diseases of the lips and tongue
TRANSCRIPT
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Dr. ShahzaD HussainBDS, FCPS(r)
Oral & Maxillofacial SurgeryNishtar Institute Of Dentistry, Multan
SNDENTALCARE.CO
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Diseases OF Lips??
Any Idea??...
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Learning Outcomes? At the End oF this Discussion we will be able to Describe Which are the Diseases Of the Lips??1. Swelling? Generalized Localized1. Angular Cheilitis? 2. Lip Fissures?3. Allergic Cheilitis?4. Actinic cheilitis?5. Exfoliative 6. Perioral Dermatitis?7. Lick Eczema?8. Cheilocandidiosis
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Swelling Of Lips? Swelling of lips
It May be
1. Generalized/Diffuse
2. Localized
Usually involves Perioral area of skin
Usually patients of Orofacial Granulomatosis and angioedema present with lip swelling.
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Causes Of lip SwellingDIffuse Localized
1. Angioedema2. Oedema3. OFG4. Crohn’s Disease5. Haemengioma6. Lymphangioma
1. Mucocele2. Abscess3. Haematoma4. Salivary adenoma5. Basal Cell Carcinoma6. Squamous cell carcinoma7. Keratoacanthoma
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Angular Cheilitis Angular Chelitis is the Inflammation of one or both
corners of mouth
Multifactorial disease
with
1. Local
2. Systemic factors
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Inadequate Dentures
• Skin creasing with slivaleakage and maceration at corners of the mouth
• Host DefencesCompromised
Systemic Diseases or
Deficiencies
• Anemia
• Iron Deficiency, B12 or Folate Deficiency
• HIV
• Diabetes Mallitus
• Sjogresn’s Syndrome
Trauma
• S. Aureus Species
• Candida Species
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Diagnosis?1. Complete Medical, social, Dental History
2. Complete Examinations Especially for anemia, ill fitting denture, denture and candidial infections.
3. Investigations?
1. Microbilogical:
1. Sampling? Smear, swab, oral rinse
2. Site? Angle, palate, fitting surface of denture
Blood Tests:
Complete Blood Count
Serum B12, ferritin, serum and red cell folate levels
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Management Elimination of local factors
Denture Hygiene
Instruct patient to leave denture at night
Referral to medical specialist for underlying medical cause
Provision of antimicrobial therapy
1. Local
2. Systemic
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Antimicrobial therapy Candida isolated
1. Nystatin pastilles (intraoral)
2. Nystatin ointment (corners)
S. aureus isolated
1. Fusidic acid cream (angles)
2. Mupirocine cream/fusidic acid cream (anterior nares)
Mixed infection
1. Miconazole gel/cream
Chlorhexidine mouthwash
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Lip Fissures Less common
Midline of lower lip
Resistant to conservative treatment usually
Majority of these is due to Infections which may be S.aureus or candida albicans
Treatment principle is based on elimination of secondary cause of infection and then topical steroid Creams application.
Recurrence is common
Commonly seen in patients of down syndrome along with angular cheilitis as well as OFG
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Allergic Chelitis Irritation and scaling of lips caused by allergy due to1. Lipsticks 2. Ointments 3. Foods 4. Moisturizes 5. Tooth pastes 6. Lipstick allergy may also be caused by straw sharing and
kissingMangement:1. Identification and removal of the cause of irritation2. Topical steroids cream can be used for short term
management
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Actinic Cheilitis Solar keratosis
predominantly male patients
Prolonged exposure to sunlight either occupational or recreational may result this
Long exposure to sunlight
Lower lip more effected
Crusting and induration of the vermilion margin
May progress to carcinoma
Biopsy is necessary for complete assessment
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Epithelial atypia is seen in this condition
Crusting and induration is due to fibrotic reaction of the connective tissues.
Treatment :
1. Excision by either lip shave operation
2. laser treatment
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Exfoliative Chelitis Production of excess amount of keratin Involves vermilion border Brown scales are formed which may be removed by the patient or
may persist Reported to be exclusively in females Histology is simply hyperparakeratosis Not a malignant condition May be related to stress, no definite cause is known Various treatments have been used like local and systemic steroids,
cautery, cryosurgery and many others but all without success. Antidepressants have also been used with some success reported. Resolves itself usually.
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PeriOral Dermatitis Relatively unommon
Young adult females
Erythematous rash on the facial skin around the mouth
Can be due to previous use of steroid creams or contact allergy
Clinical diagnosis
Treated with low potency steroid like 1% hydrocortisone
More tan one aetiological factor may be involved.
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Lick Eczema Young children
Sharply deliniated zone of irritable scaly skin around the mouth
Treatment is to stop the habit of licking
Removable appliance
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Cheilocandidosis Heavy candidial infection
Bilaterally
Lower lip
Ulcerated granular areas
Generally healthy patients with a previous history of local abnormality.
Early treatment with anti fungals is necessary.
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