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  icon Rare
  icon Not so common
  icon Common
  icon Low morbidity
  icon Considerable morbidity
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Disorders of the Mouth: Introduction

  • 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.

Diseases of the Lips

ICD-9: 528.5 ○ ICD-10: K13.0

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.

Figure 33-1.

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

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.)

Conditions of the Tongue, Palate, and Mandible

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

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.

Figure 33-2.

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

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.)

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).

Oral Hairy Leukoplakia

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