3Diseases of the oral cavity Reactive lesionsInflammatory lesionsOral cancerPrecancerous lesions (Leukoplakia & erythroplakia)Benign Tumors of Oral Cavity
4Reactive lesions 1-Irritation fibroma : Most common 61 % of all the reactive lesionsCan occur throughout the oral cavityMost common along the "bite line."Microscopically: fibrous tissue covered by squamous mucosa.
10Inflammatory Lesions Inflammation of the mouth (Stomatitis) Inflammation of the Lips (Cheilitis)Inflammation of the soft tissues around teeth typically resulting from inadequate oral hygiene (Gingivitis)Inflammmation of the tongue (Glossitis).Glossitis more commonly applied to the "beefy-red" tongues of certain deficiency states (e.g.; vitamin B12, and iron, deficiencies).Other causes of glossitis: hot and spicy foods, chronic irritation by excessive smoking, ragged tooth or syphilitic inflammation
111-Viral Infection Herpes Simplex Virus (HSV) Infections (Cold Sores) Herpes simplex virus (usually type 1) infection causes "cold sores"The virus infects the mouth in children.Most adults have had HSV1 infection, but it remains latent and produces this small sore:During periods of stressFrom local traumaEnvironmental changesCold sores consist of numerous vesicles and shallow ulcerations.Cold sore of lower lip (herpes labialis)Sore = abraded or painful area of the body
13HSV Cont. Antipyretics, analgesics, hydration TreatmentAntipyretics, analgesics, hydrationValacyclovir and famciclovir inhibit viral DNA polymerase – help to suppress and control symptoms, but does not cure (given for 1 week)If catch in the prodrome - 5% acyclovir cream for 1 week has shown to shorten course or completely abort reactivation altogetherKEY TO DIAGNOSIS – Clinical + Fluid analysis (PCR) and/or serology (Elisa, Western Blot)
14Coxackie virus & measles Coxackie A virus causes herpangiaAcute vesiculo-ulcertaive mucosal lesionOccurs in epidemicsAffects childrenBegins in tonsils, soft palate & uvulaPainfulHeal spontaneously within few daysKoplik’s spots are a feature of measlesHerpangiaKoplik’s spots
17Oral Candidiasis ( Thrush, Monaliasis ) Candida albicans is an oral commensal in 20-40% of population.Infection occurs in:InfantsPatients on broad spectrum antibiotics, steriod or cytotoxic therapyDiabetesNeutropeniaImmunodeficiency (AIDS)Presents as superficial gray-white inflammatory membranes comprising fungus in a fibrinosuppurative exudate.White exudate can be removed by scrapingExudate bleeds on removal ?
19Candidiasis Cont. Treatment Mild, acute forms – topical Nystatin Mild, chronic – topical Nystatin + Clotrimazole troches (troche=lozenge)Refractory or immunocomprimised WITHOUT systemic involvement – add oral FluconazoleSevere forms (systemic) – IV Amphotericin B with or without FluconazoleKEY TO DIAGNOSIS: Clinical + KOH Prep; culture and serum (1,3)β-D-glucan detection assay if unclear
20Bacterial Infection A - Vincent’s angina (Trench muoth, Acute ulcerative gingivitis) Caused by Borellia vincenti and fusiform bacilliBoth are normal inhabitants of oral cavityDecreased resistance (inadequate nutrition, immunofeciency) is a predisposing factor to infectionPunched out erosions → ulceration → spreads → invovles all gingival margin, which become covered by a necrotic pseudomembrane
25Apthous Ulcers (Canker Sores) Apthous ulcers are extremely common lesions (up to 20% of population)They are painful, multiple, small, shallow, recurrent ulcerationsPresented clinically as white lesions (1<,1> CM)Etiology is unknownAphtha = Whitish spot
26Aphthous Ulcers Cont.Most common cause of non-traumatic ulcerations of the oral cavityEtiology unclear10-20% of general populationDiagnosis of exclusionClassificationsMinor aphthous ulcer< 1cm in diameterLocated on freely mobile oral mucosaAppears as a well-delineated white lesion with an erythematous haloProdrome of burning or tingling in area prior to ulcer’s appearanceResolve in 7-10 daysNever scarsMajor aphthous ulcer> 1cm in diameterInvolves freely mobile mucosa, tongue, and palateLast much longer – 6 weeks or moreTypically scar upon healing
27Aphthous Ulcers Cont.Herpetiform ulcersSmall, 1-3mm in diameter ulcerations appearing in crops of ulcersTypically located on mobile oral mucosa, tongue, and palateLast 1-2 weeksCalled herpetiform because ulcerations resemble those of HSV, but there is no vesicular phaseTreatmentTopical tetracycline solution for 5-7 days has shown good resultsTopical steroids shown to shorten disease durationSucralfate suspension shown to improve pain as well as shorten disease durationMajor aphthous ulcers or more severe forms of disease require 2 week course of systemic steroidsKEY TO DIAGNOSIS: Diagnosis of exclusion; clinical appearance/course
31Diseases of the oral cavity Reactive lesionsInflammatory lesionsOral cancerPrecancerous lesions (Leukoplakia & erythroplakia)Benign Tumors of Oral Cavity
32Squamous Cell Carcinoma constitutes 95% of oral cancers Incidence:Geographic variation:Accounts for 2% of cancers in UKCommoner in S. East AsiaAges & sex :Old Men (50-60 years)Site :Lip (lower lip)Tongue (anterior ⅔)Mouth floorTonsil and Fauces
33Oral Cancer Aetiology: 1-Tobacco and alcohol are the most common associations:Smokers can have 15-fold greater risk ( than nonsmokers ) of malignancy.Chewing tobacco and betel nuts are important causes in India and parts of Asia.2- Leukoplakia and Erythroplakia3- Human papilloma virus (HPV) (type16)4- Genetic factors may also play a role(deletions in chromosomes 18q, lap, 8p, and 3p are implicated).5- Exposure to ultra-violet light (cancer of the lip).
34Squamous cell carcinoma of lip Gross:Ulcerated nodule with raised everted edgesOften on lower lipHistologically:Well differentiated squamous carcinomasSpread:Growth is relatively slowSubmandibular nodesDeeper cervical lymph nodes
35Squamous cell carcinoma of Tongue & Floor of the mouth More aggressive than tumors of the lipsGrossly starts as a nodule → malignant ulcerSpread:1-LocalLocal infiltration to floor of the mouth, facuces and pharynx leads to fixation the tongue, interfering with speech and swallowing.Local spreads into the medullary cavity of the mandible.2-lymphatic spread (occurs early) → deep cervical lymph nodes.
36Squamous Cell carcinoma of the Tongue Perform incisional Bx in any oral lesion persist for more than 2wks
37Relationship between location& prognosis of squamous cell carcinoma of oral cavity Prognosis is best with lip lesionsPoorest with mouth floor and tongue base lesions (20%-30% 5-year survival rate ).
38Uncommon Malignant Tumors of The Oral Cavity Malignant melanomaLymphomasLeukemic infiltrationAdenocarcinoma of minor salivary glandsSarcomasAcute Leukemia: gum involvement
39Diseases of the oral cavity Reactive lesionsInflammatory lesionsOral cancerPrecancerous lesions (Leukoplakia & erythroplakia)Benign Tumors of Oral Cavity
40Oral Premalignant Lesions LeukoplakiaWhitish plaque that cannot be scrapped off5-20% malignant potentialMicroscopic examination reveals hyperkeratosis and atypiaLesions on lateral tongue, lower lip, and floor of mouth more likely to progress to malignancyErythroplakiaRed patch or macule with soft, velvety textureMuch higher chance of harboring malignancy – 60-90% of untreated casesTreatment is surgical excision or laser ablation
41Precancerous Lesions Leukoplakia and Erythroplakia Causes include:1- Chronic tobacco use (pipe - smoking).2- Chronic irritation (e.g.; dentures).2- Alcohol abuse.
42Hairy Leukoplakia An oral lesion seen in HIV infected, AIDS patients Caused by Epstein-Barr virus (EBV) infection, often with superimposed candidaLesions are white patches of fluffy ("hairy") hyperkeratosis on tongue lateral borders.
43Diseases of the oral cavity Reactive lesionsInflammatory lesionsOral cancerPrecancerous lesions (Leukoplakia & erythroplakia)Benign Tumors of Oral Cavity