Ulcerative lesions of the oral cavity can be caused by local trauma, infections, recurrent aphthous stomatitis, or systemic conditions. Traumatic ulcers are usually solitary and caused by factors like sharp teeth or dental appliances. They heal within 6-10 days after removing the cause. Recurrent aphthous stomatitis causes painful ulcers and comes in minor, major, and herpetiform types. Infections like herpes virus or tuberculosis can also lead to oral ulcerations. A thorough history and examination is needed to diagnose the underlying cause of ulcers.
Mucocele and ranula are lesions caused by the extravasation of mucus from salivary glands into surrounding tissues. Mucoceles are commonly caused by trauma that severs or obstructs salivary ducts, allowing mucus to pool in surrounding tissues. Ranulas specifically occur on the floor of the mouth associated with sublingual or submandibular gland ducts. Histologically, they consist of mucus-filled cavities surrounded by granulation tissue and inflammatory cells. Treatment involves complete surgical excision to prevent recurrence.
Leukoplakia is a white patch or plaque that develops in the mouth and cannot be wiped away. It affects 1.5-12% of the population, usually those over age 40, and prevalence increases with age. Leukoplakia has various clinical forms and ranges in appearance from flat and uniform to raised or irregular patches. A biopsy is needed to examine the tissue for signs of dysplasia or oral cancer. While most leukoplakia is harmless, some may develop into cancer over time, so prevention focuses on lifestyle changes like quitting smoking and reducing alcohol.
This document discusses aphthous ulcers, also known as canker sores, which are characterized by recurring, painful ulcers in the mouth. It describes the three main types: minor aphthous ulcers, which are less than 10mm and heal within 2 weeks; major aphthous ulcers, which are larger than 10mm and can take over 6 weeks to heal, often leaving scars; and herpetiform ulcers, which present as multiple small ulcers that may join together into larger ones and persist for 1-3 years. The document provides details on symptoms, locations in the mouth, appearances, durations, and histopathology of the different types of aphthous ulcers.
A cyst is an epithelium-lined sac containing fluid or semisolid material. In the formation of a cyst, the epithelial cells first proliferate and later undergo degeneration and liquefaction. The liquefied material exerts equal pressure on the walls of the cyst from within. Cysts grow by expansion and thus displace the adjacent teeth by pressure. May can produce expansion of the cortical bone. On a radiograph, the radiolucency of a cyst is usually bordered by a radiopaque periphery of dense sclerotic bone. The radiolucency may be unilocular or multilocular. Odontogenic cysts are those which arise from the epithelium associated with the development of teeth. The source of epithelium is from the enamel organ, the reduced enamel epithelium, the cell rests of Malassez or the remnants of the dental lamina.
Erythema multiforme, Steven-Johnson syndrome and Toxic Epidermal NecrolysisBinaya Subedi
Erythema Multiforme is a common Vesiculobullous deramtological condition with mucosal manifestations trigged by Herpes virus infection and certain sulpha containing drugs.
This document summarizes recurrent aphthous stomatitis (canker sores). It defines the condition as recurring ulcers confined to the oral mucosa with no signs of systemic disease. It describes the three main types (minor, major, herpetiform), their clinical features, histopathology, associated syndromes, differential diagnosis, and treatments which include topical steroids, antimicrobial mouthwashes, analgesics, and intralesional steroid injections. The conclusion emphasizes that recurrent aphthous ulcers are the most common oral ulcers with three subtypes, unknown etiology, and palliative treatment of lesions.
This document discusses odontogenic keratocysts (OKCs), a type of jaw cyst. It covers the classification, causes, histopathology, clinical features, radiographic features, differential diagnosis, treatment principles, and surgical treatment options for OKCs. OKCs most commonly occur in the mandibular molar and ramus areas and are often radiolucent and multilocular in appearance on radiographs. Treatment options include wide surgical excision or marsupialization to prevent recurrence of these cysts which have a high rate of recurrence compared to other jaw cysts.
Dentigerous cysts are odontogenic cysts that surround the crown of an impacted tooth. They are the most common type of developmental jaw cyst, making up 20% of all jaw cysts. Dentigerous cysts typically occur in males in the second and third decades of life, with the most common sites being the mandibular and maxillary third molars and maxillary cuspid areas. Radiographically, dentigerous cysts can appear as central, lateral, or circumferential expansions surrounding the crown of an unerupted tooth. Small cysts are usually treated with enucleation, while larger cysts involving bone loss require marsupialization.
Mucocele and ranula are lesions caused by the extravasation of mucus from salivary glands into surrounding tissues. Mucoceles are commonly caused by trauma that severs or obstructs salivary ducts, allowing mucus to pool in surrounding tissues. Ranulas specifically occur on the floor of the mouth associated with sublingual or submandibular gland ducts. Histologically, they consist of mucus-filled cavities surrounded by granulation tissue and inflammatory cells. Treatment involves complete surgical excision to prevent recurrence.
Leukoplakia is a white patch or plaque that develops in the mouth and cannot be wiped away. It affects 1.5-12% of the population, usually those over age 40, and prevalence increases with age. Leukoplakia has various clinical forms and ranges in appearance from flat and uniform to raised or irregular patches. A biopsy is needed to examine the tissue for signs of dysplasia or oral cancer. While most leukoplakia is harmless, some may develop into cancer over time, so prevention focuses on lifestyle changes like quitting smoking and reducing alcohol.
This document discusses aphthous ulcers, also known as canker sores, which are characterized by recurring, painful ulcers in the mouth. It describes the three main types: minor aphthous ulcers, which are less than 10mm and heal within 2 weeks; major aphthous ulcers, which are larger than 10mm and can take over 6 weeks to heal, often leaving scars; and herpetiform ulcers, which present as multiple small ulcers that may join together into larger ones and persist for 1-3 years. The document provides details on symptoms, locations in the mouth, appearances, durations, and histopathology of the different types of aphthous ulcers.
A cyst is an epithelium-lined sac containing fluid or semisolid material. In the formation of a cyst, the epithelial cells first proliferate and later undergo degeneration and liquefaction. The liquefied material exerts equal pressure on the walls of the cyst from within. Cysts grow by expansion and thus displace the adjacent teeth by pressure. May can produce expansion of the cortical bone. On a radiograph, the radiolucency of a cyst is usually bordered by a radiopaque periphery of dense sclerotic bone. The radiolucency may be unilocular or multilocular. Odontogenic cysts are those which arise from the epithelium associated with the development of teeth. The source of epithelium is from the enamel organ, the reduced enamel epithelium, the cell rests of Malassez or the remnants of the dental lamina.
Erythema multiforme, Steven-Johnson syndrome and Toxic Epidermal NecrolysisBinaya Subedi
Erythema Multiforme is a common Vesiculobullous deramtological condition with mucosal manifestations trigged by Herpes virus infection and certain sulpha containing drugs.
This document summarizes recurrent aphthous stomatitis (canker sores). It defines the condition as recurring ulcers confined to the oral mucosa with no signs of systemic disease. It describes the three main types (minor, major, herpetiform), their clinical features, histopathology, associated syndromes, differential diagnosis, and treatments which include topical steroids, antimicrobial mouthwashes, analgesics, and intralesional steroid injections. The conclusion emphasizes that recurrent aphthous ulcers are the most common oral ulcers with three subtypes, unknown etiology, and palliative treatment of lesions.
This document discusses odontogenic keratocysts (OKCs), a type of jaw cyst. It covers the classification, causes, histopathology, clinical features, radiographic features, differential diagnosis, treatment principles, and surgical treatment options for OKCs. OKCs most commonly occur in the mandibular molar and ramus areas and are often radiolucent and multilocular in appearance on radiographs. Treatment options include wide surgical excision or marsupialization to prevent recurrence of these cysts which have a high rate of recurrence compared to other jaw cysts.
Dentigerous cysts are odontogenic cysts that surround the crown of an impacted tooth. They are the most common type of developmental jaw cyst, making up 20% of all jaw cysts. Dentigerous cysts typically occur in males in the second and third decades of life, with the most common sites being the mandibular and maxillary third molars and maxillary cuspid areas. Radiographically, dentigerous cysts can appear as central, lateral, or circumferential expansions surrounding the crown of an unerupted tooth. Small cysts are usually treated with enucleation, while larger cysts involving bone loss require marsupialization.
This document provides information on oral submucous fibrosis (OSMF), including its definition, history, pathogenesis, clinical features, and staging classifications. OSMF is a chronic disease affecting the oral cavity and sometimes pharynx, characterized by juxtaepithelial inflammatory reaction and fibrosis of the lamina propria. Chewing betel quid and areca nut releases alkaloids and tannins that cause irritation and inflammation, activating fibroblasts and increasing production and cross-linking of collagen over time, resulting in stiffness and inability to open the mouth. OSMF is considered a precancerous condition due to its association with oral cancer. Staging systems describe progression from initial symptoms to trismus and possible malignancy
This document discusses cysts of the oral and maxillofacial region. It defines true cysts as pathological cavities lined by epithelium and containing fluid, and pseudo cysts as cavities not lined by epithelium that may contain fluid. Cysts are classified based on their origin (odontogenic vs non-odontogenic) and location. Diagnosis involves history, clinical examination, radiographic evaluation and sometimes aspiration biopsy or surgical biopsy. Treatment options include enucleation, marsupialization, or a combination depending on the cyst size and location.
This document discusses different types of pigmented cellular nevi:
- Intradermal (intramucosal) nevi occur within the dermis or mucosa and appear as raised or flat dark lesions.
- Junctional nevi are located at the dermal-epidermal junction and appear as flat brown-black macules, most often on the hard palate or gingiva.
- Compound nevi exhibit characteristics of both intradermal and junctional nevi, with nevus cells in the dermis and basal epidermis.
- Blue nevi appear as dark blue papules or macules on the skin or hard palate, composed of pigment
The presentation explain white lesions in oral cavity and the classification the demonstrate the etiology, histopathology, diagnosis and treatment for each one.
This document discusses dentigerous cysts. It defines a dentigerous cyst as a cyst that forms around the crown of an unerupted tooth due to fluid accumulation between the reduced enamel epithelium and enamel surface. Dentigerous cysts most commonly occur in males in the first three decades of life in the mandibular third molar and maxillary canine regions. Clinical features include swelling and expansion of bone that may cause facial asymmetry. Treatment options include enucleation, marsupialization, or a combination of the two to remove the cyst lining while preserving adjacent structures.
Oral lichen planus is a chronic inflammatory disease that affects the oral mucosa. It is characterized by white striations (Wickham's striae) and varies in appearance from reticular to erythematous or ulcerative lesions. The cause is unknown but involves a cell-mediated immune response. Treatment focuses on reducing symptoms and includes topical corticosteroids, immunosuppressants, or retinoids. Malignant transformation may rarely occur so follow-up is important.
The document discusses different types of cysts that can occur in the oral and maxillofacial region. It defines cysts and classifies them based on their origin and location. It provides details on the pathogenesis, clinical features, radiographic appearance and histology of specific cysts such as dentigerous cysts and odontogenic keratocysts. Dentigerous cysts are defined as cysts originating from the separation of the dental follicle from around the crown of an unerupted tooth. Odontogenic keratocysts are distinctive cysts that arise from cell rests of the dental lamina and have more aggressive behavior than other cysts. Complications of cysts include recurrence, development of
Leukoplakia is a white oral lesion that cannot be characterized as any other lesion and has a malignant potential of 15.6-39.2%. Extrinsic factors like smoking and intrinsic factors like old age and nutrition can cause it. Clinically, it can be solitary or multiple and appear white on sites like the buccal mucosa or tongue. Diagnosis involves staining with Toluidine blue dye and biopsy. Treatment includes stopping causative habits, photodynamic therapy, topical chemotherapy, surgery, or chemoprevention with vitamins, minerals, or retinoids. Long term review is important after treatment due to risk of recurrence.
This document describes vesiculo-bullous lesions, which present clinically as vesicles or bullae that often rupture early, appearing as ulcerated or erosive areas. Some key points:
- Vesicles are fluid-filled lesions less than 1 cm, while bullae contain fluid and are over 1 cm.
- Causes include trauma, infection, autoimmunity, and genetic factors.
- Examples described include herpes simplex infection, varicella zoster infection, and hand foot and mouth disease. Clinical features, pathogenesis, management are provided for each. Classification is discussed based on acute vs chronic presentation, clinical presentation, and histopathological location.
Oral lichen planus is a common chronic mucocutaneous disease of unknown etiology that may undergo malignant transformation. It typically presents as white reticulated lines on the oral mucosa but can also appear as erosive, atrophic, bullous or other lesions. A confirmed diagnosis requires characteristic histopathology. While there is no cure, treatment focuses on managing symptoms like pain with topical or systemic corticosteroids and maintaining oral hygiene to reduce cancer risks.
This document describes various types of oral ulcers including their definitions, causes, clinical features and characteristics. It discusses traumatic ulcers caused by mechanical, chemical or thermal injury. It also covers infective ulcers and immunologic conditions that can cause ulcers like recurrent aphthous stomatitis, Behcet's syndrome, Reiter's syndrome and erythema multiforme. Specific ulcer types are defined and the clinical and pathological features of each type are detailed.
This document discusses and compares different types of non-odontogenic (not related to teeth) cysts. It separates them into developmental and inflammatory cysts. Developmental cysts form due to epithelial cell remnants becoming trapped during embryonic development, while inflammatory cysts form due to duct obstruction or trauma. Some examples of developmental cysts mentioned are nasopalatine duct cysts, median palatal cysts, and dermoid cysts. Inflammatory cysts include mucoceles, ranulas caused by salivary gland duct obstruction, and retention cysts of the maxillary sinus. The document provides details on pathogenesis, clinical features, histopathology, diagnosis and treatment of several of these cyst types.
Oral lichen planus is a chronic mucocutaneous disease that affects the skin and oral mucosa. It is caused by an abnormal immune reaction that results in apoptosis of epithelial cells. Clinically, it presents as white reticulated lines on the oral mucosa, as well as violaceous papules or plaques on the skin. Histologically, there is hyperorthokeratinization, saw-tooth rete pegs, and a band of inflammatory cells beneath the epithelium. Treatment focuses on managing symptoms with topical corticosteroids to resolve lesions and reduce cancer risk.
Radicular cysts are odontogenic cysts that form from cell rests of Malassez in response to inflammation from pulp necrosis. They are commonly found in the maxillary anterior and posterior regions in people aged 20-60 years old. Radicular cysts appear radiolucent on x-rays and are associated with non-vital teeth. Treatment involves root canal therapy or extraction of the offending tooth along with surgical removal of the cyst.
This document provides an overview of cysts that can occur in the oral and maxillofacial tissues. It defines cysts and discusses their classification, pathogenesis, clinical examination, and specific types such as odontogenic cysts, inflammatory cysts, dentigerous cysts, and odontogenic keratocysts. The pathogenesis involves initiation, cyst formation, and enlargement. Clinical examination includes symptoms, signs, radiographic features, and biopsy for diagnosis. Treatment depends on the type and size of the cyst.
A dental abscess (also termed a dentoalveolar abscess, tooth abscess or root abscess), is a localized collection of pus associated with a tooth.
For more information, you can book an appointment at
Dr Sachdeva's Dental Aesthetic And Implant Institute,
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
• Phone : +919818894041,01142464041
• Our Websites:
• www.sachdevadentalcare.com
• www.dentalclinicindelhi.com
• www.dentalimplantindia.co.in
• www.dentalcoursesdelhi.com
• www.facialaestheticsdelhi.com
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This document outlines the etiology and management of trismus. It defines trismus as restricted mouth opening and describes normal ranges of opening. Common causes of trismus include infections, trauma, surgery, tumors, radiation, TMJ disorders, and drugs. Management involves thorough history and examination, investigations to diagnose the underlying cause, and various treatment approaches depending on the etiology such as heat therapy, medical management, physiotherapy, surgery, and appliances.
This document describes different types of vesiculobullous diseases classified according to the Fitzpatrick system based on the anatomical level of blister formation. It discusses conditions such as pemphigus vulgaris, pemphigus vegetans, pemphigus foliaceus, paraneoplastic pemphigus, bullous pemphigoid, cicatricial pemphigoid, and familial benign pemphigus. For each condition, it provides details on pathogenesis, clinical features, histopathology, immunopathology, and oral manifestations when present.
This document discusses fibro-osseous lesions, which replace normal bone with fibrous tissue containing newly formed mineralized structures. It describes several types of fibro-osseous lesions including fibrous dysplasia, cemento-osseous dysplasias like periapical cemental dysplasia, and fibro-osseous neoplasms like ossifying fibroma. For each type, it covers definitions, clinical features, radiographic appearances, differential diagnosis, and treatment approaches.
This document contains a list of oral conditions and diseases with brief descriptions and accompanying photographs. It covers various ulcers, infections like herpes and tuberculosis, lesions such as lichen planus and erythema multiforme, pigmentation issues, oral cancers, cysts and masses. The document serves as an educational reference for identifying and diagnosing different oral pathologies.
1. The document discusses various causes and types of oral ulcers including recurrent aphthous ulcers, gastrointestinal causes like Crohn's disease and ulcerative colitis, and mucocutaneous conditions like oral lichen planus, pemphigus, and pemphigoid.
2. Recurrent aphthous ulcers are small round ulcers with erythematous halos that can be caused by genetic or nutritional deficiencies. Management involves correcting deficiencies and using mouthwashes or pastes.
3. Crohn's disease can cause oral ulcers and other manifestations. Ulcerative colitis rarely causes oral lesions but may result in chronic ulceration.
4. Mucoc
This document provides information on oral submucous fibrosis (OSMF), including its definition, history, pathogenesis, clinical features, and staging classifications. OSMF is a chronic disease affecting the oral cavity and sometimes pharynx, characterized by juxtaepithelial inflammatory reaction and fibrosis of the lamina propria. Chewing betel quid and areca nut releases alkaloids and tannins that cause irritation and inflammation, activating fibroblasts and increasing production and cross-linking of collagen over time, resulting in stiffness and inability to open the mouth. OSMF is considered a precancerous condition due to its association with oral cancer. Staging systems describe progression from initial symptoms to trismus and possible malignancy
This document discusses cysts of the oral and maxillofacial region. It defines true cysts as pathological cavities lined by epithelium and containing fluid, and pseudo cysts as cavities not lined by epithelium that may contain fluid. Cysts are classified based on their origin (odontogenic vs non-odontogenic) and location. Diagnosis involves history, clinical examination, radiographic evaluation and sometimes aspiration biopsy or surgical biopsy. Treatment options include enucleation, marsupialization, or a combination depending on the cyst size and location.
This document discusses different types of pigmented cellular nevi:
- Intradermal (intramucosal) nevi occur within the dermis or mucosa and appear as raised or flat dark lesions.
- Junctional nevi are located at the dermal-epidermal junction and appear as flat brown-black macules, most often on the hard palate or gingiva.
- Compound nevi exhibit characteristics of both intradermal and junctional nevi, with nevus cells in the dermis and basal epidermis.
- Blue nevi appear as dark blue papules or macules on the skin or hard palate, composed of pigment
The presentation explain white lesions in oral cavity and the classification the demonstrate the etiology, histopathology, diagnosis and treatment for each one.
This document discusses dentigerous cysts. It defines a dentigerous cyst as a cyst that forms around the crown of an unerupted tooth due to fluid accumulation between the reduced enamel epithelium and enamel surface. Dentigerous cysts most commonly occur in males in the first three decades of life in the mandibular third molar and maxillary canine regions. Clinical features include swelling and expansion of bone that may cause facial asymmetry. Treatment options include enucleation, marsupialization, or a combination of the two to remove the cyst lining while preserving adjacent structures.
Oral lichen planus is a chronic inflammatory disease that affects the oral mucosa. It is characterized by white striations (Wickham's striae) and varies in appearance from reticular to erythematous or ulcerative lesions. The cause is unknown but involves a cell-mediated immune response. Treatment focuses on reducing symptoms and includes topical corticosteroids, immunosuppressants, or retinoids. Malignant transformation may rarely occur so follow-up is important.
The document discusses different types of cysts that can occur in the oral and maxillofacial region. It defines cysts and classifies them based on their origin and location. It provides details on the pathogenesis, clinical features, radiographic appearance and histology of specific cysts such as dentigerous cysts and odontogenic keratocysts. Dentigerous cysts are defined as cysts originating from the separation of the dental follicle from around the crown of an unerupted tooth. Odontogenic keratocysts are distinctive cysts that arise from cell rests of the dental lamina and have more aggressive behavior than other cysts. Complications of cysts include recurrence, development of
Leukoplakia is a white oral lesion that cannot be characterized as any other lesion and has a malignant potential of 15.6-39.2%. Extrinsic factors like smoking and intrinsic factors like old age and nutrition can cause it. Clinically, it can be solitary or multiple and appear white on sites like the buccal mucosa or tongue. Diagnosis involves staining with Toluidine blue dye and biopsy. Treatment includes stopping causative habits, photodynamic therapy, topical chemotherapy, surgery, or chemoprevention with vitamins, minerals, or retinoids. Long term review is important after treatment due to risk of recurrence.
This document describes vesiculo-bullous lesions, which present clinically as vesicles or bullae that often rupture early, appearing as ulcerated or erosive areas. Some key points:
- Vesicles are fluid-filled lesions less than 1 cm, while bullae contain fluid and are over 1 cm.
- Causes include trauma, infection, autoimmunity, and genetic factors.
- Examples described include herpes simplex infection, varicella zoster infection, and hand foot and mouth disease. Clinical features, pathogenesis, management are provided for each. Classification is discussed based on acute vs chronic presentation, clinical presentation, and histopathological location.
Oral lichen planus is a common chronic mucocutaneous disease of unknown etiology that may undergo malignant transformation. It typically presents as white reticulated lines on the oral mucosa but can also appear as erosive, atrophic, bullous or other lesions. A confirmed diagnosis requires characteristic histopathology. While there is no cure, treatment focuses on managing symptoms like pain with topical or systemic corticosteroids and maintaining oral hygiene to reduce cancer risks.
This document describes various types of oral ulcers including their definitions, causes, clinical features and characteristics. It discusses traumatic ulcers caused by mechanical, chemical or thermal injury. It also covers infective ulcers and immunologic conditions that can cause ulcers like recurrent aphthous stomatitis, Behcet's syndrome, Reiter's syndrome and erythema multiforme. Specific ulcer types are defined and the clinical and pathological features of each type are detailed.
This document discusses and compares different types of non-odontogenic (not related to teeth) cysts. It separates them into developmental and inflammatory cysts. Developmental cysts form due to epithelial cell remnants becoming trapped during embryonic development, while inflammatory cysts form due to duct obstruction or trauma. Some examples of developmental cysts mentioned are nasopalatine duct cysts, median palatal cysts, and dermoid cysts. Inflammatory cysts include mucoceles, ranulas caused by salivary gland duct obstruction, and retention cysts of the maxillary sinus. The document provides details on pathogenesis, clinical features, histopathology, diagnosis and treatment of several of these cyst types.
Oral lichen planus is a chronic mucocutaneous disease that affects the skin and oral mucosa. It is caused by an abnormal immune reaction that results in apoptosis of epithelial cells. Clinically, it presents as white reticulated lines on the oral mucosa, as well as violaceous papules or plaques on the skin. Histologically, there is hyperorthokeratinization, saw-tooth rete pegs, and a band of inflammatory cells beneath the epithelium. Treatment focuses on managing symptoms with topical corticosteroids to resolve lesions and reduce cancer risk.
Radicular cysts are odontogenic cysts that form from cell rests of Malassez in response to inflammation from pulp necrosis. They are commonly found in the maxillary anterior and posterior regions in people aged 20-60 years old. Radicular cysts appear radiolucent on x-rays and are associated with non-vital teeth. Treatment involves root canal therapy or extraction of the offending tooth along with surgical removal of the cyst.
This document provides an overview of cysts that can occur in the oral and maxillofacial tissues. It defines cysts and discusses their classification, pathogenesis, clinical examination, and specific types such as odontogenic cysts, inflammatory cysts, dentigerous cysts, and odontogenic keratocysts. The pathogenesis involves initiation, cyst formation, and enlargement. Clinical examination includes symptoms, signs, radiographic features, and biopsy for diagnosis. Treatment depends on the type and size of the cyst.
A dental abscess (also termed a dentoalveolar abscess, tooth abscess or root abscess), is a localized collection of pus associated with a tooth.
For more information, you can book an appointment at
Dr Sachdeva's Dental Aesthetic And Implant Institute,
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
• Phone : +919818894041,01142464041
• Our Websites:
• www.sachdevadentalcare.com
• www.dentalclinicindelhi.com
• www.dentalimplantindia.co.in
• www.dentalcoursesdelhi.com
• www.facialaestheticsdelhi.com
• Google+ link: https://goo.gl/vqAmvr
• Facebook link: https://goo.gl/tui98A
• Youtube link: https://goo.gl/mk7jfm
• Linkedin link: https://goo.gl/PrPgpB
• Slideshare link : http://goo.gl/0HY6ep
• Twitter Page : https://goo.gl/tohkcI
• Instagram page : https://goo.gl/OOGVig
This document outlines the etiology and management of trismus. It defines trismus as restricted mouth opening and describes normal ranges of opening. Common causes of trismus include infections, trauma, surgery, tumors, radiation, TMJ disorders, and drugs. Management involves thorough history and examination, investigations to diagnose the underlying cause, and various treatment approaches depending on the etiology such as heat therapy, medical management, physiotherapy, surgery, and appliances.
This document describes different types of vesiculobullous diseases classified according to the Fitzpatrick system based on the anatomical level of blister formation. It discusses conditions such as pemphigus vulgaris, pemphigus vegetans, pemphigus foliaceus, paraneoplastic pemphigus, bullous pemphigoid, cicatricial pemphigoid, and familial benign pemphigus. For each condition, it provides details on pathogenesis, clinical features, histopathology, immunopathology, and oral manifestations when present.
This document discusses fibro-osseous lesions, which replace normal bone with fibrous tissue containing newly formed mineralized structures. It describes several types of fibro-osseous lesions including fibrous dysplasia, cemento-osseous dysplasias like periapical cemental dysplasia, and fibro-osseous neoplasms like ossifying fibroma. For each type, it covers definitions, clinical features, radiographic appearances, differential diagnosis, and treatment approaches.
This document contains a list of oral conditions and diseases with brief descriptions and accompanying photographs. It covers various ulcers, infections like herpes and tuberculosis, lesions such as lichen planus and erythema multiforme, pigmentation issues, oral cancers, cysts and masses. The document serves as an educational reference for identifying and diagnosing different oral pathologies.
1. The document discusses various causes and types of oral ulcers including recurrent aphthous ulcers, gastrointestinal causes like Crohn's disease and ulcerative colitis, and mucocutaneous conditions like oral lichen planus, pemphigus, and pemphigoid.
2. Recurrent aphthous ulcers are small round ulcers with erythematous halos that can be caused by genetic or nutritional deficiencies. Management involves correcting deficiencies and using mouthwashes or pastes.
3. Crohn's disease can cause oral ulcers and other manifestations. Ulcerative colitis rarely causes oral lesions but may result in chronic ulceration.
4. Mucoc
The document discusses factors involved in determining the prognosis and treatment plan for periodontal disease. It defines prognosis as a prediction of the course and outcome of a disease based on risk factors. Several types of prognoses are described from excellent to poor based on remaining bone support, tooth mobility, furcation involvement, maintenance difficulties, and presence of systemic/environmental factors. Both overall and individual tooth prognoses are considered based on patient age, disease severity, plaque control, compliance, smoking, systemic disease, genetic factors, subgingival restorations, and anatomic root factors. A favorable prognosis requires adequate bone support, control of etiologic factors, patient cooperation and absence of negative systemic influences.
This document describes various types of oral lesions including macules, papules, plaques, vesicles, bullae and pustules. It then discusses important causes of oral mucosal ulcers, separating them into those that involve preceding vesiculation like herpes simplex, herpes zoster, chickenpox, hand-foot-and-mouth disease and herpangina, and those without preceding vesiculation such as cytomegalovirus, tuberculosis, syphilis, traumatic ulcers, aphthous stomatitis, Behcet's disease, Reiter's syndrome, lichen planus and some mucosal drug reactions. Specific features of each condition are described in detail with examples
Chronic periodontitis is an inflammatory disease that causes the destruction of the tissues that support the teeth. It is caused by bacterial plaque accumulating at and below the gumline. The disease is characterized by pocket formation, attachment loss, and bone loss. It is usually slowly progressive and can range from mild to severe. Diagnosis involves measuring pocket depths, attachment levels, bleeding, and bone loss visible on radiographs. Risk factors include poor oral hygiene, smoking, diabetes, and genetic factors. Treatment aims to eliminate plaque and bacteria through nonsurgical methods like scaling and root planing or sometimes surgical procedures to reduce pocket depths and regenerate lost tissues.
Oral mucosal lesions in denture wearersAamir Godil
The document discusses oral mucosal lesions that can occur in denture wearers. It describes several types of denture-related mucosal lesions (DMLs) such as traumatic ulcers, denture-induced stomatitis, and denture hyperplasia. It also discusses non-denture related lesions including fissured tongue and lichen planus. A statistical analysis found the most common DMLs were traumatic ulcers and denture stomatitis. Complete denture wearers had higher rates of DMLs while partial denture wearers saw more stomatitis. The document provides details on clinical presentation and management of several specific oral lesions.
This document discusses various types of ulcerative lesions that can occur in the oral cavity. It defines an ulcer as a local defect or excavation of the surface of an organ or tissue. The main causes of oral ulceration discussed are local trauma, aphthous ulcers, infections such as herpes, drugs, malignancies, and systemic diseases. Physical trauma is a common local cause of ulcers from factors like sharp teeth or dental appliances. Ulcerative lesions can also be caused by chemical or thermal burns in the mouth.
This document discusses non-infective stomatitis, including its definition and various causes such as traumatic ulcers, aphthous stomatitis, Behcets disease, lichen planus, and lupus erythematosus. It provides detailed information on the characteristics, causes, diagnosis, and treatment of these conditions. Specifically, it describes the clinical features and types of recurrent aphthous stomatitis and lichen planus, and explains the pathogenesis of lichenoid reactions, Behcets disease, and lupus erythematosus. Complications such as malignant transformation of oral lichen planus are also mentioned.
Differential diagnosis of oral and maxillofacial lesionsAhmed Adawy
A wide variety of lesions from the soft and hard tissues may arise in the orofacial region. Clinical diagnosis is a cognitive process of applying logic and knowledge in a series of step-by-step decisions, to create a list of possible diagnosis.
Common Benign Oral cavity disorders by. Dr.vijay kumarvijaymgims
The document discusses various types of oral lesions and conditions. It begins by describing the anatomy of the oral cavity and defines a lesion. It then classifies lesions based on their depth and texture. Specific lesion types are defined such as ulcers, erosions, abscesses, cysts, blisters, pustules, hematomas and plaques. Causes of oral lesions including congenital conditions, inflammatory/traumatic conditions, autoimmune diseases and precancerous lesions are listed. Finally, examples of benign tumors such as fibromas and pyogenic granulomas are provided along with more detailed descriptions of torus, lingual thyroid and inflammatory diseases like candidiasis and Vincent's angina.
Ulcerative, Vesicular and Bullous Lesions.pptxManuelKituzi
Ulcerative, vesicular and bullous lesions can be caused by a variety of factors including infection, trauma, allergy and systemic disorders. Herpes simplex virus is a common cause of viral infections presenting as ulcers in the mouth. Primary herpes simplex infection, also known as acute herpetic gingivo-stomatitis, presents with fever and malaise followed by the development of small vesicles that rupture leaving shallow ulcers around 2-6mm in size, often affecting the palate, gums and tongue. The document describes the clinical features and management of various ulcerative conditions of the mouth.
This document discusses the spread of oral infections. It begins by defining infection and explaining how the balance between host, organism, and environment determines whether disease occurs. It then describes various ways infections can originate and spread from dental sources, such as through root canals or periodontal tissues. Specific conditions that can result from spread are discussed like cellulitis, osteomyelitis, and ludwig's angina. The routes of spread via lymphatic, blood, or direct tissue routes are also covered. Finally, it examines the anatomy of various facial spaces and how infections may disseminate between these spaces.
This document discusses space infections that can arise from dental infections. It defines fascial spaces and outlines the pathways of odontogenic (dental) infections. It describes different classifications of infections including by location (e.g. maxillary vs mandibular spaces), etiology, and causative organisms. Specific spaces that can become infected are discussed such as the canine, buccal, and infratemporal fossa. Clinical features, treatment including incision and drainage, and potential spread are covered for each space.
Syphilis is caused by the spirochete Treponema pallidum. It is transmitted through direct contact with lesions and has four stages: primary, secondary, latent, and tertiary. The primary lesion is a painless chancre. Secondary syphilis causes a rash and mucous patches. Latent syphilis is asymptomatic but infectious. Tertiary syphilis can cause damage to internal organs. Proper barrier techniques prevent transmission. Diagnosis involves serological tests and darkfield microscopy of lesions. Psoriasis is a chronic inflammatory skin condition affecting about 3% of the population. It has numerous clinical manifestations and is strongly familial. Treatment ranges from topical agents to systemic immunosup
This document provides an overview of lichen planus, specifically oral lichen planus (OLP). It discusses the history, epidemiology, definition, etiology, predisposing factors, clinical features, clinical variants (reticular, erosive, atrophic, plaque-like, papular, bullous), and histopathology of OLP. OLP is a chronic immunological mucocutaneous disorder that commonly presents as white striations or plaques on the oral mucosa. It is believed to be mediated by T-cells that trigger apoptosis of epithelial cells, though the exact cause is still unknown.
Premalignant & malignant diseases of oral cavity ii nMohammad Manzoor
1) Leukoplakia and erythroplakia are common precancerous oral lesions caused by factors like tobacco, alcohol, and HPV infection. Leukoplakia has a 3-25% risk of transforming into oral cancer while erythroplakia has over a 50% risk.
2) Oral cancers are usually squamous cell carcinomas that occur late in life, commonly on the lips, tongue, and floor of mouth. Risk factors include tobacco, alcohol, HPV infection and leukoplakia/erythroplakia. Prognosis is best if caught early but many cases are advanced at discovery.
3) Common benign salivary gland tumors
This document discusses several oral infections including syphilis, tuberculosis tongue ulcer, and actinomycosis. It provides details on the causative agents, clinical presentation, diagnosis, and treatment of each condition. Syphilis is caused by Treponema pallidum and presents in primary, secondary, and tertiary stages. Tuberculosis tongue ulcers are a rare manifestation of Mycobacterium tuberculosis infection. Actinomycosis is caused by Actinomyces bacteria and usually occurs following dental procedures or trauma. The document includes a case report demonstrating diagnosis of tuberculous glossitis.
This document provides an overview of endodontic diseases. It discusses the etiology, classification, and pathogenesis of pulpal diseases. The main causes of pulpal disease are microbial, mechanical, and chemical irritants that can cause inflammation of the dental pulp. Pulpal diseases range from reversible inflammation to total necrosis of the pulp and can spread to cause periradicular lesions if left untreated. The document compares various classification systems for pulpal diseases and conditions. It also examines the histological, hemodynamic, and neural changes that occur as part of the inflammatory response in the dental pulp.
Commonest diseases and tumours of oral cavitySarab Ji
This document summarizes diseases of the oral cavity, including developmental anomalies, tumors and cysts, teeth and periodontal diseases, and epithelial cysts of the jaw. It provides details on conditions like cleft lip/palate, leukoplakia, dental caries, periodontitis, and radicular cyst. Developmental anomalies can result from genetic or environmental factors and include conditions affecting the tongue, like macroglossia and ankyloglossia. Dental caries is caused by plaque acids demineralizing enamel and dentin. Untreated caries can lead to pulpitis and periapical abscesses. Leukoplakia is a precancerous white patch caused by hyperker
This document provides an overview of diseases of the oral cavity, including developmental anomalies, tumors and cysts, teeth and periodontal diseases, and epithelial cysts of the jaw. It discusses conditions like cleft lip/palate, Fordyce's granules, leukoplakia, dental caries, periodontitis, and radicular and dentigerous cysts among others. Key information includes the etiology, pathogenesis, clinical features, and microscopic findings of various oral diseases.
Necrotizing ulcerative gingivitis and necrotizing ulcerative periodontitisyeahlifehai
This document provides an overview of necrotizing ulcerative gingivitis (NUG) and necrotizing ulcerative periodontitis (NUP). It discusses the history and epidemiology of these conditions, describing outbreaks among military troops. Clinically, NUG presents as ulcerated and necrotic gingival tissue with characteristic punched out lesions. Untreated, it can progress to involve the underlying bone as NUP. Predisposing factors include poor oral hygiene, preexisting gingivitis, smoking, nutritional deficiencies, systemic illnesses, fatigue, stress and immunodeficiencies. Microorganisms play a role in conjunction with an impaired host response.
A case study discusses the non-surgical management of a large periapical radiolucency in a patient. The radiolucency was associated with the lower left first molar. The tooth was treated with root canal therapy and calcium hydroxide dressing, which resulted in gradual healing of the lesion over 6 months as seen on follow-up radiographs.
A dentist, Dr. Roshni Maurya, performed a surgical extraction of a supernumerary tooth for a patient. Supernumerary teeth are extra teeth that form in addition to the normal set of 32 teeth. The procedure involved surgically removing the extra tooth to prevent crowding and alignment issues with the other teeth.
A dentist, Dr. Roshni Maurya, performed a surgical extraction of a dilacerated tooth for a patient. The tooth had significant damage and twisting that made a normal extraction impossible. The surgery required incisions, bone removal, and careful extraction to remove the damaged tooth and close the extraction site.
A dentist treated a patient who had fractured their central incisor tooth. The tooth fragment was retrieved and reattached to the remaining portion of the tooth using dental adhesive cement. With proper follow up care, the reattached tooth fragment healed securely in place and the patient was able to keep their natural tooth.
Dr. Maurya, I have a patient who came in with a tooth that was knocked out during a soccer game. The tooth was placed in milk immediately after the injury. It has been about 2 hours since the injury occurred. The tooth looks in good condition. I would like to attempt reattachment. Please evaluate the tooth and advise on the best approach.
This dental record involves a pulpectomy procedure and stainless steel crown for tooth number 3. The treating dentist was Dr. Roshni Maurya. The procedure and crown placement appear to have been for a child patient based on the treatment involved and brevity of the record.
This dental record involves a pulpectomy procedure and stainless steel crown for tooth number 2. The pulpectomy was performed by Dr. Roshni Maurya to remove the infected or damaged pulp from the tooth. Following the pulpectomy, a stainless steel crown was placed on the tooth.
A dental case involves a pulpectomy procedure and stainless steel crown for tooth number 1. Dr. Roshni Maurya will perform the pulpectomy and place the stainless steel crown on the first tooth as part of dental case 1. The brief dental note indicates the necessary treatment and responsible dentist for the specified case.
Dr. Maurya, I have completed the pulpectomy on tooth #19. Upon accessing the tooth, I found a large carious lesion extending subgingivally. After removing all of the carious dentin, I was able to locate the canal orifices. I instrumented and shaped the canals using ProTaper Gold rotary files up to F3. I copiously irrigated the canals with 5.25% sodium hypochlorite solution. Once the canals were shaped, I dried them with paper points and filled them with gutta percha and AH Plus sealer using the lateral compaction technique. Post-op radiograph shows satisfactory filling of the canals. Please review and let me
Dr. Maurya, I have reviewed the radiographs and clinical examination findings for Pulpectomy Case 1. The patient is a 12-year-old male who presents with pain on biting in tooth #30. Clinical examination revealed deep carious lesion involving the pulp with no response to cold test and electric pulp test. Radiographic examination showed radiolucency extending from the pulp chamber involving more than half of the root length. Based on the clinical and radiographic findings, I would recommend performing pulpectomy of tooth #30 under local anesthesia. The procedure would involve access opening, removal of inflamed/necrotic pulp tissue, shaping and cleaning of the root canal system and obturation. Post-operative instructions would include pain
A case report discusses orthodontic extrusion of an impacted tooth. Dr. Roshni Maurya presents a case where an impacted tooth was extruded into the dental arch using orthodontic forces alone, without any surgical exposure or intervention. The impacted tooth was successfully brought into functional occlusion through controlled orthodontic forces over a period of 6 months, providing a minimally invasive treatment option for such cases.
Dr. Maurya, I have reviewed the case of orthodontic extrusion you referred. The patient is a 15-year-old female who presented with a deep overbite and gingival recession on her lower front teeth. Clinical and radiographic examination revealed that teeth #24 and #25 had grade II mobility with 4-5 mm of bone loss. Considering the patient's age and esthetic concerns, I recommend controlled orthodontic extrusion of teeth #24 and #25 over a 6 month period using fixed appliances. This approach will help reduce the overbite, close spaces, and allow for regeneration of lost periodontium and bone. Please let me know if you need any other information or have additional questions.
Oligodontia is a rare dental condition characterized by the congenital absence of six or more teeth, excluding the third molars (wisdom teeth). It can occur as an isolated finding or as part of a syndrome. The most common teeth missing are the mandibular premolars and maxillary lateral incisors. Treatment involves replacement of missing teeth with either removable or fixed partial dentures, dental implants, or a combination of these modalities. Prognosis depends on the severity and extent of missing teeth as well as presence of other associated medical conditions.
A case report discusses an impacted supernumerary tooth. Supernumerary teeth are extra teeth beyond the normal dental formula. This case involved an impacted supernumerary tooth located in the maxilla of a 12-year old patient that required surgical removal.
Fixed habit breaking appliance case 1 blue grass applianceDr. Roshni Maurya
This document appears to be about a case involving a fixed habit breaking appliance. It mentions "Case 1 Blue grass appliance" and lists "Dr. Roshni Maurya" possibly as the doctor involved. The summary provides the essential information from the brief document in 3 sentences.
A patient presented with an extra oral sinus. Dr. Roshni Maurya examined the case. The document appears to be a medical record involving a patient with an abnormal opening in the skin (extra oral sinus) that was examined by Dr. Roshni Maurya.
This document discusses a case of cross bite correction. Dr. Roshni Maurya appears to be the treating orthodontist. The case involves correcting a malocclusion where the upper teeth are positioned behind the lower teeth known as a cross bite.
The document discusses a case handled by Dr. Roshni Maurya related to a patient's biological crown. Few details are provided in the short document, but it seems to reference a medical case involving a dental procedure or issue with a patient's natural tooth structure. The document does not contain enough contextual information to provide further specifics about the nature of the case or the outcome.
This document discusses a case involving apexification with mineral trioxide aggregate (MTA). Apexification is a method to induce formation of new hard tissue in the root canal space when it is incompletely formed or damaged. MTA is a biocompatible material that can be used for apexification to encourage hard tissue formation and seal the root canal system.
A patient presented with a fracture of their anterior teeth. The patient reported that they had fallen and hit their face, causing the fracture. After examining the teeth, it was determined that a root canal treatment and crown placement was needed to restore the fractured tooth.
2024 Media Preferences of Older Adults: Consumer Survey and Marketing Implica...Media Logic
When it comes to creating marketing strategies that target older adults, it is crucial to have insight into their media habits and preferences. Understanding how older adults consume and use media is key to creating acquisition and retention strategies. We recently conducted our seventh annual survey to gain insight into the media preferences of older adults in 2024. Here are the survey responses and marketing implications that stood out to us.
Test bank clinical nursing skills a concept based approach 4e pearson educati...rightmanforbloodline
Test bank clinical nursing skills a concept based approach 4e pearson education
Test bank clinical nursing skills a concept based approach 4e pearson education
Test bank clinical nursing skills a concept based approach 4e pearson education
Enhancing Hip and Knee Arthroplasty Precision with Preoperative CT and MRI Im...Pristyn Care Reviews
Precision becomes a byword, most especially in such procedures as hip and knee arthroplasty. The success of these surgeries is not just dependent on the skill and experience of the surgeons but is extremely dependent on preoperative planning. Recognizing this important need, Pristyn Care commits itself to the integration of advanced imaging technologies like CT (Computed Tomography) and MRI (Magnetic Resonance Imaging) into the surgical planning process.
nursing management of patient with Empyema pptblessyjannu21
prepared by Prof. BLESSY THOMAS, SPN
Empyema is a disease of respiratory system It is defines as the accumulation of thick, purulent fluid within the pleural space, often with fibrin development.
Empyema is also called pyothorax or purulent pleuritis.
It’s a condition in which pus gathers in the area between the lungs and the inner surface of the chest wall. This area is known as the pleural space.
Pus is a fluid that’s filled with immune cells, dead cells, and bacteria.
Pus in the pleural space can’t be coughed out. Instead, it needs to be drained by a needle or surgery.
Empyema usually develops after pneumonia, which is an infection of the lung tissue. it is mainly caused due in infectious micro-organisms. It can be treated with medications and other measures.
Emotional and Behavioural Problems in Children - Counselling and Family Thera...PsychoTech Services
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R3 Stem Cell Therapy: A New Hope for Women with Ovarian FailureR3 Stem Cell
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The Ultimate Guide in Setting Up Market Research System in Health-TechGokul Rangarajan
How to effectively start market research in the health tech industry by defining objectives, crafting problem statements, selecting methods, identifying data collection sources, and setting clear timelines. This guide covers all the preliminary steps needed to lay a strong foundation for your research.
"Market Research it too text-booky, I am in the market for a decade, I am living research book" this is what the founder I met on the event claimed, few of my colleagues rolled their eyes. Its true that one cannot over look the real life experience, but one cannot out beat structured gold mine of market research.
Many 0 to 1 startup founders often overlook market research, but this critical step can make or break a venture, especially in health tech.
But Why do they skip it?
Limited resources—time, money, and manpower—are common culprits.
"In fact, a survey by CB Insights found that 42% of startups fail due to no market need, which is like building a spaceship to Mars only to realise you forgot the fuel."
Sudharsan Srinivasan
Operational Partner Pitchworks VC Studio
Overconfidence in their product’s success leads founders to assume it will naturally find its market, especially in health tech where patient needs, entire system issues and regulatory requirements are as complex as trying to perform brain surgery with a butter knife. Additionally, the pressure to launch quickly and the belief in their own intuition further contribute to this oversight. Yet, thorough market research in health tech could be the key to transforming a startup's vision into a life-saving reality, instead of a medical mishap waiting to happen.
Example of Market Research working
Innovaccer, founded by Abhinav Shashank in 2014, focuses on improving healthcare delivery through data-driven insights and interoperability solutions. Before launching their platform, Innovaccer conducted extensive market research to understand the challenges faced by healthcare organizations and the potential for innovation in healthcare IT.
Identifying Pain Points: Innovaccer surveyed healthcare providers to understand their difficulties with data integration, care coordination, and patient engagement. They found widespread frustration with siloed systems and inefficient workflows.
Competitive Analysis: Analyzed competitors offering similar solutions in healthcare analytics and interoperability. Identified gaps in comprehensive data aggregation, real-time analytics, and actionable insights.
Regulatory Compliance: Ensured their platform complied with HIPAA and other healthcare data privacy regulations. This compliance was crucial to gaining trust from healthcare providers wary of data security issues.
Customer Validation: Conducted pilot programs with several healthcare organizations to validate the platform's effectiveness in improving care outcomes and operational efficiency. Gathered feedback to refine features and user interface.
The Importance of Black Women Understanding the Chemicals in Their Personal C...bkling
Certain chemicals, such as phthalates and parabens, can disrupt the body's hormones and have significant effects on health. According to data, hormone-related health issues such as uterine fibroids, infertility, early puberty and more aggressive forms of breast and endometrial cancers disproportionately affect Black women. Our guest speaker, Jasmine A. McDonald, PhD, an Assistant Professor in the Department of Epidemiology at Columbia University in New York City, discusses the scientific reasons why Black women should pay attention to specific chemicals in their personal care products, like hair care, and ways to minimize their exposure.
Fit to Fly PCR Covid Testing at our Clinic Near YouNX Healthcare
A Fit-to-Fly PCR Test is a crucial service for travelers needing to meet the entry requirements of various countries or airlines. This test involves a polymerase chain reaction (PCR) test for COVID-19, which is considered the gold standard for detecting active infections. At our travel clinic in Leeds, we offer fast and reliable Fit to Fly PCR testing, providing you with an official certificate verifying your negative COVID-19 status. Our process is designed for convenience and accuracy, with quick turnaround times to ensure you receive your results and certificate in time for your departure. Trust our professional and experienced medical team to help you travel safely and compliantly, giving you peace of mind for your journey.www.nxhealthcare.co.uk
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPTblessyjannu21
Prepared by Prof. BLESSY THOMAS, VICE PRINCIPAL, FNCON, SPN.
Emphysema is a disease condition of respiratory system.
Emphysema is an abnormal permanent enlargement of the air spaces distal to terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis.
Emphysema of lung is defined as hyper inflation of the lung ais spaces due to obstruction of non respiratory bronchioles as due to loss of elasticity of alveoli.
It is a type of chronic obstructive
pulmonary disease.
It is a progressive disease of lungs.
The facial nerve, also known as cranial nerve VII, is one of the 12 cranial nerves originating from the brain. It's a mixed nerve, meaning it contains both sensory and motor fibres, and it plays a crucial role in controlling various facial muscles, as well as conveying sensory information from the taste buds on the anterior two-thirds of the tongue.
This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
This particular slides consist of- what is Pneumothorax,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is a summary of Pneumothorax:
Pneumothorax, also known as a collapsed lung, is a condition that occurs when air leaks into the space between the lung and chest wall. This air buildup puts pressure on the lung, preventing it from expanding fully when you breathe. A pneumothorax can cause a complete or partial collapse of the lung.
1. Ulcerative lesions of oral cavity
Presented by: ROSHNI MAURYA,2ND YEAR PGT
DEPT. OF PEDODONTICS & PREVENTIVE
DENTISTRY,GNIDSR
2. INTRODUCTION
• Injury to the oral mucosa may result in a localized defect of the
surface in which the covering epithelium is destroyed leaving an
inflammed area of exposed connective tissue.
• Such defects are called ulcers or erosions (term commonly used for
superficial ulcer)
• This may either follow molecular death of surface epithelium or its
traumatic removal.
• Ulceration is the most common lesion of oral mucosa and is the
manifestation for many local and genetic disorders.
3. What is an ulcer?
• Latin origin ULCUS means break in the skin.
• A mouth or oral ulcer is an open sore in the mouth, or
rarely a break in the mucous membrane or the epithelium
on the lips or surrounding the mouth.
4. • The surface of an ulcer is covered by mass of fibrin with
intermingled, dead and dying polymorphs which would dry on
the skin to form a crust or scab.
• A superficial ulcer with no evidence of significant fibrinous
exudation on the surface of polymorph exudation suggests the
possibility of bullous disorder.
• A heavy inflammatory infiltrate extends deep into the
underlying connective tissue n blood vessels may show slight
inflammatory vasculitis.
• Granulation tissue is formed with dilated blood vessels and
heavy infiltrate of plasma cells, lymphocytes and polymorphs.
5. PARTS OF AN ULCER
• Ulcer consists of:
1. Edge:- area between the margin and floor of ulcer.This
is an important finding of an ulcer which by itself not
only gives clue to diagnosis ulcer but also to the
condition of ulcer.
2. Floor:- this is the exposed part of an ulcer. The covering
of floor is important.
3. Base (on which the ulcer rests):- floor is the exposed
surface of an ulcer whereas the base is on which the
ulcer rests. Floor is seen but the base is felt.
4. Margin:- it’s the point where the ulcer joins the normal
epithelial tissue.
6. Parts of an ulcer :Davis et al. Symptom Analysis
and Physical Diagnosis (2nd edn), p. 309
7. The classic appearances of various ulcers are presented
. Infective ulcers due to Mycobacterium species, and bed sores, tend to have an undermined edge
while a trophic ulcer is punched out and typically round in surface shape. A raised firm ulcer edge
may indicate malignancy
8. • Histological examination
shows an ulcer covered
by thick layer of fibrous
exudate with a dense,
chronic inflammatory
cell infiltrate in its base
involving underlying
damaged muscle.
• The deeper parts
contain infiltrate rich in
histiocytes and
eosinophils.
• True granulomas are not
present.
20. • The most widely accepted form divides them into acute
ulcers--sudden onset and short lasting—and
• chronic ulcers--insidious onset and long lasting.
• Commonest acute oral ulcers include traumatic ulcer,
recurrent aphthous stomatitis, viral and bacterial infections
and necrotizing sialometaplasia.
• On the other hand, oral lichen planus, oral cancer, benign
mucous membrane pemphigoid, pemphigus and drug-
induced ulcers belong to the group of chronic oral ulcers.
21. Epidemiology and Frequency
• Mouth ulcer is a very common oral lesion.
Epidemiological studies show an average
prevalence between 15% and 30%. Mouth ulcers
tend to be more common in women and those
under 45.
• The frequency of mouth ulcers varies from fewer
than 4 episodes per year (85% of all cases) to more
than one episode per month (10% of all cases)
including people suffering from continuous
recurrent aphthous stomatitis .
22. Epidemiology of the most common
oral mucosal diseases in children
• The lesions most frequently considered by authors and that most
often appear in the different studies are: recurrent aphthous
stomatitis (0.9-10.8%), labial herpes (0.78-5.2%), fissured tongue
(1.49-23%), geographic tongue (0.60-9.8%), oral candidiasis (0.01-
37%) and traumatic injury (0.09%-22.15%).
• {Med Oral Patol Oral Cir Bucal 2005 Nov-Dec;10(5):376-87}
23. Diagnostic Tools for Oral Mucosa Lesions
Andrea Santarelli, DDS; and Lorenzo Lo Muzio, PhD, MD July 2012 Issue -
Expires July 31st, 2015 Inside Dentistry -
• Lesions of the oral mucosa represent a diagnostic challenge for dental
practitioners, because similar appearances are the final common
manifestation of a wide spectrum of conditions, including autoimmune
diseases; neoplastic, traumatic, or infectious lesions; nutritional
deficiencies; and drug reactions, as well as oral manifestations of systemic
diseases. One of the roles of dental practitioners is the identification and
management of oral mucosa diseases. While the diagnosis of some oral
lesions can be made on the basis of the history and/or clinical findings, for
others, the definitive diagnosis requires the aid of some tools with which
the general dentist should be familiar. -
24. Tools for diagnosis:
• History
• Examination
• Further investigation
• Additional diagnostic methods – biopsy
25. Further investigation – questions
one should ask:
• How long have you had that ulcer?
• How many ulcers do you have?
• Is it painful?
• Can you relate them to any trauma, hot food or
another factors?
• Is it the first time or you had them before?
• Where are they located in the mouth?
• Do they start as ulcer or as vesicle/bulla?
• Do you get them anywhere else on the body?
26. Things one need to look for:
• Site
• Number
• Size
• Shape
• Base
• Edge
27. Differential diagnostic, based on history
• How long have you had the ulcer?
Long time – chronic
1. Chronic trauma (single, can identify the cause, and
should improve after removal)
2. Malignancy (single, painless)
3. TB (single ulcer in the tongue/palate, associated
symptoms – chronic cough)
4. Mucous membrane pemphigoid (multiple ulcers affect
mainly gingiva, blood filled blisters)
5. Primary or tetriary syphilis
28. Recent – acute
1. Acute trauma (single, can identify the cause, and
should improve after removal)
2. Viral infection (multiple, associated symptoms –
fever)
3. Immune mediated disease (Erythema multiforme,
RAS)
29. How many ulcers do you have?
• Single
1. Traumatic
2. Primary or tetriary syphilis
3. TB
4. Malignancy
• Multiple
1. Viral infection
2. Immune mediated disease
30. Is it painful?
• Yes
Acute causes (trauma, viral, immune mediate)
• No
Chronic causes (trauma, TB)
31. Can you relate them to trauma or hot food?
• Yes
1. Confirm traumatic ulcer
2. Remove the cause
3. Review after 1 week
• No
Look for other causes
32. Do you get them anywhere else on the body?
• No
Think of oral conditions
• Yes – where?
1. Skin – mucocutaneous disease (lichen planus,
pemphigus)
34. Traumatic ulcers :
1- Physical Trauma:
- Physical traumatic ulcers are common oral lesions.
- Can be caused by a sharp or broken tooth, rough fillings, dental
instruments, biting, denture irritation, dental braces; sharp
foreign bodies, etc.
Ulcerative lesions
1) Local Causes:
37. 1- Physical Trauma:
Clinical features:
-They are clinically diverse, but usually appear as a single, painful
ulcer with a smooth red or whitish-yellow surface and a thin
erythematous halo. They are usually soft on palpation, and heal
without scarring within 6–10 days, spontaneously or after removal
of the cause.
Ulcerative lesions
Traumatic ulcers
1) Local Causes:
38. 1- Physical Trauma:
Clinical features:
- However, chronic traumatic ulcers may clinically mimic a carcinoma.
-The tongue, lip, and buccal mucosa are the sites of predilection.
-The diagnosis is based on the history and clinical features. However,
if an ulcer persists over 10–12 days a biopsy must be taken to rule
out cancer.
Ulcerative lesions
Traumatic ulcers
1) Local Causes:
40. Ulcerative lesions
Traumatic ulcers
1- Physical Trauma:
Differential diagnosis Squamous-cell carcinoma and other
malignancies, aphthous ulcer, syphilis, tuberculosis.
Treatment Removal of traumatic factors. Topical steroids may be
used for a short time.
41. Ulcerative lesions
Traumatic ulcers
2- Chemical trauma:
-Oral ulcers may arise with local application of Aspirin (Salicylic Acid),
-Clinical features:
- It appears as a red, painful erythema that may undergo
desquamation, leaving erosions.
-The lesions heal spontaneously in about a week.
-The diagnosis is made exclusively on clinical grounds.
42. Chemical (Aspirin burn) ulceration:
-The photos show a patient who placed
an aspirin on her gums. Aspirin is an
acid and burned the oral tissues (gums
and cheek).
- Fortunately the mouth heals quickly
and within two weeks healing
occurred.
43. Ulcerative lesions
Traumatic ulcers
2- Chemical trauma:
Differential diagnosis
- Thermal burn, traumatic lesions, aphthous ulcers, drug reactions.
Treatment
- Discontinue the application of the causative agent.
44. RADIATION TRAUMATIC ULCERATION
• Oral mucosa may suffer immediate
damage due to direct effects of radiation
on cells or delayed effects due to
epithelial atrophy and damage to
underlying vascular bed during
radiotherapy of head n neck cancer.
• The immediate effects are erythema,
radiation mucositis and ulceration.
• Oedema due to obstruction of regional
lymphatics may occur.
• Radiation ulcers are painful.
45. EOSINOPHILIC ULCER
• Its also referred to as traumatic granuloma or
eosinophilic granuloma of tongue.
• It is particularly associated with trauma n injury
although the pathogenesis is unclear.trauma may
be due to missing,malposed teeth,partial denture
or more commonly,erupting teeth during nursing
which results in sublingual ulcerations in infants.
• It occurs most commonly on the tongue and
presents clinically as chronic, well demarcated
ulcer which may mimic a sq. Cell carcinoma.
46.
47. 2-Recurrent Aphthous Stomatitis
Ulcerative lesions
- Recurrent aphthous ulcers are among the most common oral mucosal lesions, with
a prevalence of 10–30% in the general population.
-The cause remains unclear. Recent evidence supports the concept that cell-mediated
immune responses play a primary role in the pathogenesis.
- Several predisposing factors have been reported, such as trauma, allergy, genetic
predisposition, endocrine disturbances, emotional stress, hematological ,nutritional
deficiencies, and AIDS.
-Three clinical variations have been recognized: minor, major and herpetiform ulcers.
-They are very painful and cause the patient a lot of discomfort.
48. Herpetiform recurrent Aphthous Stomatitis
-The herpetiform variation is characterized by small, painful, shallow ulcers, 1–2 mm
in diameter, with a tendency to coalesce into larger irregular ulcers.
- Characteristically, the lesions are multiple (10–100), persist for one or two weeks,
and heal without scarring.
- usually in old age group, common in females.
Ulcerative lesions
2-Recurrent Aphthous Stomatitis
50. Minor recurrent Aphthous Stomatitis
-Minor aphthae are the most common form, and they present clinically
as small, painful, round ulcers 3–6 mm in diameter, covered by a
whitish-yellow membrane and surrounded by a thin red halo.
-The lesions may be single or multiple (two to six), and they heal
without scarring in 7–14 days.
- Mainly found in on the non-keratinized mobile mucosa, lips, cheeks,
floor of the mouth.
Ulcerative lesions
2-Recurrent Aphthous Stomatitis
52. Major recurrent Aphthous Stomatitis
-The major form is characterized by deep painful ulcers, 1–2 cm in
diameter, that persist for 3–6 weeks and may cause scarring.
- The number of lesions varies from one to ten.
- Found in any area of the mucosa, including keratinized dorsum of
the tongue, palate.
Ulcerative lesions
2-Recurrent Aphthous Stomatitis
58. Primary herpetic gingivostomatitis
• Most common cause of severe oral ulceration in
children.
• Caused by simplex type 1 virus
• Usually occurs after 6 months of age.
• Peak incidence: b/w 12 & 18 months of age
• Incubation time:3-5 days with a prodromal 48 hour
history of irritability, pyrexia and malaise
• Child is often unwell, has difficulty in eating and
drinking and typically drools.
59. Clinical features
• Stomatitis is present
• Gingival tissues becoming red & oedematous
• Intra-epithelial vesicles appear; rapidly breakdown to
form painful ulcers.
• Vesicles may form on any part of the oral mucosa,
including the skin around the lips
• Solitary ulcers are usually small (3mm);painful with
an erythematous margin, but larger ulcers with
irregular margins often result from the coalescence
of individual lesions.
• Disease is self –limiting and the ulcers heal
spontaneously without scarring within 10-14 days.
60.
61. Diagnosis:
• History & clinical features
• Exfoliative cytology
• Viral antigen can be detected by PCR
amplification.
• Viral culture
• Viral antibody detection in blood samples
62. Management
• Symptomatic care
• Encourage oral fluids
• Analgesics
• Mouthwashes for older children : CHX gluconate
,0.2%, 10 ml 4- hourly.
• Topical anaesthetics: lidocaine viscous 2% or
lidocaine (xylocaine) spray
• Antiviral chemotherapy
64. Clinical features
• -prodrome ,milder than herpes simplex (fever
,anorexia ,malaise)
• -sore throat ,dysphagia
• -ulcers mainly at post .area of oral cavity (soft
palate ,fauces ,tonsils ,posterior pharynx)
• -ulcers smaller than herpes
• -at post area and more painful.
• -no marginal gingivitis
• -mainly in epidemics
65. -Hand- foot and mouth
disease
Caused by
coxsackie virus
A16,from 8
months to 33 years
,75%under 4 years.
66. Clinical features
• -low grade fever
• -oral vesicles and ulcers more extensive than
herpes(mainly palate ,buccal mucosa)
• -macules and papules on extensor surface of
hand and feet.
• -examine hands and feet for maculopapular
lesions and vesicles if there is acute
stomatitis and fever
67. Infectious mononucleosis
• Caused by Epstein –Barr virus (EBV)
• Mainly affects older adolescents and young adults.
• Disease is highly infective and is characterized by
malaise, fever and acute pharyngitis.
• In young children, ulcers and petechiae are often
found in posterior pharynx and soft palate.
• Disease is self limiting
68. Diagnosis
• History & clinical features
• Paul –Bunnell agglutination test and atypical
monocytes on blood film
69. Varicella
• A highly contagious virus causing chickenpox in younger
subjects and shingles in older individuals.
• There is prodromal phase of malaise and fever for 24
hours followed by macular eruptions and vesicles.
• In chickenpox, oral lesions occur in around 50% of cases
but only a small number of vesicles occur in the mouth
• These lesions may be found anywhere in the mouth in
addition to other mucosal sites such as conjunctivae,
nose or anus .
• Healing of oral lesions is uneventful
71. Human Herpes virus-8 (HHV-8)
-The causative microbe for Kaposi’s sarcoma (KS).
-Kaposi sarcoma is a malignant neoplasm of endothelial cell
origin.
-Four forms of KS are recognized:
Classic, African (endemic), Immunosuppression-associated
(iatrogenic) and
AIDS-related (epidemic): This has a high incidence among AIDS
patients, primarily involves the skin, lymph nodes, viscera, and
frequently the oral mucosa.
72. Human Immunodeficiency Virus (HIV)
- A minority of patients with severe HIV disease will develop
deep, necrotic ulcers of unknown aetiology.
- These ulcers are painful, cause profound dysphagia and can
arise on any oral mucosal surface, although the buccal and
pharyngeal mucosa are the more commonly affected sites.
73. Human Immunodeficiency Virus (HIV)
-The ulcers typically resolve with systemic thalidomide
(e.g. 200 mg daily)
- Small number of patients with HIV disease may have
ulcers similar to that of recurrent aphthous stomatitis
(RAS), although whether the frequency of RAS in HIV is
truly increased remains unclear.
76. i) Acute Necrotizing Ulcerative Gingivitis (ANUG)
-This entity used to be called "Trench Mouth" because of its
prevalence in soldiers fighting in the trenches during world
war I.
- Etiology: Fusobacterium nucleatum, Treponema
vincentii, and probably other bacteria play an important
role.
- Predisposing factors are emotional stress, smoking, poor
oral hygiene, local trauma, and mainly HIV infection.
77. Clinical features
The characteristic clinical feature is painful necrosis of the
interdental papillae and the gingival margins, and the
formation of craters covered with a gray pseudomembrane.
- Spontaneous gingival bleeding, halitosis, and intense
salivation are common. Fever, malaise, and
lymphadenopathy are less common.
-Rarely, the lesions may extend beyond the gingiva
(necrotizing ulcerative stomatitis).
-The diagnosis is made at the clinical level.
79. - Differential diagnosis
- Herpetic gingivitis, Desquamative gingivitis,Agranulocytosis,
leukemia.
- Treatment
Systemic metronidazole and oxygen-releasing agents topically are
the best therapy in the acute phase, followed by a mechanical
gingival treatment.
80. ii) Syphilis
- Syphilis is a relatively common sexually transmitted disease.
- Etiology Treponema pallidum.
-Clinical features: Syphilis may be acquired (common) or
congenital (rare).
- Acquired syphilis is classified as primary, secondary and
tertiary.
81. Clinical features:
-The characteristic lesion in the primary stage is the chancre
that appears at the site of inoculation, usually three weeks after
the infection.
- Oral chancre appears in about 5–10% of cases, and clinically
presents as a painless ulcer with a smooth surface, raised
borders, and an indurated base.
- Regional lymphadenopathy is a constant finding.
82. Solitary chancre on the ventral surface of
the tongue
Two chancres on the tongue
83. - Differential diagnosis
Traumatic ulcer, aphthous ulcer, tuberculosis, herpes
simplex, candidiasis, erythema multiforme, lichen
planus.
-Treatment
Penicillin is the antibiotic of choice. Erythromycin or
Cephalosporins are good alternatives.
84. iii) Tuberculosis
-Tuberculosis is a chronic, granulomatous,
infectious disease that primarily affects the lungs.
- Etiology
-Mycobacterium tuberculosis.
85. •Clinical features
- The oral lesions are rare, and usually secondary to
pulmonary tuberculosis.
- The tuberculosis ulcer is the most common feature.
- Clinically, the ulcer is painless and irregular, with a
thin undermined border and a vegetating surface,
usually covered by a gray-yellowish exudate.
- The dorsum of the tongue is the most commonly
affected site, followed by the lip, buccal mucosa,
and palate.
88. Leprosy
• Children are deemed more susceptible to leprosy
because of their immature immune systems.
Mycobacterium leprae is a member of the same
family of organisms found to cause tuberculosis.
• The disease affects multiple systems and organs of
the body such as the nerves leading to muscle
weakness, the liver, kidneys, eyes resulting in
blindness, lymph nodes, bones, and joints. The bones
are resorbed and deformity occurs.
89. Oral Manifestations
• The oral manifestations of leprosy may be present in
19% to 60% of patients. Shambulingappa, et al. (2012)
states that the oral examination is neglected in most
leprosy clinics today.
• When oral lesions appear, they usually occur in the LL
form (disseminative and progressive lepromatous
form). This form presents with the most severe effects
on the body. The second form is the tuberculoid form
(TT), and this form is less contagious. Combinations of
both types may also occur. Oral lesions occur in the
palate intraorally, but may manifest as skin lesions
periorally affecting the lips. The lips present as
macrocheilia and exhibit flat-topped nodules.
90. • Other oral lesions may occur causing superficial ulcers,
candidiasis, fissured tongue, and loss of papillae,
glossitis, and swellings.
• Treatments for leprosy include antibiotics, anti-
inflammatory medications, steroids, thalidomide, or
combinations of MRD therapy, depending upon the
type and extent of the leprosy. Often, pain and
ulceration are treated as other complications would
be treated to relieve discomfort.
91. • The World Health Organization estimates
approximately 182,000 cases world wide in 2012,
with elimination of the disease in 119 countries out
of 122 since 1985. However, new cases have recently
been reported to have increased in India.
92. OTHER
INFEC-TIONS
CLINICAL FEATURE CAUSE SIGNIFICANCE
GONORRHEA GENITAL LESIONS WITH RARE ORAL
MANIFESTATIONS; ERYTHEMA OR
ULCERS
N.gonorrhea MAY BE CONFUSED WITH
OTHER ULCERATIVE DISEASES
TUBERCULOSIS INDURATED, CHRONIC ULCER THAT
MAY BEPAINFUL- ON ANY MUCOSAL
SURFACE
M.tuberculosis INFECTIOUS ORAL LESIONS
ARE ALWAYS RESULT OF LUNG
LESIONS
LEPROSY SKIN DISEASE WITH RARE NODULES
OR ULCERS
M.leprae COMMON IN SOUTHEAST
ASIA, INDIA, SOUTHAMERICA
ACTINOMYCOSI
S
TYPICALLY SEEN IN MANDINLE,
WOOD HARD NODULE WITH
SULFUR GRANULES
A.israelii INFECTION FOLLOWS ENTRY
THROUGH SURGICAL SITE,
PERIODONTAL DISEASE OR
OPEN ROOT CANAL
NOMA NECROTIC, NONHEALING ULCER OF
GINGIVA OR BUCCAL MUCOSA;
RARE; AFFECTS CHILDREN
ANAEROBES IN PATIENT
WHOSE SYSTEMIC HEALTH
IS COMPROMISED
OFTEN ASSOCIATED WITH
MALNUTRITION; MAY RESULT
IN TISSUE DESTRUCTION
93. 3- Fungal
Chronic Mucocutaneous Candidosis (CMC)
-Chronic mucocutaneous candidiasis (CMC) is the label
given to a group of overlapping syndromes that have in
common a clinical pattern of persistent, severe, and diffuse
cutaneous candidal infections.
-These infections affect the skin, nails and mucous
membranes
- Chronic oral candidiasis
-Related to denture stomatitis
-HIV-associated candidiasis
-Related to inhaled corticosteroid use
95. DRUG-INDUCED LESIONS
• A wide spectrum of drugs can occasionally cause
mouth lesions, by various mechanisms. Ulcers
• are common in those treated with cytotoxic drugs.
The more common examples of drug reactions
include:
• Cytotoxic agents, particularly methotrexate,producing
ulcers.
• Agents producing lichen-planus-like (lichenoid)
lesions, such as non-steroidal anti-inflammatory
agents, some antihypertensives, antidiabetics, gold
salts, antimalarials and other drugs.
96. • Agents causing local chemical burns (especially
aspirin held in the mouth).
• Agents causing erythema multiforme (especially
sulphonamides and barbiturates).
• Other drug reactions are uncommon or rare.
• Cytotoxic induced ulcers: these have a nonspecific
appearance, but are widespread and very painful.
• Lichenoid lesions: resemble lichen planus clinically
and histologically
97. Management
• Diagnosis of a drug reaction is made from the drug
history and sometimes by testing the effect of
withdrawal. Skin patch tests are, unfortunately,
rarely of real practical value.
• Treatment is to stop the causative drug and treat
the ulceration symptomatically with topical
benzydamine and, possibly, aqueous chlorhexidine.
98. Management
• Diagnosis of a drug reaction is made from the drug
history and sometimes by testing the effect of
withdrawal. Skin patch tests are, unfortunately,
rarely of real practical value.
• Treatment is to stop the causative drug and treat
the ulceration symptomatically with topical
benzydamine and, possibly, aqueous chlorhexidine.
99. Ulcerative Lichen Planus in
Childhood
• Lichen planus (LP) is an autoimmune, chronic, inflammatory
disease that affects mucosal and cutaneous tissues.
• The exact etiology is unknown, but it is believed to result
from an abnormal T cell-mediated immune response in which
basal epithelial cells are recognized as foreign because of
changes in the antigenicity of their cell surface
• Oral lichen planus (OLP) is a common disease in the middle
aged and elderly population and has a prevalence of about
0.5% to 2%.
• By contrast, oral lichen planus in childhood (OLP) is rare and it
was first reported in the 1920s.
• Oral mucosal involvement in adults itself accounts for 0.5% to
19%, while in children, it is very uncommon
100. • The oral lesions are more pleomorphic than those
of their cutaneous forms and subtypes are
categorized as reticular, papular, plaque-like,
atrophic, erosive, and bullous .
• The erosive form is extremely rare in children and
few reports on this subject have been published in
the literature.
101. • OLP in childhood was first described in 1920 and since
then only few articles have been published and most
of the studies have suggested that childhood LP is
more common in tropical countries like India(A. J.
Kanwar andD.De, “Lichen planus in childhood: report
of 100 cases,” Clinical and Experimental Dermatology,
vol. 33, pp.423–427, 2008.)
• Sharma and Maheshwari reported 50 children with LP
and with concomitant oral lesions in 15 of them and
they stated that the oral mucosa seems to be less
commonly involved in children with LP than in
adults.(R. Sharma and V. Maheshwari, “Childhood
lichen planus: a report of fifty cases,” Pediatric
Dermatology, vol. 16, no. 5, pp. 345–348, 1999.)
102. • Kanwar and Kumar reported only one case having
oral ulcerative lichen planus out of 25 patients with
cutaneous lichen planus [A. J. Kanwar andD.De,
“Lichen planus in childhood: report of 100 cases,”
Clinical and Experimental Dermatology, vol. 35, no.3,
pp. 257–262, 2010.]
103. • The difference in the prevalence of OLP in children
(0.03%) versus that of OLP in adults (0.5%–2%) is
understood by less number of associated systemic
diseases in children, autoimmune diseases, infections,
drug usage, and dental restorations in childhood; this
may reduce the risk for developing OLP in childhood [M.
Rybojad, I. Moraillon, S. Laglenne et al., “Lichen plan
del’enfant,”Annales de Dermatologie et de Venereologie,
vol. 125, no. 10, pp. 679–681, 1998.].
• Moreover, the diagnosis of OLP may be missed due to
irregular dental checkups, lack of symptoms, and
ignorance by clinicians in diagnosing the condition.[A.
Pakfetrat, A. Javadzadeh- Bolouri, S. Basir-Shabestari,
and F. Falaki, “Oral lichen planus: a retrospective study
of 420 Iranian patients,”Medicina Oral, Patologia Oral y
Cirugia Bucal, vol. 14,no. 7, pp. E315–E318, 2009.]
105. BEHÇET’S SYNDROME (Behçet’s
Disease)
• Aphthae of any of the RAS types described earlier
may rarely be a manifestation of Behçet’s syndrome
where they are associated with systemic disease,
manifesting usually with genital ulcers and uveitis.
• This rare condition affects mainly young adult males
and is most common in people from the Middle East,
Japan, China and Korea, along the ancient silk route
from Europe to the Far East.
106. Aetiology
• Behçet’s syndrome appears to have an immunogenetic
basis, with a specific association with HLA genetic type
HLA-B5101. Immuno-logical changes are like those in
aphthae. The precipitating factor is unknown but may
be Streptococcus sanguis.
• There appears to be a subset of T cells which react to
an immunostimulatory human heat shock protein with
cross-reactivity to streptococci, and produce tumour
necrosis factor (TNF) and interleukin 8 (IL-8). The
interleukin leads to the chemo-attraction of
neutrophils, which are also hyperactive and release
superoxide, leading to vasculitis.
107. Clinical Features
• Behçet’s syndrome is a multisystem disease affecting the
mouth in most cases and many other sites including,
commonly:
• Genitals: ulcers resembling oral aphthae
• Eyes: uveitis is one of the more important ocular lesions and
visual acuity is often impaired.
• Skin: erythema nodosum (painful red lumps on the shins),
various rashes may develop as well as pustules at the site of
venepuncture (pathergy).
• Joints: large joint arthropathy is not uncommon.
• Neurological system: headache, psychiatric, motor or
sensory manifestations.
• Vascular system: thrombosis of large veins may be life-
threatening.
108. Diagnosis
• Behçet’s syndrome is a clinical diagnosis, the cardinal features
being oral and genital ulceration, uveitis and erythema
nodosum. Other causes of this constellation of lesions, such as
ulcerative colitis, Crohn’s disease, mixed connective tissue
disease, lupus erythematosus and Reiter’s syndrome, must be
excluded.
• Diagnostic criteria for Behçet’s syndrome are not completely
agreed but include:
• recurrent oral ulceration
• plus two or more of the following:
• recurrent genital ulceration; eye lesions; skin lesions;
pathergy.
109. Management
• No test of reliable value, except HLA typing
• Oral ulcers: treat as for aphthae
• Systemic manifestations: immunosuppression
using, typically, corticosteroids, colchicines or
• thalidomide.
Behçet's syndrome, oral
ulceration.
110. Erythema multiforme, Stevens-Johnson
syndrome and Toxic epidermal necrolysis
• These conditions exist that present with similar
clinical signs & histological appearances.
• There is a now view that these are distinct
pathological entities and might be intiated by quite
distinct aetiological agents.
• Ailternative view: these disorders represent
different presentations of the same basic
disorder,distinguished by the severity and extent of
the lesions.
111. Erythema multiforme
• Original description of it was that of a self-limiting
but often recurrent and seasonal skin disease with
mucosal involvement limited to oral cavity.
• Lips are typically ulcerarted with blood staining and
crusting.
• Characteristics macules (‘target lesions’) occur on
the Limbs but with less involvement of the trunk or
head and neck.
• Lesions are concentric with a erythematous halo
and a central blister.
112. • Although lesions are extremely painful, th course of
illness is benign and healing uneventful.
113. Stevens-Johnson syndrome
• The condition presents with acute febrile
illness,generalized exanthema, lesions involvement the
oral cavity and a severe purulent conjunctivitis.
• Skin lesions are more extensive than those of erythema
multiforme.
• It is characterised by Vesiculobullous eruptions over the
body, in particular the trunk and severe involvement of
multiple mucuous membranes including the vulva,
penis and conjunctivia.
• Course of condition is longer and scarring may occur.
114. Toxic epidermal necrolysis (TEN)
• TEN or Lyell’s syndrome is a severe, sometimes
fatal, bullous drug –induced eruption where sheets
of skin are lost.
• It resembles third-degree burns or staphylococcal
scalded skin syndrome.
• Oral involvement is similar to SJS
115. AETIOLOGY
• Erythema multiforme is often initiated by herpes
simplex reactivation. there is some evidence that
Stevens-Johnson syndrome is initated by a
mycoplasma pneumonia infection or drug reaction.
TEN is drug-induced.
116.
117.
118. Management
• If there is a known precipating factor such as
herpes simplex infection then antivirals such as
topical acyclovir can be used as a form of
prophylaxis.
• Management is generally symptomatic and
supportive.
• Debridement of oral cavity with 0.2% CHX
gluconate or benzydamine hydrochloride and CHX
(Difflam C) is effective in removing much of the
necrotic debris from the mouth.
119. • Extensive areas of ulceration tend to be less
responsive to CHX and a minocycline mouthwash
may prove more effective.The role of systemic
steroids is controversial but they may be necessary
in severe cases requiring hospital admission.
• It also includes:
• Adequate fluid replacement and total parentral
nutrition if required.
• Pain control which may necessitate the use of
narcotics and sedation.
120. Oral manifestations of
gastrointestinal diseases
• Lesions within the jaws, oral mucosa or perioral
tissues may sometimes be seen as manifestations of
gastrointestinal (GI) diseases.
• The oral lesions may occasionally occur before the
onset of GI disease, be present during the disease
process or persist even after the disease has
resolved. Sometimes the oral lesions are similar to
GI lesions, while at other times, the oral changes are
caused by systemic alterations secondary to GI
disease, such as those related to malabsorption.
121. Crohn’s disease
• Dupuy et al (3) found that only 0.5% of their patients with Crohn’s
• disease developed oral lesions, and these patients were more likely
• to also have anal and esophageal lesions. There is a predilection for
• males and onset in youth. Occasionally, the oral manifestations
• may be the first indication that a patient has Crohn’s disease, but
• the oral lesions usually develop in patients with known bowel disease.
• The oral lesions are multifocal, linear, nodular, polypoid or diffuse
• mucosal thickenings, with a predilection for occurring in the
• labial and buccal mucosa, and the mucobuccal folds (Figure 1).
• They are characteristically firm, pink and painless to palpation
• unless there are ulcerations that may cause pain on touch, or when
• eating acidic, spicy or hot foods.
122. • These ulcers, which are typically persistent, linear and
deep (3), should not be confused with
• aphthous ulcers, which are shallow, round to oval
shaped lesions that heal spontaneously in approximately
seven to 14 days (4).
• On palpation, the lesions may feel granular below the
epithelium, reflecting the histological findings.
• Microscopically, the lesions exhibit subepithelial,
noncaseating granulomatous inflammation
characterized by epithelioid histiocytes, giant cells and
lymphocytes (Figure 2), identical to those seen in the
bowel. There is great variability in the severity of the
inflammation, which is worse if ulcers are present.
123. • Oral lesions are routinely subjected to special
histochemical stains to rule out infectious agents
such as deep fungal infections or tuberculosis, and
polarized to rule out foreign body reactions.
• Because granulomatous microscopic lesions are
seen in other diseases, including orofacial
granulomatosis and sarcoid (4), the definitive
diagnosis of Crohn’s disease cannot be made on oral
biopsy alone. However, the biopsy may direct the
clinician to investigate the GI tract for Crohn’s
disease lesions.
124. • Oral lesions of Crohn’s disease are typically
persistent, and remit and relapse over the years (3).
• Their response to systemic therapy is highly
variable and unpredictable, and they do not
necessarily parallel the activity of gut disease.
• Some oral ulcerating lesions may require topical
corticosteroid therapy or even intralesional
corticosteroid injections.
125. Ulcerative colitis
• Oral lesions of ulcerative colitis – termed
pyostomatitis vegetans (5,6) – are rare, and are far
less common than oral manifestations of Crohn’s
disease. There is a male predilection (5), and oral
outbreaks may occur at any age (6).
• The oral lesions may precede GI lesions but are
generally present synchronously. Clinically, the
lesions consist of scattered, clumped or linearly
oriented pustules on an erythematous mucosa at
multiple oral sites, with variable severity (Figure 3),
but usually sparing the dorsum of the tongue.
126. • Patient discomfort is proportional to the degree of
ulceration of the lesions, many of which remain
epithelialized.
• Long-standing lesions may become granular,
polypoid or fissured (6), clinically mimicking Crohn’s
disease.
• Some patients exhibit oral aphthous-like lesions (6)
in addition to the pustular lesions, an
approximately 10% of patients develop
inflammatory bowel disease-associated arthritis of
the temporomandibular joints (6).
127. • Microscopically, the lesions mimic the crypt
abscesses of colonic lesions, without evidence of
granulomatous inflammation.
• The oral submucosa shows edema with
neutrophils, eosinophils and lymphocytes, while
the epithelium shows spongiosis with neutrophilic
and eosinophilic abscesses (5) (Figure 4).
• The microscopic appearance in itself is not
diagnostic, because neutrophilic or eosinophilic
intraepithelial abscesses may be seen in other
conditions such as candidiasis, benign migratory
glossitis, or stomatitis areata migrans and
pemphigus vegetans (
128. • The clinical appearance and historical information must be
correlated with the microscopic findings; otherwise,
asymptomatic patients who receive an oral diagnosis of
pyostomatitis vegetans should be investigated by a
gastroenterologist for bowel disease
• The oral lesions usually respond to colonic disease treatment
(6). Topical or systemic corticosteroids (5) and dapsone (6)
have been used for recalcitrant oral lesions with variable
effectiveness.
• Because the severity of oral disease usually reflects the
severity of the bowel disease, the gasteroenterologist may
use oral manifestations, when present, as an additional gauge
to determine the severity of the bowel disease and/or the
response to therapy.
129. MALABSORPTION CONDITIONS
AFFECTING HEMATOPOIESIS
• GI diseases related to protein-caloric malnutrition (10) or
micronutrient malabsorption (11) may have an effect on the
oral tissues.
• The classical examples are iron malabsorption inducing iron
deficiency anemia and vitamin B12 malabsorption in
pernicious anemia [Field EA, Speechley JA, Rugman FR,
Varga E, Tyldesley WR. Oral signs and symptoms in patients
with undiagnosed B12 deficiency. J Oral Pathol Med
1995;24:468-70.]
• When the malabsorption is sufficiently severe, the first oral
manifestation is atrophic glossitis (Figure 6), in which the
filiform papilla and sometimes the fungiform papilla of the
dorsumof the tongue undergo atrophy, leaving a bald, red
tongue (
130. • In milder cases, the atrophy is patchy, but more
severe cases show involvement of the entire
dorsum. In very severe cases, there may be shallow,
round to oval-shaped, persistent ulcers with bright
red borders, clinically resembling aphthous ulcers
but often responsive to appropriate replacement
therapy.
• Overt tongue lesions are usually sore, but a more
common complaint is a burning sensation
(glossopyrosis) that may precede clinically
detectable oral lesions
131. • Other oral mucosa may also become involved with
atrophic zones, with or without aphthous-like
ulcers and the burning sensation, but these lesions
are not as dramatic as the bald tongue and often go
unnoticed. Affected patients are predisposed to
developing angular cheilitis, which is a candidal
infection that can be treated with antifungal
medication.
• The gastroenterologist may use atrophic glossitis as
an indicator of moderate to severe nutrient
malabsorption.
132. CYCLIC NEUTROPENIA
• THE CLINICAL FEATURES INCLUDE ORAL ULCERS
WITH PERIODICITY; INFECTIONS, ADENOPATHY;
PERIODONTAL DISEASE.
• THIS IS CAUSED BY MUTATIONS IN NEUTROPHIL
ELASTASE GENE.
• CYCLIC NEUTROPENIA RESULTS IN RARE BLOOD
DYSCRASIA.
• FEVER, MALAISE, ORAL ULCERS, CERVICAL
LYMPHADENOPATHY AND INFECTIONS CAN OCCUR.
133. • THE NEOPLASMS INCLUDE
1. SQUAMOUS CELL CARCINOMA
2. CARCINOMA OF MAXILLARY SINUS
3. OTHER CARCINOMAS
NEOPLASMS
134. • ORAL AND OROPHARYNGEAL SQUAMOUS CELL
CARCINOMAS REPRESENT ABOUT 3% OF CANCERS IN
MEN AND 2% IN WOMEN.
• OF ALL THE FACTORS, TOBACCO IS REGARDED AS THE MOST
IMPORTANT ESP THE CIGAR, PIPE AND REVERSE SMOKING.
• THE TIME-DOSE RELATIONSHIP OF CARCINOGENS FOUND
IN TOBACCO IS OF MUCH IMPORTANCE IN THE CAUSE OF
ORAL CANCER.
• MICRO ORGANISMS SUCH AS CANDIDA ALBICANS
PRODUCES N-NITROSOBENZYLMETHYLAMINE CARCINOGEN
AND HPV SUBTYPES 16 AND 18 PRODUCES ORAL
SQUAMOUS CELL CARCINOMAS.
SQUAMOUS CELL CARCINOMA
135. • CARCINOMAS OF
LOWER LIPS ARE
MORE COMMON
THAN UPPER LIP
LESIONS BUT THE
GROWTH RATE IS
SLOWER.
• THEY APPEAR
COMMONLY IN
ELDERLY PATIENTS
MOSTLY AFFECTING
MEN
•THE SQUAMOUS CELL CARCINOMA CLINICALLY PRESENTS AS
CARCINOMA OF LIPS AND TONGUE
136. • SQUAMOUS CELL
CARCINOMA OF
TONGUE IS THE MOST
COMMON INTRAORAL
MALIGNANCY
• THESE PRESENT AS AN
INDURATED, NON
HEALING ULCER, AS A
RED LESION, AS A
WHITE LESION OR AS
A RED-WHITE LESION.
137. Ischaemic ulcers: necrotising
sialometaplasia
• This is an uncommon disorder that gives rise to
large areas of deep ulcers on one side of the hard
and sometimes the soft palate. This condition is
probably associated with an ischaemic event and is
associated with factors such as smoking, alcohol
use, denture wearing, recent surgery and systemic
disease. It can also be a feature of bulimia nervosa.
The clinical and histopathological features may
mimic those of SCC.
138. • MALIGNANCIES OF PARANASAL SINUSES
OCCUR MOST COMMONLY IN MAXILLARY
SINUS.
• THIS AFFECTS ELDER PEOPLE AND GENERALLY
MEN.
• PAST HISTORY FREQUENTLY INCLUDES
SINUSITIS.
• AS THE NEOPLASM EXTENDS TOWARDS
APICES OF MAXILLARY POSTERIOR TEETH,
REFERRED PAIN MAY OCCUR.
• TOOTHACHE WHICH ACTUALLY REPRESENTS
NEOPLASTIC MOVEMENT OF SUPERIOR
ALVEOLAR NERVE IS THE COMMON
SYMPTOM OF MAXILLARY SINUS
MALIGNANCIES.
• OCCASIONALLY IT MAY PRESENT AS PALATAL
ULCER AND MASS REPRESENTING EXTENSION
THROUGH THE BONE AND SOFT TISSUE OF
PALATE.
CARCINOMA OF MAXILLARY SINUS
139. Pemphigus
• It is an important vesiculo-bullous disease mainly
affecting adults; however,children can also be
affected.
• Lesions are intra-epithelial ,rapidly break down so
that affected individuals are often unaware of
blistering, complaining instead of ulceration,mainly
affecting the buccal mucosa,palate and lips.
140. Diagnosis
• There may be positive Nikolsky’s sign and
cytological examination can reveal the presence of
Tzanck’s cells.
• Direct immunofluorescence usingfrozen sections
from an oral biopsy will reveal intracellular
immunoglobulin(igg)deposits in the epithelium,
which are diagnostic for this disease.
• Indirect immunofluorescence on blood samples is
sometimes used to monitor patients.
142. Epidermolysis bullosa
• It is aterm used to describe several hereditary
vesiculo-bullous disorders of the skin and mucosa.
• Blisters may form from birth or appear in the first
few weeks of life depending on the form of the
disease.
• Corneal ulceration may also may be present and
pitting enamel hypoplasia has been
reported,mainly in the junctional forms of the
disease.
143. Management
• Mangement is extremely difficult because of the
fragility of the skin and oral mucosa.intensive
preventive dental care is essential to prevent dental
caries,combined with treatment of early decay.
• Supportive care is required with the use of CHX
gluconate mouthwashes and possibly topical
anaesthetics such as lidocaine(Xylocaine viscous)
144. Systemic lupus erythematous
• It is a chronic inflammatory multisystem disease
occurring predominantly in young women.The
hallmark of SLE is the presence of antinuclear
antibodies which form circulating immune
complexes with DNA.
• Oral ulceration often occurs in SLE and treatment of
the condition usually involves systemic steroids.
145. leukemia
• The most frequently reported oral abnormalities
attributed to the leukemic process include regional
lymphadenopathy,mucous membrane petechiae
and ecchymoses, gingival bleeding,gingival
hypertrophy, pallor and nonspecific ulceration.
• Oral changes can be attributed to
anemia,granulocytopenia,and thrombocytopenia