STUDY - Technical - New Dacian's Medicine
Diseases
of the Oral Mucosa (3)
Translation Draft
In our presentation came the turn of changes in the language. These may be changes in size or morphology or changes in color.
In terms of changes in size or morphology, a first condition would be macroglossy, or enlarged language, which may be part of a syndrome found in developmental disorders, such as Down syndrome. It may be due to a tumor (hemangioma or lymphangioma), a disease of metabolism (like primary amyloidosis) or an endocrine disorder (such as acromegaly or cretinism).
The cracked tongue ("scrotal") is manifested by the dorsal surface and the sides of the tongue covered by shallow or deep, painless cracks, which can collect detritus and irritate. There is also the median rhomboid glossitis which is a congenital abnormality of the tongue with an ovoid region, denuded in the posterior median portion of the tongue. It can be associated with candidiasis and respond to antimycotics.
In terms of color changes we have... The "geographic" language (benign migratory glossitis) which presents itself as an asymptomatic inflammatory disease of the tongue, with the rapid loss and recovery of filiform papillae, leading to the appearance of denuded, red spots, which "move" on the surface of the tongue.
The hairy tongue is manifested by the elongation of the filiform papillae at the medial dorsal surface, due to the inability to normally descuamation of the keratin layer of the papillae. Brownish black coloration may be due to staining from alcohol, tobacco or chromagen microorganisms.
The language "raspberry" is the typical appearance of the tongue during scarlet fever, due to hypertrophy of the fungiform papillae plus changes of the filiform papillae. The "cheal" language is a form of atrophy that can be associated with xerostomy, pernicious anemia, ferriprivate anaemia, pelagra or syphilis. It can be accompanied by a painful burning sensation and can be an expression of erythematous candidiasis and responds to antimycotics.
Halitosis may be due to respiratory tract infections (bronchiectasis or pulmonary abscess), oral infection (acute primary herpetic gingivitostomatitis, acute ulcero-necrotic gingivitis, periodontal and caries), smoking, liver failure (fish hall), nitrogenemia (amoniacal or urinary breath) and diabetic ketoacidosis (sweet, fruit).
In terms of oral disease, HIV and AIDS have many manifestations. Immunodepression caused by HIV infection predisposes to numerous oral infections, neoplasms and autoimmune and idiopathic lesions. Some of these, such as oral candidiasis and hairy leukoplakia (a benign epithelial hyperplasia associated with Epstein-Barr virus - VEB), are common features of HIV disease and often precede or accompany AIDS. Some, such as Kaposi oral sarcoma and lymphoma, are diagnosed with AIDS.
Oral candidiasis is easily treated with topical or systemic antifungals. These include oral tablets of nistatin, oral tablets of clotrimazole, fluconazole and ketoconazole. While most oral lesions in HIV disease are also found in the general population, both hairy leukoplasia and necrotizing periodontal ulcerative disease are closely associated with HIV infection and are only very rare in other situations.
Only small and variable amounts of HIV can be found in saliva, but blood, tissue fluid and exudation from the gum fissures present in the oral cavity as a result of lesions or other clinical procedures, are safe sources of other viruses such as herpes simplex virus (HSV) and VEB and the same may apply to HIV.
Oral lesions in HIV and AIDS are represented by: 1. fungal such as candidiasis (pseudomembranous, erythematous or angular cheilitis), histoplasmosis and cryptococosis, 2. bacterial such as acute ulcer-necrotic gingivitis, ulcer-necrotic periodontitis, necrotizing stomatitis, M. avium complex and tuberculosis and stomatitis due to enteric microorganisms, 3. viral sorbe x such as herpes simplex, herpes zoster, hairy leukoplakia and warts, 4. such as Kaposi syndrome and lymphomas, and 5. other causes such as recurrent foot-and-mouth ulcers, immune thrombocytopenic purpura, xerostomy or enlargement of the salivary glands.
Let's move now to hematological and nutrition diseases that give manifestations at the oral level. Gingival bleeding, necrotic ulcers and thickening of the gum due to malignant infiltrationare are found in all forms of leukemia, especially in monocytic leukemia. Severe ulcers of the oral mucosa are observed in agranulocytosis, while in thrombocytopenia oral spots, bruising and gingival bleeding are encountered.
In Plummer-Vinson syndrome atrophy of the oral mucosa, especially of the lingual papillae, produces hyperemia and pain, as well as dysphagia. This is associated with an increased susceptibility to oral cancer. A smooth tongue can be found in pernicious anemia.
Severe oral mucositis with ulcerations, candidiasis, bacterial infections and xerostomy complicates local radiotherapy for head and neck neoplasms, as well as chemotherapy for local neoplasms or other neoplasms. Although found only in certain areas, oral manifestations of vitamin deficiency include oral mucositis and ulcerations, glossitis and burning sensations in the tongue (vitamin deficiencies in group B) and spots, gum swelling, bleeding and ulceration, as well as tooth loss (scurvy or vitamin C deficiency).
Let's present now a few things about salivary gland disorders. Major and minor salivary glands can be affected in mumps, sarcoidosis, tuberculosis, lymphoma, Sjogren's syndrome, etc. The latter may cause dry eyes and mouth (xerostomy) and may be associated with manifestations of connective tissue disease, including rheumatoid arthritis or systemic lupus erythematosus.
Xerostomia may also be due to medications such as diuretics, antihistamines or tricyclic antidepressants, as well as radiotherapy for head and neck neoplasms. Xerostomia can produce cervical or incisal cavities and oral candidiasis. Treatment includes mouthwashes and topical applications with fluorides, saliva substitutes, salivary stimulation with sugar-free candy and avoidance of sugar-containing beverages or foods. Candidiasis is treated with nistatin or other antifungals. Salivary calculations (sialolithiasis), usually in the duct of a large salivary gland, produce sialoadenitis with pain and swelling, often in food.
Recurrent parotiditis with no apparent cause is found in children. The most common neoplasm of the salivary glands is pleiomorphic adenoma, which is benign but recurs if it is not completely enucleite. Malignant tumors include mucoepidermoid carcinoma, cystic adenoid carcinoma and adenocarcinoma. Pleiomorphic adenoma produces a slow-growing hard mass in the parotid, palate or cheek, while malignant tumors grow faster and can cause ulceration and nerve invasion, causing paresthesia or facial paralysis.
I will complete this group of posts with some elements about neurological disorders and orofacial pain.
The oral cavity may be the site of pain in a number of vascular, neurological, muscle/conjunctive tissue or joint disorders. Multidisciplinary diagnosis and treatment programs involving neurologists, dentists, orthodontics, bucomaxilofacial surgeons, otorinolaringologists and other specialists, together with new imaging techniques for diagnosing or excluding organic lesions have begun to clarify this complex area.
Temporal arthritis causes pain in the face, jaws and tongue and can mimic disorders of the temporomandibular joint. Glucocorticoids can cause improvements. Myofascial pain is a deaf, constant pain with local sensitivity to the jaw muscles and difficulty opening the mouth.
This may be related to the gnashing and grit-tightening (bruxism) tick. Temporomandibular arthralgia causes local pain, which can irradiate the face and head. Both myofascial pain and arthralgia can be relieved by heat, rest and anti-inflammatory agents. Moving the meniscus or condile may cause pain, tightening of the teeth or blocking the mandible in the open position.
The joint may be affected in osteoatritis with minor symptoms, while rheumatoid arthritis produces pain and joint swelling, limitation of movements and, in juvenile form, severe malocclusion in children. Ankylosis may occur, requiring condilectomy.
Trigeminal neuralgia (tic douloureux) causes unilateral lancinant, severe, sudden pain, initiated upon reaching a "trigger zone" (triggers) or appearing spontaneously. Confusion with pulp or periapical pain is common, leading to inadequate endodontic or surgical treatment. Many cases respond to carbamazepine and phenytoin, but in some cases surgery to decompress the trigeminal nerve is indicated.
Similar symptoms in the distribution territory of the cranial nerve IX (tongue, pharynx, soft palate) are due to glosopharyngeal neuralgia, which can be triggered by swallowing and can cause irradiated pain in the temporomandibular joint. Postherpetic neuralgia can follow trigeminal shingles and produce burning sensations, long-lasting suffering and pain.
Facial paralysis is usually one-sided and may be due to trauma, surgery, tumours or infections of the cranial nerve VII. Bell's palsy is a form with acute onset and unknown cause, probably due to a viral infection such as herpes zoster. The corner of the mouth is deflected and there may be difficulty in speech, feeding and closing the eye.
Symptoms usually disappear spontaneously, but residual facial immobility and labptosis may persist. Abnormal or diminished taste sensations may be due to xerostomy, facial and glossopharynx nerve disorders or their central connections, aging or wearing dentures. Diseases affecting the glosopharyngeal nerve may cause atrophy of the tongue muscles with protrusion, if the lesion is bilateral or with a deviation to the affected part, if the lesion is unilateral.
Since I've been working on the signs of disease, I've started to feel like I'm at work when I'm working on this blog... And my wish is quite different... I need to get this purely "medical-traditional" section to really move on to "New Medicine" as soon as possible and pass on what I feel I need and not just what I've learned... I hope I don't quit in the meantime and get it done... Tomorrow we continue with a new section of circulatory and respiratory function disorders...
In our presentation came the turn of changes in the language. These may be changes in size or morphology or changes in color.
In terms of changes in size or morphology, a first condition would be macroglossy, or enlarged language, which may be part of a syndrome found in developmental disorders, such as Down syndrome. It may be due to a tumor (hemangioma or lymphangioma), a disease of metabolism (like primary amyloidosis) or an endocrine disorder (such as acromegaly or cretinism).
The cracked tongue ("scrotal") is manifested by the dorsal surface and the sides of the tongue covered by shallow or deep, painless cracks, which can collect detritus and irritate. There is also the median rhomboid glossitis which is a congenital abnormality of the tongue with an ovoid region, denuded in the posterior median portion of the tongue. It can be associated with candidiasis and respond to antimycotics.
In terms of color changes we have... The "geographic" language (benign migratory glossitis) which presents itself as an asymptomatic inflammatory disease of the tongue, with the rapid loss and recovery of filiform papillae, leading to the appearance of denuded, red spots, which "move" on the surface of the tongue.
The hairy tongue is manifested by the elongation of the filiform papillae at the medial dorsal surface, due to the inability to normally descuamation of the keratin layer of the papillae. Brownish black coloration may be due to staining from alcohol, tobacco or chromagen microorganisms.
The language "raspberry" is the typical appearance of the tongue during scarlet fever, due to hypertrophy of the fungiform papillae plus changes of the filiform papillae. The "cheal" language is a form of atrophy that can be associated with xerostomy, pernicious anemia, ferriprivate anaemia, pelagra or syphilis. It can be accompanied by a painful burning sensation and can be an expression of erythematous candidiasis and responds to antimycotics.
Halitosis may be due to respiratory tract infections (bronchiectasis or pulmonary abscess), oral infection (acute primary herpetic gingivitostomatitis, acute ulcero-necrotic gingivitis, periodontal and caries), smoking, liver failure (fish hall), nitrogenemia (amoniacal or urinary breath) and diabetic ketoacidosis (sweet, fruit).
In terms of oral disease, HIV and AIDS have many manifestations. Immunodepression caused by HIV infection predisposes to numerous oral infections, neoplasms and autoimmune and idiopathic lesions. Some of these, such as oral candidiasis and hairy leukoplakia (a benign epithelial hyperplasia associated with Epstein-Barr virus - VEB), are common features of HIV disease and often precede or accompany AIDS. Some, such as Kaposi oral sarcoma and lymphoma, are diagnosed with AIDS.
Oral candidiasis is easily treated with topical or systemic antifungals. These include oral tablets of nistatin, oral tablets of clotrimazole, fluconazole and ketoconazole. While most oral lesions in HIV disease are also found in the general population, both hairy leukoplasia and necrotizing periodontal ulcerative disease are closely associated with HIV infection and are only very rare in other situations.
Only small and variable amounts of HIV can be found in saliva, but blood, tissue fluid and exudation from the gum fissures present in the oral cavity as a result of lesions or other clinical procedures, are safe sources of other viruses such as herpes simplex virus (HSV) and VEB and the same may apply to HIV.
Oral lesions in HIV and AIDS are represented by: 1. fungal such as candidiasis (pseudomembranous, erythematous or angular cheilitis), histoplasmosis and cryptococosis, 2. bacterial such as acute ulcer-necrotic gingivitis, ulcer-necrotic periodontitis, necrotizing stomatitis, M. avium complex and tuberculosis and stomatitis due to enteric microorganisms, 3. viral sorbe x such as herpes simplex, herpes zoster, hairy leukoplakia and warts, 4. such as Kaposi syndrome and lymphomas, and 5. other causes such as recurrent foot-and-mouth ulcers, immune thrombocytopenic purpura, xerostomy or enlargement of the salivary glands.
Let's move now to hematological and nutrition diseases that give manifestations at the oral level. Gingival bleeding, necrotic ulcers and thickening of the gum due to malignant infiltrationare are found in all forms of leukemia, especially in monocytic leukemia. Severe ulcers of the oral mucosa are observed in agranulocytosis, while in thrombocytopenia oral spots, bruising and gingival bleeding are encountered.
In Plummer-Vinson syndrome atrophy of the oral mucosa, especially of the lingual papillae, produces hyperemia and pain, as well as dysphagia. This is associated with an increased susceptibility to oral cancer. A smooth tongue can be found in pernicious anemia.
Severe oral mucositis with ulcerations, candidiasis, bacterial infections and xerostomy complicates local radiotherapy for head and neck neoplasms, as well as chemotherapy for local neoplasms or other neoplasms. Although found only in certain areas, oral manifestations of vitamin deficiency include oral mucositis and ulcerations, glossitis and burning sensations in the tongue (vitamin deficiencies in group B) and spots, gum swelling, bleeding and ulceration, as well as tooth loss (scurvy or vitamin C deficiency).
Let's present now a few things about salivary gland disorders. Major and minor salivary glands can be affected in mumps, sarcoidosis, tuberculosis, lymphoma, Sjogren's syndrome, etc. The latter may cause dry eyes and mouth (xerostomy) and may be associated with manifestations of connective tissue disease, including rheumatoid arthritis or systemic lupus erythematosus.
Xerostomia may also be due to medications such as diuretics, antihistamines or tricyclic antidepressants, as well as radiotherapy for head and neck neoplasms. Xerostomia can produce cervical or incisal cavities and oral candidiasis. Treatment includes mouthwashes and topical applications with fluorides, saliva substitutes, salivary stimulation with sugar-free candy and avoidance of sugar-containing beverages or foods. Candidiasis is treated with nistatin or other antifungals. Salivary calculations (sialolithiasis), usually in the duct of a large salivary gland, produce sialoadenitis with pain and swelling, often in food.
Recurrent parotiditis with no apparent cause is found in children. The most common neoplasm of the salivary glands is pleiomorphic adenoma, which is benign but recurs if it is not completely enucleite. Malignant tumors include mucoepidermoid carcinoma, cystic adenoid carcinoma and adenocarcinoma. Pleiomorphic adenoma produces a slow-growing hard mass in the parotid, palate or cheek, while malignant tumors grow faster and can cause ulceration and nerve invasion, causing paresthesia or facial paralysis.
I will complete this group of posts with some elements about neurological disorders and orofacial pain.
The oral cavity may be the site of pain in a number of vascular, neurological, muscle/conjunctive tissue or joint disorders. Multidisciplinary diagnosis and treatment programs involving neurologists, dentists, orthodontics, bucomaxilofacial surgeons, otorinolaringologists and other specialists, together with new imaging techniques for diagnosing or excluding organic lesions have begun to clarify this complex area.
Temporal arthritis causes pain in the face, jaws and tongue and can mimic disorders of the temporomandibular joint. Glucocorticoids can cause improvements. Myofascial pain is a deaf, constant pain with local sensitivity to the jaw muscles and difficulty opening the mouth.
This may be related to the gnashing and grit-tightening (bruxism) tick. Temporomandibular arthralgia causes local pain, which can irradiate the face and head. Both myofascial pain and arthralgia can be relieved by heat, rest and anti-inflammatory agents. Moving the meniscus or condile may cause pain, tightening of the teeth or blocking the mandible in the open position.
The joint may be affected in osteoatritis with minor symptoms, while rheumatoid arthritis produces pain and joint swelling, limitation of movements and, in juvenile form, severe malocclusion in children. Ankylosis may occur, requiring condilectomy.
Trigeminal neuralgia (tic douloureux) causes unilateral lancinant, severe, sudden pain, initiated upon reaching a "trigger zone" (triggers) or appearing spontaneously. Confusion with pulp or periapical pain is common, leading to inadequate endodontic or surgical treatment. Many cases respond to carbamazepine and phenytoin, but in some cases surgery to decompress the trigeminal nerve is indicated.
Similar symptoms in the distribution territory of the cranial nerve IX (tongue, pharynx, soft palate) are due to glosopharyngeal neuralgia, which can be triggered by swallowing and can cause irradiated pain in the temporomandibular joint. Postherpetic neuralgia can follow trigeminal shingles and produce burning sensations, long-lasting suffering and pain.
Facial paralysis is usually one-sided and may be due to trauma, surgery, tumours or infections of the cranial nerve VII. Bell's palsy is a form with acute onset and unknown cause, probably due to a viral infection such as herpes zoster. The corner of the mouth is deflected and there may be difficulty in speech, feeding and closing the eye.
Symptoms usually disappear spontaneously, but residual facial immobility and labptosis may persist. Abnormal or diminished taste sensations may be due to xerostomy, facial and glossopharynx nerve disorders or their central connections, aging or wearing dentures. Diseases affecting the glosopharyngeal nerve may cause atrophy of the tongue muscles with protrusion, if the lesion is bilateral or with a deviation to the affected part, if the lesion is unilateral.
Since I've been working on the signs of disease, I've started to feel like I'm at work when I'm working on this blog... And my wish is quite different... I need to get this purely "medical-traditional" section to really move on to "New Medicine" as soon as possible and pass on what I feel I need and not just what I've learned... I hope I don't quit in the meantime and get it done... Tomorrow we continue with a new section of circulatory and respiratory function disorders...
A day of the best and most
full of understanding, love and gratitude!
Dorin, Merticaru