PPT MATERI OM 1

8/18/2019 PPT MATERI OM 1

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WHITE LESION


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Cheek chewing

Oral candidiasis

Chemical burn

Pseudomemb

Erythem

Denture Sto

ngular C

Median RhGlos

Hyperp


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HISTOPATHOLOGIC FEATURES• Extensive hyperkeratosis• Clusters of vacuolated cells are present in the surface of Prickle cell layer

TREATMENT• No treatment required• For patient who desire treatment : oral acrylic shield• Several authors have suggested psychoteraphy as treatment of choice


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CLINICAL FEATURES• Most causatic agents produce similar damage• Short exposures : superficial white, wrinkled appereance• Long exposures : epithelium becomes separated from underlying tissue and can be

descuamated easily -> red, bleeding, yellowish, fibripurulent membrane• Very painful

HISTOPATHOLOGIC FEATURES•

Coagulative necrosis of epithelium with only the outline of the individual epithelialcells and nuclei remaining• Underlying connective tissue contains acute and chronic inflammatory cells


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TREATMENT• The best treatment is prevention : potentially caustic drugs -> instruct the patient

to swallow not allow it to remain in oral cavity• Temporary protections : protective emollient paste or hydroxyprophyl cellulose

film• Temporary pain relief : Topical dyclonine HCL• Large area of necrosis : surgical debridement & antibiotics


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PATHOGENESIS

C. Albicans, C. Tropicalis, C. Glabrata

Adhere and penetrate to ephitelial surface facilitated by lipases


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LOCAL PREDISPOSING FACTORS


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CLINICAL FEATURES

• Painful elevated plaques that can be wiped off• Leaving eroded• Bleeding surface• Associated with poor hygene, systemic antibiotics, systemic diseases,

debilitations, reduced immune response• Chronic infections may result in erythematous mucosa without obviouswhite colonies


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SYMPTOMS• Burning sensation• Foul taste

COMMON SITES• Buccal mucosa, Tongue , Palate

ASSOCIATED FACTORS• Antibiotic therapy• Immunosupressio

DD :• Lichen Planus, hairy leukoplakia, leukoplakia, fordyce granules

MANAGEMENT :• Treat any predisposing cause and reduce smoking;• Antifungals such as nystatin oral suspension, pastilles, amphotericin lozenges, miconazole g

or tablets, or fluconazole tablets


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b. Erythematous Candidiasis• Red patch persistent lesion of candidiasis• Usually asymptomatic and chronic

APPEARANCE & SYMPTOMS• White component is not in a prominent feature• Red macules• Burning sensations• Reddened “bald” appereance of the tongue• Erythematous surface reflects atrophy and increased vascularization

COMMON SITESPosterior hard palate, buccal mucosa , dorsal tongue

ASSOCIATED FACTORSAntibiotic therapy. xerostomia. immunosuppression, idiopathic


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PREDISPOSING FACTORS• Broad spectrum antibiotic therapy• Smoking•

Iron deficiency anemia• Inhalation steroids• HIV

DD• Erythroplakia

MANAGEMENT• Treat any predisposing cause;• Antifungals such as nystatin oral suspension, pastilles, amphotericin lozenges, miconazole

gel, tablets or fluconazole tablets


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c. Denture Stomatitis• Is a varying degrees of erythema, sometimes accompanied by petechial hemorrage, localiz

to the denture-bearing areas of maxillary removable prothesis• Usually patients admits to use the denture, but periodically to clean it• Can be used by microorganism living beneath the denture of improper design of the dentu

allergy to denture base, or inadequate curing of denture

APPEARANCE & SYMPTOMS• Red• Asymtomatic

COMMON SITESConfined to palatal denture-breading mucosa

ASSOCIATED FACTORSProbably not true infection : Denture often is positive on culture but mucosa not


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DD• Erythematous candidiasis

TREATMENT• CIE : Improve denture hygene, not to use dentusre while sleeping,, store the denture in

antimicrobial solutions• Antifungal treatment


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DD• Exfoliative cheilitis• Actinic cheilitis

MANAGEMENTAntifungal cream (usually miconazole) or other antifungal therapy, repair of denture, appsmoisturizing cream, a course of oral iron or vit B supplements may be helpful


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e. Median Rhomboid GlossitisClinically characterized by an erythematous lesion inthe center of posterior part of thedorsum of the tongue

The area of erythema resulting from atrophy of the filiform papillae and the surface may blobulatedEtiology not fully clarifiedSmokers, denture weares, and patient who use inhalation steroids has an increased risk

CLINICAL FEATURES• erythematous lesion inthe center of posterior part of the dorsum of the tongue or• Depapillated rhomboidal area in the center of the dorsum of tongue anterior to

circumvallate papillae• Flat or nodular, red, or red and white• Lesion -> oval configuration• Asymptomatic


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DD• Geographic tongue

MANAGEMENT• Elimination of predisposing factors• Antifungal therapy• Cyrosurgery


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f. Hyperplastic Candidiasis

CLINICAL FEATURES• White plaques that are not removable, irregular• Asymtomatic• Histopathologic -> epithelial hiperplasia

COMMON SITES• Anterior buccal mucosa, but also can be found at dorsum of the tongue, palate, labial

commisures

PREDISPOSING FACTORS• Smoking• Nutrition deficiency• Immunodeficiency• Denture-wearers• HIV patient• Chronic iritations


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• Diagnosis must be made by biopsy

DD• Leukoplakia• Candidiasis pseudomembranous• Lichen planus

MANAGEMENT• Elimination of predisposing factors• Consumption of vegetable and fruits• Vitamin A• Antifungal therapy


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recipes

Systemic antifungal

R/ Ketoconazole tab 200mg No. XS 1 dd 1 tab 1 p.c

Topical antifungal

R/ Nystatin oral suspension fl no. IIIS 4 dd 1 ml

Vitamin A

R/ Vitamin A 10000 IU tab no. XXXS 1 dd 1


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PPT MATERI OM 1

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