c
 2.

Y Atrophied hyperemic papillae (small punctate red dots)

4.Y èauses
 

Glossitis is a condition in which the tongue is swollen and changes color. Finger- 1.Y Anemia
like projections on the surface of the tongue (called papillae) are lost, causing the 1.Y Folic Acid deficiency Anemia
tongue to appear smooth. 2.Y ÿitamin B12 Deficiency Anemia Iron Deficiency

   Anemia

Tongue inflammation; Tongue infection; Smooth tongue; Glossodynia; Burning 2.Y Other possible ÿitamin Deficiencies
tongue syndrome 1.Y Pyridoxine deficiency
2.Y Riboflavin deficiency
A.c

  

 3.Y Niacin deficiency
 3.Y Anti-cancer drugs


 4.Y Riley-Day Dysautonia Syndrome
Geographic tongue is characterised by irregularly shaped red, map-like smooth 5.Y Management
swollen patches on the tongue. A white border sometimes surrounds them. It is 1.Y Treat underlying cause (e.g. nutritional deficiency)
also known as   

 because the appearance is constantly 2. Soft, bland diet
changing. Although geographic tongue is benign (harmless) it may persist for
months or longer, and often recurs. c 





Geographic tongue occurs in up to 2% of the population. It may occur in any race, Gingivitis is an infection of the gums. It is usually painless and most people do not
age or sex. However, it appears more commonly in females than males and more realize they have it until their dentist or hygienist tells them. Bleeding of the gums
frequently in adults. during brushing or flossing is sometimes apparent to the patient, but this is not
  

Often there are no symptoms but burning or irritation of the tongue is common,
particularly with hot or spicy foods. The discomfort may come and go over time
and may worsen at certain times of a women's menstrual cycle or during
pregnancy.
Lesions are usually confined to the tongue but they sometimes arise elsewhere in
the mouth or on the lips.
always the case. The gums do become reddened and puffy due to the infection.
The infection of gingivitis is caused by the bacteria found in dental plaque, the
stuff you try to remove with brushing and flossing. It is a thin film of bacteria that
forms almost as soon as you remove it. With daily oral hygiene this plaque film is
disrupted enough to not be able to cause harm to your gums. If it is not removed
properly once every 24 hours it begins to become more pathologic, setting up the
infection of the gums. This can happen in the whole mouth but more often than


 not it occurs locally around certain teeth where adequate hygiene may be more
The exact cause is unknown but the following factors have been linked with the difficult. Tartar buildup can irritate the gums and harbor bacteria as well.
condition: 

Y It occurs more commonly in patients with psoriasis, especially pustular


  
psoriasis
Periodontal disease can affect one tooth or many teeth. It begins when the
Y There are also associations with diabetes, anaemia, atopy (asthma bacteria in plaque (the sticky, colorless film that constantly forms on your teeth)
and/or eczema) and stress causes the gums to become inflamed.
Y In some patients particular foods seem to be a trigger, especially In the mildest form of the disease, gingivitis, the gums redden, swell and bleed
cheese easily. There is usually little or no discomfort. Gingivitis is often caused by
inadequate oral hygiene. Gingivitis is reversible with professional treatment and
Y èlustering within a family suggests genetic involvement
good oral home care.
Y ÿariation with the menstrual cycle suggests hormonal factors Untreated gingivitis can advance to periodontitis. With time, plaque can spread
 
   and grow below the gum line. Toxins produced by the bacteria in plaque irritate
Geographic tongue is a benign condition that usually resolves itself without the gums. The toxins stimulate a chronic inflammatory response in which the body
causing any problems for the patient so most people do not require treatment. in essence turns on itself, and the tissues and bone that support the teeth are
There is no known cure. If there are associated medical conditions, treatment of broken down and destroyed. Gums separate from the teeth, forming pockets
these may improve the appearance of the tongue. (spaces between the teeth and gums) that become infected. As the disease
Discomfort may be treated with a mouth gargle or rinse containing antiseptic and progresses, the pockets deepen and more gum tissue and bone are destroyed.
anaesthetic agents. Topical corticosteroids may also be helpful for occasional use Often, this destructive process has very mild symptoms. Eventually, teeth can
eg. triamcinolone in dental paste applied several times a day when required. become loose and may have to be removed. 

B. 

c

Median rhomboid glossitis is an enigmatic inflammatory or infectious
condition of the dorsum of the tongue. Although it is benign, it can be mistaken
for a serious condition by the patient or an inexperienced observer.
Median rhomboid glossitis is an uncommon condition; the estimated
prevalence in adults is less than 1%, The condition is usually asymptomatic or may
cause a slight burning sensation associated with spicy foods.
The etiology of this lesion is unknown. Although in the past MRG was
considered a developmental failure of the branchial arches to cover the
tuberculum impar, over the past 20 years, evidence of an association with
candidiasis has provided a more likely pathogenesis. In the majority of cases,
èandida organisms can be cultered from the lesion, and histologic
examination reveals hyphae penetrating the superficial epithelium of the tongue,
with focal neutrophilic microabscesses.
The most common presentation of MRG is a red or red-white patch on
the midline of the dorsum of the tongue, just anterior to the region of the ÿ of the
circumvallate papillae (sulcus terminalis). The patch of reddened mucosa may be
flat or raised; it is usually sharply circumscribed, with a somewhat rhomboidal
shape. Occasionally, there is a nodular component, or the lesion may be lobulated.
The texture may be similar to the surrounding tongue or firm, and the surface is
relatively smooth.
è.

c
O
 
Periodontal disease begins with mild gum inflammation and becomes more severe
over time. Its progression can be divided into four stages.
Y The first stage is gum inflammation or gingivitis, and the gums may
become reddish or purple and slightly swollen. They may be tender
and they may bleed easily. You may have a sour taste, and your breath
may be offensive. You may have no symptoms.
Y The second stage or early periodontitis will involve the sulcus
becoming swollen and more inflamed. The sulcus expand its borders
creating an even better environment for bacterial growth. As the
inflammation spreads and worsens, it will soon attack the periodontal
ligament that holds the teeth in place. At this point a dentist would
use a periodontal probe to measure the depth of each periodontal
pocket. Periodontitis does not progress steadily, but rather
intermittently. Symptoms and the rate of destruction vary.
Y The third stage will see erosion of the gum, pockets will deepen, and
more potent forms of bacteria develop. The periodontal ligament and
alveolar bone become inflamed.
Y In the fourth stage, there is so much ligament and bone loss that the
tooth, no longer stable, will loosen in its socket. Bone loss magnifies
pressure from chewing, making the tooth progressively looser. As the
tooth loses its support it will fall out or require extraction.
The acids in plaque dissolve the enamel surface of the tooth and create holes in


the tooth (cavities). èavities are usually painless until they grow very large inside
the internal structures of the tooth (the dentine and the pulp at the core) and can
1.Y Pathophysiology
cause death of the nerve and blood vessels in the tooth, resulting in tooth abscess.
1.Y Filiform papillae(The main job of the filiform papillae is to [1] Early stages : acides dissolve the enamel in the crown of the tooth
act as an abrasive coating, which helps give the tongue a [2] Moderate tooth decay : here the dentine is attacked by acids and bacteria
cleaning and rasping action.) atrophy invade the cavity.
2.Y Symptoms [3] Advanced tooth decay : inflammation of the pulp.
1.Y Tongue dryness [4] Necrosis (death) of the pulp tissue.
2.Y Intermittent Tongue Burning [5] Periapical abcess forms at the apex of the root
3.Y Paresthesia of taste: Acids begin to dissolve tooth enamel within 20 minutes after eating, the time
Definition (MSH) Subjective cutaneous sensations (e.g., when most bacterial activity occurs. Untreated tooth decay can result in death of
cold, warmth, tingling, pressure, etc.) that are experienced the internal structures of the tooth with eventual loss of the tooth. Dietary sugars
spontaneously in the absence of stimulation. and starches (carbohydrates) increase the risk of tooth decay. The type of
Definition (NèI) Abnormal touch sensations, such as carbohydrate and the timing of ingestion are more important that the amount.
burning or prickling that occur without an outside Sticky foods are more harmful than non sticky foods because they remain on the
stimulus. surface of the teeth. Frequent snacking increases the time that acids are in
4.Y Tongue Pain may be severe in advanced stages contact with the surface of the tooth.
3.Y Signs 
1.Y Smooth, slick, sore Tongue with lost papillae 
r  r
 Direct smears and cultures from the lesions may disclose a pathogen. Darkfield
Persistent sore, swollen, red, or bleeding gums as well as tooth pain or sensitivity examination of scrapings from the lesions and STS are indicated in an attempt to
and bad breath are warning signs of periodontal disease (gum disease). rule out syphilis. In thrush, a history of recent antibiotic therapy is common.
To identify è-albicaus, scrapings from suspect lesion should be cultured and
  

 examined microscopically. A solitary undiagnosed oral lesion of more than one
well duration that does not respond to treatment must be considered malignant
Dental caries (tooth decay) is one of the most common of all disorders, second until biopsy proves otherwise.
only to the common cold. It usually occurs in children and young adults but can 
affect any person. It is the most important cause of tooth loss in younger people.
Bacteria are normally present in the mouth. The bacteria convert all
foods-especially sugar and starch-into acids. Bacteria, acid, food debris, and saliva
combine in the mouth to form a sticky substance called plaque that adheres to the
teeth. It is most prominent on the grooved chewing surfaces of back molars, just
above the gum line on all teeth, and at the edges of fillings. Plaque that is not
removed from the teeth mineralises into calculus (tartar). Plaque and calculus
irritate the gums, resulting in gingivitis. It is well known that tooth decay can lead
to the destruction and eventual loss of teeth.
$ 
Underlying systemic disorders should be treated specifically. Oral hygiene is
always necessary. èandidiasis usually responds to nystatin oral suspension.
èlotrimazole and lozenges are effective in persistent over growth.
When compliance is a problem, Ketoconazole, are 200mg tablet orally once a day
is effective. Bacterial infection should be treated with antibiotics. ÿitamins B-
complex and è should be given for three or four weeks. Month wash and rinsing
with appropriate solution is also advised.

However, periodontal disease, a disease of the supporting tissue 

around the tooth, can be so severe that the teeth loosen and fall out. 
The teeth are seated in sockets in the bones of the upper and lower jaws in %!


alveolar bone, (alveolar means "hollow"). The bone does not hold the teeth in
place, rather, the teeth are stabilised by connective tissue called periodontal An infection in the parotid glands is known as Epidemic parotitis or mumps. This
ligaments that extend between tooth-roots and sockets. disease is also known as salivary gland infections. The oral cavity has three
The part of the tooth next to the sulcus is extremely difficult to keep free of separate parotid glands and each one s located in different positions. Their chief
bacterial plaque, and if not removed constantly, or left undisturbed for a few days, function is to produce saliva to make the chewing of food easier. However, when
will form tartar - a rough, hard material that adheres to teeth. Plaque and tartar these glands are infected they get inflamed and painful and the symptoms are
build-up constitute the primary cause of periodontal disease. quite obvious; like ͞Face pain, swelling of the parotid glands, fever, headache,
 sore throat, and swelling of the temples or jaw͟. Since this disease is contagious;

 sneezing by an infected person would but naturally expel saliva and the person
 who is the closest to the infected person would catch the disease. However, there
A severe condition of lesions on the lips and its surrounding area is known as is a potent herbal treatment for this disease.
cheilosis, angular cheilosis, angular cheilitis, or perleche. This condition is Reishi mushrooms are a very good herbal treatment for mumps. This is because
characterized by inflammation as well. they have anti-bacterial propensities and are very good in removing the bacteria
of mumps. The infected person should be given 250 Gms of these mushrooms
Angular cheilosis is a painful experience, and even though it is in no way life thrice daily for a week and the symptoms of mumps would be resolved. Though,
threatening, its appearance is not too comely. It can also cause insecurities to this disease has been practically eradicated; however, sporadic cases do appear in
whoever is afflicted by it, causing him or her to have some problems in terms of lesser nations; this because medication does not reach these places.
his or her social interactions
 Mumps is anacute infectious disease caused by a virus that mainly attacks
r
 glandular and nervous tissues, frequently characterized by swelling of the salivary
 glands.
Stomatitis is an inflammation of the mouth, often a symptom of systemic disease. The disease is worldwide in distribution and can occur in epidemics. Its incidence
Fetid breath odour and blood tinged saliva may accompany any ulcerative lesions is highest between the ages of 5 and 9, but mumps may attack persons of any age.
of the oral mucosa. Because the salivary gland most often affected is the parotid, mumps is also
 known as epidemic Parotitis. The disease rarely involves the sex glands, the
!

 meninges, or the pancreas.
Stomatitis may be caused by infection, trauma, dryness, irritants and toxic agents, 
bypersensitivity, or autoimmune conditions. Infectious agents include %
 


streptococci, gonococci, fusospirochets, èandida albicans, èorynebacterium
diptheriae, Treponoma pallidum, Mycobacterium tuberculosis, and the viruses of
herpes simplex, cexsackie, measles, and infectious mononucleosis.
Stomatitis may also result from avitaminosis, particularly lack of the ÿitamins B or
è (as in pellagra, spruve, pernicious anaemia or scurvy) or from iron deficiency
anaemia with dysphasia (Plummer ÿersion syndrome), agranulocytosis or
Acute bacterial (suppurative) parotitis is characterized by painful swelling and
tenderness of the entire parotid gland. The skin overlying the gland is red and hot.
In addition, there is referred earache, fever and leukocytosis. Pus can be
expressed from the opening of Stensen's duct. Frequently, there is abscess
formation and sepsis, especially, in elderly, debilitated patients with dehydration
and poor oral hygiene. (See Kussmaul's Disease below)
leukuemia, Lichen planus, erythema multiform, SLE, Behcet's syndrome, and
pemphiges vulgaris frequently present oral mucosa signs.
Mechanical trauma from cheek biting, mouth breathing, jagged teeth, orthodontic
appliances, ill fitting dentures, or nursing bottles with hard or too-long nipples
may produce characteristic lesions. Xerostomia resulting from drugs, the aging
process, or radiation therapy predisposes the mouth to sensitivity and infection.
Generalised Stomatitis may follow excessive use of alcohol, tobacco, hot foods, or
spices, or sensitisation to toothpaste, mouthwash, candy dyes, lipstick, and rarely,
acrylic dentures, Phonation, iodides, bismuth, mercury, barbiturates, lead and
many other drugs may produce Stomatitis. èhemical Stomatitis of occupational
origin may be due to dyes heavy metals, acid fumes, or metal or mineral dust.
 Y
& #r

'

This condition designates acute parotid or submaxillary gland swelling secondary
to a mucus or fibrinous plug. It occurs in dehydrated and debilitated patients who
have a decreased salivary flow. Upon massage of the gland, debris may be
expressed from the duct, followed by a flow of turbid saliva and a decrease in the
size of the gland. This condition may lead to acute suppurative parotitis and
ultimately, chronic sialadenitis.
Y
Y
Y
r
 r  Y
èlinical signs varies according to the type of Stomatitis present.
r
 Y
is characterised by an intense, shiny erythema with slight swelling, itching, dryness Y
or burning, often present, may be due to sensitivity to foods or to lipsticks. Y
"  # 
(necrotizing, ulcerative gingivitis) causes ulceronecrotic lesions Y
of the interdental papillia that may extend to the marginal ginginae or produce Y
painful ulcers of the mucous membranes. $  caused by èandida Y
albicaus, is characterised by white, slightly raised patches resembling milk curds Y
that when removed, expose a hyperemic area that may bleed slightly. Y
The infection usually begins on the tongue and buccal mucosa and may spread to Y
the plate, gums, tonsils, pharynx, larynx, GI tract, respiratory system, and skin. Y
Thrush is common in infants. Mouth is usually dry. Y


r
, an inflammatory reaction that produces a Y
membrane like exudate, may be caused by chemical irritants, as well as bacteria. Y
Fever, lymph adenopathy and malaise may occur or the infection may be Y
localised. Y
Mucosal lesions accompanying systemic disease include the mucous patches of Y
syphilis, the strawberry, then raspberry, tongue of scarlet fever, koplick spot of Y
measdis; the ulcer of erythema multiforme; and the smooth, fiery red tongue and Y
painful mouth of pellagun. Y
 Y

 Y
Establishing the etiology may be difficult. The history may disclose a systemic Y
disease, a dietary deficiency, or contract with irritants or allergens. Physical Y
examination is obligatory, since it may reveal lesions of other mucous membrance, Y
as in erythema multitorme, candidiasis or syphilis; lesions of the skin, as in Y
pellagra, pomphigus, lichen planus, or SLE, signs of pulmonary TB, sprue, anaemia,
YYY 
Y
Y
or another contributory disease; or a general decrease in exocrine secretion. 

Y
Y
Y
Y

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