PATHOLOGY OF THE MOUTH AND PHARYNX - Inflammation

By Dr. Vishaal Bhat on Saturday 5 January 2008 with 0 comments



Stomatitis

  • This refers to generalized inflammation of the oral mucosa

  • A variety of lesion types may be seen including vesicobullous lesions (VB) and ulcers (U). Some agents e.g. Candida sp. produce characteristic lesions.


CAUSES OF STOMATITIS

Class of agent

Example

Type of lesion

Virus

Herpes simplex

VB/U


Varicella

VB/U


Coxsackie, type A

VB/U

Fungus

Candida albicans

Thrush/U

Bacteria

Vincent’s disease

U

Autoimmune

Pemphigus

VB


Bullous pemphigoid

VB


SLE

U

Other/unknown

Erythema multiforme

VB


Lichen planus

U


Aphthous stomatitis

U


  • Candidiasis


  • Usually attributable to infection with C. albicans but other species can be causative

  • Risk factors include immunosuppression, altered oral microflora (e.g. broad-spectrum antibiotics), denture use and endocrine disorders e.g. poorly controlled diabetes mellitus

  • There are numerous manifestations of oral candidiasis and some of the main ones are outlined:


Thrush: “pseudomembranous candidiasis”—loosely adherent white pseudomembrane (fungi,

inflammatory cells, debris, fibrin and bacteria) overlies inflamed mucosa

Angular stomatitis: infection in deep grooves of the lips

Candidal leukoplakia: tightly adherent membrane—?associated with heavy cigarette smoking

Chronic mucocutaneous candidiasis: skin, nails and other mucous membranes involved; many variants including familial, sporadic and those assoc. with various endocrine and chronic disorders


  • Vincent’s disease (Acute necrotizing ulcerative gingivitis)


  • Incompletely understood but factors such as emotional stress and smoking may suppress immune system and predispose to infection by commensal organisms such as Bacteroides sp.

  • Characterized by gingival necrosis, ulceration and pseudomembrane formation


  • Aphthous stomatitis ( Recurrent aphthous ulcers)


  • Condition characterized by recurrent shallow ulcers (aphthae); may be single or multiple

  • 10 to 20% of individuals affected—the most common disease of the oral mucosa; women>men; 10 to 30 yr.

  • Seen in healthy people; occasionally assoc. with certain diseases e.g. Crohn’s

  • Cause still unknown—? Trauma/stress/food products/nutritional deficiency/hormones

  • Aphthae last 1 to 3 weeks, subsequent episodes vary in frequency and the condition eventually spontaneously disappears in most people



Acquired immunodeficiency syndrome


  • Oral lesions are prominent, often early features in HIV-related diseases

  • Refractory candidiasis e.g. thrush is often the first manifestation

  • Specific oral lesion of HIV is hairy leukoplakia—bilateral, soft, white, hairy excrescences on the lateral margins of the tongue: squamous hyperplasia that appears to be induced by EBV ? in assoc. with Candida or HPV.

Category: Oral Pathology Notes

POST COMMENT

0 comments:

Post a Comment