Deviations in the oral mucosa - Oral diseases, dental and facial surgery
Deviations in the oral mucosa
Severe oral abnormalities also start as small lesions. If the deviation is still small, it is difficult to make a good diagnosis. All discolorations and elevations must be examined to rule out that this is (a preliminary stage of) a serious deviation.
Deviations from the oral mucosa can be classified in different ways:
- At location;
- By color;
- Whether or not they are malignant;
- Whether or not they can be scraped off.
We have opted for a classification by color.
White abnormalities of the oral mucosa
Linea alba is the name for a white, raised line in the cheek mucosa that runs horizontally at the occlusal plane. Usually the deviation occurs on both sides. It is caused by a chronic, mechanical irritation of the teeth when being close. Linea alba is harmless and treatment is not required (see image below).
Cheek biting, or buccorum in Latin, is the result of a habit. The patient is not always aware of this. The chronic cheek (or lip) biting damages the mucous membrane and results in a whitish, flaky change. Although the deviation is not malignant, it is wise to point out the patient's habit (see image below).
Stomatitis is an inflammation of the entire oral mucosa and often also of the lips. Stomatitis nicotina is caused by smoking and especially with pipe smokers. The palate mucosa in particular shows white changes with red inflamed openings of the accessory salivary glands. The deviation can be painful and disappears as soon as the habit is stopped (see image below).
The cause of the lichen planus skin disorder is unknown; it occurs in 0.5-2% of the population. Small elevations arise on the skin that can merge into a large plaque. In one third of the people with lichen planus on the skin, it also occurs on the oral mucosa. Preferred sites are the cheek mucosa, tongue, and lips, but the gingiva may also be affected. There is a red and a white variant. The white variant expresses itself as plaques or web-like forms. These are not painful. The red or erosive variant can cause a burning and painful feeling. Treatment consists of topical application of corticosteroids. The erosive form in particular has a tendency to develop malignantly. Annual inspection is advised in connection with this premalignant nature (see image below)
Lichen planus: a reticular form; b erosive form.
Leukoplakia is a term for a predominantly white and non-scrapable defect that cannot be defined as another defect. Leukoplakia has a pre-malignant or precancerous character: in approximately 5% of cases, the condition changes to squamous cell carcinoma. Preferred places are the cheek mucosa, the barrel edges and the mouth floor. Usually it concerns patients older than 40 years. Smoking is seen as a cause. Stopping smoking can make the deviation disappear. If this does not happen, then intervention is necessary. Small leuoplakia can be surgically removed. Large and diffuse leukoplakias are removed with CO2 laser excision or CO2 laser evaporation. Every patient with leukoplakia or who has had leukoplakia must be monitored regularly and regularly (see image below).
Candidose is a fungal infection caused by Candida albicans. C. albicans can be found in the oral cavity in about 40% of the population. Only when the fungus shows clinically visible abnormalities do we call it candidosis. The infection gets a chance with unfavorable local factors such as poor oral hygiene, dry mouth and irradiation in the oral cavity. General causal factors are immune disorders, diabetes mellitus and drug use.
Candidose manifests itself in the mouth as white, raised scrapable plaques on the cheek mucosa, the barrel edges, the palate and the oropharynx. In the erythematous form, the mucosa has a smooth and red appearance and feels painful. Treatment consists of administering an antifungal agent, such as nystatin (see image below).
Red / red-blue abnormalities of the oral mucosa
Gingivitis is a reversible inflammation of the gingiva. This is caused by bacteria in dental plaque. Gingivitis is extensively discussed in the "Periodontology" chapter.
When the gums are swollen but show no signs of inflammation, gingiva hyperplasia is present. The abnormality can be hereditary. It can also occur with the use of the drug diphantoin (for epilepsy). In severe cases, the teeth can be completely covered by the hyperplasia. Treatment consists of the surgical removal of excess gums (see image below).
An incorrect brushing habit, which involves scrubbing hard, can damage the gums. Superficial scrapes arise that should not be confused with the erosive form of lichen planus. If the brushing method is adjusted, the planes will heal within a few days (see image below).
Stomatitis prosthetics is an inflammation of the mucous membranes under a dental prosthesis. C. albicans may play a role in this deviation. Treatment consists of checking the fit of the prosthesis. The patient is advised to regularly clean his prosthesis and to take it off at night (see image below).
Yellow abnormalities of the oral mucosa
The oral mucosa contains small sebaceous glands. When these are superficial (ectopic), they are visible as yellowish, slightly elevated spots. They are mainly found in the cheek mucosa and lips. The spots are harmless (see image below).
Dark discolorations of the oral mucosa
When metal particles end up in the mucous membranes, a blue-black discoloration occurs. For example when an amalgam restoration is bored and the mucous membrane is damaged. In the past, apex sections were closed with amalgam. The amalgae pigmentation can then be found in the region of the root point. These metal discolorations are permanent and harmless (see image below).
Racial pigmentation is a common brown-black discoloration of the gingiva. People with dark skin often also have dark gums. A characteristic of racial pigmentation is that it occurs throughout the gingiva. It is an innocent phenomenon (see image below).
Racial gingiva pigmentation.
A malignant melanoma is a malignant proliferation of melanin pigment producing cells. Of the malignant melanomas, 1% occurs in the mouth. Metastases can arise through the spread of tumor cells through the blood and the lymphatic system. Treatment consists of surgical removal, but the prognosis is rather unfavorable. The chance that someone is still alive five years after the diagnosis is 15 to 20%. This is because the tumor often relapses (comes back) and easily sows (see image below).
Ulcerative abnormalities of the oral mucosa
Canker sores are painful ulcerations in the mouth. Usually they are a few millimeters in size, but with some people they can become an inch. Canker sores occur in 20% of the population. The cause is unknown. However, stress, hormonal changes, trauma and hypersensitivity to certain foods can also contribute to the development of ulcers. A special feature is that ulcers mainly occur in people who do not smoke. Preferred places are mainly the unchorted oral mucosa, such as the mucosa and the mouth floor.
The ulcer usually has a gray-yellow color and is surrounded by a red court. Especially when food comes by, ulcers are very painful. They heal automatically within one or two weeks. Some rinsing agents and toothpastes are said to be effective against ulcers, but there is no scientific evidence. In very severe cases, corticosteroids are prescribed for topical use (see image below).
Trauma can damage the mucous membranes in such a way that an ulcer occurs. Examples of this are serious pressure sites with an improper fitting prosthesis and an anesthesia ulcer. By using an anesthesia fluid with a vasoconstrictor, the blood supply can be shut off so that tissue dies. This mainly occurs with anesthesia in the stiff mucosa of the palate. This ulceration also heals itself (see image below).
Herpes simplex infection
Ulcerations of the oral mucosa can be caused by the herpes simplex virus. The first contact with the virus causes a primary infection. No antibodies have yet been formed in the blood. The patient can be very ill with a fever and general malaise. When the blisters return later, we speak of a recurrent or secondary infection. This does not make the patient sick. In contrast to aphthous ulcers, herpetiform vesicles mainly occur on the mucous membranes that are heard, such as the attached gingiva, the palate and the lips.
Infection usually takes place at childhood and through saliva. The blisters naturally heal within one or two weeks. Antiviral drugs only help if they are used at an early stage. The blisters are not yet visible, but the patient feels that they are coming (see image below).
a Herpes labialis; b herpes on the palate.