Leukoplakia Lichen planus Oral Submucous Fibrosis Candidiasis Apthous Ulcer Pemphigus Erythema Multiforme Xerostomia Herpes Simplex Infection

1. RECENT TREATMENT
MODALITIES FOR ORAL
COMMON MUCOSAL
LESIONS
DR PRIYANKA
ORAL MEDICINE AND RADIOLOGY

2. LIST OF COMMON ORAL MUCOSAL
LESIONS
 Leukoplakia
 Lichen planus
 Oral Submucous Fibrosis
 Candidiasis
 Apthous Ulcer
 Pemphigus
 Erythema Multiforme
 Xerostomia
 Herpes Simplex Infection

3. LEUKOPLAKIA
A. Elimination of habit- follow 5A principle
 Ask- about tobacco usage every time
 Advise- urge tobacco users to quit
 Assess- determine willingness to make a quit attempt
 Assist- provide help to move the individuals towards a successful quit attempt
 Arrange- follow up contact
 Pharmacological replacement of tobacco cessation are –
 Tab Bupropion – 150mg twice daily for 2 weeks
 Nicotine replacement therapy – Nicotine gums, Nicotine patch, Nicotine inhaler, Nicotine nasal spray.

4. B. Pharmacotherapy – to decrease keratinization and malignant potential
1. VITAMIN A – cause breakdown of keratin
- Oint Tretinoin 0.05%, 0.1% for 1 month
2. ANTIOXIDANT – Scaveng free radicals
- Combination of multivitamin ( VIT A, Betacarotene, C,E, Zinc, Selenium, Manganese
and copper) or
- Tab Lycopene 4-8mg / day for 1 month
- Green/ Black tea – 3-4 times a day for 3 months
3. CYTOTOXIC AGENT – to kill cancerous and precancerous cells directly
- Oint Bleomycin 0.5% , 1% 2-3 times a day for 15 days or
- Tab 5- Fluorouracil 0.5% , 1% 2 times a day for 15 days

5. C. PHOTODYNAMIC THERAPY
 Administer photosensitizer dye (5- Aminolaevulinic acid / ALA) to the body
 Selective uptake and retention to tumor site for longer time
 Dye is activated by exposure to light of specific wavelength in presence of oxygen
 Activated photosensitizer will result in formation of toxic oxygen species – singlet oxygen and free
radicals
 These highly reactive chemical species can damage the cancerous cell by damaging intracellular organelle
D. SURGERY
 Scalpel surgery
 Cryosurgery
 Laser surgery

6. LICHEN PLANUS
A. ASYMPTOMATIC RETICULAR / PLAQUE TYPE
 Avoidance of risk factor (Stress) – Tab Alprazolam 0.25 mg bd for 5 days
 Antifungal – Cream Clotrimazole 1% tid for 10 days or
- Cream Ketaconazole 2% tid for 10 days
B. ATROPIC/ EROSIVE TYPE
 Stress Reduction
 Anaesthetic agent – Benzydamine hydrochloride (0.15%) spray or mouth rinse tid for 10 days
 Antifungal
 Corticosteroid – Oint Triamcinolone acetanoid 0.1% tid for 15 days followed by tapering topical
application or
- Oint Clobetasol Propionate 0.05% tid for 15 days followed by tapering topical application

7. C. SEVERE SYMPTOMATIC ATROPIC/ EROSIVE, UNRESPONSIVE TO TOPICAL MEASURES
 Stress Reduction
 Intralesional Steroid- Triamcinolone acetanoid 10-20mg diluted with 0.5ml saline or 2% lidocaine 3-4
times a week
 - Dexamethasone 4mg/ml
 Systemic steroid – Tab Prednisolone 40-60mg/day with topical corticosteroid and antifungal
 Topical antifungal
 Immunomodulatory drugs – allergic to steroid
 - Tab Levimasole 200-300mg/day for 3 months
 - Topical Tacrolimus 0.1% 2-4 times a day for 4-8 weeks
 PUVA Therapy ( Psoralen With Long Wave Ultraviolet Light)
 - Methoxypsoralen orally followed by administration of 2hours of UV Radiation
intraorally in affected sites
 Surgical – Cryosurgery and carbon dioxide laser ablation

8. ORAL SUBMUCOUS FIBROSIS
 A. PREVENTIVE MEASURES
 Ask patient to quit habit, counsel and motivate.
 B. MEDICAL MANAGEMENT
 1. Antioxidant – Combination of Multivitamin bid for 1-3 months or
 - Tab Lycopene 4mg bd for 1 month or
 - Cap Oxitard two times a day for 3 months
 2. Intralesional Injection – Hyluronidase 2mg ( break hyaluronic acid
 - Dexamethasone 4mg or 10mg/ml triamcinolone acetanoid (anti-inflammatory)
 - Placentrax 2ml (increase vascularity and promote regeneration)
 Comibination of above biweekly for 6-8 weeks

9.  3. Turmeric, Turmeric Oil – excellent scavenger
 Turmeric oil 600mg mixed with 3g Turmeric/ day for 3 months
 4. Collagenase – 1ml mixed with 1ml of xylocaine ( control burning pain and improve mouth opening)
 5. Tab Levamisole and Betacarotene - 50mg three times a day and 2 caps/ day of betacaroetene for three
alteranate weeks
 6. Others – Pentoxyfilline, Aloe vera, Stem cell therapy (reduce blanching, burning sensation), oral stent
(as a treatment adjunct to surgery)
C. PHYSIOTHERAPY
 Puffing the cheek and keep for 10 sec
 Apply pressure from tongue to buccal mucosa
 Wooden spatula interpositioning between teeth and adding new spatula every 5-10 days.

10. D. SURGICAL MANAGEMENT
 1. Surgical resection of fibrotic bands
 2. Nasolabial Flap – disadvantage – extraoral scar- Grade III OSMF
 3. Tongue Flap – excellent result- Grade II Osmf
 4. Palatal island flap –
 5. Radial forearm flap
 6. Anterolateral thigh flap
 7. Buccal pad fat – Grade I osmf
 8. Split thickness skin graft – 0.016 inch split thickness graft – satisfactory result – Grade IV OSMF
 9. LASER (Erbium Chromium Yttrium Scandium Gallium Garnet

11. CANDIDIASIS
TOPICAL THERAPY
 1. Nystatin – oral suspension 400,000 – 600,000 units , 4-5 times a day (swish and swallow) for 7-21 days
 - cream and oint 100,000u/g 4-5 times a day
 - powder (50 million U) sprinkle on tissue contact area of denture
 2. Clotrimazole – Oral suspension 5ml 3-4 ties a day for 14 weeks
 - Troche 10mg, slowly dissolve in mouth 5times a day for 7 days
 - cream 1% 2-3 times a day for 3-4 weeks
 3. Miconazole – Cream 2% 1-2 times a day for 7 days
 4. Ketoconazole – Cream 2% 1-2 times a day for 7 days
 5. Amphotericin B – Oral suspension 100mg/ml 3-4 times a day after food for 2 weeks
 - Troche 10mg , slowly dissolve in mouth 3-4times a day for 2 weeks

12. SYSTEMIC THERAPY
 Tab Ketoconazole 200-400mg/day single dose for 7-14 days
 Cap Fluconazole 200mg on day 1 then 100mg daily for 7-14 days
 Cap Itraconazole 100mg once daily
 Cap Posaconazole 400mg bd for 7-14 days

13. APTHOUS ULCER
MINOR FORM
 Avoid stimulus (stress,food)
 Treatment of anemia, if present
 Topical Analgesic – Benzocaine gel 2-3 times a day for 7 days
 Vitamin Spplement – Tab B Folate twice daily for 7 days
 Antiseptic Mouthwash – Benzydamine Hydrochloride 3-4 times a day
 Topical application of 5% Amelaxanox 3-4 times a day (anti-inflammatory, antiallergic anf
immunomodulator)
 Topical Steroid – Triamcinolone acetonide 0.1% or Clobetasol 0.05% tid for 7 days

14. MAJOR FORM
 Topical steroid
 Intralesional Steroid – Triamcinolone actanoide 10-20mg or
 - 2ml Dexamethasone diluted with 0.5ml saline or 2% lidocaine 2 times /week
 Systemic steroid – Tab Prednisolone 40-60mg / day for 5 days
 Immunomodulator – allergic to steroid
 - Tab Levamisole 150 mg bd for 5 days or
 - Tab Dapsone 100 mg /day for 5 days

15. PEMPHIGUS
VERY MILD
 Topical Corticosteroid – Triamcinolone acetanoide
 - Clobetasol propionate
 Antifungal – Topical Clotrimazole 3-4 times a day
MODERATE CASE
 Tab Prednisolone 40-60 mg / day
 High potency Topical steroid
SEVERE CASES
 Increase dose of systemic steroid 50% for every 4-7 days then tapered
 No recovery till 100 mg then PULSED INTRAVENOUS THERAPY ( 1mg methylprednisolone in 150 ml
of dextrose and water over a period of 90 mins once daily on 1-5 consecutive days.

16. ERYTHEMA MULTIFORME
MILD FORM
 Heal in 2-6 weeks
 Topical analgesic
 Diphenhydramine hydrochloride syrup mixed with equal amount of antacid liquid in swish and swallow 3-
4 times a day
 Topical steroid
SEVERE FORM
 Systemic corticosteroid
IN CASES SUSPECTING HERPES ASSOCIATED ERYTHEMA MULTIFORME
 Acyclovir 400mg bd for 10 days or valacyclovir 500 -1000mg /day

17. XEROSTOMIA
PREVENTIVE THERAPY
 Topical fluoride application from daily to once per week
SYMPTOMATIC THERAPY
 Frequent sip of water or ice chip
 Use of humidifiers
 Aloe vera or Vitamin E
 Artificial saliva
SALIVARY STIMULATION
 Local stimulation – Chewing gums
 Systemic stimulation – Tab Pilocarpine HCL 5-7.5mg 3-4 times a day 30 mins before meals
 - Tab Cevimeline 30mg 3 times a day
 - Tab Bethanechol 25mg 3 times a day

18. HERPES SIMPLEX INFECTION
TO RELIEVE PAIN
 2% Viscous Lidocaine ( Swish and spit out 5ml ) 4-5 times a day for 14 days
 Benzydamine hydrochloride mouth rinse 3-4 times a day for 14 days
TO MAINTAIN PROPER FLUID BALANCE
 Fluid replacement
MILD TO MODERATE CASES
 Antiviral drugs – Cream 5% Acyclovir 3-4 times a day for 7 days
 - Cream Panciclovir 1% 3-4 times a day for 7 days
SEVERE CASES
 Antiviral drugs – Tab Acyclovir 200-400mg 5 times a day dor 7 days
 - Tab Valacyclovir 1g twice a day for 7 days
 - Cream Foscarnet 3% 3-4 times a day