Other name for glossodynia
burning mouth syndrome
no identifiable one etiology
Neurological etiologies for glossodynia? (4)
- peripheral nerve damage
- diabetic neuropathy
- trigeminal neuralgia
- acoustic neuroma
Psychiatric etiologies for glossodynia? (5)
- possibly psychological b/c no change in the histology
- somatoform disorder
- depression/anxiety
- cancerophobia
- OCD
Systemic etiologies for glossodynia? (6)
- sjogren syndrome
- anemia (iron deficiency, pernicious)
- nutritional deficiency
- GERD
- hypothyroidism
- AIDS
Oral etiologies for glossodynia? (7)
- xerostomia
- geographic/fissured tongue
- vesiculobullos disease
- Temporomandiular dysfunction
- Vesiculobullous disease
- Referred pain from teeth/tonsilitis
- Drugs: antibiotics, psychiatric meds, chemotherapy
What are the disorders of the tongue? (13)
- Glossodynia
- Macroglossia
- Glossitis
- Geographic tongue
- Fissured Tongue
- White/Black Hairy Tongue
- Oral Hairy Leukoplakia
- Candida
- Prominent circumvallate paillae
- Oral tonsil/lingual tonsil
- Lingual Varicosities
- Fibroma
- Cancer
What are the disorders of the salivary glands? (5)
- Xerostomia
- Mucocele
- Multiple Mucoceles
- Ranula
- Diffuse Parotid Gland Enlargement
What are the disorders of the gingiva and periodontium? (4)
- Papillon-lefevre syndrome
- Erosive Gingivostomatitis (desquamative gingivitis)
- Lichen Planus
- Lichenoid Mucositis
What are the disorders of the lips?
- Actinic Cheilitis
- Angular Cheilitis
- Cheilitis Glandularis
- Chelilitis Glandularis Apostematosa
- Exfoliative Cheilitis (factitious cheilitis)
Symptoms/signs of glossodynia?
- burning discomfort/pain
- irritation
- rawness
Somatoform glossodynia usually occurs…
in the afternoon when patients have high anxiety
What is sjogren syndrome?
- autonomic disease
- destroys parotid and lacrimal gland
- tissue volume decreases but gland is enlarged from inflamation
- dry mouth & dry eyes
- can be any gland
How do you test for sjogren syndrome?
-check for autoantibodies
How do you test for glossodynia?
all diagnostic test are normal but may have complications
Is macroglossia congenital or acquired?
both
What is macroglossia?
tongue is disproportionately large relative to the patient’s jaw size
What complications occur with macroglossia? (2)
- difficulty with mastication and speech
- accidental tongue biting
Differential diagnosis for macroglossia? (5)
- Down syndrome
- hypothyroidism
- Beckwith-Wiedemann syndrome
- Neurofibromatosis
- infection by mycobacteria/ filamentous bacteria
What is hypogeusia?
lack of taste
What is dysgeusia?
reduced taste
What is glossitis? (3)
- pain
- irritation/burning
- hypogeusia/dysgeusia
What are the types of glossitis? (3)
- Atrophic glossitis
- Moeller/Hunter glossitis
- Median Rhomboid Glossitis
What is atrophic glossitis?
-filiform depapillation
Can either be:
1. mild patchy erythema
2. smooth atrophic beefy-red surface
Etiology of atrophic glossitis? (4)
- Deficiencies: pernicious anemia (lateral aspect of tongue) protein, other nutritional
- Chemical irritants/drug reactions
- amyloidosis, sarcoidosis, vesiculobullous diseases
- oral candidiasis/ systemic infections
What is moeller/hunter glossitis? (2)
- pernicious anemia
- affects lateral aspects and top of tongue
What is Median Rhomboid Glossitis?
-atrophic disorder of tongue secondary to candida
What is geographic tongue? (3)
- benign inflammatory condition
- loss of filiform papillae
- forms erythematous plaques with annular / serpiginous well demarcated white border
Etiology of geographic tongue? (8)
- Psoriasis, Reiter syndrome
- Atopic dermatitis
- Diabetes mellitus, anemia, hormonal disturbances
- Down syndrome, lithium therapy
What is fissured tongue?
- furrowed, scrotal or grooved tongue
- numerous small irregular fissures oriented laterally on the dorsal tongue
Fissured tongue is seen in what percentage of individuals?
5-11%
Fissured tongue can be seen in these disorders:
- Melkersson-rosenthal syndrome
- psoriassis
- downsyndrome
- acromegalgy
- sjogren syndrome
What is melkersson-rosenthal syndrome?
granuloamatosis disease with specific inflamation
What symptoms do those with melkersson-resenthal syndrome have? (3)
- Fissured tongue
- Peripheral Facial Paralysis
- Oral Facial EDEMA
What is white/black hairy tongue?
Hypertrophy of filiform paillae which looks like hair
etiology of white/black hairy tongue? (7)
- debilitated patients
- tobacco
- antibiotics
- poor oral hygiene
- mouth breathing
- radiation
- bismuth antacids
What colors can black/white hairy tongue be? (5)
- white
- yellow
- green
- brown
- black
The colors from white/black hairy tongue are due to… (3)
- chromogenic bacteria OR
- staining OR
- exogenous sources
Etiology of oral hairy leukoplakia? (3)
- HIV patients with epstein barr virus
- organ transplant recipients
- chemotherapy
What is oral hairy leukoplakia? (3)
- asymptomatic
- corrugated white plaques
- accentuatuon of vertical folds on lateral borders of tongue
What is prominent circumvallate papillae disorder of the tongue? (2)
- uncommon, variation of normality - no treatment needed
- posterior dorsum tongue
What do circumvallate papillae look like?
large mushroom shaped
What is another name for oral tonsil?
lingual tonsil
What is oral tonsil? (2)
- common
- bilateraly raised reddish areas on the lateral tongue base
etiology of oral tonsil?
lymphatic tissue in tongue
Differential diagnosis of oral tonsil? (2)
- oral SCC
* the bilateral location occurrence establishes correct diagnosis without biopsy
What is lingual varicies? (4)
- common
- older people
- distended vessels on lingual tongue surface
- no treatment needed
What is a fibroma?
tumor found on tongue
What is xerostomia? (2)
- dry mouth
- decreased saliva prodution
Which sex is more affected by xerostomia?
females are twice as likely than men
Etiology of xerostomia? (7)
- medications
- medical conditions
- granulomatous inflammation
- dehydration
- treatments
- old age
- periodontal disease
etiology involving medicines for xerostomia? (3)
- antidepressants
- antihistamines
- diuretics
etiology involving medical conditions for xerostomia? (5)
- parkinsons
- diabetes
- anemia
- cystic fibrosis
- rheumatoid arthritis
etiology involving granulomatous inflammation for xerostomia? (3)
- tuberculosis
- sarcoid
- sjogren syndrome
- HIV
- amyloid
etiology involving dehydration for xerostomia? (7)
- fever
- excessive sweating
- vomiting/diarrhea
- blood loss
- burns
- smoking
- tea/coffee
etiology involving treatments for xerostomia? (2)
- Radiation Therapy of head and neck
- surgical removal of the salivary glands
Signs and symptoms of xerostomia? (9)
- halitosis
- altered taste / smell
- difficulty swallowing
- dry/cracked lips
- increased thirst
- heavy plaque /salivary calculi
- recurrent yeast infections
- burning sensation
- difficulty wearing dentures
What is mucocele? (3)
- mucous retention cysts
- benign painless
- dome shaped fluctuant papules
etiology of mucocele?
trauma/obstruction of minor salivary gland ducts
Multiple mucoceles etiology? (5)
- immunosuppresive diseases
- sjogren syndrome
- graft vs host disease
- lichen planus
- cicatrical pemphigoid
What is ranula?
- large blue/translucent fluctuant mass
- on floor of mouth
ranula etiology? (2)
obstruction of :
- submandibular duct OR
- sublingual duct
What is diffuse parotid enlargement?
-inflamed and destroyed parotid gland
diffuse parotid enlargement etiology? (2)
- acute mononucleosis
- HIV
What is papillon-lefevre syndrome?
- severe destructive periodontal disease
- exfoliation of adult and primary teeth
What is another name for erosive gingivostamatitis?
desquamative gingivitis
What is erosive gingivostamatitis?
- inflammation and erythema of the gingiva
- non specific pattern
Etiology of erosive gingivostomatitis?
- virus
- autoimmune
- inflammatory and blistering disorder
What is lichen planus?
- painful OR asymptomatic lacy white patches/plaques/papules
- erosions / ulcerations
*ask patient about DRUG CONSUMPTION
What is the etiology of Lichenoid Mucositis?
- similar to lichen planus
- NSAIDs
- antihypertensive medication
- contact allergy
- GVHD
What is the most common cause of oral ulcerations?
oral aphthous disease
What is oral aphthous disease?
acute, recurrent, painful ulcers
Where does oral aphthous disease occur?
nonkeratinizaed mucousa
What do the ulcers in oral aphthous disease look like?
gray or yellow pseudomembrane and erythematous margin
What percentage of the population is affected by oral aphthous disease?
30%
What is the natural history of oral aphthous disease?
spontaneous healing
Etiology of oral aphthous disease?
- herediatary
- emotional
- allergy
- decreased mucosal barrier integrity
- hematologic & immunologic disorders
What conditions are associated with oral aphthous disease? (4)
- hematinic deficiency (iron, folic acid, vit b12)
- GI malabsorption: celial, crohns, pernicious anemia, herpetiformis, dermatitis
- lupis erythematosus
- reactive arthritis
- HIV/Behcet’s disease
- PFAPA
- MAGIC
What is behcet’s disease?
- associated with oral aphthous disease
- Ulcers in different places (mouth, genitals and the eyes).
- vascularities and inflammation
What is PFAPA?
- associated with oral aphthous disease
- Periodic Fever Aphthous stomatatis Pharyngitis and cervical Adenitis
What is the etiology for PFAPA?
-unknown
What is MAGIC?
- associated with oral aphthous disease
- Mouth And Genital ulcers with Inflamed Cartilage
What is the etiology for MAGIC?
unkown
Treatment for oral aphthous stomatitis? (8)
- unclear if effective because heals in 5 days naturally
- chlorhexidine
- benzyledamide
- carboximetilcelulose (pain+inflamation): lidocaine,steroids
- sucralfate
- pentoxyphilin, colchicin thalidomide
- immunosuppresants
Major criteria for behcets disease? (2)
- oral aphthae
- genital ulcers
Minor criteria for behcets disease? (4)
- Proteinuria + haematuria
- Thrombophlebitis
- Aneurysms
- Arthralgias
Behcet’s disease occular (3)
- iridocyclitis
- retinal vasculitis
- optic atrophy
Behcet’s disease dermatological (3)
- pustules
- erythema nodosum
- pathergy
Behcet’s disease CNS lesions (5)
- meningoencephalitis
- cerebral infarction
- cranial nerve palsies
- cerebellar and spinal cord lesions
- psychosis
What is leukoedema? (4)
- common
- benign generalized whitening of buccal mucosa
- african americans
- no treatment needed
What is white sponge nevus? (4)
- uncommon
- inherited: autosomal dominant
- white thickening/folded/corrugated buccal mucosa (bilateral in mouth and floor of mouth)
- no treatment needed
What two disorders cause whitening of the buccal mucosa? (2)
- leukoedema (benign, common)
- white sponge nevus (autosomal dominant, uncommon)
Where does white sponge nevus occur? (3)
- buccal mucosa
- both sides of mouth
- can be on the floor of mouth also
What is actinic cheilitis? (5)
- premalignant
- affects lower lip - vermillion border
- edematous and erythematous
- later: atrophic, white, scaly plaques
- ulceration/induration (biopsy to rule out malignancy)
What is the etiology of actinic cheilitis?
chronic UVR exposure
What is another name for angular cheilitis?
perleche
What is angular chelitis? (3)
- PAINFUL
- inflammatory reaction, erythema, maceration at angles of mouth
- fissuring & crusting may be present
What are the predisposing factors of angular chelitis?
- advanced age
- ill-fitting dentures
- thumb-sucking in children
- oral Candidiasis + bacterial infections
What is cheilitis glandularis? (3)
- PAINLESS
- inflam. enlargement of lower lip (sometimes upper)
- elderly men
Etiology of chelitis glandularis? (4)
- actinic damage
- bacterial infection
- tobacco esposure
- chronic irritation
What is Cheilitis Glandularis Apostematosa?
- PAINFUL enlargment and eversion of lip
- erosions
- recurrent bacterial infections
- malignant transformation
What is another name for Exfoliative chelitis?
Factitious chelitis
What is exfoliative chelitis?
- chronic superficial inflammation of vermillion border of lips
- persistent scaling
What disorders affect the vermillion border of lips?
- exfoliative chelitis
- actinic chelitis
etiology of exfoliative chelitis? (3)
low temperature
dryness
lip sucking/chewing/manipulation