radiation causes changes in the serous

secretory cells, resulting in a reduction in
salivary output and increased viscosity of
the saliva.
A common early complaint following
radiation therapy is thick or sticky saliva.
The degree of permanent xerostomia
depends on the volume of salivary gland
exposed to radiation and the radiation
dose.

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When the total radiation dose exceeds

5,200 cGy, salivary flow is reduced, and
little or no saliva is expressible from the
salivary ducts. These changes are
typically permanent.

Certain cancer chemotherapeutic drugs

can also change the composition and flow
of saliva, resulting in xerostomia, but
these changes are usually temporary
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Patients experiencing xerostomia from

radiation therapy or cancer chemotherapy
are at particular risk of infections from
normal oral flora. Oral ulcerations can
become invasive gram-positive and gramnegative infections, and opportunistic
infections with fungal organisms such as
Candida can occur.

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