Selected Disorders of Oral Mucosa - 2

By Unknown on Wednesday, December 12, 2007 with 0 comments

Inflammation of the whole oral mucosa is called stomatitis. If various metals are present at oral cavity, stomatitis electrogalvanica may rise at sensitive individuals. This disorder is accompanied by salivation defects, metal-like bad taste, dynic or neuralgia-forming problems. Erythemas, surface erosions or sclerotization defects appear on the mucosa. Alterations of the oral mucosa may as well originate during general infectious diseases - Koplik’s spots during measles, or raspberry colored tongue during the scarlet fever. In other cases, changes inside a mouth are primary and the major symptom of a disease - gingivostomatitis herpetica or ulcerosa.

Bullous (blistery) diseases.

  • The most serious disease of this group is pemphigus vulgaris. The primary morpha is a vesicle or bulla without an inflammatory rim. Besides large blisters, just disruptions of the epithelium and a livid, dim mucosa are sometimes observed. Crusts appear on the vermilion, the tongue is covered with an uncleanly flaccid fur. Diagnosis is supported by Nikolsky sign - tearing off the mucosa’s epithelial cover by pressure applied by fingers. Histological picture shows an intraepithelial blister and acantholysis. The diagnosis is confirmed by a positive result of immunofluorescence. Corticosteroids and even sometimes cytostatics are used for therapy.
  • Benign pemphigus and bullous pemphigoid are diseases similar to vulgar pemphigus. However, during histological examination, a subepithelial blister can be found. These diseases can be differentiated by immunofluorescence assays as well.
  • Lichen ruber planus belongs among diseases with an unclear etiology, accompanied by defect of keratinization. It affects the oral mucosa with no skin manifestations in 50% of cases. The basic morpha is a whitish, matte and flat papula. Morphae often aggregate and form porcelain-white, net-like or garland-like structures. Sometimes, morphae fuse together and their typical form can be found only at edges. Therapy is usually accomplished with “Kenalog” in “Orabase”, anti-malaric drugs, hypodermic injections of procaine containing “Kenalog” in cases of localized foci.

Mucous manifestations of drugs intolerance have colorful and variable clinical picture. The predominant part of the clinical picture in case of purely allergic reactions is an acute mucosa inflammation. Erythema, catarrhal inflammation, blistering, pseudo-membranous changes, even erosions and ulcers can be found. The tongue shows a wet, whitish and intensified fur. If toxic effects prevail, these signs are rather localized, with erosions and ulcers. Unaffected mucosa remains pale. Hyperkeratoses or lichenous morphae appear at a chronic intoxication. The tongue has less fur and a smooth surface. Hyperkeratoses occur on its smooth surface. Similar manifestations can be observed at epileptics after treatment with barbiturates or patients suffering with rheumatism after treatment with gold.

During a mixed allergo - toxic mucous reaction, mucous manifestations combine after the initial allergic reaction followed by the toxic and mucous component of the reaction. Tiny hemorrhages, above which the mucosa decomposes thus forming erosions, are among the first clinical signs of this disease. Upon a long-term intoxication, potentially malignant leukoplakias may emerge.

A stomatitis of viral etiology appears usually after an influenza. These diseases are accompanied by redness of mucosa at the soft palate. Some viral diseases, such as variola, varicella, vaccinia, herpes simplex, zoster or herpetic gingivostomatitis, cause appearance of blisters. Red Koplik’s spots appear at molars area during measles; a catarrhal inflammation of mucosa occurs during rubeola. Exulcerations and tiny hemorrhages can be found in a mouth during infectious mononucleosis.

Category: Oral Medicine Notes , Oral Pathology Notes



Post a Comment