1. Mouth & Salivary Glands
Diseases of the
Mouth & Salivary Glands

2. Causes of Oral Ulceration
Aphthous:
Idiopathic
Pre-menstrual
Infection:
Fungal e.g. Candidiasis
Bacterial e.g. Vincent’s angina, Syphilis
Viral e.g. herpes simplex
GIT diseases:
Crohn’s disease
Celiac disease
Dermatological conditions:
Lichen planus dermatitis herpetiformis
Pemphigus erythema multiformi
Pemphegoid

3. Causes of Oral Ulceration - cont.
Drugs:
Hypersensitivity e.g. Steven’s Johnson syndrome NSAID losartan ACE inhibitor cytotoxic
Systemic diseases:
SLE
Behcet’s disease
Neoplasia:
Carcinoma
Leukemia
Kaposi’s Sarcoma

4. Oral ulceration in patient with aplastic anemia

5. Aphthous ulceration

6. Deep ulcers in patient with Behcet Disease

7. Oral thrush

8. Chronic oral candidiasis Acute oral candidiasis

9. Herpes Simplex

10. Angular Stomatitis & atrophic glossitis in patient with IDA

11. Stevens Johnson’s syndrome

12. Lichen planus

13. Peutz Jegher syndrome

16. Scurvy

17. Gingival hypertrophy due to phenytoin therapy

18. Lead poisoning

19. Yellow staining of teeth due to Tetracyclin therapy

20. Gastro-Esophageal
Reflux Disease

21. Gastro-Esophageal Reflux Disease (GERD):
Definitions
Gastro-Esophageal Reflux Disease (GERD):
It is a chronic disorder which describes any symptomatic or histopathologic alteration resulting from episodes of gastro-duodenal reflux into the esophagus and/or adjacent organs more than twice/week for more than 2 months

22. ERD NERD Erosive Reflux Disease Non Erosive Reflux Disease 2/3
Definitions
ERD
Erosive
Reflux
Disease
1/3
NERD
Non
Erosive
Reflux
Disease
2/3

23. Typical: Symptoms Heartburn Acid regurgitation > 2x/week
> 4 to 8 weeks

24. Symptoms-Atypical Esophageal: Pulmonary: Non-cardiac chest pain
Non-obstructive dysphagia
Globus hystericus
Pulmonary:
Asthma
Chronic cough
Hemoptysis
Bronchitis
Bronchiectasis
Recurrent pneumonia

25. Symptoms-Atypical Otorhinolaryngological: Oral
Hoarseness
Throat cleaving laryngitis
Sinusitis
Otolagia
Oral
Etching of dental enamel
Halitosis

26. Epidemiolgy

27. Shubbar & Taka

28. Increasing Prevalence:% %

29. Pathogenesis Transient lower esophageal sphincter (LES) relaxation
Hypotensive LES
Delayed Esophageal clearance
Delayed gastric emptying
Salivary function
Tissue resistance

30. Diagnosis

31. 1-History Age Alarm features Nocturnal reflux Dysphagia Odynophagia
Weight loss
GI bleeding
Nausea &/or vomiting
Family history of cancer
Nocturnal reflux

32. -ve endoscopy is seen in 2/3 of GERD
Useful in:
Grading
Hiatus hernia
Ulcer or stenosis
Barrett’s Esophagus
Indications:
Age over 40 years-old
Alarm features
Atypical symptoms
-ve endoscopy is seen in 2/3 of GERD

33. 24 hrs pH Recording Indications: Atypical symptoms
NERD who do not respond to PPI
When esophagitis is not demonstrated in the pre-operative endoscopic examination . IMPEDANCE testing

34. Management

35. Symptoms
Antacids/Alginates
Proton pump inhibitor
Full dose
Poor response
Consider pH
Monitoring
Reconsider
diagnosis
Normal
Fundoplication
Maintenance dose
Good response
H2 receptor
Antagonists
Antacids

36. Behavioral modifications in the treatment of GERD
Elevation of the headboard of the bed (15 cm)
Ingestion of the following foods in moderation & based on symptom correlation: fatty foods, citrus, coffee, chocolate, alcoholic & carbonated beverages, mint, tomato-based products.

37. Behavioral modifications in the treatment of GERD
Special care with at risk medications: anticholinergics, theophylline, tricyclic antidepressants, Ca channel blockers, B-Adrenergic agonists, alendronate.
Avoidance of lying down for 2 hrs after meals
Avoidance of large meals
Drastic reduction in, or cessation of, smoking.
Reduction of body weight if overweight

38. Surgical treatment Indications:
No response to medical treatment including atypical symptoms.
Continuous maintenance treatment is required especially in patients younger than 40 year old.
Financial impediment

39. Complications
Barrett’s esophagus
Stenosis
Ulcer
Bleeding