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Diagnosis1
1. Recurrent Aphthous Ulcer
• Etiology:
• Local altered immune response.
• Systemic etiologies include nutritional
deficiencies (iron, B6, B12), diabetes
mellitus, inflammatory bowel disease,
immunosuppression.
• Biopsy will rule out other
vesiculoulcerative disease.
2. Recurrent Aphthous Ulcer
• Appearance:
• Minor aphthous ulcer: <0.6 cm shallow
ulceration with gray pseudomembrane and
erythematous halo on non-keratinized
mucosa.
• Major aphthous ulcer: >0.5 cm ulcer, more
painful, lasting several weeks to months;
will scar.
5. Inflammatory Conditions
(Denture Related of the Oral
Mucosa)
• Inflammatory papillary hyperplasia
• Epulis fissurata (inflammatory
fibrous dysplasia)
• Candidiasis
6. Inflammatory Papillary
Hyperplasia
• Etiology:
• Poorly fitting denture
• Occurs in more than 50%
of Denture Wearers
• Appearance:
• Multiple small polypoid or
papillary lesions.
• Typically on hard palate,
that produces a
cobblestone appearance.
7. Inflammatory Papillary
Hyperplasia
• Etiology:
• Poorly fitting denture
• Occurs in more than 50%
of Denture Wearers
• Appearance:
• Multiple small polypoid or
papillary lesions.
• Typically on hard palate,
that produces a
cobblestone appearance.
8. Inflammatory Papillary
Hyperplasia (Papillomatosis)
• Treatment:
• Discontinue using denture
• Surgical removal of hyperplastic tissue.
• Occasionally tissue conditioner may
reduce the problem, while reconstruction
of new denture may be necessary.
9. Epulis Fissurata (Inflammatory Fibrous
Dysplasia, Denture Granuloma)
• Etiology:
– Over-extended denture flanges.
– Resorption of alveolar bone that makes the
denture borders over-extended.
• Appearance:
– Hyperplastic granulation tissue surrounds the
denture flange.
– Pain, bleeding, and ulceration can develop.
10.
11. Epulis Fissurata (Inflammatory Fibrous
Dysplasia, Denture Granuloma)
• Differential Diagnosis:
• Verrucous carcinoma
• Squamous cell carcinoma
• Traumatic fibroma
• Treatment:
• Small lesions may resolve if flanges of
denture are reduced.
• Surgical excision is necessary prior to
rebasing/relining of denture.
13. Candidiasis
• Four fungal organisms: Candida albicans,
Candida stellatoidea, Candida tropicalis, and
Candida pseudotropicalis.
• Candida albicans is most common.
• Morphologically, presents in 3 forms: yeast
cell, hypha and mycelium (last form is
pathogenic phase).
• Carriers of oral candida do not show the
mycelial phase.
17. Acute Pseudomembranous
Candidiasis (Thrush)
• Etiology:
• Oral candidiasis
• Appearance:
• White slightly elevated plaques that can be
wiped away leaving an erythmatous base.
• Direct smear can be fixed and stained
using PAS reagent to reveal the candida
hyphea microscopically.
18.
19. Acute Atrophic Candidiasis
(Antibiotic Sore Tongue)
• Etiology:
• Oral candidiasis secondary to antibiotics
or steroids.
• Appearance:
• Similar to thrush without overlying
pseudomembrane: erythematous and
painful mucosa.
• Differential Diagnosis:
• Erosive lichen planus.
• Chemical erosion.
20.
21. Chronic Atrophic Candidiasis
(Denture Sore Mouth)
• Etiology:
• Most common form of oral candidiasis;
candidal infection of denture as well.
• Treatment should be directed towards
mucosa and denture.
22.
23. Chronic Atrophic Candidiasis
(Denture Sore Mouth)
• Appearance:
• Mucosa beneath denture is erythematous
with a well-demarcated border.
• Swabs from the mucosal surface may
provide a prolific growth, but biopsy shows
few candida hyphae in spite of high serum
and saliva antibodies to candida.
• Differential Diagnosis:
• Inflammatory papillary hyperplasia.
24.
25.
26.
27. Chronic Hyperplastic Candidiasis
(Candida Leukoplakia)
• Etiology
• Oral Candidiasis lesions should be
considered as potentially premalignant.
Treatment should be directed toward
mucosa and Leukoplakia.
• Appearance
• Confluent leukoplakic plaques
characterized by Candida invasion of
oral epithelium with marked atypia.
28.
29. Angular Cheilitis
• Etiology:
• Diminished occlusal vertical dimension
• Vitamin B or iron deficiencies
• Superimposed candidiasis
• Affects approximately 6% of General Population
• Appearance:
• Wrinkled and sagging skin at the lip commisures.
• Desiccation and mucosal cracking.
32. Angular Cheilitis
• Rx: Nystatin-triamcinolone acetonide
ointment.
Disp: 15 gm tube.
Sig: Apply to affected area after each
meal and qhs. Concomitant intraoral
antifungal treatment may be indicated.
34. Diagnostic Criteria
• C.F.U. in Candidiasis can vary from
1,000/ml to 20,000/ml.
• As an adjunct to saliva samples,
smears stained with PAS.
• Thus clinical manifestations, salivary
culture and stained smears are needed
to confirm a diagnosis of Candidiasis.
37. Candidiasis
• Rx: Nystatin oral suspension 100,000
units/ml.
Disp: 60 ml.
Sig: Swish and swallow 5 ml qid for 5 min.
• Rx: Nystatin ointment.
Disp: 15 gm tube.
Sig: Apply thin coat to affected areas after
each meal and qhs.
• Rx: Clotrimazole trouches 10 mg.
Disp: 70 trouches
Sig. Let 1 trouch dissolve in mouth 5 times
daily.
38. Candidiasis
• Rx for Dentures: Improve oral hygiene
of appliance.
• Keep denture out of mouth for extended
periods and while sleeping.
• Soak for 30 min in solutions containing
benzoic acid, 0.12% chlorhexidine, or
1% sodium hypochlorite and thoroughly
rinse.
39. Candidiasis
• Apply a few drops of Nystatin oral
suspension or a thin film of Nystatin
ointment to inner surface of denture
after each meal.
48. XEROSTOMIA
• Xerostomia (dry mouth) is
defined as a subjective
complaint of dry mouth
that may result from a
decrease in the
production of saliva.
49. XEROSTOMIA
• It affects 17-29% of samples
populations based on self-reports
or measurements of salivary flow
rates.
• More prevalent in women.
• Can cause significant morbidity
and a reduction in a patient’s
perception of quality of life.
50. SALIVA
• It keeps the teeth healthy by
providing a lubricant, calcium
and a buffer.
• It also helps to maintain the
health of the gums, oral tissues
(mucosa) and throat.
• It also plays a role in the control
of bacteria in the mouth.
51. •It helps to cleanse the mouth of food
and debris.
•It provides minerals such as calcium,
fluoride, and phosphorus.
•It helps in swallowing and digesting
food.
52. •Lack of saliva will make the
mouth more prone to disease
and infection.
•Lead to a burning feeling.
53. Oral Dryness in the Elderly
0
10
20
30
40
50
60
70
80
90
Normal Radiotx Sjogren Drugs
Subjective sensation of oral dryness in the
elderly
%Population
54.
55. Flow Rate of Saliva
0.0
0.1
0.2
0.3
0.4
0.5
20-39 yr 40-59 yr > 60 yr
Age
ml/min
unstimulated
stimulated
