• Nalaka de Silva

Intra Oral Lesions

Updated: Jun 16, 2019

Please note that the following is a general guideline only.




Outline


Traumatic

-Cheek biting/ dentures/ burns/ chemicals


Infective

-Viral -HSVI, HSVII, V Zoster, Coxsakie V,

-Bacterial- seconadry, Syphillis,

-Fungi- Candida


Inflammatory

-Immune-Behcets, Erythema multiforme, Lichen planus, Benign mucous membrane pemphigoid, Bullous pemphigoid,Pemphigus vulgaris , E Multiforme

-Granulomatous-wegners


Neoplastic


Idiopathic

-Apthous


Systemic

-Chron’s/ vitamine lack, coeliac








I INFECTIVE






Candida


Definition


Candia infection usually by Candida albicans-yeast like organism



Aetiology

Candida Albicans


Pathophysiology

Local factors-dehydration, sjogrens, XRT, dentures Systemic-reasons for immune suppression, antibiotics, diabetes etc



Clinical


I Acute Thrush (psedo membraneos Candidasis)

Easily wiped off

Leaves a raw bed

White plaque on mucosal surface








II Acute Atrophic Candidasis

Acute burning sensation Red patch or diffuse patch Painful

De keratinisation-de papillation-hence atrophic







III Chronic Hyperplastic candidasis

Resembles leukoplakia ie Cant be rubbed off




















IV Angular cheilitis












V Median Rhomboid Glossitis












Treatment


-If non-responsive will require biopsy and PAS stain. Need to exclude dysplasia. -Chronic candida infection may lead to cancer development.


-Remove offending reason ie stop smoking/ stop antibiotic use/ check immune status etc

-If acute form Nylstatin topically- lozenges/ drops

-If Chronic form Myconazole gel until lesion disappears

-If non-responsive try oral fluconazole or itraconazole for at least 2 weeks



-Dentures soak in Chlorexidine




HSV types I and II


Definition

-Primary Infection By a DNA virus



Aetiology

Herpes -DNA virus types I and II



Epidemiology

Common, Young

Clinical

Primary

Herpetic gingivostomatitis

Often asymptomatic ie non-painful

May be associated with fever, chills, malaise Vesicles-ulcers-crusting

Anywhere in the oral cavity

Diagnosis, clinical, smears, a rising titre of antibodies




Secondary Infection

Reactivation of latent virus in 20 – 30% Not associated with systemic symptoms Small vesicles


Treatment

Aciclovir, peniciclovir cream, analgesia












II INFLAMMATORY/ IMMUNE




Lichen Planus



Definition

Lichen planus is an inflammatory muco-cutaneous condition


Epidemiology

Can occur in the buccal mucosa also finger nails Higher in older ager >40 yrs

F>M




Aetiology

Inflammatory disorder

T cells attacking the basal layer= autoimmune origin likely

Papular Plaque-like Atrophic/erosive




Clinical

Usually asymptomatic

Some ulcerate

If buccal may have restricted mouth opening Bilaterally symmetrical-buccal, lateral tongue Gingiva may have ulceration

Palate-unlikely





erosive risk of Cancer











Reticula -Common form












Papular











Plaque like- rare











Treatment

Asymptomatic non erosive forms (Reticular)-No treatment


Symptomatic

If Symptomatic

Medium potency - Topical corticosteroids Triamcinalone acetonide (0.1% Kenalog in Orabase) Betamethasone valerate (0,05% Betnovate cream) Systemic corticosteroids???? Not usually necessary Prednisone tablets (5mg)

Erosive- Malignant potential- Excise







III IDIOPATHIC



Geographic Tongue


Aetiology

unknown

uneven de keratinisation of tongue

may get secondary infection with candida

Hereditary ie allergic cause




Clinical



can be red and painful

















Treatment

avoid irritants

miconazole / nylstatin if candida




Apthous Ulcers



Definition-Idiopathic painful reccurent ulcers in the oral cavity


Epidemiology V common (most common ulcer)



Aetiology


Unknown

Possibilities- Exaggerated response to trauma Infections

Immunologic Gastrointestinal disorders


Haematologic deficiencies

Hormonal disturbance Stress




Clinical




Minor aphthous ulcers

most common, small, round, or oval, and are less than 10 mm across. They look pale yellow, but the area around them may look swollen and red. Only one ulcer may develop, but up to five may appear at the same time. Each ulcer lasts 7-10 days, and then goes without leaving a scar. They are not usually very painful.









Major aphthous ulcers

occur in about 1 in 10 cases. They tend to be 10 mm or larger across. Usually only one or two appear at a time. Each ulcer lasts from two weeks to several months, but will heal leaving a scar. They can be very painful and eating may become difficult.







Herpetiform ulcers

occur in about 1 in 10 cases. These are tiny pinhead-sized ulcers, about 1-2 mm across. Multiple ulcers occur at the same time, but some may join together and form irregular shapes. Each ulcer lasts one week to two months. Despite the name, they have nothing to do with herpes or the herpes virus




Treatment

Analgesia- systemic and topicas Steroids-topical/ systemic Topic tetracycline


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