Miscellaneous conditions

Acute Ulcerative Gingivitis

AETIOLOGY

Anaerobic fusiform and spirochaete bacteria

PRESENTATION

Ulceration at the tips of the dental papillae, soreness, gingival bleeding and halitosis. There may also be evidence of systemic involvement.

TREATMENT

This involves debridement and oral hygiene instruction, peroxide mouthwash, metronidazole and then a periodontal assessment once the acute phase of the disease has resolved.

Acute necrotising ulcerative gingivitis

 

Amalgam tattoo

Amalgam particles can be incorporated in to healing wounds.

A biopsy may be required to distinguish from a naevus or a melanoma.

Ankyloglossia (Tongue tie)

The lingual fraenum anchors the tongue tip, restricting movement. Oral cleansing but not speech is impaired. Surgery to release tongue if severe.

Basal Cell Carcinoma (Rodent Ulcer)

Common neoplasm of the skin of the face, particularly in the elderly with a history of long exposure to UV radiation. Typically a slow growing nodule that eventually ulcerates centrally.

Fordyce granules

Sebaceous glands are present in the oral mucosa of 80% of adults and they can grow in size with age and appear in the oral mucosa as soft, symmetrically distributed, creamy spots a few millimeters in diameter. They are mainly located on the buccal mucosa, but can also be present on the lips and rarely the tongue. They are often mistaken for disease.

Occlusal bite lines

These white lines are caused by the teeth biting on the inside of the cheeks. The epithelium is moderately hyperplastic. Also called Linea Alba.

Black hairy tongue

Hair-like appearance on the dorsum of the tongue probably produced by pigment-producing bacteria and fungi, but not Candida albicans .

Periodic scraping of the tongue with a toothbrush may improve appearance. Harmless condition.

Palatal and mandibular tori

Palatal Tori (singular: torus) are slow growing asymptomatic bony lumps in the middle of the palate. Mandibular tori (usually bilateral) are slow growing asymptomatic bony lumps growing on the lingual surfaces of the body of mandible. Usually require no treatment unless interfering with the fitting of dentures.


Palatal Torus



Mandibular Tori

Fibroepithelial polyp

Irritation causing fibrous hyperplasia

Requires excision for histolological examination


Fibro Epithelial Poly of the lower lip

Benign melanosis

Bluish/brownish macules seen most frequently.

May require a biopsy for exclusion of malignant melanoma .

Non racial pigmentation

Pyogenic Granuloma

Possibly a reactive vascular lesion which usually presents as a small red painless mass that bleeds easily, ulcerates and grows rapidly. Seen on the gingival margin, tongue or rarely the lip and usually requires excision.

Denture Irritation Hyperplasia

Hyperplastic mucosa at the periphery of an ill-fitting denture.

Leaf-like folds of granulation tissue embracing the over-extended of the denture (see diagram below)

Tissue firm in consistency and not grossly inflamed but there are often areas of ulceration at the base.

May require surgical removal and better fitting dentures.


 

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