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Oral Cavity ORAL CAVITY Oral Cavity – Applied Anatomy – Symptomatology – Inflammatory and ulcerative conditions – Ulcerative condition – Other benign conditions • Edited by – Dr. Murtaza Ahsan Ansari ANATOMICAL REGION & SITES OF THE ORAL CAVITY Buccal Mucosa Mucosal surface of upper & lower lip Mucosal surface of cheek Retro molar area Bucco-alveolar sulci, upper & lower Upper Alveolus & Gingiva Lower Alveolus & Gingiva Hard Palate Tongue Dorsal surface & lateral borders Anterior to vallate papillae (ant. 2/3rd) Floor Of Mouth Lining: Non-keratinizing Stratified Sq. Epithelium containing taste buds, and many minor salivary glands – • • • • • • • • • • • • • • • • • • • • • • SYMPTOMATOLOGY Pain including Referred pain Ulcers and Bleeding Halitosis (foetor oris) Dysphagia , Odynophagia Difficulty in Speech Xerostomia Dribbling of saliva or Increased salivation Taste (bad taste or loss of taste) Trismus CAUSES OF THE ULCERS OF THE ORAL CAVITY • Infection • Immune Disorders • Trauma • Neoplasms • Skin Disorders • Drug Allergy • Vitamin Deficiencies • Miscellaneous CAUSES OF ULCERS OF ORAL CAVITY • • Infections Viral: • Herpangina • Herpes simplex primary and secondary • HPV • Epstein B virus • Hand-foot and mouth disease • AIDS HERPENGINA • • • • Coxsackie virus Children Multiple small vesicles rupture to form ulcers. Yellow base with red areola HERPES Primary • Children • Clusters of multiple vesicles, rupture to form ulcers. • Fever, malaise • Lymphadenopathy • • Treatment • Acyclovir 200mg 5 times a day for 5 days. Secondary • Adults • Milder • Mostly at vermilion border of lip • Virus remains dormant in trigeminal ganglion. • Activated by fever fatigue and emotional stress CAUSES OF ULCERS OF ORAL CAVITY BACTERIAL: Non-Specific • Staph aureus • Streptococci Specific • Vincent’s infection • Tuberculous granuloma • Syphilis FUNGAL: • Candidiasis • • • • • VINCENT’S INFECTION (Acute necrotising ulcerative gingivitis) Fusiform bacillus+ Spirochete (Borrelia vincenti) Young and middle aged persons Gingivae become red edematous and necrose. Also affects Tonsils (Vincent’s angina) Treatment – Improve oral hygiene – Mouth washes with Na HCO3 – Penicillin / Erythromycin – Metronidazole CANDIASIS • • Candida albicans White grey patch on oral mucosa and tongue • Common in children and immuno-compromised (diabetics, malignancy) • Treatment • Nystatin • Clotrimazole • – – – – – • • • IMMUNE DISORDRES Aphthous ulcer Recurrent multiple about 2—10 mm Affecting movable mucosa Central necrotic area with red halo No constitutional symptoms Etiology Stress? Autoimmune? Nutritional? BECHET’S SYNDROME (Occulo-oro-genital syndrome) Aphthous like ulcers with punched out margins affecting: • • • Oral cavity Genital ulcers Uveitis TRAUMATIC ULCER PHYSICAL: • • • Cheek Bite Jagged teeth Ill-fitting denture CHEMICAL: • Silver nitrate • Phenol • Aspirin burn THERMAL: • Hot food or fluid • Reverse smoking ORAL ULCERS ASSOCIATED WITH SKIN DISORDERS • Erythema multiforme • Lichen planus • Bullous pemphigoid • Lupus erythematosus • • • • • • • • • • • • • ORAL ULCERS ASSOCIATED WITH BLOOD DISORDERS Leukaemia Agranuloycytosis Pancytopenia. Cyclic neutropenia Sickle cell anaemia DRUG ALLERGY Mouth washes Tooth paste Denture Aspirin Penicillin Sulphonamides Barbiturates Phenytoin Steven Johnson Syndrome due to Sulphonamides NUTRITIONAL DEFICIENCIES • Iron deficiency anemia • Vitamin A • Vitamin C • Folate • Vitamin B1, B2, B6, and B 12 ACUTE EXANTHEMAS • • • Chickenpox Measles Glandular fever MISCELLANEOUS • • • • Radiation mucositis Cancer chemotherapy Diabetes mellitus Uraemia. MOUTH ULCERS (Management) History Examination Depending upon the diagnosis • Attention to oral hygiene • Removal of local Irritants • Antibiotics, antiseptics & • Analgesics • Local Anaesthetics • Steroids Correction of nutritional deficiencies • Replacement of blood RETENTION CYSTS Result due to blockage of ducts of minor salivary gland RANULA DEFINITION: • Uni or multilocular mucous filled cyst in the floor of the mouth due to blockage of duct of sub-lingual salivary gland, resembles belly of frog. PRE CANCEROUS CONDITIONS Various pre-malignant lesions of oral cavity are: • Leukoplakia • Erythroplakia • Lichen planis • Leukokeratosis nicotina palati • Leukoderma • Submucous fibrosis • ―PAAN‖ or betel stomatitis LEUKOPLAKIA • Raised white patch • 5 mm or more • Cannot be scrapped off • • • • • ERYTHROPLAKIA Red patch, interwoven with leukoplakia, definitely pre-malignant Red colour is because of capillary engorgement & absence of keratin Overlying ca. in early stage PAAN STOMATITIS Consupmtion of tobacco & ―Qivam‖ is carcinogenic Repeated chewing produces very early epithelial changes • • Varies histologically from dysplasia to malignancy Bizarre appearance of mucosa • SUB-MUCOSAL FIBROSIS Incidious chronic condition affecting any part of oral cavity and pharynx • Unknown etiology SUB-MUCOSAL FIBROSIS Probable factors Chewing of betel nuts Tobacco Lime & Paan Anaemia Genetically predisposed patients • • • • • • • • • • • • • PREVENTIVE MEASURES AGAINST MALIGNANCY Antioxidants – Vegetables & Fruits are rich source Micronutrients are anti-carcinogenic Fibre intake Avoidance of smoking Avoidance of supari, paan, tobacco, lime etc. Improving dental & oral hygiene Correct fitting of dentures SUB-MUCOSAL FIBROSIS (Treatment) Avoidance of causative factor (betel nut etc.) Improvement of oral hygiene Correction of vitamins & mineral deficiencies Mouthwashes Topical corticosterods Anxiolytic Drugs ? Very resistant to treatment Refer to ENT Surgeon • ENT SURGEON / SPECIALIZED CARE For early stage cancer surgical excision is the therapy of choice • CO2 laser has added advantage • Partial thickness skin grafting following excision • Temporo-mandibular condylectomy in S M F • Nasolabial flap after excision of mucosa Physiotherapy • ------------------THANK YOU-----------------