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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, 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.

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ICD-9 : 528.5 • ICD-10 : K13.0

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Angular Cheilitis (Perlèche)

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  • 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.

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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 or invasive if papule or nodule or ulcer occur. (See “Solar Keratosis,”Section 10.)

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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. 34-1, 34-2).
  • Associated disorders: Psoriasis, Down syndrome, acromegaly, Sjögren syndrome.

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

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Figure 34-1
Graphic Jump Location

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

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Figure 34-2
Graphic Jump Location

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.

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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. 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.

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Synonym: Lingua villosa (nigra)

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Oral Hairy Leukoplakia

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(See Section 31)

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  • 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.
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