Sat 12 June 2010 Millennium WS 28 + 38 Diagnostic sieve 2.00-2.55; 3.05-4.00 PM • Infections – Dental caries • Developmental Looking Beyond the – Periapical infections conditions Vermillion Border – Periodontal diseases – Oral fungal infections • Inflammatory Laurence J. Walsh – Oral malodour conditions BDSc, PhD, DDSc, FFOP(RCPA), GCEd, • Degenerative – Oral mucosal pathology FICD, FPFA, FADI, FIADFE conditions – Oral ulcerative diseases The University of Queensland – Dental erosion – Auto-immune diseases – Accelerated wear – TMJ problems © 2010 – Cervical dentinal – Manifestations of systemic hypersensitivity diseases • Neoplasia – Medication-induced side – SCC effects – Salivary gland – Other oral cancers

Specialty Private Practice Time bombs for medical GPs !

• Endodontic and periodontal • Untreated periodontitis and abscesses recurring fungal infections in – Suns et rule diabetics – Beta lactamase producing • Impaired nutrition • Irreversible / pulpal – Third molars, peric oronitis and necrosis tris mus – Unstimulated w hich – TMJ dysfunction keeps patient aw ake – Primary or reactivated HSV – Root filling or extract infection intraorally • Endodontic pathology in • oncology immune – , floor of mouth, tongue compromised patients • Maxillary anterior teeth – Fev ers of unknow n origin – Dangerous triangle for • Mucormycosis or sinusitis cavernous s inus thrombos is – Sy mptom of maxillary • Mandibular teeth toothache – Ludw ig’s angina

Normal

1 Minor salivary glands 1 per square cm

Normal floor of mouth Normal buccal mucosa (should have watery saliva)

Ethnic melanin pigmentation

Ethnic melanin pigmentation

2 Fordyce granules Ectopic sebaceous glands

Fordyce granules Ectopic sebaceous glands

Sinister lesions: Parotid papilla: Stensen’s duct opposite upper second molar Specialist dental referral (Oral Medicine / Oral Surgery)

Acute myeloid leukaemia Chronic myeloid leukaemia

3 Mucositis from chemo/radiotherapy

Lichenoid drug reactions Oral

Oral lichen planus

Chronic GVHD or oral lichen planus

4 Smoker’s keratosis

Chronic GVHD or oral lichen planus

Leukoplakia

Speckled (epithelial dysplasia) Dysplasia (soft )

5 Oral cancer Oral cancer

Angular Looking Beyond Mixed infection of Candida albicans and Staph epidermidis the Vermillion Border Part 2 Infections

Angular cheilitis

Pseudomembranous candidosis (thrush) and depapillation

6 Median rhomboid Median rhomboid glossitis (Candida albicans) (Candida albicans)

Median rhomboid glossitis (Candida albicans) Erythematous candidosis (Candida albicans)

Erythematous candidosis Papillary hyperplasia (Candida albicans) (Candida albicans)

7 Bacterial invasion: suppuration and Bacterial invasion: NUP (HIV-P) periodontal abscesses

ANUG Post-extraction infection

Fate of localized infections • Local spread through alveolar bone and soft tissues – Osteomyelitis (MX, MD) – Sinus tract on the skin • Systemic mediator release – Total burden of infection Periapical abscess • Osteomyelitis (MX, MD)

8 Regional spread of dental infections Cellulitis

• A lymphadenitis can form • Risk factors: a cellulitis, which can – low socioeconomic status suppurate and – poor oral hygiene become an abscess. – immune dysfunction (including HIV, diabetes, and immunosuppression) • Infections sources include dental infections as well as pharyngitis, tonsillitis, otitis, adenitis, adenoiditis, sinusitis, and nasal infections.

Infected canine extending into the submandibular space

Ludwig’s angina Haematogenous spread to distant sites

• Serious, potentially life- • Spread by the • Orbit threatening cellulitis infection bloodstream to distant • Brain of the tissues of the floor of sites in immune • Liver the mouth compromised patients • Lung • Usually occurring in adults • Systemic sepsis and with concomitant dental intravascular • Spleen – abscess infections coagulation • Angina refers to the feeling of strangling (compromise of the airway) • Tracheostomy often needed for airway support

9 Acute herpetic gingivostomatitis

Herpes labialis

Recurrent palatal HSV Oral (early)

Kaposi’s sarcoma Zoster affecting V3 (trigeminal)

10 EBV Infectious mononucleosis HPV Papilloma

Condyloma accuminatum (HPV multiple lesions)

Part 3 Common entities

No maxillary denture Atrophy of the oral mucosa

11 Mild hyperkeratosis of the gingiva

Mucosal atrophy, , enamel lamellae in advanced age

Extrinsic staining from smoking Tongue piercings

Coated tongue Cheek biting (squames, mucins and bacterial biofilm)

12 Mucosal scarring from trauma

Linea buccalis

Partial depapillation and scarring Scar from tongue biting from trauma

Hairy tongue

Hairy tongue after using CHX or CPC mouthrinses

13 Haemangioma

Ulceration related to Haemangioma denture periphery. Ulcers over 2 weeks in duration with no apparent local cause must be regarded as suspicious.

Lingual tori Tori

14 Tongue tie

Part 4

Common oral mucosal pathology

Dry mouth, tooth wear, Xerostomia dental erosion, root surface caries

Sialadenitis in xerostomia

15 Hereditary gingival overgrowth Sialadenitis in xerostomia

Drug-induced

Drug-induced gingival overgrowth

Localized gingival overgrowth Denture hyperplasia (medication induced)

16 Denture hyperplasia and papillary hyperplasia

Fibroma

Fibroma Angiogranuloma (pregnancy )

Aspirin chemical burn Aphthous ulceration

17 Aphthous ulceration

Part 5

Dental Caries and Periodontitis

Dental plaque and

Supragingival calculus Supragingival calculus (gross!)

18 Recession Recession

Chronic periodontitis Dental caries

Dental caries Caries from illegal drugs

19 Sever caries “” Decoronated teeth Crystal Methamphetamine

Heavily restored teeth and fractured cusps

Denture-related caries on adjacent teeth

Root surface caries Part 6

Pathological tooth wear and dental erosion

20 Dental erosion from subclinical dehydration

Dental erosion

Dental erosion from chronic regurgitation/

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