Presentation on theme: "Recurrent Aphthous Ulcer"— Presentation transcript:
1Recurrent Aphthous Ulcer Etiology:Local altered immune response.Systemic etiologies include nutritional deficiencies (iron, B6, B12), diabetes mellitus, inflammatory bowel disease, immunosuppression.Biopsy will rule out other vesiculoulcerative disease.
2Recurrent Aphthous Ulcer Appearance:Minor aphthous ulcer: <0.6 cm shallow ulceration with gray pseudomembrane and erythematous halo on non-keratinized mucosa.Major aphthous ulcer: >0.5 cm ulcer, more painful, lasting several weeks to months; will scar.
5Inflammatory Conditions (Denture Related of the Oral Mucosa) Inflammatory papillary hyperplasiaEpulis fissurata (inflammatory fibrous dysplasia)Candidiasis
6Inflammatory Papillary Hyperplasia Etiology:Poorly fitting dentureOccurs in more than 50% of Denture WearersAppearance:Multiple small polypoid or papillary lesions.Typically on hard palate, that produces a cobblestone appearance.
7Inflammatory Papillary Hyperplasia Etiology:Poorly fitting dentureOccurs in more than 50% of Denture WearersAppearance:Multiple small polypoid or papillary lesions.Typically on hard palate, that produces a cobblestone appearance.
8Inflammatory Papillary Hyperplasia (Papillomatosis) Treatment:Discontinue using dentureSurgical removal of hyperplastic tissue.Occasionally tissue conditioner may reduce the problem, while reconstruction of new denture may be necessary.
9Epulis Fissurata (Inflammatory Fibrous Dysplasia, Denture Granuloma) Etiology:Over-extended denture flanges.Resorption of alveolar bone that makes the denture borders over-extended.Appearance:Hyperplastic granulation tissue surrounds the denture flange.Pain, bleeding, and ulceration can develop.
11Epulis Fissurata (Inflammatory Fibrous Dysplasia, Denture Granuloma) Differential Diagnosis:Verrucous carcinomaSquamous cell carcinomaTraumatic fibromaTreatment:Small lesions may resolve if flanges of denture are reduced.Surgical excision is necessary prior to rebasing/relining of denture.
13CandidiasisFour fungal organisms: Candida albicans, Candida stellatoidea, Candida tropicalis, and Candida pseudotropicalis.Candida albicans is most common.Morphologically, presents in 3 forms: yeast cell, hypha and mycelium (last form is pathogenic phase).Carriers of oral candida do not show the mycelial phase.
14EtiologyMixed infection of Candida albicans, staphylococci and streptococci.
16PAS Stained Candida Albicans Hyphae Embedded in The Oral Mucosa
17Acute Pseudomembranous Candidiasis (Thrush) Etiology:Oral candidiasisAppearance:White slightly elevated plaques that can be wiped away leaving an erythmatous base.Direct smear can be fixed and stained using PAS reagent to reveal the candida hyphea microscopically.
23Chronic Atrophic Candidiasis (Denture Sore Mouth) Appearance:Mucosa beneath denture is erythematous with a well-demarcated border.Swabs from the mucosal surface may provide a prolific growth, but biopsy shows few candida hyphae in spite of high serum and saliva antibodies to candida.Differential Diagnosis:Inflammatory papillary hyperplasia.
27Chronic Hyperplastic Candidiasis (Candida Leukoplakia) EtiologyOral Candidiasis lesions should be considered as potentially premalignant. Treatment should be directed toward mucosa and Leukoplakia.AppearanceConfluent leukoplakic plaques characterized by Candida invasion of oral epithelium with marked atypia.
29Angular Cheilitis Etiology: Appearance: Diminished occlusal vertical dimensionVitamin B or iron deficienciesSuperimposed candidiasisAffects approximately 6% of General PopulationAppearance:Wrinkled and sagging skin at the lip commisures.Desiccation and mucosal cracking.
34Diagnostic CriteriaC.F.U. in Candidiasis can vary from 1,000/ml to 20,000/ml.As an adjunct to saliva samples, smears stained with PAS.Thus clinical manifestations, salivary culture and stained smears are needed to confirm a diagnosis of Candidiasis.
37Candidiasis Rx: Nystatin oral suspension 100,000 units/ml. Disp: 60 ml.Sig: Swish and swallow 5 ml qid for 5 min.Rx: Nystatin ointment.Disp: 15 gm tube.Sig: Apply thin coat to affected areas after each meal and qhs.Rx: Clotrimazole trouches 10 mg.Disp: 70 trouchesSig. Let 1 trouch dissolve in mouth 5 times daily.
38Candidiasis Rx for Dentures: Improve oral hygiene of appliance. Keep denture out of mouth for extended periods and while sleeping.Soak for 30 min in solutions containing benzoic acid, 0.12% chlorhexidine, or 1% sodium hypochlorite and thoroughly rinse.
39CandidiasisApply a few drops of Nystatin oral suspension or a thin film of Nystatin ointment to inner surface of denture after each meal.
48XEROSTOMIAXerostomia (dry mouth) is defined as a subjective complaint of dry mouth that may result from a decrease in the production of saliva.
49XEROSTOMIAIt affects 17-29% of samples populations based on self-reports or measurements of salivary flow rates.More prevalent in women.Can cause significant morbidity and a reduction in a patient’s perception of quality of life.
50SALIVAIt keeps the teeth healthy by providing a lubricant, calcium and a buffer.It also helps to maintain the health of the gums, oral tissues (mucosa) and throat.It also plays a role in the control of bacteria in the mouth.
51It helps to cleanse the mouth of food and debris. It provides minerals such as calcium, fluoride, and phosphorus.It helps in swallowing and digesting food.
52Lack of saliva will make the mouth more prone to disease and infection. Lead to a burning feeling.