Diseases of the mouth
المرحلة الرابعة/ د.خلدون العبايجيCauses of mouth ulcers
1. Aphthous ulcerations
2. Infections e.g fungal (candida), viral(herpes simplex), bacterial(syphilis).
3. Gastrointestinal e.g celiac disease and Crohns disease.
4. Skin disease e.g lichen planus, pemphigus, pemphigoid.
5. Drugs e.g Steven-Johnson syndrome, cytotoxic drugs.
6. Systemic e.g SLE, Behcets syndrome.
7. Neoplasia e.g carcinoma, Kaposi sarcoma, leukemia.
Aphthous ulceration
- Idiopathic, may occur in the premenstrual period, and after stress.
- Any site of the mouth, superficial and painful.
- Common and recurrent.
- Treatment: topical 0.1% triamcinolone in orabase, choline salicylate 8.7%gel, local anesthetic mouth wash, rarely oral steroids. Colchicine for severe recurrent condition.
Candidiasis
- Candida albicans is a normal mouth commensal.
- proliferate and cause mouth thrush.
- occur in: babies, debilitated patients, use of steroids and antibiotics, diabetes, immune suppression, AIDS.
- white patches on the tongue and buccal mucosa.
- May involve the pharynx and esophagus leading to dysphagia and odynophagia.
- Diagnosis: clinical, brushing and biopsy.
- Treatment: nystatin or amphotericin suspension or lozenges, oral fluconazole for resistant cases.
Salivary glands
Causes of salivary gland swelling
1. Infection: viral (mumps), bacterial2. Calculi
3. Sjogren syndrome
4. Sarcoidosis
5. Tumors: benign and malignant, lymphoma
6. Alcoholism
7. Anorexia nervosa
Parotitis
- viral, bacterial- mumps is selflimiting
- bacterial infection after surgery due to dehydration and poor oral hygiene.
- painful parotid swelling and may lead to abscess.
- Treatment by broad spectrum antibiotics and abscess drainage.
Gastritis
Acute gastritis- Causes: aspirin, NSAIDs, H.pylori, alcohol, stress (burns), biliary, CMV, H.simplex, AIDS.
- Pathology: mucosal inflammation, erosions, bleeding.
- clinical picture: often a symptomatic, epigastric pain,dyspepsia, anorexia, nausea, vomiting, hematemesis and melena.
- Diagnosis: clinical, may need endoscopy and biopsy to exclude peptic ulcer, cancer and to know source of bleeding.
- usually resolve quickly.
- Treat the cause, antacids, PPI, antiemetics, antispasmodics.
Chronic gastritis
A. Chronic non-specific gastritis: H.pylori, atrophic autoimmune, postgastrectomy, Menetriers disease.
B. Specific (rare): CMV, TB, Crohns disease, sarcoidosis,granulomatous gastritis.
Chronic gastritis due to H.pylori
- It is the most common cause.
- Lymphocytic and plasma cell infiltration
- if the patient has trouble some dyspepsia then eradicate H.pylori by PPI and two antibiotics e.g amoxil and clarithromycin for 10 days.
Autoimmune chronic gastritis
- involve body of the stomach and spares the antrum.
- diffuse inflammation, atrophy and loss of fundic glands, intestinal metaplasia.
- serum contains antibodies against parietal cells and intrinsic factor.
- develop hypochlorhydria and usually a symptomatic.
- may be associated with thyroid disease.
- patient develops pernicious anemia and has risk of gastric cancer.