Oral Lesions Flashcards
What are oral lesions
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
Causes of it
Poor denture rentention
Poor oral hygiene
Mechanical trauma
Candida albicans
Denture-induced stomatitis is the most common lesion in denture weare
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
Risk factors predisposing
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
Diagnosis
Clinical presentation
Smear
Denture stomatitis
Denture sore mouth
Candida associated denture induced stomatitis
Inflammatory papillary hyperplasia
Erythematous hyperplasia
Type 1 denture stomatitis
Localised simple infection
Characterised by pinpoint hyperaemia
Usually trauma induced
Type 2
Erythematous type
Diffuse erythema involving a part or the entire denture –bearing mucosa
Microbial plaque accumulation is also involved
Type 3
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
Systemic predisposing factors of denture stomatitis
Immunocompromised
Co morbidities - diabetes
Old age
Malignancy
Nutritional deficiency
Local predisposing
Xerostomia - caused by strogens syndrome , irradiation and poly pharmacy
Overwearing dentures
High carbohydrate diet
Smoking
Prolonged ant
Local predisposing
Xerostomia - caused by strogens syndrome , irradiation and poly pharmacy
Overwearing dentures
High carbohydrate diet
Smoking
Prolonged ant
Local predisposing
Xerostomia - caused by strogens syndrome , irradiation and poly pharmacy
Overwearing dentures
High carbohydrate diet
Smoking
Prolonged ant
Management
Supportive
Drug therapy
Surgical removal
Supportive therapy
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
Drug therapy
Antifungal treatment
Local application of nystatin solution
Incorporation of miconazole gel in tissue conditioner
Systemic admin of amphotericin b or clotrimazole in immunocompromised .
Tissue conditioner : how to used
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
Angular chelitis
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
Surgerical removal
Type 3
Cryosurgery to remove papillary hyperplasia
Denture induced lesion
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 .
DENTURE INDUCED LESIONS FLABBY RIDGES
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
Liddelow
Mucostatic impression technique
Open window is left in special tray to avoid distortion of flabby tissue
Impression is plastered over flabby area
Liddelow
Mucostatic impression technique
Open window is left in special tray to avoid distortion of flabby tissue
Impression is plastered over flabby area
Tissue conditioner
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
