Common Oral Lesions

Oral lesions, with or without symptoms, are common among older adults using dental prostheses.
 
Oral cancer rates nearly triple between the age groups of 55 to 64 years and 85 years and older.
 
Note any lesions on the tongue. There may be age related atrophy with reduced papilla on the lingual epithelium.
Check the oro-pharynx and the gingiva. Identify any areas of a possible biopsy. You should decide if the patient should be referred to a specialist.
  • Acute Necrotizing Gingivitis

  • Angular Cheilosis

  • Candidiasis

  • Endodontics

  • Facial Cellulitis

    ORAL00000430.gif
    Etiology:
    Abscessed Tooth.

    Description: A diffuse non-suppurative inflammatory process involving serious exudation with subcutaneous abscess formation.  Photo shows diffuse swelling and subcutaneous abscess.

    Treatment: Antibiotic therapy, surgical drainage, endodontic therapy, dental extraction of affected teeth.

     

  • Fibroma

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    Etiology: Hypertropic scars secondary to chronic irritation.

    Description: Found on buccal mucosa, tongue border, lip and vestibular mucosa.

    Treatment: Surgical Excision and removal of cause of chronic irritation.

     

  • Geographic Tongue

  • Gingival Hyperplasia

    ORAL00000424.gif

    Arrow points to hyperplasic gingivitis

    Etiology: Long continued local irritation or drug therapy with dilantin.

    Description: Soft spongy and swollen tissue that may display inflammatory exudates. Caused by anticonvulsant usage usually in patients with less than ideal oral hygiene. Dilantin has been implicated in the over growth of the marginal gingiva.

    Treatment: Surgical excision, electro cautery is useful in treatment. Good oral hygiene practices in home care, plus regular dental cleaning.

     

  • Hemangioma

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    Etiology: Blood vessel, a benign tumor that occurs on skin of face, neck and buccal mucosa.

    Description: There are 3 types: cavernous, capillary and sclerosing.

    Treatment: Small lesions may be surgically corrected. These lesions have a rich blood supply.

     

  • Leukoplakia

     

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    Etiology:
    Chronic tissue irritation may lead to white plaque.

    Description: Thickened white patches of epithelium occur on mucous membranes, including the mouth. Hyperkeratosis and dyskeratosis that is often considered precancerous.

    Treatment Planning: Remove irritant, observe for healing for short time (2 weeks) or carry out a biopsy to rule out malignancy.

     

  • Occlusal Decay

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    Arrow indicates occlusal decay.

    "Occlusal decay" is caries occurring on the grinding or biting surface of the tooth.

     

  • Palatal Abscess

  • Papilloma

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    Etiology: Squamous epithelium.

    Description:Benign growth with broad base, white surface, may appear as a sessile, cauliflower growth.

    Treatment:Surgical excision.

     

  • Pyogenic Granuloma

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    Etiology: Response to minor trauma.

    Description: Over growth of granulation tissue with size up to 2-3 cm, may be ulcerated, red, purple, or brown in color. Appears in both sexes.

    Treatment: Excision. Lesion may recur if not completely removed.

     

  • Radiation Decay

  • Reticular Lichen Planus

  • Root Decay

  • Traumatic Ulcer

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    Etiology: Biting lip, cheek or tongue while chewing.

    Description: Teeth penetrating into tissue cause maceration and ulcer formation. The vascular damage is obvious in this example.

    Treatment: Salt water rinses, if infection occurs then antibiotic or chlorhexidine mouth rinse.

     

  • Tuberculosis
     

    (no image) The tongue and palate are favored locations for TB lesions.  The typical lesion is indurated, chronic, non-healing, and ulcerated.  These lesions are highly infectious.  Geriatric patients often report a history of TB, and should be able to provide documentation of treatment.  Patients with active TB are a real danger to the dental treatment team.  OSHA guidelines help guide clinicians in safe practice patterns.

 
ORAL00000016.gif Screening for Oral Cancer
 
ORAL00000016.gif Oral Manifestations of Drug Regimens