Oral Lesions

Question 1

What are oral lesions

Answer 1

Localised or diffuse change on the normal appearance of the oral mucosa ; normally appearing as a red area. It cannot be clinically or pathologically defined

Question 2

Causes of it

Answer 2

Poor denture rentention
Poor oral hygiene
Mechanical trauma
Candida albicans

Question 3

Denture-induced stomatitis is the most common lesion in denture weare

Answer 3

Usually related to Candida albicans infection
Acute or chronic inflammation due to ill-fitting denture
Poor denture cleaning
Xerostomia
Denture age
Continuous wearing of the denture - wearing it when you sleep
Mechanical trauma

Question 4

Risk factors predisposing

Answer 4

the greater the tissue coverage the higher the risk:
• Mostly prevalent in maxillary dentures
• Denture-induced stomatitis is higher in denture wearers
• Doubles in men,
• higher in elderly patients :
-due to co-morbidities and polypharmacy
-changes in quality and quantity of saliva
-together with the use of a denture promote the development of candida albicans

Question 5

Diagnosis

Answer 5

Clinical presentation
Smear

Question 6

Denture stomatitis

Answer 6

Denture sore mouth
Candida associated denture induced stomatitis
Inflammatory papillary hyperplasia
Erythematous hyperplasia

Question 7

Type 1 denture stomatitis

Answer 7

Localised simple infection
Characterised by pinpoint hyperaemia
Usually trauma induced

Question 8

Type 2

Answer 8

Erythematous type
Diffuse erythema involving a part or the entire denture –bearing mucosa
Microbial plaque accumulation is also involved

Question 9

Type 3

Answer 9

Granular type
• Involving the central part of the hard palate and alveolar mucosa
• Seen in association with types I & II
• Microbial plaque accumulation is involved

Question 10

Systemic predisposing factors of denture stomatitis

Answer 10

Immunocompromised
Co morbidities - diabetes
Old age
Malignancy
Nutritional deficiency

Question 11

Local predisposing

Answer 11

Xerostomia - caused by strogens syndrome , irradiation and poly pharmacy
Overwearing dentures
High carbohydrate diet
Smoking
Prolonged ant

Question 12

Local predisposing

Answer 12

Xerostomia - caused by strogens syndrome , irradiation and poly pharmacy
Overwearing dentures
High carbohydrate diet
Smoking
Prolonged ant

Question 13

Local predisposing

Answer 13

Xerostomia - caused by strogens syndrome , irradiation and poly pharmacy
Overwearing dentures
High carbohydrate diet
Smoking
Prolonged ant

Question 14

Management

Answer 14

Supportive
Drug therapy
Surgical removal

Question 15

Supportive therapy

Answer 15

Correction of denture wearing habits - discontinue denture use a4 night
Removal and Cleaning dentures after every meal
Soak dentures in 0.2 chlorehexidine gluconate solution
Dental and oral hygiene education

Question 16

Drug therapy

Answer 16

Antifungal treatment
Local application of nystatin solution
Incorporation of miconazole gel in tissue conditioner
Systemic admin of amphotericin b or clotrimazole in immunocompromised .

Question 17

Tissue conditioner : how to used

Answer 17

Clean the denture fitting surface
• If ill-fiiting adjust flange extension
• Mix according to manufacture’s instructions
• Add antifungal agent and mix
• Place on fitting surface
• Patient must be in centric occlusion
• Trim excess with hot wax knife or scalpel blade
• Replace in 14 days if necessary

Question 18

Angular chelitis

Answer 18

Associated with denture stomatitis
It is macerations , eythrema and crusting of the corner of the mouth/ commissures and surrounding skin involvement
Results in deep fissures and bleeding tendency

Question 19

Surgerical removal

Answer 19

Type 3
Cryosurgery to remove papillary hyperplasia

Question 20

Denture induced lesion

Answer 20

Epulis fissaturum / inflammatory fibrous hyperplasia
It is due to the continued tolerance of denture trauma leading to a fibrous response.
A flabby inflammatary hyperplasia is formed
Correlated with denture use , overextended denture flanges and poor occlusion
Usually in vestibule .

Question 21

DENTURE INDUCED LESIONS FLABBY RIDGES

Answer 21

Caused by replacement of bony alveolar ridge by fibrous tissue
Usually in single complete denture where the anterior maxillary denture is opposed by natural dentition
May complicate impression taking

Question 22

Liddelow

Answer 22

Mucostatic impression technique
Open window is left in special tray to avoid distortion of flabby tissue
Impression is plastered over flabby area

Question 23

Liddelow

Answer 23

Mucostatic impression technique
Open window is left in special tray to avoid distortion of flabby tissue
Impression is plastered over flabby area

Question 24

Tissue conditioner

Answer 24

Clean denture fitting surface
If ill-fitting adjust flanges
Mix the tissue conditioner according to manufacturer
Add antifungal and mix
Apple on fitting surface
Pt must be in centric occlusion
Trim excess with hot wax knife or scalpel
Reapply after 14 days if needed