Oral Hypersensitivity Reactions. Oral hypersensitivity reactions (OHRs) have a variety of manifestations: acute onset of EM ulcers, red and white reticular lesions such as lichenoid reactions, fixed drug eruption (usually seen as ulcers on the lip vermilion after exposure to drugs with resolution on withdrawal and relapse on rechallenge), swelling of the lips, and oral allergy syndrome (itching with or without swelling of oral structures and oropharynx) [3, 44, 45].
Plasma Cell Stomatitis. Plasma cell stomatitis (PCS) was first described in the late 1960s and early 1970s as a hypersensitivity reaction and likely a contact stomatitis to a component of chewing gum. This entity usually occurs few days after exposure and presents as erythematous macular areas of oral cavity. Ulceration, epithelial sloughing, and desquamation may also be seen. Gingivae is the mostly affected site. Angular cheilitis with fissuring and dry atrophic lips have been found in patients with PCS [3]. OHRs and PCS are usually self-limiting. Nevertheless, pain control and anti-inflammatory agents can help diminish the healing time [3, 44, 45].
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Necrotizing Sialometaplasia. Although this lesion usually occurs on the palate, it can be seen anywhere from oral mucosa, which contains salivary glands including the retromolar trigon and the lips. NS initially presents as a tender erythematous nodule, followed by a deep ulcer with a yellowish base [3]. Average age of patients is 46 years and it is more common in males. It resembles squamous cell carcinoma and ulcerated mucoepidermoid carcinoma to a large extent during its ulcerated phase [5]. NS is mainly a self-limiting lesion, and healing time may be varied from 2 to 12 weeks according to the severity of the lesion [5, 11, 34]. Therefore, NS can be classified as an acute or chronic solitary ulcer.
Ulcerative Squamous Cell Carcinoma. Squamous cell carcinoma (SCC) represents about 95% of all oral malignancies [22, 54]. It presents as a red, white, red-white, exophytic, or ulcerative lesion. SCC is a persistent ulcer in the oral cavity, which is of high importance especially on the lips. SCC is often asymptomatic; therefore, patients usually are not aware of it until it has become relatively progressive. The classic ulcerative SCC is described as a craterlike lesion having a rolled, indurated border and a velvety base (Figure 8). It may be covered with a crust when occurring on the vermilion [5, 22]. The mostly affected sites in the oral cavity are lower lip, floor of the mouth, and ventral and lateral borders of the tongue. Lesions are usually solitary, but in rare cases multifocal [5]. According to Wood and Goaz, a lesion is most likely a SCC if the patient is male, older than 40 years, smokes or drinks heavily, no evidence of trauma or systemic disease exists, serologic findings are negative, and the lesion is not located on the posterolateral region of the hard palate [5]. Ulcerative form of SCC is locally destructive; thereby timely and correct diagnosis of oral SCC plays a key role in the improvement of patients prognosis and survival rate [3, 55]. There is no single treatment for oral SCC; however, various therapeutic modalities from surgery, radiotherapy, and chemotherapy to combination different methods have been introduced [54].
Mucous membrane pemphigoid (MMP) has been known by different names including benign mucous membrane pemphigoid, cicatricial (scarring) pemphigoid, and ocular cicatricial pemphigoid [61]. MMP is a common immune-mediated subepithelial blistering disease mainly affecting oral mucosa (over 90%); however, skin lesions are also present in 20% to 30% of cases. The most affected site in the oral cavity is gingivae followed by buccal mucosa and palate. It occurs twice as frequently in females and is generally seen in patients more than 50 years old [3, 5, 62, 63]. Desquamative gingivitis is the most common presentation of the disease, which can be the only feature of MMP. Blood blisters which result from bleeding into bullae are a diagnostic feature of MMP in the oral cavity. Use of topical or systemic corticosteroids is considered as an acceptable treatment for MMP. Furthermore, when there is ocular involvement dapsone therapy is recommended [3].
Bullous pemphigoid (BP) is the most common subepithelial blistering disease, which occurs chiefly in patients over the age of 60 [3]. In this entity, oral mucosal involvement is not common. According to Budimir et al., oral mucosal lesions are found in only 16.6% of cases [64], which are similar to PV but are smaller and less painful. Meanwhile, extensive labial involvement which is common in PV is not present in BP. Desquamative gingivitis has been mentioned as the most frequent oral manifestation in BP and gingivae may be the only affected site [3]. Clinically, oral lesions are not distinguishable from PV or MMP, but early remission of BP is more common [64, 65]. Noteworthy, BP has been reported in conjunction with other diseases such as multiple sclerosis, malignancies, or medications particularly diuretics [3]. Bullous pemphigoid is self-limiting and may last from a few months to 5 years. Topical clobetasol or betamethasone has been suggested in the management of localized oral lesions, whereas, in more extensive disease, use of systemic corticosteroids alone or in combination with immunosuppressive drugs is recommended [3, 64].
Recurrent Herpes Stomatitis. Herpes simplex virus can establish latency in the trigeminal ganglia and periodically reactivate to cause recurrent herpetic stomatitis (RHS). There are two subgroups: recurrent herpes simplex labialis (HSL) (Figure 11), which is more commonly seen in healthy subjects. It begins as vesicles that rupture soon, which leave superficial crusted ulcers and heal without scarring. Recurrent intraoral herpes (RIH) is more common in immunocompromised patients. However, RIH in immune competent patients is limited to the keratinized mucosa, especially on the hard palate usually as clustered and unilateral vesicles. Common triggers of RHS are physical/emotional stress, UV light, cold weather, hormonal changes, upper respiratory tract illness, and lip/mouth trauma [3, 72]. Although the lesions are self-limiting, symptomatic treatment by using ice or lanolin is recommended. Applying acyclovir ointment 5% every 2 hours since the prodromal phase until the lesions subside has been suggested as well. Elective dental treatments should be deferred in patients with active lesions to prevent aerosolization of the virus [71].
A residence, with shared living areas, where clients receive supervision and other services such as social and/or behavioral services, custodial service, and minimal services (e.g., medication administration).
Pathological conditions in the oral cavity (excluding mucosal presentations) may present as a swelling in the submucosa or jaws, symptoms related to teeth and/or gums or an incidental finding on imaging. In this review, the authors outline the most common submucosal or jaw swellings, organised according to their clinical presentations, and describe their typical appearance and management.
Broadly speaking, oral pathology can present as a mucosal surface lesion (discussed in an accompanying article by these authors),1 swelling present at an oral subsite (lips/buccal mucosa, tongue, floor of mouth, palate and jaws) or symptoms related to teeth (pain, mobility). The last of these presentations has been excluded from this article as it is assumed patients with teeth-related symptoms are more likely to present to their dentists than their general practitioners.
A mucocele presents as a smooth, fluid-filled lump in areas with minor salivary glands that are commonly susceptible to oral trauma (eg lips, buccal mucosa; Figure 1). They occur when mucus/saliva escapes into surrounding tissues after trauma to the duct and is walled off by granulation or connective tissue. Alternatively, they can occur with obstruction of the salivary gland duct itself.
A fibroepithelial polyp is, as its name suggests, a polypoid outgrowth of tissue from the mucosal surface, which consists of fibrous connective tissue covered by normal or hyperkeratotic epithelium. It is a consequence of exuberant healing after minor oral trauma, and it is most commonly found in the lower lip or buccal mucosa in response to occlusal trauma (Figure 3). Fibroepithelial polyps can also be ulcerated. Treatment involves surgical excision.
Figure 5. Right palatal swelling at the junction of the hard and soft palate. The lesion was firm on palpation. The overlying mucosa was not ulcerated. The diagnosis was mucoepidermoid carcinoma of the right palate, and treatment involved surgical excision (maxillectomy) and free flap reconstruction.
Figure 16. Orthopantomogram showing a multilocular radiolucency present in the left ramus/angle of the mandible associated with root resorption of the lower left third molar. The patient presented with left jaw swelling, and biopsy revealed solid/multicystic ameloblastoma. This required segmental resection of the mandible and free flap reconstruction.
The management of malignant tumours of the jaw will almost invariably involve segmental resection of the jaw and free flap reconstruction with the possibility of adjuvant radiotherapy and chemotherapy depending on the type of tumour, pathological stage, lymph node involvement and surgical margin (Figure 18).9
Most oral health conditions are largely preventable and can be treated in their early stages. Most cases are dental caries (tooth decay), periodontal diseases, tooth loss and oral cancers. Other oral conditions of public health importance are orofacial clefts, noma (severe gangrenous disease starting in the mouth mostly affecting children) and oro-dental trauma.
The WHO Global Oral Health Status Report (2022) estimated that oral diseases affect close to 3.5 billion people worldwide, with 3 out of 4 people affected living in middle-income countries. Globally, an estimated 2 billion people suffer from caries of permanent teeth and 514 million children suffer from caries of primary teeth. 2ff7e9595c
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