- Oral mucosa covers and protects tissues beneath it and conveys sensory information from the surface.
- Normal function is required for mastication, deglutition, chemosensory function, phonation.
- Structures of mouth: lips, oral mucosa, gingivae, tongue, palate, teeth.
- Impaired oral mucosal health causes pain, malnutrition, infection, compromised immune function, and exacerbations of medical disorders.
ICD-9 : 528.5 • ICD-10 : K13.0
Angular Cheilitis (Perlèche)
- Intertrigo. Associated with increased moisture at commissures.
- Predisposing factors: thumbsucking in children; sagging face and loss of teeth in older persons; candidiasis in immunocompromised persons; S. aureus in atopic dermatitis and isotretinoin treatment.
- Findings: erythema and maceration at commissures (see Fig. 25-29); white candidal colony.
- Diagnosis: KOH for candidiasis; culture for S. aureus,Candida.
- Management: Identify and treat causes.
Actinic/solar keratoses, usually of the lower lip. Rule out squamous cell carcinoma in situ or invasive if papule or nodule or ulcer occur. (See “Solar Keratosis,” Section 10.)
ICD-9 : 528.6, 528.7, 529 • ICD-10 : K14
- Normal variant in up to 11% of population. Asymptomatic.
- Findings: Multiple folds with anterior-posterior orientation on the dorsal surface of the tongue (Figs. 34-1, 34-2).
- Associated disorders: Psoriasis, Down syndrome, acromegaly, Sjögren syndrome.
Synonyms: Lingua fissurata, lingua plicata, scrotal tongue, grooved tongue, furrowed tongue.
Fissured tongue Deep furrows on the dorsum of the tongue are asymptomatic.
Hairy and fissured tongue A 57-year-old healthy male. Tongue has a white surface due to retained keratin. A midline fissure is also present.
Black or White Hairy Tongue
- 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. 34-2). 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)
- Pathogenesis: Epstein-Barr virus infection; low CD4 cell counts.
- Findings: White corrugated plaques on lateral aspects of tongue (see Fig. 31-3). Does not occur in successfully treated HIV/AIDS....