A coaching institution for ADC examination, ORE and Government dental jobs exam.
Erythroplakia is a clinical term for a potentially malignant fiery red lesion that cannot be attributed to any particular condition.
Lesions are usually asymptomatic and isolated, and commonly appear on the floor of the mouth, tongue, soft palate and buccal mucosa. Lesions may appear as smooth, velvety, granular or nodular plaques, often with clear margins.
Chemotherapy is the use of chemicals to destroy or inhibit the growth of cells. Two broad classes of chemotherapeutic agents are used in pharmacology:
The basis of antimicrobial chemotherapy is a differential sensitivity of the patient and microbe cells to the action of the drug. The drug may affect a structural component of the target cell which is not found in the patient, for example, the bacterial cell wall. Alternatively, a chemotherapeutic agent may inhibit a metabolic pathway peculiar to the microbe cells, for example, synthesis of folate.
Normally there is one opening of the parotid gland which is located in buccal vestibule opposite the upper 2nd molar tooth.
Parotid fistula is a patent tract connecting a parotid gland or duct to the exterior apart from the parotid duct opening.
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| Photo 1. Pre-operative picture of parotid fistula with leakage of serous fluid from the fistulous tract and scarring of surrounding area (red circle) [1] |
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| Photo 2. showing discharge of serous fluid from the right cheek in the angle of mandible region [2] |
Important points to remember about Kaposi Sarcoma
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| Kaposi's sarcoma or oral cavity |
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| Kaposi's sarcoma of the skin |
Cemento-osseous dysplasia (COD) is a benign fibro-osseous lesion of bone characterized by the replacement of normal bone by fibrous tissue and subsequently followed by its calcification with osseous and cementum-like material. It arises from the fibroblasts of the periodontal ligaments.
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| Orthopantamogram showing a well-defined radiopaque mass in the right mandible region extending from the distal root of 45 to the mesial root of 47 [1] |
As per WHO, there are three clinical presentation of cemento-osseous dysplasia.
These occur in the anterior mandible and involve only a few adjacent teeth.
involve few teeth in posterior mandible
The cells of periapical granuloma which are predominantly lymphocytes increase by division at the periphery.
There are hyperaemia and oedema of the PDL; localised increase in the vascularity leads to local bone resorption mediated by osteoclast mediated delayed hypersensitivity. In the specimen slide, cholesterol crystals having needle-like appearance, and eosinic hyaline bodies known as Rushton bodies are seen. Macrophages and multinucleated giant cells are also seen. Epithelium is present.
The cells in the centre are separated from their source of nutrition; hence degenerate and liquefy. This results in an epithelium lined cavity filled with fluid known as periapical cyst.
Treatment involves RCT with apicoectomy or extraction with curettage.
Majority of streptococci produce hyaluronidase, an enzyme that dissolves hyaluronic acid which is a universal intercellular cementing substance. It helps in the spread of infection. Usually staphylococci are good producers of hyaluronidase, so there is no spread of infection and the infection becomes localised in the form of abscess in case of staph infection.
Oral cancer is associated with significant morbidity and mortality. Early presentations of oral cancer are usually asymptomatic, whereas late presentations include pain, discomfort, reduced mobility of the tongue, increased mobility of the teeth or an inability to wear dentures. Oral cancer varies in appearance and can mimic many other oral mucosal diseases.
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| Squamous cell carcinoma of the left anterior ventral surface of the tongue |
Oral cancer can mimic many other oral mucosal diseases, so early specialist referral is required for investigation and biopsy of any suspicious lesion.
Any suspicious lesion needs early specialist referral for investigation and biopsy.
Squamous cell carcinoma is the most common oral malignancy, which arises from the epithelium of the oral cavity. Oral squamous cell carcinoma can affect any part of the oral mucosa; however, it most commonly occurs on the lateral surfaces of the tongue, the floor of the mouth or the gingivae.
Cancers originating from the salivary glands and supporting nonepithelial tissues are less common than squamous cell carcinoma. Metastatic cancers to the oral soft tissues and jawbones commonly originate from primary malignancies in the breast, prostate, kidneys or lungs. Leukaemia and lymphoma may also present in the oral cavity.
The treating specialist should perform the biopsy of an oral mucosal lesion. In rural or remote areas where a delay in specialist review is expected, seek expert advice on biopsy technique. A punch biopsy is not appropriate.
References:
Therapeutic guidelines (Oral & Dental) 2019
Oral leukoplakia (OL) is a clinical term for a nonremovable white lesion that is not easily recognisable as any particular condition and therefore requires further investigation.
