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 tooth wear – TMJ problems © 2010 – Cervical dentinal – Manifestations of systemic hypersensitivity diseases • Neoplasia – Medication-induced side – SCC effects – Salivary gland lesions – 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 pulpitis/ pulpal – Third molars, peric oronitis and necrosis tris mus – Unstimulated toothache w hich – TMJ dysfunction keeps patient aw ake – Primary or reactivated HSV – Root filling or extract infection intraorally • Endodontic pathology in • Oral cancer oncology immune – Lip, 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 molar teeth toothache – Ludw ig’s angina
Normal oral mucosa
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 lichen planus
Oral lichen planus
Chronic GVHD or oral lichen planus
4 Smoker’s keratosis
Chronic GVHD or oral lichen planus
Leukoplakia Leukoplakia
Speckled erythroplakia (epithelial dysplasia) Dysplasia (soft palate)
5 Oral cancer Oral cancer
Angular cheilitis 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 glossitis 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 Pericoronitis 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 Dental abscess 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 hairy leukoplakia (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, attrition, 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 Fissured tongue
Hairy tongue after using CHX or CPC mouthrinses
13 Geographic tongue 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 Sialadenitis in xerostomia
15 Hereditary gingival overgrowth Sialadenitis in xerostomia
Drug-induced gingival enlargement
Drug-induced gingival overgrowth
Localized gingival overgrowth Denture hyperplasia (medication induced)
16 Denture hyperplasia and papillary hyperplasia
Fibroma
Fibroma Angiogranuloma (pregnancy epulis)
Aspirin chemical burn Aphthous ulceration
17 Aphthous ulceration
Part 5
Dental Caries and Periodontitis
Dental plaque and gingivitis
Supragingival calculus Supragingival calculus (gross!)
18 Recession Recession
Chronic periodontitis Dental caries
Dental caries Caries from illegal drugs
19 Sever caries “meth mouth” 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/vomiting
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