This document discusses various diseases that can affect the lips and tongue. It outlines conditions like swelling of the lips, angular chelitis, lip fissures, and perioral dermatitis that involve the lips. For the tongue, it describes abnormalities, infections like hairy tongue, traumatic injuries, geographic tongue, and median rhomboid glossitis. It provides details on symptoms, causes, and treatment approaches for many of these oral diseases.

1. Diseases of Lips & Tongue
Arsalan Wahid Malik

2. Diseases of Lips….
Any Idea?

3. Diseases of Lips
 Swelling of lips
 Angular Chelitis
 Lip Fissures
 Allergic Chelitis
 Actinic Chelitis
 Exfoliative Chelitis
 Perioral dermatitis
 Lick Eczema
 Cheilocandidiosis

4. Swelling of lips
May be
Diffuse
Localized
Perioral area of skin
OFG
Angioedema

5. Angular Chelitis
Inflammation of one or
both corners of mouth
Multifactorial disease
Local
Systemic factors

6. Marker of Systemic Diseases
 Anemia
 Iron, B 12, Folate deficiency
 OFG
 HIV Infection
 DM
 Sjogren Syndrome

7. Management
 Elimination of local factors
Denture Hygiene
Instruct patient to leave denture at night
 Referral to medical specialist for underlying medical cause
 Provision of antimicrobial therapy
Local
Systemic

8. Antimicrobial therapy
 Candida isolated
Nystatin pastiles
Nystatin ointment
 S. aureus isolated
Fusidic acid cream
Mupirocine cream
 Mixed infection
Miconazole gel

9. Allergic Chelitis
 Irritation and scaling of lips caused by allergy
Lipsticks
Ointments
Foods
Moisturizes
Tooth pastes
 Lipstick allergy may also be caused by straw
sharing and kissing

10. Allergic Chelitis

11. Actinic Chelitis (Solar keratosis)
 Prolonged exposure to sunlight either occupational or
recreational may result this
Long exposure to sunlight
Lower lip more effected
Crusting and induration of the vermilion margin
May progress to carcinoma

12. Actinic Chelitis (Solar keratosis)

13. Exfoliative Chelitis
 Production of excess amount of keratin
 Involves vermilion border
 Histology is simply hyperparakeratosis
 Not a malignant condition
 May be related to stress

14. Exfoliative Chelitis (Treatment)
 Local or systemic steroids
 Tranquilizers
 Cautery
 Cryosurgery
 Skin must be peeled off before applying gel

15. Lick eczema
 Sharply circumscribed zone
of irritable scaly skin around
the mouth
 Children and specially young
patients are effected
 It’s the result of licking habit

16. Lick eczema (Treatment)
 Remove the causative factor
 Removable appliance with a sharp edge to touch the tongue is
beneficial.

17. Cheilocandidosis
 Heavy candidal infection of lower lip.
 Bilaterally spreading
 Secondary candidal infection
 Antifungals may be used

18. Diseases of the Tongue

19. Diseases of the Tongue
 Neoplasms of the tongue are of great significance because they
may grow to a considerable size before presentation of
symptoms (Pain & Paresthesia)

20. Developmental abnormalities
 Ankyloglossia
 Associated with microglossia
 Macroglossia
 Congenital hypothyroidism
 Down’s Syndrome
 Acromegaly
 Amyloidosis

21. Diseases of the Tongue
 Tongue fissure
 Coated tongue
 Hairy tongue
 Atrophy of the lingual
epithelium
 Traumatic irritation of
tongue
 Enlargement of foliate
papillae
 Geographic tongue
 Median rhomboid glossitis

22. Tongue fissure
 Normal structure showing
variation in depth, number &
arrangements.
 Fissures may be exaggerated
during some conditions like CMC
 Cholorhexidine mouthwash is the
treatment of choice for
symptomatic cases

23. Scrotal Tongue
 Normal morphological variation
 Multiple fissures on dorsum of
tongue
 Irregular border of the tongue
resembling ‘’Pie Crust’’ is called
‘’Crenated Tongue’’.

24. Crenated Tongue

25. Coated Tongue
 Coating consists of mucus, desquamated
epithelial cells, microorganisms and
debris.
 Normal mobility of the tongue and
salivary flow help in cleaning the tongue
 When the balance is upset, coating starts

26. Coated Tongue
 Lack of mobility
 Painful lesions
 ↓ salivary flow
 ↑ tobacco or alcohol use
 Gastric or respiratory upset
 Build up of coating on dorsal surface
of tongue
 Color depends on tobacco / dietary
habits

27. Treatment
 Tongue scrappers
 Brushing of tongue
 Effervescent mouthwashes having ascorbic acid

28. Hairy Tongue
 Elongation of filiform papillae
 Dark brown and black color is
common
 May be due to long antibiotic
course
 Resolves with time on completion
of drug course
 Candidal infection may be
common

29. Hairy Tongue (Treatment)
Resolves with completion of
antibiotic therapy
Mucous solvent
mouthwashes
Chemical cauterization
Sucking a dry peach stone
(not much effective)

30. Atrophy of the lingual epithelium
 Opposite to hairy tongue
 May be due to hematological & nutritional deficiencies
Iron deficiency
Megaloblastic anemia
Vitamin deficiency

31. Atrophy of the lingual epithelium
 Surface appears shiny, red &
painful
 Investigations
Serum Ferritin
SerumFolate
B12
Glucose

32. Atrophy of the lingual epithelium
May be associated with following generalized condition
 Anemias
 Salivary gland hypofunction
 Rhematoid arthritis
 Sjogren syndrome
 Burning Mouth Syndrome (BMS)

33. Traumatic Irritation of the Tongue
 Acute (fracture of the tooth)
 Chronic (continuous rubbing of tongue on denture or anterior
teeth)
 Superficial traumatic lesions leads to inflammation and ulcers
with surrounding white borders
 It gives suspicion of malignancy but are always benign
 They relieves within a week after removal of irritant
 If not relieves then biopsy must be taken and sent to lab

34. Traumatic Irritation of the Tongue
 Most difficult cases are of
tongue biting
 Hematological investigations
must be carried out to rule out
systemic cause
 Mild erythema of tip of the
tongue and mucosa of lower lips
is sign of trauma

35. Geographic Tongue
 Depapillation of tongue
 Red patches surrounded by
white borders
 Distributed in a map like
fashion & tend to vary their
position with time
 Involves palate and lingual
mucosa

36. Geographic Tongue
 Etiology is unknown
 Hematinic deficiency may be
associated
 If tongue is symptomatic then
hematinic investigation must be
carried out
 Biopsy is rarely indicated
 Simple analgesic mouthwash provides
symptomatic relief

37. Median Rhomboid Glossitis
 Candidal pseudo membrane +
fissuring and fibrosis of tongue
 Diabetes or iron deficiency may
be associated
 May vary from immediately in
front of vallate papillae towards
anterior surface

38. Median Rhomboid Glossitis
 Short term use of systemic
antifungal drugs
(Nystatin Pastilles)
 Long term use of topical
antifungal drugs
(fluconazole)
 Seen associated with HIV

39. Disturbance of taste
 A neurological disturbance that is due to surgical trauma to the
chorda tympani following middle ear surgeries
 Bells palsy may have the same situation

40. Disturbance of taste
Dysgeusia
Unpleasant / altered taste sensation
Ageusia
Complete loss of taste
Hypogeusia
Reduced taste sensation

41. Disturbance of taste
 Drugs
Antirheumatics
Antimetabolite
Pencilliamine
Captopril
Metronidazole

42. Disturbance of taste
 Dental conditions
 Associated structures
 Systemic diseases
 Deficiencies
 Drugs
 Smoking
 Psychogenic

43. Halitosis (Bad breath)
Local Causes
Mouth
Poor oral hygiene
Pericoronitis
Dry socket
Infections
Food packing
Pharynx
Tonsilitis
Pharyngitis
Sinusitis