THERAPEUTIC DENTISTRY, 5 TH YEAR STUDENTS (lecture #1) 1. Introduction and types of diseases. 2. Patients examination.

ORAL MEDICINE What is oral medicine? Broadly speaking, it is the field of medicine that encompasses the diagnosis and management of diseases the oral cavity. Many conditions produce oral signs and symptoms, and yet the oral cavity is an unfamiliar zone for many clinicians.

Physicians generally receive little formal training in dental and oral medicine, and tend to view the oral cavity as a place reserved for their ‘’dental’’ colleagues. Likewise, dentists are experts in the diagnosis and management of diseases related to the teeth: however, the proportion of dental education dedicated to the “non-dental” part of the oral cavity often falls short. For these reasons, it is not at all uncommon for a patient to visit five or ten doctors before receiving a correct diagnosis and treatment plan. That’s why that part of dentistry is so necessary to learn.

On current course we will take a view on such groups of diseases:

Bacterial infections of the mouth For example: Syphylis - a sexually transmitted or congenital infection caused by the bacterium Treponema pallidum.

Gonorrhea - a sexually transmitted infection caused by bacteria called Neisseria gonorrhea. This is a result of orogenital contact with an infected partner and presents as a nonspecific stomatitis or pharyngitis with frequent persisting superficial ulcers.

Viral infections of the mouth Such as : Herpes simplex virus (HSV) - responsible for common vesicular eruptions of the skin and mucosa. Although oral infection with HSV-1 and HSV-2 is described below, most oral-facial herpetic lesions are due to HSV-1. Antibodies indicating past infection are virtually ubiquitous in adults.

Human papilloma virus has been associated with squamous cell papilloma, condyloma acuminatum (multiple white/pink nodules), focal epithelial hyperplasia (multiple painless papules), and verruca vulgaris (white exophytic lumps). The last three are very rare. Rx: local surgery and interferon. Measles (Rubeola) A highly contagious viral infection caused by a member of the pramyxovirus family of viruses. The prodromal phase of measles may be marked by small white spots with an erythematous margin on the buccal mucosa, known as Koplik's spots. A few days later the maculopapular rash of measles appears, usually behind the ears, then spreading to the face and trunk. There is no specific treatment for measles.

Acute and chronic candidiasis: Acute pseudomembranous candidiasis (thrush) is most common in infancy, old age and the immunosuppressed or debilitated (e.g., those on radiotherapy, cytotoxics, or steroids, or with diabetes, cancer, HIV, or hematological malignancy), or those on broad- spectrum antibiotics. Clinically it appears as creamy, lightly adherent plaques on an erythematous oral mucosa, usually on the cheek, palate, or oropharynx.

Chronic candidiasis: Chronic hyperplastic candidiasis (candidal leukoplakia) More commonly seen in smokers. Typically presents as a white patch on the oral commissural buccal mucosa bilaterally. Although there is an ↑ risk of malignant change, the initial approach after ensuring the diagnosis (microbiologically and histopathologically) is to eradicate the candidal infection.

Recurrent aphthous stomatitis (ulcers)

Erythema multiforme This is a group of signs and symptoms of multifactorial etiology; the most severe form is known as Stevens-Johnson syndrome. It affects skin and mucous membranes with an acute onset, usually in young adult males, and is probably due to deposition of immune complexes. It is associated with exposure to certain drugs (sulfas, barbiturates) or infecting organisms (herpes, mycoplasma) in a susceptible individual (hormonal changes). Diagnosis is from clinical features, which include “target lesions,” concentric rings of erythema on the palms, legs, face, or neck. The oral mucosa is covered in bullae, which break down, the lips and gingiva becoming crusted with painful erosions. There is usually a fever. It is a self-limiting condition in 3-4 weeks, but can recur once or twice a year.

Premalignant lesions Leukoplakia is described as white patch or plaque that cannot be characterized clinically or pathologically as any other disease and is not associated with any physical or chemical agent except the use of tobacco (WHO).

Abnormalities of the lips and tongue Although many diseases of the oral mucosa will involve the lips and tongue, there are a number of conditions specific to these structures, in part because of their highly specialized nature. The tongue is a peculiar muscular organ covered with specialized sensory epithelium, and the lips form the interface between skin and mucosa.

Tongue

Lips

Oral manifestations of HIV infection and AIDS AIDS is the terminal stage of infection with the human immunodeficiency virus (HIV), which is recognized as undergoing a number of mutations. The underlying severe immunodeficiency leads to a number of oral manifestations that, although not pathognomonic, should raise the possibility of HIV infection.

Allergic diseases:

Oral manifestations of different organs diseases:

Traumas

Cancer

First step to successful treatment is examination. Lets remind ourselves oral cavity anatomy:

And oral mucosa anatomy :

And after that to learn the main pathological elements (all that diseases consist of): Vesicle - is a small blister a few millimeters in diameter. Bulla - is a larger blister. Intraepithelial bullae - are caused by loss of attachment between individual cells (acantholysis). Subepithelial bullae - separate the epithelium from the underlying corium. Ulcer - is a breach in the mucous membrane. Immunopathology: immunofluorescence is a prime diagnostic test. Direct immunofluorescence is performed on a fresh biopsy specimen. Indirect immunofluorescence is performed on a serum sample. Erosions - are shallower than ulcers.

Examination methods  clinical (main) – using near patient bed or dental unit;  paraclinical (additional) - instrumental, lab, x-ray. All examinations that hold usind additional services.

Main examination methods  subjectively (patient interview) - complaints, life history, anamnesis;  Object examination – external and internal mouth review.

Additional tests  Special clinical tests (temperature diagnostics, index rating of oral hygiene, periodontal index);  Functional tests methods (electric pulp test, fluorescent diagnostics, determination of periodontal capillaries);  Lab test methods (clinical and biochemical parameters of blood, urine, saliva, oral and gingival liquids);  Microbiological;  Allergic;  X-ray.

Intraoral radiography Orthopantomography Tomography Sialography Fluorescence diagnostic

The VELscope Oral Cancer Screening System

Orascoptic Orascoptic DK is an innovative diagnostic tool that enhances the ability to identify oral lesions at their earliest stages– when they are most curable.

The Microlux/DL diffused illuminator is designed to enhance dental examinations of the oral mucosa and help identify abnormal lesions found on the soft tissues of the mouth.

The OralCDx BrushTest is a noninvasive test of oral “precancer”