Masaryk University Press Brno 2020 Authors: Prof. MUDr. Lydie Izakovičová Hollá, Ph.D., Department of Stomatology, St. Anne’s University Hospital Brno and Faculty of Medicine, Masaryk University, Brno Prof. MUDr. Antonín Fassmann, CSc., Department of Stomatology, St. Anne’s University Hospital Brno and Faculty of Medicine, Masaryk University, Brno MUDr. Hana Poskerová, Ph.D., Department of Stomatology, St. Anne’s University Hospital Brno and Faculty of Medicine, Masaryk University, Brno Doc. RNDr. Petra Bořilová Linhartová, Ph.D., Department of Stomatology and Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno MUDr. et MUDr. Zdeněk Daněk, Ph.D., Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Masaryk University, Brno, and University Hospital Brno Consultant: Prof. MUDr. Markéta Hermanová, Ph.D., Institute of Pathological Anatomy, St. Anne’s University Hospital Brno and Faculty of Medicine, Masaryk University, Brno Reviewers: MUDr. Věra Sazmová Doc. MUDr. Ivan Erdelský CSc. Translated to English by: RNDr. Jaroslav Janošek, Ph.D. BYBY NC NDND CC BY-NC-ND 4.0 Crea�ve Commons A�ribu�on-NonCommercial-NoDeriva�ves 4.0 © 2020 Masaryk University Press ISBN 978-80-210-9563-2 ISBN 978-80-210-9550-2 (Czech edition) Table of Contents TABLE OF CONTENTS ......................................................................................................... 3 FOREWORD ............................................................................................................................ 9 LIST OF ABBREVIATIONS AND ACRONYMS ............................................................. 10 1. NOTES ON THE MORPHOLOGY OF THE ORAL MUCOSA ................................. 12 2. PRINCIPLES OF PATIENT INVESTIGATION ........................................................... 16 2.1. Patient history .............................................................................................................................................. 16 2.2. Objective findings and methods of examination of the oral cavity .......................................................... 17 2.2.1. Histopathological changes ............................................................................................................... 18 2.2.2. Morphology of mucosal manifestations .......................................................................................... 19 Primary efflorescences ................................................................................................................................. 19 Secondary efflorescences ............................................................................................................................. 20 2.2.3. Location and duration of mucosal manifestations ........................................................................... 21 2.2.4. The examination .............................................................................................................................. 21 2.3. Additional laboratory tests .......................................................................................................................... 23 2.3.1. Haematological tests ....................................................................................................................... 23 2.3.2. Immunological tests ........................................................................................................................ 23 2.3.3. Biopsy ............................................................................................................................................. 23 2.3.4. Microbiological examination .......................................................................................................... 24 Virological examination ............................................................................................................................... 24 Bacteriological examination ......................................................................................................................... 25 Mycological examination ............................................................................................................................. 26 2.4. Specialist examinations and consultations ................................................................................................. 26 3. COMMON ANATOMICAL ABNORMALITIES OF THE ORAL MUCOSA .......... 28 3.1. Linea alba...................................................................................................................................................... 28 3.2. Fordyce spots/granules (morbus Fordyce) ................................................................................................. 28 3.3. Leukoedema .................................................................................................................................................. 28 3.4. Physiological melanin hyperpigmentations ................................................................................................ 28 4. CONGENITAL AND DEVELOPMENTAL ABNORMALITIES OF THE ORAL MUCOSA ................................................................................................................................ 30 4.1. Cleft lip .......................................................................................................................................................... 30 4.2. Double lip ...................................................................................................................................................... 30 3 4.3. Bifid uvula/hypoplasia of the uvula ............................................................................................................ 30 4.4. Ankyloglossia (lingua accreta, tongue tie) .................................................................................................. 30 4.5. White sponge nevus (Cannon disease, naevus spongiosus albus) ............................................................. 31 4.6. Darier disease (hereditary follicular dyskeratosis) ................................................................................... 31 4.7. Geographic tongue (lingua geographica, glossitis migrans) ..................................................................... 31 4.8. Fissured tongue (l. plicata/ gyrata/scrotalis/cerebriformis/fissurata) ...................................................... 32 4.9. Crenated tongue (impressions on the sides of the tongue) ........................................................................ 33 5. EXTERNAL CAUSES ....................................................................................................... 34 5.1. Physical factors ............................................................................................................................................. 34 5.1.1. Traumatic changes of the oral mucosa ............................................................................................ 34 Traumatic ulcer ............................................................................................................................................ 34 Neurodystrophic ulcer of the oral mucosa .................................................................................................... 35 Traumatic gingivitis/stomatitis ..................................................................................................................... 35 Epulis fissuratum (denture hyperplasia) ....................................................................................................... 35 Cheek and lip bite stomatitis (morsicatio buccarum et labiorum) ................................................................ 36 Frictional keratosis ....................................................................................................................................... 36 Cotton roll stomatitis .................................................................................................................................... 36 Oral haematoma ........................................................................................................................................... 36 Suction trauma of the palatal mucosa ........................................................................................................... 36 Common cheilitis (chapped lips, cheilitis simplex) ...................................................................................... 37 Exfoliative chelitis (cheilitis exfoliativa) ..................................................................................................... 37 5.1.2. Stomatitis caused by thermal factors ............................................................................................... 37 5.1.3. Electrogalvanic stomatitis ............................................................................................................... 37 5.1.4. Actinic cheilitis (solar cheilitis, ch. actinica, solaris, abrasiva) ....................................................... 38 5.2. Chemical factors ........................................................................................................................................... 38 5.2.1. Stomatitis due to corrosive substances (burning) ............................................................................ 39 5.2.2. Toxic effects of xenobiotics ............................................................................................................ 39 Drug-induced stomatitis of