Variants of Normal

Variants of Normal

Fordyce Granules

  • Description: Ectopic sebaceous glands.

  • Clinical Presentation:

    • Appearance: White, creamy white, or yellow slightly raised papules.

    • Size: 1-2 mm in diameter.

    • Configuration: Occur in clusters.

  • Location:

    • Buccal mucosa.

    • Labial mucosa.

    • Vermillion border of lips.

Torus Palatinus & Mandibularis

  • Description: Bony protuberances.

  • Significance: Most common intraoral lesion.

  • Clinical Presentation:

    • Appearance: Hard growths with smooth rounded contours.

    • Mucosal Appearance: Normal–appearing or slightly pale mucosa.

    • Base: Sessile base; often with lobulated surface.

  • Location:

    • Hard palate (torus palatinus).

    • Floor of mouth (torus mandibularis).

    • May be unilateral or bilateral.

Melanin Pigmentation

  • Description: Generalized and constant dark pigmentation of oral mucosa.

  • Prevalence: Common in dark-skinned individuals.

  • Cause: Results from increased amounts of melanin deposited in the mucosa.

  • Clinical Presentation:

    • Appearance: Diffuse ribbon-like dark band.

    • Border: Well-defined and curved border separating it from alveolar mucosa.

  • Location:

    • Attached gingiva (most common).

Retrocupsid Papilla

  • Clinical Presentation:

    • Appearance: Firm round papule, approximately 1-4 mm in diameter.

    • Color/Texture: Pink, soft, smooth.

  • Location:

    • Lingual surface of attached gingiva of mandibular cuspids.

    • Usually bilateral.

Lingual Varicosities

  • Prevalence: Common in elderly individuals.

  • Cause: Loss of elasticity of vascular wall as a result of aging.

  • Clinical Presentation:

    • Appearance: Enlarged, dilated veins.

  • Location:

    • Ventral surface of tongue.

Linea Alba

  • Clinical Presentation:

    • Appearance: White line extending from posterior to anterior along occlusal plane.

  • Location:

    • Buccal mucosa.

    • May be bilateral.

Leukoedema

  • Prevalence: Most commonly observed in dark-skinned individuals.

  • Clinical Presentation:

    • Appearance: Generalized opalescence.

    • Behavior: Becomes less prominent when mucosa is stretched.

  • Location:

    • Buccal mucosa.

Lingual Thyroid Nodule

  • Description: Undescended, trapped remnants of thyroid tissue.

  • Prevalence: More common in females (ratio of 4:1).

  • Clinical Presentation:

    • Appearance: Raised asymptomatic mass, approximately 2 cm in diameter.

    • Base: Sessile base.

  • Location:

    • Tongue, posterior to circumvallate papilla.

Fissured Tongue

  • Clinical Presentation:

    • Appearance: Numerous linear fissures or grooves, 2-5 mm deep with varying widths.

    • Associated Condition: Associated with hyposalivation/xerostomia.

  • Location:

    • Dorsal surface of tongue.

Median Rhomboid Glossitis

  • Clinical Presentation:

    • Appearance: Asymptomatic rhomboid or ovoid shaped red area.

    • Border: Irregular, but rounded, borders.

    • Etiology: Results from chronic Candida albicans infection.

  • Location:

    • Midline of dorsum of tongue, just anterior to circumvallate papilla.

Geographic Tongue (Benign Migratory Glossitis)

  • Description: Benign inflammatory condition.

  • Clinical Presentation:

    • Appearance: Irregular bald patches (absence of filiform papillae).

    • Behavior: "Map-like" appearance, with location changing from day to day.

  • Location:

    • Dorsum of tongue.

Black Hairy Tongue

  • Cause: Results from chromogenic bacteria combined with extrinsic factors (e.g., food, drink, tobacco stains).

  • Clinical Presentation:

    • Appearance: Brown-to-black filiform papillae.

  • Location:

    • Dorsum of tongue.

White Hairy Tongue

  • Cause: Results from either an increase in keratin production or a decrease in normal desquamation.

  • Clinical Presentation:

    • Appearance: Elongated, white filiform papillae.

  • Location:

    • Dorsum of tongue.

Leukoplakia

  • Description: Protective reaction against chronic irritants.

  • Clinical Presentation:

    • Appearance: White plaque or patch that cannot be rubbed off and cannot be classified as any other disease.

    • Variability: Vary considerably in size, location, and clinical appearance.

  • Locations:

    • Lateral and ventral tongue.

    • Floor of mouth.

    • Buccal/labial mucosa and vestibule.


Week 5: Diseases of the Oral Tissues

Diseases of the Oral Soft Tissues: Leukoplakia

  • Definition: Leukoplakia means white patch.

  • Description: Lesions vary in appearance and texture from a fine white transparency to a heavy, thick, warty plaque.

  • Etiology: The cause is unknown, but it is commonly linked to chronic irritation or trauma.

  • Clinical Significance: Very often precedes the development of a malignant tumor.

  • Possible Causes:

    • Smokeless tobacco

    • Poorly fitting dentures

  • Locations: Can occur anywhere in the mouth.

Diseases of the Oral Soft Tissues: Lichen Planus

  • Definition: A benign, chronic disease that affects the skin and oral mucosa.

  • Etiology: Many factors have been implicated in lichen planus; however, the cause remains unknown.

  • Clinical Presentation: Characterized by patchy white lesions on the oral mucosa with a distinctive pattern termed Wickham striae (interconnecting lines).

  • Types:

    • A second type can cause erosive lesions on the gingiva, often worsening with emotional stress.

  • Treatments:

    • Aloe Vera

    • Steroids

    • Immunosuppressive drugs

    • Antihistamines

Diseases of the Oral Soft Tissues: Candidiasis

  • Definition: A superficial infection caused by the yeastlike fungus Candida albicans.

  • Predisposing Factors:

    • Antibiotic therapy

    • Diabetes

    • Xerostomia (dry mouth)

    • Weakened immunologic reactions

  • Clinical Significance: Can be an initial manifestation for patients with acquired immunodeficiency syndrome (AIDS). Common types include diaper rash, vaginitis, and thrush.

  • Symptoms:

    • Accompanied by discomfort or pain, halitosis (unpleasant breath odor), and dysgeusia (distorted sense of taste).

  • Types of Candidiasis:

    • Pseudomembranous candidiasis (thrush):

    • Description: Creamy white plaques form in the mouth that resembles cottage cheese or curdled milk.

    • Symptoms: Painful, burning sensation, an unpleasant taste, or the feeling of blisters forming in the mouth. The "blisters" are pseudomembranous plaques.

    • Hyperplastic candidiasis:

    • Appearance: A white plaque that cannot be removed by scraping, often found on the buccal mucosa in patients with HIV.

    • Atrophic candidiasis:

    • Appearance: Smooth red patches on the dorsal areas of the tongue and palate, also known as erythematous candidiasis.

    • Symptoms: May occur after broad-spectrum antibiotic use; patients report a scalded or burned feeling, similar to swallowing something too hot.

  • Treatment for Candidiasis:

    • Anti-fungal medications

    • Unsweetened yogurt

    • Topical antiseptic (throat spray)

Aphthous Ulcers

  • Definition: Also known as aphthous stomatitis or canker sores; recurrent outbreaks of blister-like sores inside the mouth and on the lips.

  • Contagious: Not contagious.

  • Common Locations: Lining mucosa of the cheeks, edge of the tongue, floor of the mouth, palates, and soft red portion of the lip.

  • Etiology: Can be an adverse effect of most chemotherapeutic agents; often painful.

  • Minor RAU (Recurrent Aphthous Ulcers):

    • Definition: Episodes occur fewer than six times a year; lesions usually heal within 7 to 10 days.

    • Prevalence: Accounts for 90% of all cases.

  • Major RAU:

    • Definition: Involves larger, deeper ulcers that take longer to heal; occurs in about 10% of cases. Often found in patients with a compromised immune system.

  • Treatments of RAU:

    • Local anesthetic

    • OTC or prescription gels, rinses, ointments

    • Steroids

    • Anti-inflammatory medications

    • Laser light therapy (performed in a hospital for patients undergoing chemotherapy)

Cellulitis

  • Definition: Inflammation spreading through soft tissue or organs.

  • Symptoms: Rapid swelling, accompanied by high fever and severe throbbing pain; skin appears very red.

  • Etiology: Often associated with oral infections, such as abscessed teeth. Potentially dangerous due to rapid spread to sensitive tissues like the eyes or brain.

  • Treatment of Cellulitis:

    • Oral antibiotics; in severe cases, hospitalized for IV antibiotics.

    • Ice pack application to relieve discomfort.

Learning Objectives for Lesson 17.2: Tongue Conditions, Oral Cancers, and Other Disorders

  1. Describe the changes in the tongue from normal to abnormal appearances and conditions.

  2. Understand the significance of early oral cancer detection and its tissue origins.

  3. Recognize the appearance and conditions related to leukemia.

  4. Discuss the side effects and various types of therapy for oral cancer.

  5. Analyze oral manifestations linked to HIV/AIDS.

  6. Identify developmental disorders in the oral cavity deviating from normal.

  7. Understand habits affecting teeth and recognize signs of methamphetamine use.

  8. Summarize the dangers of oral piercings.

Conditions of the Tongue

  • Glossitis: General term for inflammation and topographical changes of the tongue.

  • Common Conditions:

    • Black hairy tongue

    • Geographic tongue

    • Fissured tongue

  • Pernicious Anemia: Autoimmune condition causing vitamin B12 absorption issues, resulting in symptoms such as anemia, weakness, pallor, etc.

    • Oral manifestations include angular cheilitis and mucosal ulceration, alongside a burning tongue.

    • Treatment: Intramuscular vitamin B12 injections or high doses of oral B12 supplements.

  • Other Tongue Conditions:

    • Black Hairy Tongue:

    • Caused by an imbalance of oral flora post-antibiotic use; filiform papillae elongate, leading to staining and appearance resembling a black tongue.

    • Geographic Tongue:

    • Loss of filiform papillae in patterns resembling a map; affects 1%-3% of the population, more common in women.

    • Fissured Tongue:

    • Considered a variant of normal; characterized by deep grooves on the tongue's surface.