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Disorders of the Mouth: Introduction

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  • Oral mucosa covers and protects tissues beneath it and conveys sensory information from the surface.

  • Normal function is required for mastication, deglutition, chemosensory function, and phonation.

  • Impaired oral mucosal health causes pain, malnutrition, infection, compromised immune function, and exacerbations of medical disorders.

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Diseases of the Lips

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ICD-9: 528.5 ○ ICD-10: K13.0

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Angular Cheilitis (Perlèche)

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  • Associated with increased moisture at commissures, salivation (at sleep).

  • Predisposing factors: thumb sucking in children; sagging face and loss of teeth in older persons; candidiasis in immunocompromised persons; Staphylococcus aureus in atopic dermatitis and isotretinoin treatment.

  • Findings: erythema and maceration at commissures (see Fig. 33-1); white candidal colony.

  • Diagnosis: KOH for candidiasis; culture for S. aureus, Candida.

  • Management: Identify and treat causes.

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Figure 33-1.

Angular cheilitis Mild erythema and scaling in bilateral commissures. (Courtesy of Dr. Nathaniel Treister.)

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Actinic Cheilitis

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Actinic/solar keratoses, usually of the lower lip. Rule out squamous cell carcinoma in situ (SCCIN) or invasive if papule or nodule or ulcer occurs. (See “Solar Keratosis” in Section 10.)

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Conditions of the Tongue, Palate, and Mandible

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ICD-9: 528.6, 528.7, 529 ○ ICD-10: K14

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Fissured Tongue

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  • Normal variant in up to 11% of population. Asymptomatic.

  • Findings: Multiple folds with anterior-posterior orientation on the dorsal surface of the tongue (Figs. 33-2 and 33-3).

  • Associated disorders: Psoriasis, Down syndrome, acromegaly, Sjögren syndrome.

  • Synonyms: Lingua fissurata, lingua plicata, scrotal tongue, grooved tongue, furrowed tongue.

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Figure 33-2.

Fissured tongue Deep furrows on the dorsum of the tongue are asymptomatic.

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Figure 33-3.

Hairy tongue Defective desquamation of filiform papilla noted in posterior aspect of tongue. Tongue has a white surface due to retained keratin. (Courtesy of Dr. Nathaniel Treister.)

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Black or White Hairy Tongue

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  • Pathogenesis: Defective desquamation of filiform papillae resulting in hair-like projections on the dorsum of the tongue.

  • Associations: Heavy tobacco use, mouth breathing, systemic antibiotic therapy, poor oral hygiene, general debilitation, radiation therapy, chronic use of bismuth-containing antacids, lack of dietary roughage.

  • Symptoms: Gagging sensation, altered taste, halitosis, cosmetic disfigurement.

  • Findings: Furry plaques on dorsal tongue (Fig. 33-3). Chromogenic bacteria or exogenous pigment stain tongue: white, yellow, green, brown, black. Candidiasis may occur secondarily.

  • Management: Eliminate predisposing factors; good oral hygiene.

  • Synonym: Lingua villosa (nigra).

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Oral Hairy Leukoplakia

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