ORAL MEDICINE

It is common for a patient to associate the dental consulting-room with attention to diseases only related to the teeth. He often does not know that the mouth is formed by different structures, all of them subject to change. Oral Medicine takes care of the clinical diagnosis and treatment of all the diseases of the mouth. Occasionally, it will be necessary to take an altered tissue sample (biopsy), and carry out a microscopic study to establish a definite diagnosis, which is the task of oral pathology.

Oral medicine is the field that takes charge of the diagnosis of all diseases that affect the mouth and the maxillary-facial region, as well as treatment of changes that do not require a surgical solution, orthopaedics or prosthetics. The treatments are fundamentally pharmacological. Oral medicine also studies the oral manifestations of diseases that compromise the general state of the patient, so as to apply the correct orthodontic treatment.

Find out, call our Dental Clinic and ask for an oral revision!

What is oral medicine?

In short, it is a clinical academic field devoted to diagnosis, the management and research of oral diseases that have medical treatment and of systematic diseases with oral and facial manifestations.

What type of a patient has to go to an expert in oral medicine?

Any patient that has a medical condition in the oral cavity can be examined by an expert in oral medicine. We can say that all of those who do not attribute their medical condition to the dental organ could benefit the most from an expert in oral medicine.

What techniques and treatments are carried out in oral medicine?

Oral medicine uses the management of clinical history in a very special way, which involves a correct exploration in patients that have some idea of what the cause of their medical condition may be. As complementary techniques, there are biopsies and different diagnostic image techniques and analytic tests.

What importance does prevention have and how is it carried out?

One of the most important problems is oral cancer prevention and its complications. Another aspect to be highlighted is oral pathology associated with immune-compromised patients or with a serious systemic pathology. Examples would be patients with chemotherapy treatment with biphosphonates or who are going to be treated with radiotherapy. The best prevention is to take steps before problems appear, which involves knowing them and being well advised by professionals so as to try to keep the problems from appearing or so that they are the least as possible.

Remember (before reading this information) that preventing an alteration in time is very important. Come to our clinic and have the revisions that our dentists advise. Call us and ask for an appointment with no obligation.

Alterations in the oral mucous membranes

The oral mucous membrane forms part of the upper digestive tract, and diseases of local or systemic origin can be produced in it. Any alteration of the mouth requires a detailed exam of the whole oral cavity: mucous membrane, gums, palate and tongue. Not only do we resort to inspection but also to palpation, and anatomical-pathological study, and they tend to be indispensable tools for the diagnostic confirmation.

Inside the alterations of the mucous membrane we can differentiate several categories:

Variations of the normal structure:

Fordyce Disease: Characterised by the appearance of Fordyce spots ( small lesions of a yellowish colour that are isolated or in groups, above all, in the lip mucous membrane). Histologically, they are ectopic sebaceous glands, that is, of normal morphology but in an abnormal place.

Fissured tongue: an increase in the number of channels and folds on the back of the tongue. It tends to be asymptomatic, although it can have secondary alterations to infectious or traumatic processes (like brushing).

Average rhomboid Glossitis;   erythematous plaque in the central part of the back of the tongue. We are dealing with an epidermic hyperplasia whose colonization by candida is very, very frequent.

Lingual veins: They are dilated blood veins of a bluish-violet colour located, above all, in the lateral and ventral sides of the tongue. They have no clinical significance.

Osteochondroma: exostosis or a bony prominence in the middle line of the hard palate. It does not need any treatment.

Periodontal diseases:

They are extensively dealt with in the corresponding chapter. The following stand out:

Periodontitis: Periodontal inflammation is the most frequent cause of dental loss.

Gingiva hyperplasia: abnormal development of the gums. It may be found in physiological states like pregnancy, but the most frequent cause is that secondary to medications (phenytoin, nifedipine, cyclosporine or a combination of these). Some cases may need surgery.

Viral infections:

– Acute herpetic stomatitis gingiva: It is caused by the simple herpes virus. It is most common in children. Only about 50% have symptoms. It may appear with an oedematous oral mucous membrane with ulcers that coalesce, making vessels difficult to detect. They tend to heal within 1-2 weeks without leaving any scars. They can be accompanied by fever, lateral-cervical lymph nodes and an involvement of the general state.

– Recurrent Labial Herpes: It is present in 30% of the population. Aetiology: Virus type I. We are dealing with the recurring formation of vesicles on the outer third of the lip or perioral region. They tend to last from 3-7 days. They heal without leaving a scar. The application of conventional antiretroviral does not lessen the length of the process.

– Mouth-hand-foot disease: caused by a Coxsackie type A. These are vesicular lesions in the oropharynx, skin on the hands and feet and the gluteal region. It heals without a scar in two weeks.

-Herpes Zoster: caused by a varicella zoster virus. They are vesicles that ulcerate following a unilateral mess and causing the neuralgia of the same.

Bacterial Diseases:

The most common will be: Acute necrotic ulcerative gingivitis,

syphilis, gonorrhoea, tuberculosis and actinometers.

Fungal Diseases:

• Candidiasis: Albicans Candida are present in 40% of healthy individuals. It can have different clinical forms: muguet, chronic candidiasis, cheilitis angular, candidiasic glossitis …

The infectious process is due to a weakening of the resistance capacity of the individual more than to the pathogen itself. It is a frequent pathology in the immunosuppressed.

• Hystoplasmocitosis: caused by the Hystoplasma capsulatum. It is frequent in individuals affected by systemic diseases. An ulcerated nodule can be detected in the oral mucous membrane, very painful. A biopsy must be done on it to confirm the diagnosis.

Dermatological diseases:

• Pemphigus Vulgaris: autoimmune blistering disease that affects the skin and mucous membranes. The cause is unknown.

• Lichen Planus: a papillary, itchy, inflammatory rash and which is chronic that affects the skin and mucous membranes. The cause is unknown but it is influenced by stress, viral infections and psychological burdens.

Lichen Planus lesions heal spontaneously or with treatment and tend to leave residual hyperpigmentation. Lichen Planus in the mucous membranes is very frequent in the form of a net-like rash, whitish-grey in colour, grouped together or isolated.

– Multiform Erythema: the cause is unknown. It appears with oedema and erythema that progress, giving rise to a blister. It tends to be resolved in 4-6 weeks.

– Contact Stomatitis: It is due to a an irritative or allergic contact reaction.

It can be due to physical agents like heat or chemical agents like

aspirin, peroxide, chlorhexidine mouthwash and tobacco.

It tends to affect the hard palate.

The one caused by allergies tends to be associated with toothpaste,

antiseptics and orthodontic products.

Black hairy tongue: Benign hyperplasia of the filiform papillae of the

front 2/3 of the tongue. Macroscopically, a pigmented and hairy area

can be noted.

Systemic diseases:

A lot of clinical entities are associated with the pathology of the oral mucous membrane, among them the most relevant would be: Behçet Disease (oral and genital ulcers with ocular and neurological involvement), Reiter Disease, systemic Lupus erythematosus, Crohn disease, Histiocytosis X…

Benign tumours:

• Epulis: a fibrous tumour that is frequently located in the interdental papilla. It tends to be reactive to inflammatory process. It is the benign tumour-like lesion that is most frequent in the oral mucous membrane.
• Pyogenic granuloma: a pedunculated nodule of a soft consistency and a reddish colour, approximately 0´5-1 centimetres in diameter. It bleeds easily. It tends to be in response to a small injury. It is most usual during pregnancy and is located most frequently in the gums.
• Mucous retention cyst: cystic tumour very frequent in the mucous membrane part of the lower lip or ventral side of the tongue. Its size tends to be smaller than a centimetre. It is usually secondary to small injuries of the mucous membrane glands. Clinically, a small tumour of cystic consistency and bluish colour is shown. When it affects the sublingual mucous membranes, its size tends to be be bigger and it has been given the name, ranula.
• Hemangioma: a very frequent vascular tumour in the oral mucous membrane. There may be one or they may be multiple. They have different sizes and can be found in different regions of the oral mucous membrane. They adopt a reddish-bluish colour. The biggest tend to be associated with macroglossia. They can be part of vascular syndromes.
• Lymphangioma: frequent tumour of the oral cavity by proliferation of the lymphatic nodes. Clinically, the appearance of one or more polylobate masses, of a whitish-blue colour. Its most frequent location is the tongue, causing, in this case, macroglossia. The treatment is surgical but difficult because of haemostasis.
• Tumour of granule cells: Tumour made up of granule cells, above all, affecting the tongue.   It usually has an approximate size of 0´5-3 centimetres of diameter, its consistency is hard with a node-like appearance and slow growth. A differential diagnosis must be carried out with the squamous cell carcinoma.
• Neurofibroma: Above all, it affects the tongue. A fourth of the patients that have it are affected with neurofibromatosis.

Pre-malignant and malignant lesions:

• Actinic cheilitis: its chronic form is the consequence of excessive and prolonged exposure to solar light. It predominantly affects the lower lip. Clinically, a lesion is shown in the labial mucous membrane, in appearance whitish-grey, scaly and with atrophic areas. It bleeds easily. A differential diagnosis must be carried out with the squamous cell carcinoma.
• Nicotinic stomatitis: The oral mucous membranes of smokers has typical inflammatory alterations located in the palate. Subsequently, they will become nodular lesions of a whitish colour.
• Leucoplakia or Leucoplasia: it means “white spot”. They are lesions that can not be detached easily by scraping. Lichen Planus must be ruled out when confronted by a whitish lesion. It has the appearance of well defined whitish plaque, irregular borders and a rough or velvety surface. Its diagnosis is practically clinical but it needs a biopsy for confirmation.
• Erythroplasia: erythematous plaques, well circumscribed, velvety surface. Found any place in the mucous membrane.
• Warty carcinoma in the oral cavity: It is a variety of the squamous cell carcinoma. It has a slow growth and warty appearance but is locally invasive. It affects oral mucous membranes and the gum. The diagnosis must be carried out with a biopsy. It usually does not produce long distance metastasis and on few occasions does it in the lymphatic nodes.
• Squamous cell carcinoma: It affects individuals between 50 and 70 years of age. Its main risk factors are alcohol and tobacco. In addition, there is an inverse relationship between the consumption of fruits and vegetables and the incidence of oral cancer. The prognosis is highly variable according to the time of diagnosis. Small lesions tend to have a better prognosis. The most frequent location is in the lower lip and adopts a hard, ulcer, node-like form with an inflammatory component. In the inside of the oral cavity, the tongue is the most frequent place, having a hard node-like appearance, and it is painful, often ulcerated, located in the front third of the tongue, above all, on the edges of the sides of it.

Patients with cancer in the oral mucous membrane have a high risk of relapse or the appearance of secondary neoplasia and, therefore, need an exhaustive follow-up. Likewise, they must avoid risk factors, above all, alcohol and tobacco. It is recommended that persons older than 50 years of age and who are habitual alcohol and tobacco consumers have an annual oral exam.

– Malignant Melanoma: It is a rare entity. It is very aggressive and has a bad prognosis. The most frequent locations are the gums and palate.