( I. Penyakit Mulut )
1. Hypertrophy or inflamatory
enlargement ( increase in the
size of the cellular elements )
2. Hyperplasi or fibrotic
enlargement ( increase in the
number of the cellular elements )
Causes of the Gingival
Enlargement
1.Local Inflammatory and
traumatic factors
a. Poor oral hygiene and
accumulation of calculus
b. Malposed teeth
c. Incorrect toothbrush habits
d.Occlusal interferences
e. Irritation from ill-fitting prosthetic
or orthodontic appliances
f. Mouth breathing
2. Systemic predisposing factors
A. Endocrine
a. Puberty
b. Menstruation, pregnancy,
contraseption medication
c. Diabetes
d. Hypothyroidism & pituitary
dysfunction
B. Nutritional
a. Scurvy
b. Nutritional deficiencies
C. Blood dyscrasias
a. Leukemias
b. Polycethemia vera
TREATMENT
- stop administration of dilantin
- gingivectomy, gingivoplasty
FUSO SPIROCHAETAL INFECTION
A. Acute Necrotizing Ulcerative
Gingivostomatitis = Vincent’s stomat-
itis = Trench mouth
The precise etiology is not known, it is
believed to be a polymicrobial infection
Vincent identified Borrelia vincentii ( a
spirochaeta) and Bacillus vincentii
(fusiform)
Fusobacterium necrophrom, prevotella
intermedia, treponema species
Predisposing factors
1. Local factors
a. erupting or malposed teeth,
pericoronal infection
b. faulty restoration, ill-fitting
prosthetic food impaction
c. poor oral hygiene
d. local circulatory and
nutritional disturbances of
marginal gingiva
2. Systemic factors
a. malnutrition
vit. C and Bc deficiencies, vit A
b. disease of the blood forming
tissues --- leukemia, anemia
c. gastrointestinal and endocrine
disturbances
d. stressful situation and extreme
fatigue
Sign and symptom
Onset is sudden
severe burning pain
hypersalivation
metallic taste spon -
tanous bleeding of
the gingiva tissue
bad odor
teeth are sensitive
to pressure
punch out ulcerat-
ion developing
most on the
interdental papil
and margin
gingiva
yellowish gray
membrane
Ulceration may on the cheek, lips,
tongue, palate and pharyngeal areas
alveolar proc sequestration
TREATMENT
1. Control of bacteri : topical or systemic
antibiotic (penicillin , metronidazole)
2. Elimination of the local & systemic
predisposing factors
3. Educationing the correct OH habits
4. Surgical manipulation is contra -
indicated
5. Hydrogen peroxide (H2O2 3%) mouth
rinse
B. Noma
Predisposing factors
a. systemic : - malnutrition
- circulatory inadequate
b. local : - poor oral hygiene
- chronic irritation
- trauma
Cancrum Oris in Children
Premature infant or
malnourish children
foul, putrid odor
extensive necrotic
area of the cheek
mucosasequestra
tion of alveolar
bone exfoliation of
the teeth
Perforation of the
effected cheeks and
lips, hipersalivation
halitosis, fever,
malaise, and
regional
lymphadenopathy
are common
Treatment
antibiotics systemic
in high dose
improvement in
nutrition
Local wound care
Cancrum oris in adults and the aged
oralsurgery on patient with ANUG
Develops in illness patients
Treatment = in children
ULCERATIVE , VESICULAR
and BULLOUS LESIONS
( K 12 – ICD WHO )
Etiologi reactivation
of varicella zoster
virus
( produces varicella
zoster )
Following resolution,
the virus lies
dormant in the dorsal
root ganglia until
reactivation along
Predisposing
factors
overwork, fatique
stress
malnutrition
chronic disease
(leukemia,
cancer, hiv)
radiasi
Sign & Symptom
An itching sensation and a stabbing
burning, constant or intermittent pain
unilateral, along the distribution of a
sensory nerve trunk
involvement the 2nd & 3rd of the 5th
nerve result both dermal and oral
manifestation
vesicle formation surrounded by
erythematous base ulcers
Treatment
Supportive
acyclovir (if needed)
though the lesion dissapear ----
neuralgia may persist weeks or
months corticosteroid
5. Erythema Multiforme
Dermatosis characterized by great
variation in the form, size,
distribution and appearance of the
lesion
80-90% mouth involvement
etiologi ??? Herpes virus ?
Occurs in infant, children, young
adult
Hypersensitivity reaction
Sign & Symptom
Onset is sudden,
fever, sore throat,
joint pain, acute ill
skin & mucosal
eruption. Initial
lesion is vesicular
or bullous, found
on the lips,cheeck,
palate, tongue
lesions are
irregular,
reddish, raised
areas of varying
size
bloody, crusted
lesion on the
vermillion
border of the
lips, oedem.
Ulcerated moist mucosa
The tongue is extremely painful,
identation marking , lymphadenopathy
Syndromes :
Steven Johnson : EM +conjunctivitis
Behcet : dermal, oral, conjunct.
genital
Reiter : dermal, acute arthritic
D.D: - stomatitis medicamentosa
- recurrent aphthous stomatitis
- pemphigus fulgaris
TREATMENT
corticosteroid
antimicrobial agent topically or
parenteral
mouthwash
vit Bc & C
WHITE LESIONS
Devided into 2 main groups :
A. not associated with hyperkeratosis
B. associated with hyperkeratosis
Etiology :
multiple etiologic factors, local &
systemic
1. Systemic
a. Possible constitutional
characteristic
Iritan + Iritan -
Hilangkan iritan
Biopsi
Respons + Respons -
Displasia - Displasia +
Observasi Tx kanker
- true : creatinism
mongolism
- may arise from
limphangiomatou
s&
hemangiomatous
process
- radiation-surgery
Macroglossia
True Pseudo
Generalised Localised
Congenital Congenital
Inflammatory Inflammatory
Traumatic Traumatic
Metabolic Neoplastic
Metabolic
Congenital
Traumatic Traumatic
Neoplastic
Congenital
2.Benign Migratory Glossitis
(BMG)
( K 14.1 ) = Geographic tongue
etiologi : idiopatik
lesi oral inflamasi yang kronis,
imunnology-meditated, dengan
etiologi yang tidak diketahui.
Anomali kongenital, herediter
asimtomatik, dan pasien lainnya
merasa adanya peningkatan
sensitivitas pada makanan panas dan
pedas.
Area terlokalisasi
Melingkar tidak
teratur
Bercak merah yang
dikelilingi batas
putih
Bercak merah
atrofi papila
filiformis
Bercak putih
regenerasi papila
filiformis,
campuran keratin
dan neutrofil
3.Black Hairy Tongue = Lingua
Nigra
( K 14.3 )
Akumulasi keratin pada
papila filiformis lidah
yang menghasilkan pola
seperti rambut.
True BHT : elongation of
filiform p.
Pseudo BHT : dis -
coloration from fruits,
candy, drugs
4. Glossopyrosis-Glossodynia
( K 14.6 )
A. calculus
B. collaps of ducts
--------------- mucocele, ranula
Divided by 5 groups :
1. In relation with non pathologic local
factors
- decreasing of salivary flow
- denture
2. In relation with pathologic local factors
-- poor O.H
- dental caries
- gum and periodontal disease
- infection
- cancrum oris
- neoplasma/oral cancer
3. In relation with non pathologic
systemic factors
- age
- food
-
4. In relation with pathologic systemic
factors
- diabetes, renal failure, hepar failure
lung abscess, gastrointestinal
disturbances, respiratory and
sinus conditions
- neuropsychiatri, etc
5. Medications
- antihistamines, antipsychotics,
antispasmodics, antidepressants
xerostomia
Allergy
- similar to cutaneous allergy, except
that the mucous has mucous
glands for lubrication & protection,
and no hair follicles
The oral lesion resulting from the
absorption of drugs ----- stomatitis
medicamentosa. Resulting from
contact -------- stomatitis venenata
1. Stomatitis medicamentosa
Lesion are produced by
certain of drugs
due absorption via the
gastrointestinal tract ,
respiratory tract or skin
occur in any area of the body
the lesions are multiple,
amorphous, eroded or fungoid
appearance
vary from marked erythema to
vesicle, an erosive , an
ulcerative or gangraen lesion
2. Stomatitis Venenata =
Contact Allergi Stomatitis
contact of the causative agent with
the tissues
include two different processes :
a. stomatitis due to physical agents
or irritants
b. stomatitis due to sensitizing
substances
the symptoms are local
In the early stages : red color and
smooth wax-like appearance
in mild reaction : small shallow
ulcerations
in severe reactions : actual
necrosis of the mucosal tissues
the lesion develop soon after
contact with the causative agent
Treatment
a. elimination of the causative agents
b. local symptomatic care :
- anti allergy
- anaesthetic troche
Oral Manifestation of
Systemic Disease
1. Leukemia
A. Acute Leukemia
- adenopathy
- gingival enlargement with or
without area of necrosis
- ulceration of the cheek, tonsils
bleeding from the
gingiva after tooth
extraction
severe odontalgia
mobility of the teeth
AML
Hyperplasi + bleeding
Treatment
- maintaining good OH
- relieving pain
- minimizing irritation of the
necrotic lesion
- parentral antibiotic to minimize
the development of the
ulceronecrotic mucosal lesion
- extraction, oral biopsies, deep
scalling are contra indicated
B. Chronic Leukemia
adenopathy
gingival hiperplasi
ulceration
petechie and
echymosis
Treatment
= Acute Leukemia
Pernicious anemia
- Autoimmune disease vit B12
deficiency
- tongue changes in 75% of cases
:appears red, smooth, and shiny, owing
to atrophy of the papillae a smooth
and erythematous tongue
- burning tongue = glossopyrosis-
glossodynia
- Pallor of the gingiva, mucosal atrophy,
erythema and ulceration
- Lab Tx : vit B12
Pernicious anemia
Iron deficiency anemia
Gingiva, soft palate: atrophy & pale
burning tongue : papillary atrophy &
pale (glossopyrosis-glossodynia)
Angular cheilitis, occurring at the
commissures of the lips, is caused by
Candida albicans infection reddening
and cracking
Plummer-Vinson syndrome : glossitis
and ulceration of the oral mucosa and
oropharynx dysphagia
Lab Tx : prep Fe
Cheilitis Angularis
Glossopyrosis-Glossodynia
2. Diabetes
-75% of uncontrolled adult diabetics --
- periodontal disease
-gingiva is a deep red color, edema,
slightly enlarged
- a generalized painful suppuration of
the marginal gingiva and interdental
papillae
-the teeth are sensitive to percussion
-recurrent periodontal abscess
- extensive loss of supporting
tissues ----- loosening of the
teeth
- rapid deposition of calculus
- xerostomia
- enlargement and hyperaemi of
the fungi form papillae
glossopyrosis & glossodynia
-musculature of the
tongue is flabby
-indentation marking
-increase incidence of
caries
-severe odontalgia
without caries
-candidiasis
-oral surgical
procedures including
curettage are contra Candidiasis
indicated
Dental surgery in the diabetic
require a consideration of :
a. prevent an elevation in
blood sugar
b. choice of anaesthetic
c. prevent postoperative
complication
3. Syphilis
A. Acute Syphilis
a. Prenatal Syphilis = Congenital S. =
Heredity S.
- the first 16 weeks of pregnancy
the fetus is protected
- after 16 weeks becomes
vulnerable to infection ----- occur
after 6 months
Oral aspects of congenital syphilis :
Lab test :
CD4 count
HIV viral load
Neutrophil count
Oral manifestations of
HIV infection :
- gingivitis
- periodontitis marg
- proc. Alv
destruction
sequester
- stomatitis , ANUG,
- Kandidiasis
Sarkoma Kaposi
- Leukoplakia
- Ca Kaposi
Stomatitis
Leukoplakia
Marginal periodontitis
Kaposi’s sarcoma
Necrotizing Stomatitis
ANUG
GASTROINTESTINAL DISEASES
Crohn’s Disease
= unknown etiology, inflammatory,
fissuring, fistulae of the small intestine,
colon thickening narrowing of the
lumen
= the gastrointestinal signs and symptoms :
cramping, pain, nausea, and diarrhea.
= swelling of lips, angular cheilitis,
hyperplastic rigid buccal mucosa, linier
ulcerations in the buccal vestibule,
fissuring lower lip, apthous ulcers, gingv
Oral Manifestations
Ulkus tunggal
Indurasi+
Tanda Trauma lokal
keganasan +
Risiko+ Hilang penyebab Hilang penyebab
Lesi hilang Lesi tetap >2mg
KSS
Iritan + Iritan -
Hilangkan iritan
Biopsi
Respons + Respons -
Displasia - Displasia +
Observasi Tx kanker