Professional Documents
Culture Documents
( I. Penyakit Mulut )
Definition : Oral mucosal disease
Oral mucosa : - gingiva
- buccal/labial mucosa
- tongue
- palate
1. Gingiva
2. Periodontal membrane
3. Cement
4. Alveolar proc.
Gingiva
Sign of healthy gingiva:
a. pink colour
b. attach to the teeth & alveolar
bone
c. does not bleed easily
d. no edema
e. no exudate
f. gingiva sulcus < 2 mm
Gingival Enlargement
( K 06.1 ICD WHO )
1. Hypertrophy or inflamatory
enlargement ( increase in the
size of the cellular elements )
2. Hyperplasi or fibrotic
enlargement ( increase in the
number of the cellular elements )
d.Occlusal interferences
e. Irritation from ill-fitting prosthetic
or orthodontic appliances
f. Mouth breathing
2. Systemic predisposing
factors
A. Endocrine
a. Puberty
b. Menstruation, pregnancy,
contraseption medication
c. Diabetes
d. Hypothyroidism & pituitary
dysfunction
B. Nutritional
a. Scurvy
b. Nutritional deficiencies
C. Blood dyscrasias
a. Leukemias
b. Polycethemia vera
D. Drugs (dilantin & barbiturat )
E. Idiophatics : diffuse
fibromatosis
HYPERTROPHY GINGIVA
-Hypertrophy is more commonly than
hyperplasia
- begins at an area of poor oral hygiene
mechanical irritation, food impaction
- first the interproximal gingiva then
spread to----- intire labial / buccal
- edema, bright red or purplish red color,
tendency to hemorrhage
TREATMENT
1. Establish excellent oral
hygiene
2. Eliminate the local
predisposing f
3. Eliminate the systemic
predispo sing causes
4. Proper home care
HYPERPLASI G.E
- normal pink color
- firm, hard and fibrous in
concystency
- does not bleed readily
- are associated with dilantin, rarely
the
barbiturates
- long standing gingival
hypertrophy
FUSO SPIROCHAETAL
INFECTION
A. Acute Necrotizing Ulcerative
Gingivostomatitis = Vincents stomatitis = Trench mouth
The precise etiology is not known, it is
believed to be a polymicrobial infection
Vincent identified Borrelia vincentii ( a
spirochaeta) and Bacillus vincentii
(fusiform)
Fusobacterium necrophrom, prevotella
intermedia, treponema species
Predisposing factors
1. Local factors
a. erupting or malposed teeth,
perico ronal infection
b. faulty restoration, ill-fitting
prosthetic ---- food impaction
c. poor oral hygiene
d. local circulatory and nutritional
disturbances of marginal gingiva
2. Systemic factors
a. malnutrition
vit. C and Bc deficiencies, vit A
b. disease of the blood forming
tissues
----- leukemia, anemia
c. gastrointestinal and
endocrine
disturbances
d. stressful situation and
extreme
fatigue
TREATMENT
1. Control of bacteri : topical or systemic
antibiotic (penicillin , metronidazole)
2. Elimination of the local & systemic
predisposing factors
3. Educationing the correct OH habits
4. Surgical manipulation is contra indicated
B. Noma
Is a rapidly spreading and frequently
fatal gangraen of the mucocutaneous
orifices such as the lips, nostrils,
external auditory canal or genital
Noma of the oral cavity (the most
frequent site) is called cancrum oris
---- begins on the mucosa surface
A rare disease
- circulatory
inadequate
b. local
: - poor oral hygiene
- chronic irritation
- trauma
Perforation of
the effected
cheeks and lips,
hipersalivation
Treatment
antibiotics
systemic in high
dose
improvement in
nutrition & gen.
resist.
ULCERATIVE , VESICULAR
and BULLOUS LESIONS
( K 12 ICD WHO )
Ulceration is the most frequently
Signs & symptoms of diseases
ranging from the most benign
traumatic of mastication, to the most
rapidly fatal form of malignancy
careful attention ! ! !
- history
- onset, recurrences,
frequency,
severity
- chronic progressive
process????
- evaluation of lymp nodes
- laboratory
- biopsy
Treatment :
- supportive
- mouth rinse
- acyclovir ( if
needed)
Treatment
supportive ( vit
C & Bc )
Lip lesion
maybe minimize
with acyclovir
cream 5%
applied in the
prodrome
3. Recurrent Aphthous
Ulceration / stomatitis
Characterized by the reccurent
appearances of painful ulcers on the
oral mucosa membr.
A prodome of 1-24 hours, sensation
of burning & tingling in the effected
mucosa
Initial change : appearance of small
erythematous macules crateriform
ulcers, extremely painful
difficulty in eating & speaking
Etiology of RAS
- is not intirely clear
- a minor degree of immunological
dysregulation underlies aphthae
- praedisposing factors :
* genetic
* deficiency : Fe, folic acid.
* stress
* trauma from biting, dental appliances
* allergies to food
* endocrine factors : menstrual c ,
contra- ceptive pill
- immunological features
Treatment :
corticosteroid :
locally
systemically
mouth rinse
eliminate
etiology factors
4. Herpes Zoster
Etiologi reactivation of
varicella zoster virus
( produces varicella
zoster )
Following resolution,
the virus lies dormant
in the dorsal root
ganglia until
reactivation along
Predisposing
factors
- overwork,
fatique
- stress
- malnutrition
- chronic disease
(leukemia, cancer,
hiv)
- radiasi
Treatment
Supportive
acyclovir (if needed)
though the lesion dissapear ---neuralgia may persist weeks or
months
5. Erythema Multiforme
Dermatosis characterized by great
variation in the form, size,
distribution and appearance of the
lesion
80-90% mouth involvement
etiologi ??? Herpes virus ?
Occurs in infant, children, young
adult
-Steven Johnson : EM
+conjunctivitis
WHITE LESIONS
Devided into 2 main groups :
b. Moniliasis
-the common form is thrush
-etiology : Monilia ( candida)
Predisposing factors :
- administration of AB
mouth wash
- xerostomia
- denture
- heavy smoking
3. Corticosteroid
- topical , sistemic
4. Radiation to head & neck
5. Age :
- infancy, old age
6 Hospitalization
7. Systemic diseases :
- diabetes, leukemia, lymphomas, HIV
Treatment :
nystatin drop / susp
3-5x/day 1-2 weeks
- an immunologically mediated
mucocutaneous disorder
- typically bilateral
-on the buccal mucosa (mostly), the
pa late ,tongue, floor of the mouth,
gingiva, vermillion portion of lower lip
Diagnosis is clinical supported by
biopsy
Treatment :
- Topical vit A
-more frequently
-pain, interference when eating
-cheek mucosa, tongue, attched
gingiva, palate
-pre-maglinant potential
Treatment : - anaesthetic
- mouthwash
- steroid - topical
- systemic
2. LEUKOPLAKIA
- is used as a clinical descriptive term
- potentially precancerous
- the most serious lesion in the oral
mucosa
Etiology :
systemic
1. Systemic
a. Possible constitutional
characteristic
loss of flexibility,
well defined
Find on the cheek
mucosa, tongue
(lack of papillae)
floor of the mouth,
palate, dentulous
ridge
Smoker patch: a
white plaque on
the vermellion
border of lip
Treatment
biopsy ---- non dyskeratotic lesions:
-vit Bc & C
-vit A
-should be followed
------ hyperkeratosis with dyskeratosis
TONGUE
( K 14 ICD Disease of tongue )
4 main types of papillae :
1. Circumvallate papillae
- 8 - 12 in number
tongue change
1.
2.
3.
4.
5.
6.
7.
Developmental anomalies
Benign migratory glossitis (BMG)
Black Hairy tongue
Glossodynia & glossopyrosis
Changes in tongue coating
Identation marking
Traumatic injuries
1.Developmental anomalies
1. Ankyloglossia
- a shortened
lingual
frenulum
- cause of
speech
impairment
- if severe -----
surgical
2. Bifid tongue
- incomplete
fusion of
lateral halves
- rare
- clinical
curiosity
3. Scrotal tongue
- commonest
deve- lopment
anomalies
- the length,
depth and
number is
increased
- inflammation
occurs in the
fissure
4. Median Rhom
-boid Glossitis
( K 14.2 )
- a rhomboid or
diamondshaped non
papillated area
found in the
midline, smooth
- red
5. Macroglossia
- true : creatinism
mongolism
2.Benign Migratory
Glossitis (BMG)
( K 14.1 )
= Geographic tongue
etiologi : unknown
occurs in children and young adult
stress ?, heriditary ?,creatinase ?
Usually multiple, wide variation
from patient to patient, from day
to day in the same patient
Irregular outline,
nonindurated
pink to red
macular spot
margin are well
defined, slightly
raised, yellow
no treatment,
self limiting
growth of a blck
pigment
producing fungus
True BHT : elonga
tion of filiform p.
&
Pseudo BHT : dis coloration from
fruits, candy,
drugs
4. GlossopyrosisGlossodynia
( K 14.6 )
A painful or burning tongue
an early or a nonspecific manifestation
of systemic disorder
may be local causation or psychogenic
divided into 2 groups :
1. Associated with clinical change
2. Without clinical change
uncontrolled
diabetes
anemia
anaemia
: tip & lateral margins have bright,
red color , painful
-Vit Bc def. : exten
sive generalized
atrophy, raw red
or purplish-red
color
-uncontrolled
diabetes : red
color, burning
-Fe def. :
general
atrophy of
papillary
coating,
burning
6. Identation Marking
Along the margin of the tongue
associated with systemic diseases
any inflamatory process-----enlargement of the tongue
macroglossia
vit. Bc hyponutrition, uncontrolled
diabetes, myxedema
7. Traumatic Injuries
A frequent site of injury
accident, epilectic seizures,
injuries in dental treatment
B. Decreased salivary
secretion =
asialorrhea = xerostomia
A. calculus
B. collaps of ducts
--------------- mucocele, ranula
Halitosis
bad breath / odor
a symptom, not a disease
a social handicap, especially who work in
close contact with the public
local and systemic factors
slightly sweetish odor is normal depending
on
- time of the day
- salivary flow
- dental caries
- periodontal disease
- infection
- cancrum oris
- neoplasma
3. In relation with non
pathologic systemic factors
- age
- food
Allergy
- similar to cutaneous allergy, except that
the mucous has mucous glands for
lubrication & protection, and no hair
follicles
The oral lesion resulting from the
absorption of drugs ----- stomatitis
medicamentosa. Resulting from contact
-------- stomatitis venenata
1. Stomatitis medicamentosa
Lesion are produced by
certain of drugs
due absorption via the
gastrointestinal tract ,
respiratory tract or skin
occur in any area of the
body
the lesions are multiple,
amorphous, eroded or
fungoid appearance
vary from marked
erythema to vesicle, an
erosive , an ulcerative or
gangraen lesion
Treatment
a. elimination of the causative agents
b. local symptomatic care :
- anti allergy
- anaesthetic troche
Oral Manifestation of
Systemic Disease
1. Leukemia
A. Acute Leukemia
- adenopathy
bleeding from
the gingiva
after tooth
extraction
severe
odontalgia
mobility of the
teeth
Treatment
- maintaining good OH
- relieving pain
- minimizing irritation of the
necrotic lesion
- parentral antibiotic to minimize
the development of the
ulceronecrotic mucosal lesion
- extraction, oral biopsies, deep
scalling are contra indicated
B. Chronic Leukemia
-adenopathy
gingival hiperplasi
ulceration
petechie and
echymosis
Treatment
= Acute Leukemia
2. Diabetes
-75% of uncontrolled adult diabetics -----periodontal disease
-gingiva is a deep red color, edema,
slightly enlarged
- a generalized painful suppuration of the
marginal gingiva and interdental papillae
-the teeth are sensitive to percussion
-recurrent periodontal abscess
-musculature of the
tongue is flabby
-indentation marking
-increase incidence of
caries
-severe odontalgia
without caries
-candidiasis
-oral surgical procedures
including curettage are
contra indicated
3. Syphilis
A. Acute Syphilis
a. Prenatal Syphilis = Congenital S. =
Heredity S.
b. Acquired Syphilis
1. Chancre of orofacial
B. Chronic
Syphilis
1. Syphilitic gummata
AIDS
Oral manifestation of HIV
infection :
- gingivitis
- periodontitis
marginalis
- proc. Alv
destruction- ----sequester
- stomatitis , ANUG,
- Kandidiasis
- Leukoplakia
- Ca Kaposi
Leukoplakia
Stomatitis
Etiologi
Belum jelas, beberapa faktor dikaitkan :
-zat karsinogen : tembakau, alkohol
dll.
-sinar matahari ---- kanker bibir
-infeksi : sifilis, kandidiasis, virus
-kelainan mukosa mulut : leukoplakia,
lichen planus
-genetik
-defisiensi nutrisi
- faktor lokal: OH jelek. Iritasi kronik
Gambaran klinis
-sering dimulai dari lesi
prakanker
(precancerous lesion)
-tidak semua lesi prakanker jadi
kanker
-tidak semua kanker berasal
dari lesi pra kanker
Permukaan rata
atau sedikit diba
-wah permukaan
warna merah tak
selalu
eritroplakia ,
dpt trauma fisik,
ki- mia atau
inflamasi
Apabila
penyebab tidak
diketahui atau
lesi merah dlm
1 bulan tidak
sembuh ----curiga
erytroplakia
3. Ulkus
Tidak khas bentuk
kanker , dapat
ulkus stomatitis
aftosa, ulkus
dekubitis dll.
-penting riwayat
peny.:
sakit/tidak,
sembuh/tidak,
kambuh/tidak
Iritasi/trauma
krn karies,
tambalan atau
protesa yang
tajam
4. Lesi Eksofilik
dpt krn reaksi
jar. berlebihan
krn iri -tasi --contoh hiperplasi
krn gigi palsu.
Iritasi
dihilangkan---- tidak sembuh
---biopsi