Oral Soft Tissues anConditions

Oral Soft Tissues of the Mouth (SQA Unit Code - J8W3 04)

Introduction to Oral Health Assessment

• Preparation: Involves preparing equipment, instruments, materials, and medicaments necessary for assessment.

• Chairside Support: Providing close support during individual assessments by:

  • Recording and charting information from examinations of the head, neck, teeth, periodontium, and soft tissues.

  • Monitoring individuals during procedures to identify complications.

  • Taking necessary actions in case of complications.

• Settings for Dental Procedures: May be carried out in:

  • General dental practices.

  • Public dental services.

  • Hospital settings.

  • Domiciliary (home) or other non-standard environments.

Definition and Key Components of Oral Soft Tissues

• Definition: Oral soft tissues refer to the various membranes lining the inside of the mouth.

• Crucial Roles: These tissues play vital roles in:

  • Speech.

  • Chewing.

  • Swallowing.

  • Taste.

• Importance of Regular Examination: They are susceptible to conditions ranging from minor irritations to serious diseases, making regular examination by a dentist or oral health professional extremely important.

• **Key Components:

  • Oral Mucosa: The mucous membrane lining the oral cavity.

  • Gingiva: The soft tissues surrounding and supporting the teeth.

  • Buccal Mucosa: The lining of the cheeks.

  • Labial Mucosa: The lining of the lips.

  • Tongue: A muscular organ covered in soft tissue and papillae.

  • Floor of the Mouth: The area located under the tongue.

  • Hard Palate: The bony front portion of the roof of the mouth.

  • Soft Palate: The muscular back portion of the roof of the mouth.

Importance of Oral Soft Tissues

• Protection: They protect underlying structures from mechanical, chemical, and biological stimuli.

• Secretion: Salivary glands within the oral mucosa produce saliva, which aids in digestion and maintains oral moisture.

• Sensory Function: Contain nerve endings allowing perception of taste, touch, temperature, and pain.

• Speech: The tongue and soft palate are essential for articulation.

• Swallowing: Soft tissues assist in moving food from the mouth into the oesophagus.

• Overall Health Indicator: The condition of oral soft tissues can reflect the overall health of the body.

Common Conditions Affecting Oral Soft Tissues

• Infections:

  • Viral: e.g., Herpes Simplex.

  • Fungal: e.g., Candida.

  • Bacterial: Can all cause inflammation and lesions.

• Inflammation:

  • Gingivitis: Inflammation of the gums.

  • Stomatitis: Inflammation of the oral mucosa.

  • Causes: Poor oral hygiene, irritation, or systemic conditions.

• Trauma:

  • Causes: Injuries from biting, burns, or accidental damage.

  • Outcomes: Can lead to ulcers, cuts, or swelling.

• Oral Lesions:

  • Range: From benign growths (e.g., fibromas) to potentially cancerous lesions.

• Dry Mouth (Xerostomia):

  • Effect: Reduced saliva production.

  • Consequences: Discomfort, difficulty swallowing, increased risk of infections.

• Importance of Examination: Regular examination and maintenance are crucial for overall oral health and early detection of problems.

Anatomical Landmarks (Diagrams Referenced)

• Structures Labeled: Hard palate, uvula, tongue, soft palate, retromolar area, tonsil, labial frenum (upper and lower), palatoglossal arch, palatopharyngeal arch, palatine tonsil in tonsillar fossa, posterior wall of oral part of pharynx, dorsal surface of tongue.

• Oral Vestibule:

  • Borders:

    • Anteriorly and laterally: Lips and cheeks.

    • Posteriorly and medially: Teeth and gums.

Function of the Soft Palate

• Swallowing & Breathing: Aids these processes by altering the patency of the respiratory and digestive tracts, respectively.

• Speech: Plays an important role in pronunciation in conjunction with the tongue.

Specific Oral Conditions

1. Xerostomia (Dry Mouth)

• Causes:

  • Systemic Diseases: e.g., Diabetes, Sjögren's Syndrome.

    • Sjögren's Syndrome: Immune system targets tear and saliva glands, reducing saliva and tear production, leading to dry mouth and dry eyes.

  • Radiotherapy.

  • Increased Age: Can cause a normal reduction of saliva.

  • Therapeutic Drugs: e.g., Beta blockers, Parkinson's disease medications.

  • Dehydration.

  • Hormonal Disturbances.

• Treatment/Management: Saliva substitutes (e.g., Xerostom with Saliactive).

2. Angular Cheilitis

• Description: Inflammation and dry, cracked skin at one or both corners of the mouth.

• Symptoms: Discomfort during eating, talking, and smiling; skin can split and bleed. Begins with saliva pooling at corners, then drying, leading to dry, cracked, and irritated skin. Patients may lick lips, worsening irritation. Moist, cracked skin creates a perfect environment for microorganisms (bacteria, Candida yeast), causing swelling, itching, burning. Patches may appear white, scaly, and blistered.

• Causes/Risk Factors:

  • Poor-fitting dentures.

  • Sagging skin (weight loss, aging).

  • Thumb-sucking and excessive lip licking in children.

  • Excessive mouth washing or aggressive use of dental floss.

  • Genetic conditions: Down syndrome, Sjögren's syndrome.

  • Weakened immune systems: Diabetes, HIV.

  • Nutritional deficiencies: Lack of Vitamin B or iron.

• Treatment:

  • Antibiotic or antifungal cream to treat infections.

  • Petroleum jelly or lip balm with SPF to protect skin barrier.

  • Dental work: Repair dentures or correct a misaligned bite.

  • Behavior modifications: Prevent thumb-sucking.

  • Diet changes/vitamin supplements: Correct nutritional deficiencies.

  • Proper oral hygiene: Keep lips and mouth clean and free from infections.

3. Lichen Planus

• Nature: Skin or mucosal disorder.

• Demographics: Middle-aged women affected more than men.

• Symptoms: Usually symptomless, but can cause discomfort when eating spicy foods.

• Prevalence: Affects around $2\%$ of the UK population.

• Skin Lesions: Usually resolve within about $18$ months.

• Intraoral Presentation: White patches affecting the buccal mucosa, tongue, and attached gingivae.

4. Oral Cancer

• Early Detection: Paramount for successful treatment.

• Appearance: Similar to an ulcer, with raised, rolled edges and hardening around the periphery area.

• Common Sites: Lips, tongue, floor of mouth, cheek, upper and lower jaw bones, and palate.

• Detection Challenges: Often a small, painless white or red spot, easily ignored. Lack of regular dental care contributes to late detection.

• Referral: Referral to an oral medicine department is recommended.

• Risk Factors:

  • Smoking.

  • Chewing betel nut.

  • Drinking alcohol.

  • HIV/AIDS.

  • HPV virus.

  • Aging.

  • Chronic mouth irritation.

  • Poor oral hygiene.

• Prevention:

  • Stop or avoid tobacco use.

  • Drink alcohol in moderation or abstain.

  • Regular dental visits.

  • Eat a well-balanced diet.

  • Limit sun exposure, especially for the lower lip, to reduce risk of lip cancer.

5. Oral Thrush (Candida Infection)

• Nature: Type of yeast infection caused by the fungus Candida, most commonly Candida albicans.

• Demographics: Seen in the young and the elderly, diabetics, and people with weakened immune systems. Also common in individuals taking antibiotics, as antibiotics kill oral bacteria, allowing thrush to proliferate.

• Appearance: Creamy white substance; when removed, reveals a red, raw mucosa.

• Locations: Found on the palate, tongue, or cheek.

• Pain: Usually painless, but can be tender when eating.

• Chronic Candidosis: Seen in denture wearers, known as denture stomatitis.

• Danger: For most people, oral thrush is not dangerous and resolves quickly with treatment.

• Treatment: Usually straightforward, involving anti-thrush drugs like nystatin or miconazole, taken orally as drops or a gel. These drugs effectively kill yeast infections with typically no side effects.

6. Cold Sores (Herpes Simplex)

• Cause: Herpes Simplex virus.

• Triggers: Sun exposure, stress, menstruation.

• Appearance: Appear on the lip, burst, then crust over.

• Onset Symptom: Tingling sensation at the beginning.

• Duration: Lasts for around $10-14$ days.

• Infectiousness: Patient is infectious during this period.

• Dental Treatment: Often avoided during an active outbreak.

• Treatment: Antiviral ointment (e.g., Zovirax).

7. Oral Ulceration

• Causes: Many causes exist.

• Most Common Types: Caused by trauma and aphthous ulceration.

• Monitoring: Ulcers should always be monitored; patient reviewed weekly.

• Traumatic Causes: Sharp cusp, ill-fitting denture, biting cheek or lip, toothbrush damage.

• Treatment (Examples): Iglü Mouth Ulcer treatment (gel, pastilles) for pain relief, protection, and fighting infection.

8. Cleft Lip/Palate (OH3 for Clinical Assessment, OH6)

• Nature: Congenital malformation.

• Prevalence: Approximately $1$ in $700$ births in the UK are affected. Children born to a parent with a cleft have approximately a $1$ in $20$ chance.

• Gender: Males are affected more than females.

• Anatomy:

  • Philtral Ridge: Vertical ridges running from the base of the nose to the upper lip.

  • Philtrum: Groove between the philtral ridges.

  • Vermillion Border: Outline of the lips.

  • Incisive Foramen: Opening in the hard palate behind the incisors.

  • Primary Palate: Front part of the palate.

  • Secondary Palate: Back part of the palate.

• Types of Clefts (as depicted in diagrams):

  • Normal lip, normal palate.

  • Cleft palate.

  • Left unilateral cleft lip.

  • Left cleft lip (unspecified if unilateral/bilateral).

  • Left unilateral cleft lip and palate.

  • Bilateral cleft lip and palate.

  • Bilateral cleft lip.

  • Bilateral cleft lip with full palate.

• Surgical Repair: Cleft lip and cleft palate repairs are illustrated with before and after images.

Future Topics

• Next week's topic: Muscles of Mastication and Facial Expression.

• Orthodontics is covered in OH3 for clinical assessment and will continue into OH6.