Oral red lession

1. Dr. Hidayah Elyas
Lecture 1 :-
Red Diseases of Oral Cavity
Napata Collage
Dentistry program
Oral Medicine
Semester (9)

2. Red lesions
 A“RED LESION” appearsas “Red” because histologically
it’s characterized by
1-Atrophic changes in superficial epithelium
2-OR Breach in superficial layer of epithelium
3-OR Increased/prominent vascularity in uderlying
connective tissue

3. Causes Of Oral Red Lesions
1. Oral ulcers
2. Mucosal inflammation
3. Reactive lesions
4. Atrophy
5. Purpura
6. Vascular anomalies
7. Neoplasms

4. Mucosal Inflammation
Viral infections
Fungal infections
Radiation induced mucositis
Chemotherapy induced mucositis
Immunological reactions

5. Denture stomatitis (Chronic Atrophic Candidiasis)
 Inflammation (manifesting as erythema) of mucosa
beneath denture. Usually maxillary.
 Management:-
 Cure any underlying systemic problem
 Chances of getting infection are increased if denture
worn for 24 hours a day.
 Dentures should be left out of mouth at night,
cleaned & disinfected by placing in antiseptic denture
cleanser (Milton’s Solution).

6. Denture stomatitis (Chronic Atrophic
Candidiasis)
 A discoloring agent e.g; Rayner’s Blue Solution to
see whether you are cleaning denture thoroughly
 Mucosal infection is eradicated by
1-Brushing palate
2-Using antifungals for 4 weeks.
 Effective agents include
Nystatin or Miconazole oral gel
administered concurrently with Chlorhexidine
mouthwash

7. Median Rhomboid Glossitis
 Candida associated lesion.
 Bacterial species could also be responsible
 Red, rhomboidal depapillated (lingual papilla) area in
midline of tongue, in front of circumvallate papillae
 d/d: Oral Squamous Cell Carcinoma
 No treatment
 Antifungal agents (nystatin)
and antiseptic gargles used for irritation

8. Chemotherapy Induced Mucositis
 Following Chemotherapeutic Agents
sometimes cause mucositis:
1-Fluorouracil (solar keratoses)
2-Cisplatin (cancers)
usually cause mucositis
 Management:- is by Opioids (PAIN)
 Avoid irritants
 Maintain oral hygiene
 Topical analgesics or analgesic
mouthwash.
 Not effective then Betamethasone
mouthwash which is steroid for
inflammation and itching

9. Radiation mucositis
 Occurs usually within 3 Weeks of irradiation by Radiation
Therapy of Head & Neck Tumors.
 Clinically presents as “Mild Erythema” to “Deep Mucosal
Ulceration”.
 In advance stage Ulcers are covered by
Pseudomembrane.
 Management is by opoids (morphine & hydromorphone),
 Avoid irritants (smoking, spicy food & alcohol)
 Maintain good oral hygeine
 Topical analgesics (lidocaine)
 Amifostine 200mg /day
 Prevents xerostomia healing of the mucosa usually starts
to take place within 3 weeks of end of radiotherapy

10. Mucositis due to Immunological Reaction
 Following are some Autoimmune Conditions which can
induce Mucositis:
1. Plasma cell gingivostomatitis
2. Granulomatous disorders (wegener’s granulomatosis)
3. Amyloidosis
4. Graft versus host disease (GVHD)

11. Wegener's Granulomatosis
 Possible cause of the disease includes:-
1-Abnormal immune reaction secondary to a nonspecific
infection
2-Hypersensitivity response to an inhaled antigen.
 Can involve almost every organ.
 The most characteristic oral manifestation is
 (Strawberry Gingivitis)
 The surface forms:-
Numerous short bulbous projections
(hemorrhagic and friable)
Oral ulceration

12. Wegener's Granulomatosis
 Investigation:-Cytoplasmic localization (c-ANCA) is
useful
 The drugs of choice are :-
1. Cyclophosphamide with Glucocorticoids
2. (suppress immune reaction)
3. Cytoplasmic antineutrophil
4. Cytoplasmic antibodies

13. NOTE
 Cyclophosmamide
Is an alkylating agent used for treatment of:-
1-Cancer
2-Auto-immune Diseases
But it has Life Threatening
 Adverse Effects such as:-
1-Acute Myeloid Leukemia,
2-Bladder Cancer
3-Permanent Infertility if given in high doses

14. Lichenoid Reaction in GVHD(Graft versus host
disease)
 Graft causing damaged immune response against the
recipient Allogenic bone marrow transplant.
 Mucosal lesions more common in chronic GVHD..
 Lichenoid Reactions (widespread as comp to Lichen
Planus)..
 Painful Erythema, Mucosal Ulceration, Oral Purpura.
 May be associated with infections such as Candidiasis &
HSV Infection or with Xerostomia
 Treatment
 Oral Hygiene Measures, Analgesics, Immunosuppressant's
such as CICLOSPORIN , Non-astringent Mouthwash,
Nystatin Mouthwash incase of fungal infections, Saliva
Supplements and Pilocarpine (Recovery after 1 year post
transplant)

15. Lupus Erythematosus
 Auto-immune
 More common in women (20-40 yrs).
 Triggered by sun exposure, drugs
 hormones and chemicals
 Amongst others, two types: DLE and SLE
 ORAL LESIONS comprise of White Striae with a Radiating
Pattern, and these may terminate toward the center of the
lesions, which has Erythematous appearance Palatal
Lesion can be purely Erythematous
 DLE has Butterfly like rashes on cheek and nose termed
Malar rash
 SLE diagnosis requires four or more of the American
College of Rheumatology criterias
 Management of Intraoral Lesions via Topical steroids with
Anti-Fungal Therapy

16. Pemphigus Vulgaris
 Rare etiology: Penicillamine, which is a chelating agent
that removes certain materials from the blood
▪ ACE inhibitors, which are a type of blood pressure
medication
▪ Systemic treatment includes:
▪ An anti-inflammatory drug called dapsone.
▪ Corticosteroids.
▪ Medicines containing gold.
▪ Medicines that suppress the immune system (such as
cyclosporine)

17. Thank
you