Nursing

1. Disorders oftongue, salivary
glands, tongue, lips and teeth
Prepared By: Justin V Sebastian, MSc N, RN, PhD Scholar

2. Oral
hairy
leukoplakia
▪ OHL – corrugated white lesion seen on
ventral and lateralsurfaces of tongue
▪ Commonlyassociated with HIV
▪ EBV – causative agent
▪ Lesions are shaggy and frayed
▪ Plaque likeand often bilateral
▪ Microscopy – reveals viral nuclear inclusions
with a rim of chromatin

3. Oral
hairy
leukoplakia
Shaggy corrugated
hyperkeratoticplaque

4. Treatment
▪ No treatment is required
▪ Resolves with- zidovudine.Acyclovir, gancyclovir
▪ Topically application of- podophyllin resin andtretinion
▪ OHL is highly predictive ofAIDS development

5. Hairy
tongue/
lingua
villosa/Lingua
nigra
▪ Defective desquamation of filiform papillae
▪ Accumulation of excess keratin on filiform papillae of the
dorsal part of tongue
▪ Dark color results from trapping of debris and bacteria
▪ Radiation therapy
▪ Seen in smokers and persons with poor oral hygiene
▪ Increased coffee and tea drinking

6. Treatment
▪ Notreatment is required
▪ Gentle tongue scrapping and removal of etiology
▪ Surgical removal of papillae- laser
,electrodesication
Filiform papillae
attains 15 mmlength

7. Ankyloglossia/ tongue tie
▪ Inferior frenulum attaches to the bottom of tongue
▪ Restricts freemovement of tongue
▪ Frenulectomy isrecommended

9. Squamous cell carcinoma of the tongue

10. SCC
of
tongue
▪ Smoking,alcohol abuse are risk factors for
SCC of tongue
▪ HPV is implicated in tonguecancer
▪ Seen in anterior two thirds of tongue
▪ Usually painless
▪ Presents as a non healing ulcer
▪ Nodal metastasis is common due to
lymphatic drainage of tongue

11. ▪ Symptomsof tongue cancer
▪ A red or white patch on the tongue, that willnot
go away
▪ sore throat
▪ A sore spot (ulcer)or lump
▪ Pain whenswallowing
▪ Numbnessin the mouth
▪ Unexplained bleeding from the tongue (that is
not caused by biting your tongue or other injury)

12. Treatment
▪ Hemiglossectomy
▪ Totalglossectomy
▪ Radiation therapy
▪ Chemotherapy
Hemiglossectomy

13. Salivary Gland Diseases

14. Salivary Gland Diseases
● Functional disorders
● Obstructive disorders
● Non-neoplastic disorders
● Neoplastic disorders

15. Functional Disorders
● Sialorrhea (Increase in saliva flow)
– Psychosis, mental retardation, certain
neurological diseases, rabies,
– mercury poisoning
● Xerostomia (Decrease in saliva flow)
– Mumps, sarcoidosis

16. Obstructive Disorders
● Sialolithiasis
– 92% occur in submandibular gland
– 6% in parotid gland
– Multiple occurrence in same gland is common

17. Submandibular Gland Lithiasis
● Diagnosis
– Pain and sudden enlargement of gland while
eating
– Palpation of stone submandibular duct
– Occlusal radiograph (80%)

18. Submandibular Gland Lithiasis
● Treatment
– Can be removed transorally if in duct and easily
palpable
– If in gland and gland is damaged, then gland
should be removed

19. Parotid Lithiasis
● Diagnosis
– Based on history
– Swelling during meals
– Bimanual palpation of painful gland
– 40% non-radiopaque
– Most
parotid stones are multiple

20. Parotid Lithiasis
● Treatment
– Stones in extra-glandular portion of duct
can be removed transorally
– Intraglandular stones removed
from extra-
oral approach

21. Non-Neoplastic Disorders

22. Acute Sialadentis
● Etiology
– Viral - ( Mumps)
– Bacterial

23. Acute Sialadentis
● Bacterial - swelling and dehydration,
xerostomia, failure of secretion with
ascending infection
– (Staph aureus, Strep progenies, most
common infective organism)
● Painful swelling parotid gland, overlying
skin red, pus from parotid duct

24. Acute Sialadentis
● Treatment
– Culture pus
– Appropriate
antibiotic
– Supportive therapy
• Fluids
• Heat
• Salivary stimulants

25. Chronic Sialadentis
● Chronic recurrent parotitis
– Age 3-6
– Caused by Strep viridian
– May spontaneously heal during
puberty

26. Necrotising Sialometaplasis
● Benign inflammatory condition
● Usually involves in minor salivary gland
of hard palate
● Will often simulate a malignant condition
● No definite etiology
● 1-3 cm
ulcer heals spontaneously

27. Neoplastic Disorders

28. Salivary Gland Tumors
● Adenomas (Epithelial)
– Pleomorphic adenoma
– Monomorphic adenoma
– Adenolymphoma

29. Salivary Gland Tumors
● Carcinomas
– Adenoid cystic carcinoma
– Adenocarcinoma

30. Diseases OF Lips??
Any Idea??...

31. Swelling Of Lips?
Swelling of lips
It May be
1. Generalised/Diffuse
2. Localised
Usually involves Perioral area of skin
Usually patients of Orofacial Granulomatosis and
angioedema present with lipswelling.

32. Causes Of lip Swelling
DIffuse Localized
1. Angioedema
2. Oedema
3. Crohn’s Disease
4. Haemengioma
5. Lymphangioma
1. Mucocele
2. Abscess
3. Haematoma
4. Salivary adenoma
5. Basal Cell Carcinoma
6. Squamous cell carcinoma

36. Angular Cheilitis
Angular Cheilitis is the Inflammation of one or
both corners of mouth
Multifactorial disease
with
1. Local
2. Systemic factors

37. Inadequate
Dentures
• Skin creasing with sliva
leakage and maceration
at corners of the mouth
• Host Defences
Compromised
Systemic
Diseases or
Deficiencies
• Anemia
• Iron Deficiency, B12or
Folate Deficiency
• HIV
• Diabetes Mallitus
Trauma
• S. Aureus Species
• Candida Species

38. Diagnosis?
1. Complete Medical, social, Dental History
2. Complete Examinations Especially for anaemia,
ill fitting denture, denture and candidial
infections.
3. Investigations?
Microbiological:
Blood Tests:
Complete Blood Count
Serum B12,ferritin, serum and red cell folate levels

39. Management
Elimination of local factors
Denture Hygiene
Instruct patient to leave denture atnight
Referral to medical specialist for underlying medical
cause
Provision of antimicrobial therapy
1. Local
2. Systemic

40. 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

41. Lip Fissures
Less common
Midline of lower lip
Majority of these is due to Infections which may be
S.aureus or candidaalbicans
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

43. Allergic Cheilitis
Irritation and scaling of lips caused by allergy due to
1. Lipsticks
2. Ointments
3. Foods
4. Moisturises
5. Tooth pastes
6. Lipstick allergy may also be caused by straw sharingand
kissing
Mangement:
1. Identification and removal of the cause of irritation
2. Topical steroids cream can be used for short term
management

45. 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
May progress to carcinoma
Biopsy is necessary for completeassessment

46. Crusting and induration is due to fibrotic reaction of
the
connective tissues.
Treatment :
1. Excision by either lip shaveoperation
2. Laser treatment

47. Exfoliative Cheilitis
Production of excess amount of keratin
Brown scales are formed which may be removed by the patientor
may persist
Reported to be exclusively in females
Histology is simply hyper parakeratosis
Not a malignantcondition
May be related to stress, no definite cause isknown
Various treatments have been used like local and systemic steroids,
cautery, cryosurgery and many others but all withoutsuccess.
Antidepressants have also been used with some successreported.
Resolves itself usually.

49. PeriOral Dermatitis

51. Lick Eczema
Young children
Zone of irritable scaly skinaround the mouth
Treatment is to stop the habit of licking

55. It is a gluey, gelatine - like substance
that adheres to the teeth.

56. Dental caries or tooth decay is an erosive process that begins
with the action of bacteria on fermentable carbohydrates in
the mouth, which produces acids that dissolve tooth enamel.

57. PATHOPHYSIOLOGY
Poor dental hygiene
A small hole, usually in a fissure or in an area that is
hard to clean
The decay penetrates the enamel into the dentin and
pulp
Exposure of blood vessels, lymph vessels and nerves to
the decaying area
Infection and abscess formation

58. Clinical manifestation
• Pulsating pain
• Abscess formation
• Swollen face

59. Prevention
• Mouth care.
• Diet.
• Fluoridation.
• Pit and fissure sealants.

64. PERIODONTITIS

65. PATHOPHYSIOLOGY
• EARLY LESION
• MODERATE LESION
• ADVANCED LESION

66. DEEP CLEANING (SCALING AND ROOT
PLANNING)
Management

68. DEFINITION
PERIAPICAL ABSCESS REFERRED TO AS AN
ABSCESSED TOOTH, INVOLVES THE COLLECTION
OF PUS IN THE APICAL DENTAL PERIOSTEUM
(FIBROUS MEMBRANE SUPPORTING THE TOOTH
STRUCTURE) AND THE TISSUE SURROUNDING THE
APEX OF THE TOOTH (WHERE IT IS SUSPENDED IN
THE JAW BONE).

69. TYPES
• ACUTE PERIAPICAL ABSCESS
• CHRONIC PERIAPICAL ABSCESS

70. Signs and symptoms of a dental abscess include:
• pain in the affected area when biting or when touching the
affected area
• sensitivity to cold or hot food and liquids
• a foul taste in the mouth
• fever
• a generally unwell feeling
• difficulties opening the mouth
• swallowing difficulties
• insomnia

71. Treatments
• Root canal treatment will be used to remove the abscess. A
drill is used to bore a hole into the dead tooth so that the pus
can come out. Any damaged tissue will be removed from the
pulp.
• Over the counter (OTC) painkillers may help reduce the
pain while an individual is waiting for treatment
• Antibiotics may be prescribed to prevent the infection from
spreading and may be taken together with painkillers.
Examples of antibiotics include amoxicillin or metronidazole.