Red Lesions of the oral cavity #1 copy.pdf

Red lesion affecting oral cavity part 1

1. Dr. Hidayah Elyas
Lecture 1 :-

Red Diseases of Oral Cavity
Dentistry program
Oral Medicine

2. Red lesions
●A“RED LESION” appearsas “Red” because histologically it’s
characterized by
1-Atrophic changes in superficial epithelium
2-OR Breach in superficial layer of epithelium
3-OR Increased/prominent vascularity in uderlying connective tissue

3. 













1.Oral ulcers
2.Mucosal inflammation
3.Reactive lesions
4.Atrophy
5.Purpura
6.Vascular anomalies
7.Neoplasms

4. Mucosal Inflammation

●Viral infections
●Fungal infections
●Radiation induced mucositis
●Chemotherapy induced mucositis
●Immunological reactions

5. Denture stomatitis (Chronic Atrophic Candidiasis)
●Inflammation (manifesting as erythema) of mucosa beneath
denture. Usually maxillary.
●Management:-
●Cure any underlying systemic problem
●Chances of getting infection are increased if denture worn
for 24 hours a day.
●Dentures should be left out of mouth at night, cleaned &
disinfected by placing in antiseptic denture cleanser
(Milton’s Solution).

6. Denture stomatitis (Chronic Atrophic Candidiasis)
●A discoloring agent e.g; Rayner’s Blue Solution to
see whether you are cleaning denture thoroughly
●Mucosal infection is eradicated by
1-Brushing palate
2-Using antifungals for 4 weeks.
●Effective agents include
Nystatin or Miconazole oral gel
administered concurrently with Chlorhexidine
mouthwash

7. Median Rhomboid Glossitis
●Candida associated lesion.
●Bacterial species could also be responsible
●Red, rhomboidal depapillated (lingual papilla) area in midline
of tongue, in front of circumvallate papillae
● d/d: Oral Squamous Cell Carcinoma
●No treatment
●Antifungal agents (nystatin)
and antiseptic gargles used for irritation

8. Chemotherapy Induced Mucositis
●Following Chemotherapeutic Agents
sometimes cause mucositis:
1-Fluorouracil (solar keratoses)
2-Cisplatin (cancers)
usually cause mucositis
●Management:- is by Opioids (PAIN)
●Avoid irritants
●Maintain oral hygiene
●Topical analgesics or analgesic
mouthwash.
●Not effective then Betamethasone
mouthwash which is steroid for
inflammation and itching

9. Radiation mucositis
●Occurs usually within 3 Weeks of irradiation by Radiation
Therapy of Head & Neck Tumors.
●Clinically presents as “Mild Erythema” to “Deep Mucosal
Ulceration”.
●In advance stage Ulcers are covered by Pseudomembrane.
●Management is by opoids (morphine & hydromorphone),
●Avoid irritants (smoking, spicy food & alcohol)
●Maintain good oral hygeine
●Topical analgesics (lidocaine)
●Amifostine 200mg /day
●Prevents xerostomia healing of the mucosa usually starts to take
place within 3 weeks of end of radiotherapy

10. Mucositis due to Immunological Reaction
●Following are some Autoimmune Conditions which can induce
Mucositis:
1.Plasma cell gingivostomatitis
2. Granulomatous disorders (wegener’s granulomatosis)
3.Amyloidosis
4.Graft versus host disease (GVHD)

11. Wegener's Granulomatosis
●Possible cause of the disease includes:-
1-Abnormal immune reaction secondary to a nonspecific
infection
2-Hypersensitivity response to an inhaled antigen.
●Can involve almost every organ.
●The most characteristic oral manifestation is
●(Strawberry Gingivitis)
●The surface forms:-
Numerous short bulbous projections
(hemorrhagic and friable)
Oral ulceration

12. Wegener's Granulomatosis
●Investigation:-Cytoplasmic localization (c-ANCA) is useful
●The drugs of choice are :-
1.Cyclophosphamide with Glucocorticoids
2. (suppress immune reaction)
3.Cytoplasmic antineutrophil
4. Cytoplasmic antibodies

13. NOTE
●Cyclophosmamide
Is an alkylating agent used for treatment of:-
1-Cancer
2-Auto-immune Diseases
But it has Life Threatening
●Adverse Effects such as:-
1-Acute Myeloid Leukemia,
2-Bladder Cancer
3-Permanent Infertility if given in high doses

14. Lichenoid Reaction in GVHD(Graft versus host disease)
●Graft causing damaged immune response against the recipient
Allogenic bone marrow transplant.
● Mucosal lesions more common in chronic GVHD..
● Lichenoid Reactions (widespread as comp to Lichen Planus)..
●Painful Erythema, Mucosal Ulceration, Oral Purpura.
●May be associated with infections such as Candidiasis &
HSV Infection or with Xerostomia
●Treatment
●Oral Hygiene Measures, Analgesics, Immunosuppressant's such
as CICLOSPORIN , Non-astringent Mouthwash, Nystatin
Mouthwash incase of fungal infections, Saliva Supplements and
Pilocarpine (Recovery after 1 year post transplant)

15. Lupus Erythematosus
●Auto-immune
●More common in women (20-40 yrs).
● Triggered by sun exposure, drugs
●hormones and chemicals
●Amongst others, two types: DLE and SLE
●ORAL LESIONS comprise of White Striae with a Radiating
Pattern, and these may terminate toward the center of the
lesions, which has Erythematous appearance Palatal Lesion can
be purely Erythematous
●DLE has Butterfly like rashes on cheek and nose termed Malar
rash
●SLE diagnosis requires four or more of the American College
of Rheumatology criterias
●Management of Intraoral Lesions via Topical steroids with
Anti-Fungal Therapy

16. Pemphigus Vulgaris
●Rare etiology: Penicillamine, which is a chelating agent that
removes certain materials from the blood
▪ ACE inhibitors, which are a type of blood pressure medication
▪ Systemic treatment includes:
▪ An anti-inflammatory drug called dapsone.
▪ Corticosteroids.
▪ Medicines containing gold.
▪ Medicines that suppress the immune system (such as
cyclosporine)

17. Thank you