This document describes a case study of a 74-year-old woman who presented with pain, burning sensation, and numbness of the tongue for 3 months. Examination revealed an atrophic, depapillated tongue and signs of anemia. Laboratory tests confirmed vitamin B12 and folate deficiency anemia. She was treated with vitamin B12, folate, and mouthwashes, which resolved her tongue abnormalities and anemia over several months. The case illustrates how atrophic glossitis can be an early clinical sign of nutritional deficiency anemia in elderly patients. Dentists should be aware of this relationship to properly diagnose and manage oral signs of systemic diseases.
This document describes primary herpes simplex infection, commonly known as cold sores. It is usually caused by HSV-1 and presents with fever, headache, malaise and painful sores in the mouth. Lesions start as vesicles that rupture, leaving shallow ulcers that heal within 10-14 days. Diagnosis is made through clinical examination, with viral culture and biopsy used for confirmation. Treatment focuses on pain relief and short term use of antivirals or steroids to reduce symptoms.
The document discusses various respiratory disorders and their dental management considerations. It provides information on common respiratory conditions like sinusitis, nasal polyps, obstructive sleep apnea, allergic rhinitis, tonsillitis, pharyngitis, laryngitis, influenza, post nasal drip syndrome, chronic obstructive pulmonary disease, bronchitis, asthma, emphysema and pneumonia. It outlines the symptoms, causes, diagnosis and treatment for these conditions. It emphasizes the importance of thorough medical history taking and providing treatment with precautions based on a patient's respiratory condition.
dental management patients with cardiovascular disorders.pptxPooja461465
This document discusses cardiovascular diseases and their relevance to dentistry. It describes common conditions like hypertension, coronary heart disease, myocardial infarction, and infective endocarditis. For hypertension, it covers classification, signs/symptoms, diagnosis and dental management considerations like stress reduction and cautious use of vasoconstrictors. For coronary heart disease, it explains angina, myocardial infarction, and emphasizes stress reduction during dental treatment. It provides guidance on managing patients who are taking antiplatelet drugs or anticoagulants. The document concludes by discussing infective endocarditis and recommendations for antibiotic prophylaxis during certain dental procedures to prevent bacteremia.
This document provides information about case histories in dentistry. It defines a case history as a planned conversation between patient and doctor to determine the nature of the patient's illness or mental state. The summary includes details about the contents, purpose, and components of a thorough case history, which establishes the patient's medical history, dental history, and other relevant details to allow for an accurate diagnosis and safe treatment plan. Physical examinations and potential investigations are also discussed.
Definition
Contents of case history Personal Information
General Physical Examination
Extra oral examination Intra oral examination Investigations Diagnosis
List of references
Conclusion
This document provides information on describing gingival characteristics. It discusses the normal color, size, consistency, contour, surface texture, and position of gingiva. It describes changes seen in these characteristics due to various inflammatory and non-inflammatory conditions. Treatment approaches for conditions that alter gingival characteristics are also summarized, such as procedures for depigmentation and techniques for treating gingival recession.
This document provides an overview of how to take a case history for a dental patient. It discusses the importance of gathering demographic data, chief complaints, medical history, dental history and conducting examinations. The key components of a case history are outlined, including the steps of taking a history, examining the patient, making a provisional diagnosis, conducting investigations, reaching a final diagnosis and developing a treatment plan. Taking a thorough case history is important for understanding the patient's condition, making an accurate diagnosis and determining an effective treatment approach.
This document describes primary herpes simplex infection, commonly known as cold sores. It is usually caused by HSV-1 and presents with fever, headache, malaise and painful sores in the mouth. Lesions start as vesicles that rupture, leaving shallow ulcers that heal within 10-14 days. Diagnosis is made through clinical examination, with viral culture and biopsy used for confirmation. Treatment focuses on pain relief and short term use of antivirals or steroids to reduce symptoms.
The document discusses various respiratory disorders and their dental management considerations. It provides information on common respiratory conditions like sinusitis, nasal polyps, obstructive sleep apnea, allergic rhinitis, tonsillitis, pharyngitis, laryngitis, influenza, post nasal drip syndrome, chronic obstructive pulmonary disease, bronchitis, asthma, emphysema and pneumonia. It outlines the symptoms, causes, diagnosis and treatment for these conditions. It emphasizes the importance of thorough medical history taking and providing treatment with precautions based on a patient's respiratory condition.
dental management patients with cardiovascular disorders.pptxPooja461465
This document discusses cardiovascular diseases and their relevance to dentistry. It describes common conditions like hypertension, coronary heart disease, myocardial infarction, and infective endocarditis. For hypertension, it covers classification, signs/symptoms, diagnosis and dental management considerations like stress reduction and cautious use of vasoconstrictors. For coronary heart disease, it explains angina, myocardial infarction, and emphasizes stress reduction during dental treatment. It provides guidance on managing patients who are taking antiplatelet drugs or anticoagulants. The document concludes by discussing infective endocarditis and recommendations for antibiotic prophylaxis during certain dental procedures to prevent bacteremia.
This document provides information about case histories in dentistry. It defines a case history as a planned conversation between patient and doctor to determine the nature of the patient's illness or mental state. The summary includes details about the contents, purpose, and components of a thorough case history, which establishes the patient's medical history, dental history, and other relevant details to allow for an accurate diagnosis and safe treatment plan. Physical examinations and potential investigations are also discussed.
Definition
Contents of case history Personal Information
General Physical Examination
Extra oral examination Intra oral examination Investigations Diagnosis
List of references
Conclusion
This document provides information on describing gingival characteristics. It discusses the normal color, size, consistency, contour, surface texture, and position of gingiva. It describes changes seen in these characteristics due to various inflammatory and non-inflammatory conditions. Treatment approaches for conditions that alter gingival characteristics are also summarized, such as procedures for depigmentation and techniques for treating gingival recession.
This document provides an overview of how to take a case history for a dental patient. It discusses the importance of gathering demographic data, chief complaints, medical history, dental history and conducting examinations. The key components of a case history are outlined, including the steps of taking a history, examining the patient, making a provisional diagnosis, conducting investigations, reaching a final diagnosis and developing a treatment plan. Taking a thorough case history is important for understanding the patient's condition, making an accurate diagnosis and determining an effective treatment approach.
Acute herpetic gingivostomatitis (AHG) is a viral infection of the oral mucosa caused by the herpes simplex virus type 1. It occurs most frequently in infants and children under 6 years old and presents with diffuse erythema and edema of the gums, as well as clusters of vesicles dispersed throughout the mouth, lips, palate, and tongue. The symptoms include generalized oral soreness and fever, and the full course of the disease is typically 7-10 days. After the primary infection subsides, the virus can remain latent in nerve tissues and potentially reactivate to cause cold sores.
Gingival enlargement can result from chronic or acute inflammation, drugs, or systemic conditions. Drug-induced enlargement is common with anticonvulsants like phenytoin and presents as a painless, bead-like enlargement of the papillae that progresses to cover tooth crowns. Histologically, there is pronounced hyperplasia of connective tissue and epithelium. While the enlargement is caused by the drug, secondary inflammation from plaque complicates the condition, adding to the size and producing redness. Approximately 50% of patients on phenytoin experience gingival overgrowth.
This document summarizes various blood disorders and their oral manifestations. It discusses disorders of red blood cells like iron-deficiency anemia, megaloblastic anemia, pernicious anemia, and sickle cell anemia. It also covers disorders of white blood cells such as leukemia and leukopenia. For each condition, it describes the causes, clinical features, diagnosis, and potential oral signs including gingival bleeding, ulcers, and infections. In general, these blood disorders can cause oral pallor, infections, and changes in taste or tooth development.
This document discusses gingival inflammation and gingivitis. It begins by defining inflammation and describing the cardinal signs. It then outlines the stages of gingivitis from initial to established to advanced/periodontitis. Microorganisms attached to teeth secrete enzymes that damage tissues and widen junctional epithelium, allowing bacterial products to access connective tissue and activate immune cells. Studies showed that not practicing oral hygiene led to plaque buildup and gingivitis within 10-21 days. Gingivitis is characterized by redness, swelling, bleeding and is prevalent worldwide. The document discusses features, course, distribution and systemic influences of gingival inflammation.
Diagnosis and treatment planing in EndodonticsSalem Rekab
This document provides an overview of endodontic diagnosis and treatment planning. It discusses the importance of gathering a chief complaint, health history, dental history, and conducting a subjective and objective examination of the patient. The subjective examination involves questioning the patient about their symptoms such as the intensity, spontaneity, and persistence of any pain. The objective examination includes extraoral and intraoral soft tissue exams, examining the dentition, and performing clinical tests like percussion, palpation, and pulp vitality tests using heat, cold, or electricity. Together, the subjective and objective exams allow the clinician to make a tentative diagnosis which is then confirmed through further examination and testing.
Case history & diagnosis in periodontics /certified fixed orthodontic course...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Oral medicine involves diagnosing and managing diseases of the oral cavity, salivary glands, and orofacial region in patients with systemic conditions. Specialists provide care to medically complex patients and those receiving cancer treatment. They diagnose non-surgical oral conditions and manage pharmacotherapy. Examinations include medical history, vital signs, head/neck exam, and lab tests to establish diagnoses and treatment plans considering medical factors.
The document discusses diagnosis and treatment planning in operative dentistry. It covers patient assessment and information gathering, including recording demographic data, the chief complaint, medical history, and dental history. It also covers clinical examination techniques for diagnosing dental caries and existing restorations, as well as treatment planning including prognosis. The overall document provides guidance to dentists on conducting a thorough patient examination and developing an appropriate treatment plan.
Dental consideration in respiratory disorders/prosthodontic coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Cavity preparation for cast metal restorationschatupriya
This document discusses cavity preparation for cast metal restorations. It begins by introducing cast metal restorations and their history. It then defines inlays and onlays. The document discusses various materials used for cast restorations including gold, platinum, and nickel-chromium alloys. It covers the requirements, properties, and classes of different dental casting alloys. The document provides details on cavity preparation principles, outline forms, and features to provide resistance and retention. It also discusses preparation modifications and secondary retention methods.
This document describes the characteristics of various types of oral ulcers. It defines ulcer terminology like margin, edge, and floor. It outlines the shapes, numbers, positions, edges, floors, discharges, and bases that can help differentiate ulcers. Common acute ulcers include traumatic, necrotizing, herpetic, and syphilitic. Chronic ulcers include tuberculous and major aphthous. Neoplastic ulcers are typically painless and non-healing. The document provides details on examining, diagnosing, and managing different oral ulcer conditions.
This document discusses various clinical examination techniques used to collect diagnostic information from patients. It describes inspection, palpation, percussion, probing, and other techniques. Inspection uses visual senses to examine contour, color, surface texture, and can involve magnification or transillumination. Palpation relies on touch to assess consistency, mobility, size, and other characteristics. Percussion evaluates tenderness and pain by striking tissues. Probing uses slender tools to identify narrow cavities or tracts, such as examining caries or periodontal pockets. Clinical examination provides foundational information for accurate diagnosis and treatment planning.
Saliva plays an important role in oral health by forming a protective coating, regulating pH, and providing minerals that strengthen teeth. Reduced saliva flow can be caused by radiation, certain drugs, or illness and increases the risk of dental caries. For patients with dry mouth, conservative measures like drinking water and avoiding irritants can help. Stimulating saliva production with gum or lozenges and using saliva substitutes can also relieve symptoms. Close dental monitoring and preventive strategies like excellent plaque control, fluoride use, and chlorhexidine application are needed to manage caries risk.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
In this lecture I explain in step-by-step fashion the basics of Dental Management of patient with Hypertension. a photo guide is attached to the guide to aid in better understanding of the topic
A case history provides essential clinical information to arrive at an accurate diagnosis and treatment plan. It involves gathering details from the chief complaint, medical history, dental history, and diagnostic tests. A thorough case history examination covers vital statistics, medical/dental histories, a review of symptoms, and physical and dental examinations. This information is analyzed to form provisional and differential diagnoses before confirming the final diagnosis and developing an appropriate treatment plan. A case history is a critical part of the clinical decision making process.
DENTAL CASE HISTORY (DEMOGRAPHIC DATA ,CHIEF COMPLAINT,HOPI)edsbaba
This document provides an overview of how to take and document a case history for a dental patient. It discusses the importance of collecting demographic data such as the patient's name, age, and occupation. The chief complaint and history of present illness are also highlighted as important components to document the reason for the patient's visit and elaborate on their symptoms. Common chief complaints like pain, swelling, and ulcers are then described in more detail regarding what factors to explore, such as location, duration, aggravating/relieving factors, and prior treatments. The case history aims to establish the patient-clinician relationship and provide necessary clinical information to aid in diagnosis and treatment planning.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The periodontal pocket is defined as a pathologically deepened gingival sulcus and is one of the most important clinical features of periodontal disease. Pockets can be classified as gingival (pseudo) pockets caused by gingival enlargement without tissue destruction or periodontal pockets which involve the destruction of supporting tissues. Clinical attachment loss refers to the amount of periodontal support that has been destroyed around a tooth and is measured from the cementoenamel junction. Periodontal pockets contain microorganisms, their products, food remnants, and inflammatory cells.
This document provides an overview and summary of various dental indices used to measure oral health conditions. It defines key indices like DMFT/DMFS for dental caries, deft for primary dentition, RCI for root caries, and OHI for oral hygiene. Properties of an ideal index and purposes/uses of indices are outlined. The document also discusses indices like Sic, SCI, and Nyvad's criteria which provide additional information beyond traditional indices. Limitations of various indices are noted.
Treatment of Gingival Overgrowth in a Patient with Celiac Disease: A Case Rep...semualkaira
Celiac Disease (CD) presents a wide variety of clinical signs and symptoms, including oral manifestations.
The most reported oral manifestations were recurrent aphthous
stomatitis, delayed dental eruption, geographic tongue, dental caries, dental enamel defects and xerostomia/salivary abnormalities.
However, data about the other oral manifestations of CD, such as
angular cheilitis, atrophic glossitis, glossodynia/burning sensation,
and gingival overgrowth, are scanty
Acute herpetic gingivostomatitis (AHG) is a viral infection of the oral mucosa caused by the herpes simplex virus type 1. It occurs most frequently in infants and children under 6 years old and presents with diffuse erythema and edema of the gums, as well as clusters of vesicles dispersed throughout the mouth, lips, palate, and tongue. The symptoms include generalized oral soreness and fever, and the full course of the disease is typically 7-10 days. After the primary infection subsides, the virus can remain latent in nerve tissues and potentially reactivate to cause cold sores.
Gingival enlargement can result from chronic or acute inflammation, drugs, or systemic conditions. Drug-induced enlargement is common with anticonvulsants like phenytoin and presents as a painless, bead-like enlargement of the papillae that progresses to cover tooth crowns. Histologically, there is pronounced hyperplasia of connective tissue and epithelium. While the enlargement is caused by the drug, secondary inflammation from plaque complicates the condition, adding to the size and producing redness. Approximately 50% of patients on phenytoin experience gingival overgrowth.
This document summarizes various blood disorders and their oral manifestations. It discusses disorders of red blood cells like iron-deficiency anemia, megaloblastic anemia, pernicious anemia, and sickle cell anemia. It also covers disorders of white blood cells such as leukemia and leukopenia. For each condition, it describes the causes, clinical features, diagnosis, and potential oral signs including gingival bleeding, ulcers, and infections. In general, these blood disorders can cause oral pallor, infections, and changes in taste or tooth development.
This document discusses gingival inflammation and gingivitis. It begins by defining inflammation and describing the cardinal signs. It then outlines the stages of gingivitis from initial to established to advanced/periodontitis. Microorganisms attached to teeth secrete enzymes that damage tissues and widen junctional epithelium, allowing bacterial products to access connective tissue and activate immune cells. Studies showed that not practicing oral hygiene led to plaque buildup and gingivitis within 10-21 days. Gingivitis is characterized by redness, swelling, bleeding and is prevalent worldwide. The document discusses features, course, distribution and systemic influences of gingival inflammation.
Diagnosis and treatment planing in EndodonticsSalem Rekab
This document provides an overview of endodontic diagnosis and treatment planning. It discusses the importance of gathering a chief complaint, health history, dental history, and conducting a subjective and objective examination of the patient. The subjective examination involves questioning the patient about their symptoms such as the intensity, spontaneity, and persistence of any pain. The objective examination includes extraoral and intraoral soft tissue exams, examining the dentition, and performing clinical tests like percussion, palpation, and pulp vitality tests using heat, cold, or electricity. Together, the subjective and objective exams allow the clinician to make a tentative diagnosis which is then confirmed through further examination and testing.
Case history & diagnosis in periodontics /certified fixed orthodontic course...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Oral medicine involves diagnosing and managing diseases of the oral cavity, salivary glands, and orofacial region in patients with systemic conditions. Specialists provide care to medically complex patients and those receiving cancer treatment. They diagnose non-surgical oral conditions and manage pharmacotherapy. Examinations include medical history, vital signs, head/neck exam, and lab tests to establish diagnoses and treatment plans considering medical factors.
The document discusses diagnosis and treatment planning in operative dentistry. It covers patient assessment and information gathering, including recording demographic data, the chief complaint, medical history, and dental history. It also covers clinical examination techniques for diagnosing dental caries and existing restorations, as well as treatment planning including prognosis. The overall document provides guidance to dentists on conducting a thorough patient examination and developing an appropriate treatment plan.
Dental consideration in respiratory disorders/prosthodontic coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Cavity preparation for cast metal restorationschatupriya
This document discusses cavity preparation for cast metal restorations. It begins by introducing cast metal restorations and their history. It then defines inlays and onlays. The document discusses various materials used for cast restorations including gold, platinum, and nickel-chromium alloys. It covers the requirements, properties, and classes of different dental casting alloys. The document provides details on cavity preparation principles, outline forms, and features to provide resistance and retention. It also discusses preparation modifications and secondary retention methods.
This document describes the characteristics of various types of oral ulcers. It defines ulcer terminology like margin, edge, and floor. It outlines the shapes, numbers, positions, edges, floors, discharges, and bases that can help differentiate ulcers. Common acute ulcers include traumatic, necrotizing, herpetic, and syphilitic. Chronic ulcers include tuberculous and major aphthous. Neoplastic ulcers are typically painless and non-healing. The document provides details on examining, diagnosing, and managing different oral ulcer conditions.
This document discusses various clinical examination techniques used to collect diagnostic information from patients. It describes inspection, palpation, percussion, probing, and other techniques. Inspection uses visual senses to examine contour, color, surface texture, and can involve magnification or transillumination. Palpation relies on touch to assess consistency, mobility, size, and other characteristics. Percussion evaluates tenderness and pain by striking tissues. Probing uses slender tools to identify narrow cavities or tracts, such as examining caries or periodontal pockets. Clinical examination provides foundational information for accurate diagnosis and treatment planning.
Saliva plays an important role in oral health by forming a protective coating, regulating pH, and providing minerals that strengthen teeth. Reduced saliva flow can be caused by radiation, certain drugs, or illness and increases the risk of dental caries. For patients with dry mouth, conservative measures like drinking water and avoiding irritants can help. Stimulating saliva production with gum or lozenges and using saliva substitutes can also relieve symptoms. Close dental monitoring and preventive strategies like excellent plaque control, fluoride use, and chlorhexidine application are needed to manage caries risk.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
In this lecture I explain in step-by-step fashion the basics of Dental Management of patient with Hypertension. a photo guide is attached to the guide to aid in better understanding of the topic
A case history provides essential clinical information to arrive at an accurate diagnosis and treatment plan. It involves gathering details from the chief complaint, medical history, dental history, and diagnostic tests. A thorough case history examination covers vital statistics, medical/dental histories, a review of symptoms, and physical and dental examinations. This information is analyzed to form provisional and differential diagnoses before confirming the final diagnosis and developing an appropriate treatment plan. A case history is a critical part of the clinical decision making process.
DENTAL CASE HISTORY (DEMOGRAPHIC DATA ,CHIEF COMPLAINT,HOPI)edsbaba
This document provides an overview of how to take and document a case history for a dental patient. It discusses the importance of collecting demographic data such as the patient's name, age, and occupation. The chief complaint and history of present illness are also highlighted as important components to document the reason for the patient's visit and elaborate on their symptoms. Common chief complaints like pain, swelling, and ulcers are then described in more detail regarding what factors to explore, such as location, duration, aggravating/relieving factors, and prior treatments. The case history aims to establish the patient-clinician relationship and provide necessary clinical information to aid in diagnosis and treatment planning.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The periodontal pocket is defined as a pathologically deepened gingival sulcus and is one of the most important clinical features of periodontal disease. Pockets can be classified as gingival (pseudo) pockets caused by gingival enlargement without tissue destruction or periodontal pockets which involve the destruction of supporting tissues. Clinical attachment loss refers to the amount of periodontal support that has been destroyed around a tooth and is measured from the cementoenamel junction. Periodontal pockets contain microorganisms, their products, food remnants, and inflammatory cells.
This document provides an overview and summary of various dental indices used to measure oral health conditions. It defines key indices like DMFT/DMFS for dental caries, deft for primary dentition, RCI for root caries, and OHI for oral hygiene. Properties of an ideal index and purposes/uses of indices are outlined. The document also discusses indices like Sic, SCI, and Nyvad's criteria which provide additional information beyond traditional indices. Limitations of various indices are noted.
Treatment of Gingival Overgrowth in a Patient with Celiac Disease: A Case Rep...semualkaira
Celiac Disease (CD) presents a wide variety of clinical signs and symptoms, including oral manifestations.
The most reported oral manifestations were recurrent aphthous
stomatitis, delayed dental eruption, geographic tongue, dental caries, dental enamel defects and xerostomia/salivary abnormalities.
However, data about the other oral manifestations of CD, such as
angular cheilitis, atrophic glossitis, glossodynia/burning sensation,
and gingival overgrowth, are scanty
This case series describes the individualized treatment of 4 cases of gingival enlargement with different etiologies. Case 1 involved phenytoin-induced gingival enlargement that was treated by substituting the medication and performing supportive periodontal therapy. Case 2 involved gingival enlargement caused by both amlodipine use and inflammation, which was treated with scaling, surgery, and follow ups. Case 3 was a case of inflammatory gingival enlargement that resolved with scaling and surgery. Case 4 involved gingival enlargement caused by both inflammation and mouth breathing, treated with scaling, electrosurgery, and orthodontics to correct the anterior open bite. The cases demonstrate that treatment for ging
This document summarizes a study comparing the efficacy of Pentoxifylline to placebo in the treatment of oral submucous fibrosis (OSF). OSF is a premalignant condition caused by chewing areca nut and characterized by fibrosis in the mouth restricting opening. The study involved randomly assigning 62 patients with OSF to receive either Pentoxifylline or a placebo for 7 months. Outcomes like mouth opening, symptoms, and signs of OSF were evaluated and compared between the two groups at baseline and over 18 months of follow-up.
ANGULAR CHEILITIS CASE REPORTS AND LITERATURE REVIEWClaire Webber
This document presents 3 case reports of patients presenting with angular cheilitis and reviews the condition. Case 1 involves a 52-year-old male with uncontrolled diabetes presenting with angular cheilitis, which was treated with antifungal cream. Case 2 describes a 33-year-old female with pale conjunctiva and brittle nails also having angular cheilitis and geographic tongue, treated with antifungal gel. Case 3 is a 25-year-old female who developed angular cheilitis after a dental procedure, which resolved after antifungal treatment. The document then reviews angular cheilitis, identifying causes as fungal/bacterial infections and deficiencies, with treatment involving addressing underlying causes and using antifungals
This document discusses oral manifestations of systemic diseases in older patients. It provides background on oral structures and functions. It then examines relationships between oral symptoms and conditions like drug reactions, fungal/viral infections, leukemia, Behcet's disease, Sjogren's syndrome, diabetes mellitus, nutritional deficiencies, and amyloidosis. For each condition, it describes common oral presentations and recommendations for treatment and differential diagnosis. The document concludes that the mouth can provide insights into a patient's immune function and that differential diagnosis is important.
The document describes a case of a 34-year-old woman presenting with symptoms of periodontitis including swollen gums, bleeding gums when brushing, and loss of a tooth. An examination showed poor oral hygiene, plaque, calculus, gingival recession, attachment loss, pus discharge, and bone loss seen on radiographs. [END SUMMARY]
1. The document discusses various periodontal and gingival diseases that can affect children and adolescents. It provides classifications and descriptions of different plaque-induced, non-plaque induced and systemic gingivitis conditions.
2. Case descriptions are presented for different diseases along with questions asking for diagnoses, management, and key factors. Conditions covered include eruption cysts, dental plaque gingivitis, primary herpetic gingivostomatitis, acute candidiasis, acute streptococcal gingivostomatitis and others.
3. Periodontal diseases are also summarized, including cases of generalized aggressive periodontitis, hypophosphatasia, Papillon-Lefevre syndrome
This study evaluated the effectiveness of pentoxifylline versus placebo in treating oral submucous fibrosis (OSF). 75 patients with OSF were divided into two groups - group A received placebo and group B received 400 mg of pentoxifylline daily for 7 months. Improvement was measured using symptom and sign scores. Group B showed significantly greater improvement in total scores compared to group A, indicating pentoxifylline was more effective at reducing symptoms and improving mouth opening. Pentoxifylline may help OSF by improving microcirculation and reducing inflammation. The study demonstrates pentoxifylline is superior to placebo for OSF treatment.
The document discusses diseases of the mouth cavity. It defines the mouth and its functions, and describes common mouth problems like cold sores, canker sores, and infections. Diagnosis involves examination by a dentist, and treatment depends on the specific problem but may include cleaning, surgery, or maintenance visits. Prevention strategies include avoiding tobacco and excessive alcohol, eating fruits and vegetables, protecting lips from sun, and regular dental exams.
This document summarizes a study comparing the efficacy of pentoxifylline to placebo in the treatment of oral submucous fibrosis (OSF). OSF is a premalignant condition characterized by fibrosis of the oral cavity and restricted mouth opening. The study included 62 patients with OSF who were randomly assigned to receive either pentoxifylline or a placebo for 7 months. Outcomes including symptoms, mouth opening, and fibrosis were assessed. The results showed greater improvement in symptoms and signs for the pentoxifylline group compared to the placebo group, with few side effects reported. The study concluded that pentoxifylline may be an effective treatment for OSF.
This document discusses diseases of the mouth cavity. It defines the mouth and its functions, and describes common mouth problems like cold sores, canker sores, and leukoplakia. Oral diseases can increase risks for other health issues. Diagnosis involves examination for signs like sores, growths, or pain. Treatment depends on the problem but may include cleaning, antibiotics, or surgery. Regular dental checkups and good oral hygiene can help prevent issues and support overall health.
Relationship between Severity of Periodontal Disease and Control of Diabetes ...Dr. Anuj S Parihar
Background: Both diabetes mellitus (DM) and periodontitis
are chronic diseases affecting large number of the population
worldwide. Changes in human behavior and lifestyle over the
last century have resulted in a dramatic increase in the incidence
of diabetes in the world. This study was designed to evaluate the
relationship between severity of periodontal disease and control of
diabetes (glycated hemoglobin [HBA1c]) in patients with Type 1
DM in a hospital based study.
Materials and Methods: Fifty patients (n = 50) with Type 1
diabetes were enrolled in the study. They were divided into three
groups based on the degree of glycemic control by measuring
HbA1c levels as: “Good” (HBA1c ≤7) Group A, fair (HBA1c = 7-8)
Group B and poor (HBA1c >8) Group C. All enrolled patients
underwent detailed history and dental checkup. Evaluation for
periodontal disease was done by measuring dental plaque (plaque
index), inflammation of gums (gingival index), probing pocket
depth (PPD), and clinical attachment level.
Results: Type 1 diabetics with poor glycemic control had
increased gingival inflammation (P < 0.05), more dental plaque
(P < 0.05), increased PPDs (P < 0.05) and attachment loss
(P < 0.05) as compared to those with fair and good glycemic
control, respectively.
Conclusion: Severity of periodontal disease increases with poor
glycemic control in patients with Type 1 DM.
Key Words: Glycated hemoglobin levels, periodontal disease,
Type 1 diabetes mellitus
A case of childhood Burkitt's lymphoma with gingival swelling as the first sy...komalicarol
This case report describes a 4-year-old child who presented with gingival swelling as the initial symptom of Burkitt's lymphoma. The child was eventually diagnosed with stage IV Burkitt's lymphoma/leukemia based on bone marrow and genetic testing. After initial chemotherapy, the gingival swelling and right cheek swelling recurred, indicating disease recurrence. The child received further chemotherapy but ultimately passed away half a year later. This case highlights that gingival swelling can be an early oral symptom of systemic disease like Burkitt's lymphoma. Dentists and oral physicians play an important role in identifying signs of systemic conditions through oral examinations.
Drug-Induced Gingival Overgrowth in Hypertensive Patients on Calcium Channel ...Hasanain Alani
The document describes a case-control study that assessed 103 patients taking calcium channel blockers (CCBs) for hypertension and their risk of developing drug-induced gingival overgrowth (GO). The study found that 89 patients developed GO, with 75 requiring treatment, and that the type and dosage of CCB impacted the frequency and severity of GO. The aim was to evaluate how CCB medication influences GO occurrence, treatment responses, and additional costs.
A Modality in the Diagnosis and Treatment of Oral Candidiasisasclepiuspdfs
Candidiasis as an infection spread all over the oral cavity finds the appropriate conditions to show the clinical appearance, mainly in patients with reduced immune status. For the purpose of facilitating the case diagnosis of case studies, supported also in literature, the study aims at the application of blue methylene as an indicator of Candida colonies in various areas of oral cavity mucosa. Identification with blue methylene is a simple procedure that reduces the microbiological stages of planting and testing the candidate’s candidacy, shortening the timing of diagnosis, and performing this procedure at the dental chair. Based on the literature, though few, in number, the references indicate Lugol’s application, the 2% iodine solution as a candidate for treatment of candidiasis previously detected with blue methylene in the patients involved in the studies referred to in the literature. Iodine delivery in patients is progressively carried out, ranging from 1 drop to day, 2.5 mg, to a maximum of 5 drops/day, 12.5 mg, proportionally divided by day. Patients involved declare for lack of iodine allergies, and during subtype in this therapy, were kept under control for systemic sensations previously unpublished but based on literature, as sleeping disturbances, worries in the nutritional constituents of the individual diet, or any other concern.
“Desquamative Gingivitis Treated By An Antioxidant Therapy- A Case Report”inventionjournals
Desquamative gingivitis is described as an erythematous, desquamated or eroded gingival lesion. Various etiologic factors are present for the appearance of such lesions. Despite of considering etiology, treatment is oftenly provided by systemic or topical corticosteroids. Apart from steroid application, another optionable treatment is antioxidant therapy which provides rapid healing of the tissue. As antioxidants posses various advantageous properties, it can be considered as a first treatment option for desquamative gingivitis. The presented case report of desquamative gingivitis is successfully treated using systemic antioxidants in the form of commercially available „oxitard capsule‟.
“Desquamative Gingivitis Treated By An Antioxidant Therapy- A Case Report”inventionjournals
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“Desquamative Gingivitis Treated By An Antioxidant Therapy- A Case Report”inventionjournals
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1. 70
DENTINO
JURNAL KEDOKTERAN GIGI
Vol IV. No 1. Maret 2019
ATROPHIC GLOSSITIS AS A CLINICAL SIGN FOR ANEMIA IN THE
ELDERLY
(Case report)
Rahmatia Djou1
, Indah Suasani Wahyuni2
1
Oral Medicine Specialist Study Program, Faculty of Dentistry, Universitas Padjadjaran, Bandung,
Indonesia
2
Oral Medicine Department, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
ABSTRACT
Background: Atrophic glossitis is caused by nutritional deficiencies and this condition commonly
affects elderly patients. It may be the first sign of more serious systemic diseases or condition like
anemia. Aim: Describe about the atrophic glossitis in an elderly woman as a first clinical sign of
anemia and the treatment. Case: The patient was a 74-year-old woman with complaints of pain,
burning sensation and numb of the tongue for the last 3 months. The patient has gone to the general
dentist and given some medicines but the complaint still persists. Case management: Extra oral
examination showed the conjunctiva was anemic, and from intraoral examination found depapillated
and glossy tongue. Then the laboratory tests showed haemoglobin, haematocrite and the number of
erythrocytes were decreased, while MCV and MCH level were increased. The patient's tongue
abnormalities were diagnosed as atrophic glossitis associated with anemia Vitamin B (B12 dan folate)
deficiencies. Patients were given high dose of folic acids and vitamin B12 per oral, and mouthwash
containing hyaluronic acid as anti inflammation alternating with chlorhexidine gluconate 0,2%
mouthwash as an antiseptic. The tongue was repaired after 1 month therapy and healed in 2 months.
Discussion: Atrophic glossitis is considered as one of the the clinical signs of anemia, that appears as
areas of complete or irregular partial loss of papillae of the tongue, which is caused by atrophy of the
lingual papillae. The analysis of the appropriate diagnose and causative factors can be assisted
through a complete blood examination and will help us to decide the appropriate therapy. Conclusion:
Dentists must be aware of the clinical signs of atrophic glossitis, because it can be an indication of a
major health problem especially anemia.
Keywords: Anemia macrocytic, atrophic Glossitis, elderly
Correspondence : Rahmatia Djou , Departement of Oral Medicine, Faculty of Dentistry, Universitas
Padjadjaran, Jalan Sekeloa Selatan no 1, Bandung, Indonesia. Email: tiadjou.am@yahoo.com,
indah.wahyuni@fkg.unpad.ac.id,
2. 71
INTRODUCTION
Anemia is a major public health problem,
affecting around a quarter of the world's population,
especially among women in developing countries.
Anemia is the main haematological consequence of
nutritional deficiency.1,2
Anemia in the elderly
(defined as people more than 60 years old) is
common and increases with population growth, and
has a significant effect on quality of life, including
physical health, psychological health, social relations
and relationships with the environment. In the
elderly the most common cause of anemia is
deficiency of vitamin B12 and folic acid.3,4,5
The oral mucosa reflects general health status.
Some changes in the tongue may be a manifestation
of systemic diseases, nutritional deficiencies and
early signs of severe disease. Atrophic glossitis is an
inflammatory disorder, which gives the appearance
of a smooth dorsum tongue with a reddish color,
accompanied by pain and burning sensation.
Atrophic glossitis, occurs when the loss of 50% of
the fungiform and filiform papillae on the dorsum of
the tongue. In general, Atrophic glossitis is caused
by nutritional deficiencies associated with deficiency
of vitamin B12, iron, folic acid, riboflavin, and
niacin. Atrophic glossitis is considered as a sign of
nutritional deficiency anemia.6,7,8
The aim of this case report was to explain about
Atrophic Glossitis in a woman, elderly patients as a
clinical sign of anemia and will describe its
management.
Case Report
A 74-year-old woman came to Oral
Medicine Installation at our Dental Hospital with
complaints of pain, burning sensation and numb of
her oral mucosa, especially on the tongue. This has
caused difficulty in eating and swallowing also
unable to feel the taste of foods. Complaints were
felt for the last 3 months. Patients has gone to the
general dentist and were given topical steroid gel
treatment as anti-inflammatory, but the
complaints still persists. Patients had a history of
gastrointestinal disease and routinely went to the
internal medicine doctor every month. She also had
received antacid DOEN and Lanzoprazole treatment
routinely.
On extra oral examination found anemic
conjunctival eyes, and dry lips. Intra oral
examination showed paleness of the oral mucosa and
gingival, depapillation in the dorsal tongue and
fissure tongue (figure 1). We found grade 2 mobility
in teeth 31, 32, 33, 41, 42, 47, and 48 also tooth
missing 36.
Figure 1. Atrophic glossitis, the clinical feature
of the tongue was depapillated and glossy
(Visit I)
Based on the history taking and clinical
examination, the diagnosis of the patient was
suspected to Atrophic glossitis with anemia as
predisposing factors. The differential diagnosis were
burning mouth syndrome or oral manifestations of
Diabetes Mellitus, because of dry lip and
periodontitis that also found. Initial managements
were given a non-steroidal anti-inflammatory
mouthwash containing Hyaluronid acid and aloe
vera, instructions to maintaining cleanliness and oral
health, to eat balanced nutrition, drink milk and
adequate hydration, get enough rest and light
exercise. Patients were also asked to do a routine 8-
parameter of complete blood count (Haemoglobin,
leukocyte count, platelet count, hematocrit,
erythrocyte count, MCV, MCH, and MCHC), fasting
blood sugar and 2-hours post pandrial blood sugar.
At the second visit (1 week later), the patient
came with burning sensation and pain of the tongue
were felt by patients to be slightly reduced. The
mouthwash was used regularly, but the clinical
condition of the tongue had not shown significant
improvement (figure 2). The results of a laboratory
Djou: Atrophic Glossitis As A Clinical Sign For Anemia In The Elderly
3. 72
examination showing 9.8 g/dl Hb (normal: 12.0-16.0
g / dl), 29% hematocrit (normal: 37%-47%) and the
erythrocytes count 2.56 million/mm3 (Normal: 4.2-
54 million/mm3), MCV 112.5fl (Normal: 86-98 fl),
MCH 38,3pg (Normal: 27-32 pg), MCHC 34.0%
(Normal: 32%-36%), fasting blood sugar 82 mg/dl
(Normal: 82-115mg/dl) and 2 hours pp blood sugar
96 mg/dl (normal <120 mg/dl). It can be concluded
that Hb levels, hematocrit and the number of
erythocytes decreased while the MCV and MCH
values increased, but the MCHC, fasting blood sugar
and 2-hours PP blood sugar were still within normal
limits.
Figure 2. Atrophic glossitis, the clinical
condition of the tongue had not shown significant
improvement (Second Visit)
Based on the laboratory test results of clinical
diagnoses were supporting Atrophic glossitis related
to vitamin B deficiency anemia, and the differential
diagnosis were excluded. Further management in
patients were still given non-steroidal anti-
inflammatory mouthwash containing Hyaluronid
acid and aloe vera, added with administration of
2x50mcg/day of Vitamin B12, and multivitamins
containing Vit C, Vit E, Vit B1, Vit B2, Vit B6, Vit
B12, Folic Acid and Zinc.
On the third visit (1 week later), complaints of
burning sensation and pain of the tongue still
existed, but patients were more able to feel the taste
of food. Patients complained of abdominal pain after
taking a multivitamin given beforehand so that the
drug was not taken anymore, but mouthwash and
vitamin B12 were used as recommended. On intra-
oral examination it was found that the dorsum of the
tongue still had depapillation, accompanied by
macular erytema with diffuse margin on the upper
and lower labial mucosa and both of buccal mucosa
(figure 3).
Figure 3. a. Atrophic glossitis the dorsum of the
tongue still had depapillation and there were not
significant improvement yet, b-e. erytematous
macular with diffuse margin on the upper and lower
labial mucosa and both of buccal mucosa (Third
Visit)
The therapy given was replacement of the
previous mouthwash with 0.2% Chlorhexidine
gluconate mouthwash as antiseptic used 3x10ml/day.
The oral administration of folic acid 1x1000mcg/day
and 2x50 mg vitamin B12 per day were also given.
At the fourth visit (the following 1 week), the
complaints of burning sensation diminished and the
numbness in the tongue showed a slight good
improvement. The appetite of the patient was said to
be getting better, and the weight increase occurred to
37.4 kg (previously 37 kg), but the patient also
complained of canker sores on the upper lip mucosa.
On intra-oral examination found, depapillation
of the dorsum of the tongue appears to be repaired
slightly, erythematous macular lesions on both
buccal mucosa, upper and lower labial mucosa was
not found, but in the upper labial mucosa were found
multiple ulcers with a yellowish base surrounded by
erythematous and irregular edges, the diameter of
ulcers size between 1mm-3mm (figure 4). Then oral
therapy was given vitamin B12 in the same doses as
before, but the folic acid doses was increased to
1x5000 mcg/day.
a b c
d e
Dentino (Jur. Ked. Gigi), Vol IV. No 1. Maret 2019 : 70-76
4. 73
a b
Figure 4a. Atrophic glossitis showed slightly
good improvement. b-c. multiple ulcers with a
yellowish base surrounded by erythematous and
irregular edges at upper labial mucosa(Forth Visit)
On the fifth visit, complaints on the tongue have
diminished and are getting better day by day so that
it increased the appetite. The intra oral examination
were not found the multiple ulcers anymore and the
atrophic glossitis lesions getting better (figure 5).
The patient's body weight also increased slightly to
37.5 kg. Subsequently the patient was consulted for
the management of chronic periodontitis with grade
2 mobility in several anterior mandibular teeth. The
therapy given was still the same as the previous visit.
Patients were asked to control the following 2
weeks.
Figure 5. Atrophic glossitis showed better
improvement and multiple ulcers had healed (Fifth
Visit)
Sixth visit, complaints on the tongue have
improved so that the patient's appetite also gets
better. Provision of therapy was continued in the
form of vitamin B12 2x50 mcg/day and folic acid
1x5000 mcg/day. The patient was asked to do again
for 8 parameter complete blood count test and
control is recommended again after treatment in the
periodontia department.
At the last visit (after 1 month), complaints in
the oral cavity and tongue were no longer felt,
appetite improved and the patient's weight became
37.9 kg. The results of laboratory tests showed
improvement too, even though it had not reached the
normal reference value yet, namely Hb 10.3g/dl,
hematocrit 32%, and erythrocytes count 3.06
million/mm3, MCV 106.2 fl, and MCH 33.7 pg.
Thus the Hb value, hematocrit and the number of
erythocytes have increased from the previous
examination approaching the normal reference value,
and the MCV and MCH have decreased from the
previous approach to the normal value of the
reference value.
The clinical feature of the tongue has shown a
normal tongue papilla since previous visit (figure
6a), but in this visit accompanied by a slight plaque
on the patient's dorsum of the tongue (figure 6b).
Patients were asked to continue per oral treatment of
vitamin B12 2x50 mcg/day and folic acid
1x5000mcg/day, keep maintain tongue hygiene and
continue periodontal treatment until completion.
Figure 6a. Dorsum of the tongue showed normal
papillation (Sixth Visit). b. Dorsum of the tongue at
seventh visit with slightly plaque
Discussion
In this case, Atrophic Glossitis occurs in elderly
patients and is associated with anemia. This anemia
can occur due to lack of nutritional intake. In the
elderly, a decrease in nutritional intake and appetite
can be caused by various factors, including reduced
sensory and appetite functions, oral health status,
dental status such us mobility teeth and periodontitis.
The elderly medical or diseases factors and
consumption of certain drugs can affect absorption
of nutrients in the elderly, such as lansoprazole,
omeprazole, methotrexate, antikovulsan, and
antacid.9,10,11
This elderly patient is a woman who
has long been in the care of an internist and
consumes gastrointestinal drugs, namely DOEN
Antacids and Lansoprazole, so this drugs can be
expected to impaired nutrient absorption in patients
that result in deficiencies, especially vitamin B12
and folic acid.
a b c
Djou: Atrophic Glossitis As A Clinical Sign For Anemia In The Elderly
5. 74
Nutritional deficiencies can cause changes in the
tissue structure of the oral cavity, if there is a change
in the tongue papilla such as depapillation or
atrophy, it can reduce a person's appetite. Vice versa,
changes in the tongue papilla are often also the
initial clinical signs of nutritional deficiencies, so
that it can be said that nutrition affects the health of
the oral cavity and thus also the opposite.
Deficiencies in the intake of certain nutrients are
known to trigger the development of oral lesions and
can cause signs and symptoms in the oral cavity such
as Atrophic Glossitis or oral mucous ulceration.
Inadequate hydration also causes dry lip, which is
also found in these patients.12,13,14
In this case, a 74-year-old patient diagnosed
with Atrophic Glossitis, based on the history taking
that complained of burning sensation, pain and numb
in the oral mucosa especially on the tongue, so that
she unable to feel the taste of food, making it
difficult to eat and swallow. Based on the results of
the extra oral examination at the beginning of the
visit, which is found anemic signs in the conjunctiva,
and the intra-oral examination found dorsum of the
tongue looks depapillated, glossy and reddish. This
leads to the diagnosis of Atrophic Glossitis which is
suspected to nutritional deficiency anemia
involvement. After the results of a complete blood
count test were carried out, it is known that anemia
in these patients was macrocytic anemia or vitamin
B deficiency anemia (folic acid and vitamin B12).
In Atrophic Glossitis, the tongue will look
smooth and shiny all parts of the tongue or only in a
small portion. Atrophic Glossitis results from
atrophy in the filiform, fungiform, foliate and
circumvallata papillae. In the papilla atrophy which
first disappears is the filiform, then the fungiform
papilla. Atrophy of the filiform papilla has a more
severe clinical effect than the abnormalities of the
other papilla because the filiform papilla is the most
sensitive part to stimulation and systemic
changes.6,9,14
This is because of the micro vascularity of the
filiform papilla, in the form of a loop that resembles
a flower, and is interconnected, so that if there is a
disruption in the vascularization system it will also
affect the papilla. The tongue papilla cells have high
levels of cell regeneration, so micronutrients are
needed for cell proliferation and maintain cell
membrane thickness. Micronutrient deficiencies
which lasted for a long time can lead to
depapillation. Another mechanism for the
pathogenesis of papillary atrophy is thought to be
associated with a disruption in certain enzyme
systems, circulatory disorders or nutritional
deficiencies, that are important for the body and as a
result of systemic diseases.15,16
If there is atrophy in the papilla, especially the
filiform papilla, there may be a disruption in the
intracellular process. If the condition of
micronutrient deficiency does not last long then
physiologically regeneration will occur and not
resulted in a feature of atrophy. The papilla of the
tongue condition is one of the most sensitive
indicators of nutritional status, so dentists especially
oral medicine specialists, must be aware of the
clinical signs of Atrophic Glossitis, because this can
be an indication of systemic health problems,
especially anemia.16,17
Anemia is a multifactorial condition and with
several pathological mechanisms. Anemia based on
the criteria of the World Health Organization
(WHO) is defined as a hemoglobin concentration of
less than 12 g/dL in women and less than 13 g/dL in
men. High anemia prevalence is found in the elderly
and in women because it has many risk factors for
anemia such as nutritional deficiencies, bleeding and
chronic diseases. 18,19
Symptoms of anemia begin to
appear when there is a decrease in the amount of
normal hemoglobin, hematocrit and the erythrocytes
count in the blood circulation. 21
In this case, the patient suffers from macrocytic
anemia related to folic acid and vitamin B12
deficiency, this can be seen from the results of
hematological examination that found hematocrit,
hemoglobin value and the number of erythrocytes
lower than the normal value range, while mean
corpuscular volume (MCV), and mean corpuscular
haemoglobin (MCH) were increases. Vitamin B
deficiency in these patients is thought to be
associated with chronic gastritis in patients who have
been suffering for a long time. Gastritis causes
malabsorption of vitamin B12, which triggers
anemia which can lead to the emergence of atrophic
glossits. The treatment of chronic gastritis that is
consumed routinely by patients is Lansoprazole and
Antacids. The use of this drug is also thought to play
Dentino (Jur. Ked. Gigi), Vol IV. No 1. Maret 2019 : 70-76
6. 75
a role in impaired absorption of vitamin B12 and
folic acid. 11,20,21
.
The anamnesis taking found that patients also
experienced physical and psychological stress due to
family problems. Prolonged physical and
psychological stress can lead to an increase in gastric
acid, causing chronic gastritis which can triggers
micronutrient malabsorption and continues to
anemia. Stress can also cause hyposalivation or dry
mouth which worsen the apetites of the patients than
will causing difficulty eating, so that nutrient intake
is reduced and trigger to the occurrence of
anemia.22,23
In addition to the presence of atrophic glossitis,
patients also had multiple ulceration in the upper
labial mucosa. This is because anemia can cause the
activity of enzymes in the epithelial cells
mitochondria decrease due to disruption of oxygen
and nutrients transport, thereby inhibiting the
differentiation and growth of epithelial cells. As a
result the process of end stage differentiating
epithelial cells towards the stratum corneum is
inhibited and then the oral mucosa will become
thinner because of loss of normal keratinization, then
the atrophy occurs, and more easily to be ulcerated.
Anemia also causes damage to cellular immunity,
reduced bactericidal activity from
polymorphonuclear leukocytes, inadequate antibody
response and abnormalities in epithelial tissue.
Ulcerations as found in these patient is often found
in someone who had deficiencies in vitamin B12,
folate, and iron.20,24
Pharmacological management for these
patients, at the beginning of therapy was given a
non-steroidal anti-inflammatory mouthwash
containing Hyaluronid acid and aloe vera, and oral
administration of Vitamin B12 2x50mcg/day and
multivitamins. The mouthwash then was replaced
with chlorheksidine gluconate 0.2% as an antiseptic
to prevent secondary infection. After the diagnosis of
macrocytic anemia decided, the oral administration
of vitamin B12 2x50 mcg/day continued and the
addition of folic acid become 1x5000 mcg/day.
Hyaluronid acid in mouthwash given as an anti-
inflammatory that increases oral mucosa tissue
hydration and accelerates healing, while the content
of polyvinyl pyrilidone (PVP) works by coating the
oral mucosa to prevent direct contact with the oral
environment or by blocking the irritation pathway,
and Aloe vera extract also functions as an anti-
inflammatory, works by stimulating the immune
system function and the growth of collagen.
Chlorhexidine gluconate in this treatment given as
an antiseptic that is expected to prevent secondary
infections and create an oral environment conducive
to the healing process.25,26
Giving vitamin B12 with
folic acid orally will form S-adenosylmethionine
compounds involved in immune function of body
cells. Vitamin B12 and folic acid also play a role and
work together in the process of erithrocyte
regeneration and cell reepithelialization. 27
The second complete blood count test have
shown good improvement but have not reached the
normal value limit yet, so the next treatment plan is
to continue the administration of Vitamin B12 and
folic acid, Oral Hygiene Instruction (OHI) and
Communication Information and Education (CIE)
that prioritize tongue hygiene and balanced healthy
nutritional intake to prevent reappearance of the oral
manifestation such as atrophic glossitis, ulceration
and dryness of the mouth. Treatment for systemic
conditions is then referred to an internal medicine
specialist or geriatric division.
The treatment of periodontal conditions in these
patient is carried out in collaboration with the
periodonsia department, because the periodontitis
will interfere the function of mastication and patient
comfortness or convenience while eating.
Periodontal treatment that has been done is to do
scaling and root planning, so that after treatment the
condition of tooth mobility is no longer found.
Replacement the missing teeth is needed with
artificial denture to improve the optimal masticatory
function, especially for elderly patients. Recovery of
masticatory function is important in supporting the
treatment of oral and periodontal conditions
especially for the management of elderly patients
with nutritional deficiency anemia, because
conditions that are not conducive to mastication will
affect adequate nutritional intake.
Elderly is a high risk group suffering from
anemia. This requires comprehensive management
by collaborating health care providers from various
fields of science. Early detection and correction of
nutritional deficiencies can prevent further
Djou: Atrophic Glossitis As A Clinical Sign For Anemia In The Elderly
7. 76
complications, as well as improve the prognosis for
patients. It can be concluded that dentists must be
aware of the clinical signs of Atrophic Glossitis,
because this can be an indication of systemic health
problems, especially anemia.
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