A guide to common oral lesions – Discuss Dentistry

A guide to common oral lesions

drsnehamaheshwari — Sat, 23 Mar 2013 04:52:19 +0000

Lymphoid aggregates

DESCRIPTION: Lymphoid aggregates appear as small, slightly elevated nodules that may be normal colored or have a slight yellow-orange hue. Those illustrated here are in the soft palate. They may be found anywhere in the mucosa but are especially common where the mouth meets the throat, including the base of the tongue. This lymphoid rich area has been called Waldeyer’s ring. When they occupy the same area as the foliate papillae, the papillae may take on a more nodular appearance. In the tongue they have been referred to as “lingual tonsils.”

ETIOLOGY: They are normal structures, components of Waldeyer’s ring.

TREATMENT: None required.

PROGNOSIS: Good. They may enlarge or regress in relationship to oral or upper respiratory infections.

DIFFERENTIAL DIAGNOSIS: Although foliate papillae and lymphoid aggregates of lingual tonsils may occupy the same area, they are different entities.

A guide to common oral lesions

drsnehamaheshwari — Sun, 24 Mar 2013 02:07:20 +0000

Mucocele

DESCRIPTION: A mucocele is a collection of saliva in the oral mucosa. They are soft elevations whose color ranges from that of normal mucosa to light blue or even white. Patients with mucoceles regularly state that the lesion “gets larger, then smaller, then larger again.” This has become an important diagnostic sign. The mucosa of the lower lip and buccal mucosa are the most common sites, but any area that contains intraoral salivary glands is a potential site.

ETIOLOGY: Traumatic severance of salivary ducts permitting salivary escape into mucosa is the accepted etiology.

TREATMENT: Surgical excision deep enough to include the underlying gland that feeds it.

PROGNOSIS: Good

DIFFERENTIAL DIAGNOSIS: Salivary gland neoplasms (especially mucoepidermoid carcinoma), varix, and hemangioma.

A guide to common oral lesions

drsnehamaheshwari — Mon, 25 Mar 2013 10:52:34 +0000

Irritation fibroma (traumatic fibroma)

DESCRIPTION: Traumatic fibroma is a dome-shaped soft tissue mass usually found on buccal mucosa along the line of occlusion. Less frequently they may be found on lips and tongue. They are among the most common oral soft tissue lesions. The color is usually the same as the surrounding mucosa and the consistency is surprisingly soft. Patients are generally aware of the lesion being present months to years with little change. Histologically, they exhibit fibrous hyperplasia that is collagenous and acellular.

ETIOLOGY: The presumed etiology is trauma to the affected mucosa. Accidental biting probably accounts for most of these lesions.

TREATMENT: Excision

PROGNOSIS: Good

DIFFERENTIAL DIAGNOSIS: Salivary gland tumors and other soft tissue tumors may have a similar appearance but are usually more firm. Other lesions such as mucocele may also resemble traumatic fibroma.

A guide to common oral lesions

drsnehamaheshwari — Tue, 26 Mar 2013 04:40:22 +0000

Leukoedema

DESCRIPTION: Leukoedema appears as a filmy, opaque, white to slate gray discoloration of mucosa, chiefly buccal mucosa. Redundancy of the mucosa may impart a folded or wrinkled appearance to the relaxed mucous membrane. It partially disappears when the mucosa is stretched. It is stated to be seen in 90% of Blacks and 10–90% in Whites. This variation may be due to the difficulty in observation of leukoedema in non-pigmented mucosa. Leukoedema is accentuated in smokers.

ETIOLOGY: Leukoedema is a variation of normal that should not be confused with something ominous.

Intracellular edema of the superficial epithelial cells coupled with retention of superficial parakeratin is thought to account for the white appearance. Microscopic examination reveals superficial squamous cells have a clear, seemingly empty cytoplasm but it has not been shown that there is an increase in intracellular water. Thus, the term edema is questionable.

TREATMENT: None required.

PROGNOSIS: Good

DIFFERENTIAL DIAGNOSIS: White sponge nevus, hereditary benign intraepithelial dyskeratosis, and dyskeratosis congenital. All are extremely rare.

A guide to common oral lesions

drsnehamaheshwari — Thu, 28 Mar 2013 03:45:43 +0000

Pyogenic granuloma

DESCRIPTION: Pyogenic granuloma is a red, nodular overgrowth of granulation tissue that arises from the mucosal or skin surface. Approximately two-thirds of oral lesions are found on the gingival followed in descending order by the lips, tongue, buccal mucosa, palate, vestibule and edentulous areas. The interdental papilla of the maxillary facial gingival is the single most common site. A review of more than 800 cases disclosed the mean size to be approximately 1.0 cm with a range of 3 mm to 4 cm. Females were more often affected (72%). Duration varied widely with a mean of 5.5 months. Because of the vascular nature of pyogenic granuloma, they bleed easily and some cause mild pain. They commonly develop during pregnancy. The association with pregnancy is so common that the lesion has also been called granuloma gravidarum or pregnancy tumor. Because pus is infrequently found in this lesion, the term pyogenic granuloma is a misnomer but remains the preferred term.

ETIOLOGY: The stimulus that provokes this overgrowth of granulation tissue is unknown although mild trauma and infection are prominently mentioned.

TREATMENT: Conservative excision. They may recur.

PROGNOSIS: Good.

DIFFERENTIAL DIAGNOSIS: Peripheral giant cell granuloma and peripheral ossifying fibroma.

A guide to common oral lesions

drsnehamaheshwari — Fri, 29 Mar 2013 13:31:05 +0000

Torus palatinus and torus mandibularis

DESCRIPTION: Bony exostoses in the midline of the hard palate and on the lingual aspect of the mandible are referred to as torus palatinus and torus mandibularis respectively. Some studies suggest they are inherited whereas others suggest environmental factors. They start in childhood and reach peak incidence in young adults. Once they have reached “programmed size”, their growth stops. Some are so subtle they hardly constitute an abnormality, whereas others are so large they frighten the uninitiated observer. In the mandible, they may form a row of nodules as illustrated. In most individuals they occur bilaterally. Those in the palate may be divided by deep grooves to form a cluster of nodules. Exostoses entirely similar to tori occur elsewhere on the alveolar bone, but there is no specific name for them. It has been estimated that palatal tori occur in 20-35% of the population. Mandibular tori are less common, about 10% of the population are affected.

ETIOLOGY: Tori are developmental over-growths of normal bone and as previously stated they may be inherited.

TREATMENT: Tori and other exostoses seldom cause symptoms. Because they extend above the level of surrounding normal mucosa, they invite trauma. Small traumatic ulcers are therefore commonly seen on the mucosa that covers tori, more commonly palatal tori. Tori may interfere with prosthetic appliances and, for that reason, may require removal.

PROGNOSIS: Good

DIFFERENTIAL DIAGNOSIS: Tori have such a characteristic clinical appearance and history that differential diagnosis is seldom a problem.

A guide to common oral lesions

drsnehamaheshwari — Sat, 30 Mar 2013 13:28:54 +0000

Varix (plural: varices)

DESCRIPTION: Varices appear as red, blue, or deep purple broad-based elevations in oral mucosa. The size is usually less than 5 mm. The buccal mucosa is a common place to find them, however, they are also found in lip mucosa and ventral and lateral mucosa of the tongue and floor of the mouth. On ventral tongue they are apt to be multiple and the term “caviar tongue” has been commonly used to describe them. They are seen more commonly in the elderly.

ETIOLOGY: A varix is a distended vein that elevates the overlying mucosa. The reason for venous distention is unclear but may be related to weakening of the vessel wall secondary to aging.

TREATMENT: None usually required. They often thrombose but this is of little clinical consequence.

PROGNOSIS: Good

DIFFERENTIAL DIAGNOSIS: Mucocele, hemangioma and angina bullosa hemorragica.

A guide to common oral lesions

drsnehamaheshwari — Sun, 31 Mar 2013 08:22:19 +0000

Osteoporotic bone marrow defect

DESCRIPTION: As the name implies, this is a localized increase of hematopoietic bone marrow that creates a radiolucent radiographic defect. They occur more commonly in women in the midyears and show a predilection for the molar region of the mandible. They are especially common in extraction sites. Scattered trabeculae may extend short distances into the defect or, in some instances, through it giving the defect a fairly characteristic appearance. Naturally there are no clinical symptoms.

ETIOLOGY: The etiology remains unknown. No connection has been found linking the osteoporotic bone marrow defect with anemia or systemic need for increased erythrocytes.

TREATMENT: Once the diagnosis is established, no treatment is required.

PROGNOSIS: Good

DIFFERENTIAL DIAGNOSIS: This defect may easily be mistaken for a cyst or tumor. In those cases where there is doubt about the diagnosis, biopsy should be done.

A guide to common oral lesions

drsnehamaheshwari — Tue, 02 Apr 2013 12:17:27 +0000

Aphthous stomatitis

(Canker sores, recurrent aphthous stomatitis, RAS)

DESCRIPTION: This is one of the most common oral diseases. The exact incidence is unknown, but estimates range from 20% to 60% of the population. Lesions appear as painful ulcers ranging in size from less than 1 mm to 2 centimeters. They may be single or multiple. Small lesions (less than 0.5 cm) have been referred to as minor aphthae and large lesions (more than 0.5 cm) have been called major aphthae. An uncommon presentation of this disease appears as multiple, pinpoint areas of ulceration that seldom exceed 1 mm. This has been referred to as the herpetiform pattern, an unfortunate terms since herpes virus is not the cause.

Each lesion begins as a red macule, less often a papule but not as a blister. It soon ulcerates and the ulcer becomes covered by a pyogenic membrane producing the characteristic yellow-white center with surrounding erythematous flare. The shape is usually round to oval but may be elongated in natural folds such as the vestibule. Aphthous stomatitis occurs on freely movable mucosa that does not overlie bone. The lips, cheeks, soft palate, floor of mouth, ventral and lateral tongue are often involved but attached gingival, hard palate and dorsal tongue are seldom affected.

Aphthous lesions affect all age groups from young to old but young adults and females are more affected. Elapsed time between recurrences is extremely variable; some unfortunate patients have almost continuous disease whereas others go from months to years between episodes.

ETIOLOGY: The cause is unknown. The concept that canker sores are caused by a microbiologic agent has been superceded by theories revolving around an immunopathogenesis. The deposition of antibodies and complement within epithelium and basement membrane during the early stages of the disease suggests a humoral immune response, and the influx of lymphocytes rather than neutrophils in early lesions points to a cellular immune reaction as well. It is yet to be learned if the immune response is directed against self (autoimmunity) or against an extrinsic antigen such as bacteria or viruses. To further cloud the issue, a variety of other factors have been implicated. Withdrawal of certain foods such as cheese, tomato products and gluten, as well as sodium lauryl sulfate-containing toothpastes, has been claimed to help some patients whereas in others, correction of iron, B12 and folate deficiencies have brought about a cure.

Improvement of aphthous lesions during the last stages of pregnancy with exacerbation after delivery suggests that gonadal hormones may lay a role. The occurrence of canker sores during menstruation also suggests a hormonal basis. To add a final element of mystery, aphthous stomatitis has been reported to worsen when cigarette smoking is discontinued. There are too many theories for them all to be correct. Aphthous stomatitis may not be a single disease with a single cause but instead a variety of diseases all manifested by painful mouth sores.

TREATMENT: To reduce pain, patients with few lesions may be treated with topical medications such as Orabase® with Benzocaine, Zilactin®, or Soothe-N-Seal®. Anti-inflammatory agents such as topical steroids or Aphthasol® have also been shown to be effective. For severe or widespread disease, systemic prednisone such as a Medrol 4 mg Dosepak® is helpful. Long-term systemic steroid therapy may be associated with numerous adverse effects, including osteoporosis, asceptic necrosis, cataracts, depression, fluid retention and exacerbation of diabetes.

PROGNOSIS: Cure is seldom achieved but palliation and long-term remission may be achieved by above mentioned treatment. Without treatment, healing time varies from 4 days for a small lesion to a month or more for major aphthae. Major aphthae may also cause scarring.

DIFFERENTIAL DIAGNOSIS: Aphthous stomatitis must be differentiated from herpetic stomatitis, the disease with which it is most often confused. Recurrent intraoral herpes occurs almost exclusively on mucosa overlying bone. The hard palate is the most common site. Lesions indistinguishable from aphthous stomatitis have been reported in Behcet’s syndrome, Reiter’s syndrome, Crohn’s disease and celiac disease.

A guide to common oral lesions

drsnehamaheshwari — Wed, 03 Apr 2013 09:26:35 +0000

Oral cryptococcosis:

-Cryptococcosis is a rare fungal disease, caused by cryptococcus nepformans. Two varieties of the organism have been identified, C.Neoformans Var. Neoformans and C.Neoformans Var. Gatti.

The fungus is found all over the world in soil. It may also be associated with bird droppings, and it is acquired through inhalation of the spores.

Sometimes the infection is asymptomatic. In immunocompromised patients, it can spread to anywhere in the body, including the central nervous system, and it can be lethal.

-Recently, there’s been large increase in the incidence of Cryptococcal infections. The main predisposing factors are HIV Infections, Diabetis, Immunosuppresive therapy.

-Two forms of the disease have been recognized- PULMONARY which is the commonest and Disseminated which may involve CNS, Lymph nodes, Skin, GIT and Oral mucosa.

-In Oral cavity, It presents as abnormai chronic ulcerations with vegetating surface, tender on palpation.

-Tongue, Palate, Gingiva, Tooth socket are the most common sites.

-DIAGNOSIS: Culture test, Detection of cryptococcus in the serum.

-TREATMENT: Systemic amphotericin B, Fluconazole, & Itraconazole