This document discusses oral premalignancies, which are lesions with potential for malignant transformation. Erythroplakias carry the highest risk, while some leukoplakias have a lower risk depending on the degree of dysplasia found histologically. Biopsy is important to assess dysplasia. Risk factors include erythroplakia, sublingual keratosis, snuff or tobacco use, lichen planus, lupus erythematosus, and oral submucous fibrosis. Management includes stopping habits, treating infections, biopsy, and ablation or excision of high risk lesions.
presentation for department of oral medicine and radiology.
while presenting make sure to focus more on differential diagnosis and read about each cyst in detail as i havent included the details.
Odontogenic keratocyst (OKC) is the cyst arising from the cell rests of dental lamina. It can occur anywhere in the jaw, but commonly seen in the posterior part of the mandible. Radiographically, most OKCs are unilocular when presented at the periapex and can be mistaken for radicular or lateral periodontal cyst.
Although, dental plaque is considered as the primary etiological factor in the development of periodontal diseases; the presence of dental calculus is also one of the great concern to the clinicians because it facilitates plaque formation by providing the surface for its formation and keeps it in close contact with the gingival tissues.
presentation for department of oral medicine and radiology.
while presenting make sure to focus more on differential diagnosis and read about each cyst in detail as i havent included the details.
Odontogenic keratocyst (OKC) is the cyst arising from the cell rests of dental lamina. It can occur anywhere in the jaw, but commonly seen in the posterior part of the mandible. Radiographically, most OKCs are unilocular when presented at the periapex and can be mistaken for radicular or lateral periodontal cyst.
Although, dental plaque is considered as the primary etiological factor in the development of periodontal diseases; the presence of dental calculus is also one of the great concern to the clinicians because it facilitates plaque formation by providing the surface for its formation and keeps it in close contact with the gingival tissues.
'Oral Potentially Malignant Disorders' includes a variety of lesions with risk of progression to malignancy. It is widely prevalent in the Indian population, and early diagnosis and management is the need of the hour.
Here's a discussion of the same with methods of early diagnosis of such lesions.
Dental attrition is a type of tooth wear caused by tooth-to-tooth contact, resulting in loss of tooth tissue, usually starting at the incisal or occlusal surfaces. Tooth wear is a physiological process and is commonly seen as a normal part of aging.
Tooth discoloration is abnormal tooth color, hue or translucency. External discoloration is accumulation of stains on the tooth surface. Internal discoloration is due to absorption of pigment particles into tooth structure.
Dentine, unlike enamel, has the ability to react to the progression of caries due to the presence of odontoblasts. Odontoblasts can respond to irritation by depositing minerals in the dentinal tubules
Minimal intervention dentistry vs g.v blackEdward Kaliisa
Minimal Intervention Dentistry (MID) is a response to the traditional, surgical manner of managing dental caries, that is based on the operative concepts of G.V. Black of more than a century ago. MID is a philosophy that attempts to ensure that teeth are kept functional for life
Tooth resorption is the progressive loss of dentine and cementum by the action of osteoclasts. This is a physiological process in the exfoliation of the primary dentition, caused by osteoclast differentiation due to pressure exerted by the erupting permanent tooth
Nutrition and dental caries. Promotion of sound dietary practices is an essential component of caries management, along with fluoride exposure and oral hygiene practices. ... Fermentable carbohydrates interact dynamically with oral bacteria and saliva, and these foods will continue to be a major part of a healthful diet.
Dentinogenesis imperfecta (DI) is a genetic disorder of tooth development. This condition is a type of dentin dysplasia that causes teeth to be discolored (most often a blue-gray or yellow-brown color) and translucent giving teeth an opalescent sheen.
SEQUELAE. Most dental pain occurs as a result of caries. Initially, caries presents as a painless white spot (decalcification of the enamel, which may be reversible), followed by cavitation and brownish discoloration. ... Untreated caries can progress through the dentine to the pulp, which becomes inflamed (pulpitis)
Tooth decay, also known as dental caries is an epidemic, microbiological contagious disease of the teeth that ends in localized dissolution and damage of the calcified structure of the teeth. ... The time factor is significant for the commencement and development of caries in teeth.
Dental radiographs are commonly called X-rays. Dentists use radiographs for many reasons: to .... Detect any presence or position of unerupted teeth.2-D Conventional radiographs provide excellent images for most dental radiographic needs. Their primary use is to supplement the clinical examination by providing insight into the internal structure of teeth and supporting bone to reveal caries, periodontal and periapical diseases, and other osseous conditions.
Amelogenesis imperfecta is a disorder of tooth development. This condition causes teeth to be unusually small, discolored, pitted or grooved, and prone to rapid wear and breakage
The traditional method of detecting dental caries in clinical practice is a visual‐tactile examination often with supporting radiographic investigations.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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2. ORAL PREMALIGNANCY
• Oral premalignancies are lesions which have a potential for malignant
change.
• Various oral mucosal lesions particularly red lesion ( erythroplasias)
and some white lesions (leukoplakias) have a potential for malignant
change.
• The risk of malignancy transformation is more common with
erythroplakias. The most common white lesions have the lowest risk
of malignant transformation.
• The best predictor of potential for malignant transformation is the
degree of dysplasia( abnormal growth) seen histologically. For this
reason, biopsy of red and white patches is mandatory.
3. • Dysplastic cells show histologically nuclear hyperchomatism, nuclear
pleomorphism and altered nuclear/cytoplasmic ratio, excess mitotic activity,
loss of polarity of cells, deep cell keratinization, disordered or loss of
differentiation.
• Surveys indicate that the risk of malignant change in
white lesions is higher in non-smokers.
• Surveys indicate also that malignant change in white lesions is more
frequent in women
4. PREMALIGNANT LESIONS AND CONDITIONS
1)Erythroplasia ('erythroplakia')
• Erythroplasias are red patches.
• Erythroplasia is uncommon in the mouth but carries the
highest malignant transformation.
• Lesions are often already malignant on first biopsy.
• Eurythroplastic lesions show severe epithelial dysplasia.
• The epithelium is atrophic and this, together with
inflammation, accounts for the red color seen clinically.
5.
6.
7. 2. Idiopathic Leukoplakia
• Leukoplakia is defined as a white patch which cannot be wiped
off the mucosa.
• If investigations fail to reveal any cause, it is called idiopathic leukoplakia.
• The most extensive follow-up studies on white patches suggest that idiopathic
leukoplakia now has the highest risk of developing cancer.
• The malignant transformation rate of leukoplakia is relatively low, around 1-2% in
5 years
8. • Even in smokers the vast majority of leukoplakias show no dysplasia
histologically and carry no risk of malignant transformation.
• Idiopathic leukoplakias are tough and adherent and form plaques
whose surface is raised above the surrounding mucosa.
• The most common sites are the posterior buccal mucosa, retromolar
region, floor of mouth and tongue.
9.
10. SUBLINGUAL KERATOSIS
• The term sublingual keratosis is applied to white lesions on the
floor of mouth and ventral tongue.
• Malignant change was reported in an unusually high proportion of cases
(30%) in one series but this has not been widely confirmed.
• Probably the risk of malignant transformation is less than 10%
and possibly much lower.
• Clinical features
Sublingual keratosis is a white, soft plaque, usually with a finely
wrinkled surface, an irregular but well-defined outline and
sometimes bilateral with a butterfly shape.
11. • The plaque typically extends from the anterior floor of the mouth to
the undersurface of the tongue .
12. PIPE SMOKERS' KERATOSIS
• Palatal keratosis due to pipe smoking is benign.
• Any carcinomas related to pipe-smoking appear in
another site in the mouth and may not be preceded by keratosis.
13. SMOKELESS TOBACCO-RELATED KERATOSES
• Hyperkeratotic mucosal lesions can result from smoking or use
of smokeless tobacco ('topical tobacco' — snuff-dipping and
tobacco chewing).
• there is no characteristic hyperkeratotic lesion associated with the far more
common habit of cigarette smoking .
• The habit of snuff-dipping or tobacco-chewing may be maintained for
decades and gives rise to keratoses in the buccal or labial sulcus, where the
tobacco is held.
14. • Early changes are erythema and mild, whitish thickening.
• Long-term use gives rise to extensive white thickening and wrinkling
of the buccal mucosa.
• Malignant change can follow, but only after several decades of use.
• The main changes are thickening of the epithelium with plump
or squared-off rete ridges.
• There are varying degrees of hyperorthokeratosis or parakeratosis and
there may be subepithelial fibrosis in the area where the tobacco is
held.
• Dysplasia may eventually be seen.
15. Management
• Diagnosis is based on the history of snuff use and the white
lesion in the area where the tobacco is held.
• Biopsy is required to exclude dysplasia or early malignant change.
• in snuff-dippers carcinomas appear at a later age and are better
differentiated than in non-users.
• Snuff-dippers' lesions will resolve on stopping the habit even
after 25 years of use.
16. CHRONIC HYPERPLASTIC CANDIDOSIS (CANDIDAL LEUKOPLAKIA)
• Chronic oral candidosis produces a tough adherent plaque,
distinguishable only by biopsy from other leukoplakias.
• The most affected are Adults, typically males of middle age
or over.
• The usual sites are the dorsum of the tongue and the post-
commissural buccal mucosa.
• The plaque is variable in thickness and often rough or
irregular in texture, or nodular with an erythematous
background (speckled).
17. • Unlike thrush, the plaque cannot be wiped off, but fragments
can be detached by firm scraping.
• Gram or periodic acid-Schiff(PAS) staining shows candidal hyphae embedded in
clumps of detached epithelial cells.
• Like thrush, the plaque of chronic candidosis is parakeratotic,
but more coherent because it is not widely infiltrated by
inflammatory exudate .
• PAS stain clearly shows the hyphae growing (as in thrush) through the full thickness
of the keratin to the prickle cell layer where the inflammatory cells tend to be more
concentrated.
• Electron microscopy shows Candida albicans to be an
intracellular parasite growing within the epithelial cytoplasm
18. • Induction of epithelial proliferation by Candida albicans
infection has been demonstrated experimentally.
• in candida plaques there is often rete hyperplasia with rounded
downgrowths and acanthosis.
Management
• After confirmation of the diagnosis by histology, treatment
should be with a systemic antifungal drug such as fluconazole.
• Stopping the patient from smoking and elimination of candidal infection
from under an upper denture are important.
• Any iron deficiency should also be treated.
19.
20. LICHEN PLANUS
• Lichen planus is a common chronic inflammatory disease of
skin and mucous membranes. It mainly affects patients of middle
age or over.
• The potential of lichen planus to undergo malignant change is
controversial.
21.
22. LUPUS ERYTHEMATOSUS
• Lupus erythematosus is an uncommon connective tissue disease
• There is a small risk of malignant change in cutaneous lupus,
especially in lesions of the lower lip.
23. DYSKERATOSIS CONGENITA
• Dyskeratosis congenita is a rare heritable recessive or dominant
trait.
• The main features are dysplastic white or red lesions of
the oral mucosa, cutaneous pigmentation, dystrophies of the
nails and haematological abnormalities.
• Many patients may also be immunodeficient or have other
abnormalities.
• Causes of death include cancers of the mouth or other sites,
bleeding (gastrointestinal or cerebral) but in 50% from infections,
which are frequently opportunistic
24. ORAL SUBMUCOUS FIBROSIS
• Affected areas of the oral mucosa such as the palate or buccal mucosa appear
almost white.
• The pallor is due to the underlying fibrosis and ischaemia
rather than a superficial plaque.
• the mucosa is typically smooth, thin and atrophic.
• Erythroplasia and leukoplakia may be associated and the epithelium may
show dysplasia on biopsy.
• Surveys suggest that oral submucous fibrosis undergoes
malignant transformation in 4.5-7.6% of cases.
• Contributes to the high incidence of oral cancer in the Indian
subcontinent and in Asian immigrant populations in other countries.
25. SYPHILITIC LEUKOPLAKIA
• Leukoplakia of the dorsum of the tongue is a characteristic
complication of tertiary syphilis.
• The lesion has an irregular outline and surface.
• Cracks, small erosions or nodules may prove on histology to be foci of invasive
carcinoma.
• Carcinoma developing near the centre of the dorsum of the tongue is typically a sequel to
syphilitic leukoplakia.
• In addition to hyperkeratosis and acanthosis, often with dysplasia,
the characteristic late syphilitic chronic inflammatory changes, with plasma cells
predominating, may be seen.
• Giant cells and rarely, granulomas may be present and endarteritis of small arteries
is particularly characteristic.
26. • Management
• The diagnosis is confirmed mainly by the serological findings.
• even if positive, biopsy is still essential, as minute areas of malignant
change may be found, and the management is affected accordingly.
• The presence of syphilitic endarteritis, may be a contraindication to
radiotherapy.
• Antibiotic treatment of syphilis does not cure the leukoplakia.
27.
28. • EARLY CARCINOMA
• An early carcinoma produces surface keratin and
appears as a white patch
• It should not be interpreted as malignant change in a leukoplakia.
29. • MANAGEMENT OF DYSPLASTIC LESIONS
• The prognosis in oral carcinoma is good only when the diagnosis is
made early and the tumour is small.
• The best predictor of malignant potential is the presence of
dysplasia on biopsy
30. Principles of management of dysplastic lesions
• Stop any associated habits, e.g. smoking
• Treat candidal infection and/or iron deficiency if present
• Biopsy to assess dysplasia
• Assess risk of premalignant change on clinical and histological
findings
• Consider ablation of individual lesions
• Maintain observation for signs of malignant change
31. Options for management of premalignant lesions
• Observation for early detection of carcinoma
• Surgical excision with grafting, if required
• Cryotherapy
• Laser excision or vaporisation
• Topical chemotherapy
• Retinoids