The Mouth & salivary glands Atlas Prof. Dr. Khalid A. Al-Khazraji MBCHB, MD, CABM, FRCP, FACP

Angular stomatitis is inflammation of the corners of the mouth. Stomatitis: is inflammation in the mouth from any cause, such as ill-fitting dentures. Angular stomatitis is inflammation of the corners of the mouth. Angular stomatitis

Glossitis Glossitis is a red, smooth, sore tongue associated with B12, folate or iron deficiency. It is also seen in infections due to Candida and in riboflavin and nicotinic acid deficiency. A black hairy tongue is due to a proliferation of chromogenic microorganisms causing brown staining of elongated filiform papillae. The causes are unknown, but heavy smoking and the use of antiseptic mouthwashes have been implicated. A geographic tongue is an idiopathic condition occurring in 1–2% of the population and may be familial. There are erythematous areas surrounded by well-defined, slightly raised irregular margins. The lesions are usually painless and the patient should be reassured.

Glossitis

Geographic tongue Black hairy tongue

Lesions of the mouth I- Aphthus. II- Infectious. (Viral , Bacterial , Fungal). III- Neoplastic (ulcerative).

Aphthus lesions Types: Minor aphthus

Distinctions between Aphthous and Herpetic Oral Ulcers Condition Mucosa Location Aphthous unkeratinized Lateral tongue, floor of the mouth, labial and buccal mucosa, soft palate, pharynx Herpes simplex Keratinized Gingiva, hard palate, dorsal tongue.

Major Aphthus Herpetiform aphthus lesion

Herpes simplex Infection with HSV commonly produces painful vesicles and ulcers on the genitalia, eyes, lips, mouth, and skin. Primary herpetic gingivostomatitis is caused by HSV type 1. Primary infection occurs in up to 90% of the population before puberty. The illness is often mild and mistaken for a routine upper respiratory tract infection; it may include varying degrees of fever, malaise, and adenopathy, together with oral and gingival ulcers. Lesions may appear on the lips. They generally heal in one to two weeks. Recurrent orolabial herpes simplex is caused by reactivation of HSV that has been dormant in regional ganglia. Episodes may be precipitated by fever, sunlight, and physical or emotional stress. Typically, the lesions involve the lips and are preceded by several hours of prodromal symptoms. Vesicles then appear but soon rupture. Labial and oral herpetic ulcers normally heal in less than two weeks. Recurrent HSV is the most common cause of recurrent erythema multiforme. Management is palliative, but acyclovir, 400 mg three times a day, may shorten the course and reduce severity. Secondary bacterial infection is common and can be treated topically.

In immunocompromised patients, HSV can affect any mucocutaneous surface and appear as large, irregular, pseudomembrane-covered ulcers. HSV is usually diagnosed from the history and clinical findings. A cytologic smear showing multinucleate giant cells is suggestive, although viral cultures and monoclonal antibody staining of smears are more sensitive and specific. Systemic acyclovir is regularly used for treatment of primary or recurrent attacks in immunosuppressed patients (2 g orally in divided doses, or 5 mg/kg intravenously three times daily until lesions heal).

Herpes simplex

Oral erythema multiforme

Acute necrotizing ulcerative gingivitis ANUG ( Vincent’s angina)

Oral cancer

Candidiasis Oral candidiasis or candidosis (moniliasis, thrush) typically appears as white curd-like patches or as red (atrophic) or white and red friable lesions on any mucosal surface. Candidiasis often occurs during or after antibiotic or glucocorticoid therapy, in denture wearers, pregnant women, and older adults, and in patients with anemia, diabetes mellitus, Hashimoto's thyroiditis, Cushing's disease, or familial hypoparathyroidism. Oral candidiasis is also associated with xerostomia, whatever the cause. Topical therapy is most effective in patients with no underlying chronic conditions and may use of the following: (1) nystatin (Mycostatin), 100,000-U vaginal tablet dissolved orally three to five times daily; (2) clotrimazole (Mycelex), 10-mg troche to be dissolved orally five times daily; or (3) clotrimazole, 500-mg vaginal tablet, to be dissolved orally at bedtime. Topical agents are effective in the absence of immunosuppression, whereas oral antifungal agents are needed in immunocompromised patients.

Candidiasis

Addison’s disease

Oral lichen planus

Peutz-Jeghers Syndrome

Causes of Halitosis 1- Poor oral hygiene. 2- Anxiety when halitosis is more imaginary than real. 3- Esophageal stricture. 4- Pulmonary sepsis. 5- Gastric outlet obstruction. 6- Intestinal gastric fistula.

Gingival swelling hereditary Drugs Pregnancy Scurvy Leukemia Wegeners granuloma

Diseases of Salivary glands 1- Infectious. 2- Autoimmune ( Sjögren's syndrome ). 3- Inflammatory (Sarcoidosis ). 4- Neoplastic. 5- others ( chronic liver disease.)

Parotitis

Causes of Xerstomia ( dry mouth ) 1- sjogren's syndrome. 2- Drugs ( e.g. antimuscarinic, antiparkinsonian, antihistamine, lithium) 3- radiotherapy 4- Psychogenic causes. 5- Dehydration, shock and renal Failure. 6- D.M

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