Mouth disease

"Maxillofacial disorder" redirects here. For the surgery, see Maxillofacial surgery. For certain abnormalities of the face and/or cranium, see Craniofacial abnormality.

Mouth disease
Classification and external resources
ICD-10	K00-K14
ICD-9	520-529
MeSH	D009057

Stomatognathic disease or mouth disease refers to the diseases of the mouth ("stoma") and jaw ("gnath"). It is the term used by MeSH (along with the synonym dental diseases), but other organizations use different terms.

The mouth is an important organ with many different functions. It is also prone to a variety of medical and dental disorders.

The clinical evaluation and diagnosis of oral mucosal diseases are in the scope of oral & maxillofacial pathology specialists and oral medicine practitioners, both disciplines of dentistry. When a microscopic evaluation is needed, a biopsy is taken, and microscopically observed by a pathologist. The American Dental Association uses the term oral and maxillofacial pathology, and describes it as "the specialty of dentistry and pathology which deals with the nature, identification, and management of diseases affecting the oral and maxillofacial regions. It is a science that investigates the causes, processes and effects of these diseases."

The World Health Organization uses the term "Diseases of oral cavity, salivary glands and jaws."

Oral and maxillofacial pathology

Oral and maxillofacial pathology, also sometimes termed oral pathology, is a speciality involved with the diagnosis and study of the causes and effects of diseases affecting the oral and maxillofacial regions (i.e. the mouth, the jaws and the face). It can be considered a speciality of dentistry and pathology. Oral pathology is a closely allied speciality with oral and maxillofacial surgery, oral surgery and oral medicine.

Training

United Kingdom

There are less than 30 oral pathologists in the UK. No medical degree is mandatory, only a dental degree. The shortest pathway to becoming a oral pathologist in the UK is completion of 2 years general professional training and then 5 years in a diagnostic histopathology training course. After passing the required exams and gaining a Certificate of Completion of Specialist Training, the trainee is entitled to apply for registration as a specialist.

Examples of conditions which can involve the mouth

Infections

Bacterial infections

Scarlet fever

Scarlet fever is caused by streptococci species, and starts as tonsilitis and pharyngitis before involving the soft palate and the tongue. It usually occurs in children where a fever occurs and a rash develops on the skin. It is treated with penicillin and the prognosis is generally excellent.

Viral infections

Herpes simplex virus

Another very common disorder of the oral cavity is infection with herpes simplex virus (HSV). This virus can cause blisters and sores around the mouth (gingivostomatitis) and lips (herpes labialis). HSV infections tend to recur periodically. Although many people get infected with the virus, only 10% actually develop the sores. The sores may last anywhere from 3–10 days and are very infectious. Some people have recurrences either in the same location or at a nearby site. Unless the individual has an impaired immune system, e.g., owing to HIV or cancer-related immune suppression, recurrent infections tend to be mild in nature and may be brought on by stress, sun, menstrual periods, trauma or physical stress.

Mumps

Mumps of the salivary glands is a viral infection of the parotid glands. This results in painful swelling at the sides of the mouth in both adults and children. The infection is quite contagious. Today mumps is prevented by getting vaccinated in infancy. There is no specific treatment for mumps except for hydration and painkillers. Sometimes mumps can cause inflammation of the brain, testicular swelling or hearing loss.

Fungal infections

Oral candidiasis

Pseudomembranous candidiasis of the posterior mouth and oropharynx

Oral candidiasis is by far the most common fungal infection that occurs in the mouth. It usually occurs in immunocompromised individuals. Individuals who have undergone a transplant, HIV, cancer or use corticosteroids commonly develop candida of the mouth and oral cavity. Other risk factors are dentures and tongue piercing. The typical signs are a white patch that may be associated with burning, soreness, irritation or a white cheesy like appearance. Once the diagnosis is made, candida can be treated with a variety of anti fungal drugs.

Salivary gland diseases

There are both major and minor salivary gland in the mouth which secrete saliva and a variety of enzymes to help process foods and make swallowing easy. These salivary glands can get infected or inflamed and can also be very painful; sometimes the salivary glands also develop benign and malignant cancers. However, the most common problem with salivary gland is formation of stones in the small ducts which prevent free flowing of saliva. The gland swells as they cannot empty and often get infected. While most stones in the duct may resolve, sometimes surgery and antibiotics are required.

Mucosal disease

Aphthous stomatitis

2 minor aphthae on the lower labial mucosa

Aphthous stomatitis is a condition where ulcers (canker sores) appear on the inside of the mouth, lips and on tongue. Most small canker sores disappear within 10–14 days. Canker sores are most common in young and middle aged individuals. Sometimes individuals with allergies are more prone to these sores. Besides an awkward sensation, these sores can also cause tingling or a burning sensation. Unlike herpes sores, canker sores are always found inside the mouth and are usually less painful.^{[citation needed]} Good oral hygiene does help but sometime one may have to use a topical corticosteroid.

Geographic tongue

Geographic tongue

Migratory stomatitis is a condition that involves the tongue and other oral mucosa. The common migratory glossitis (geographic tongue) affects the anterior two thirds of the dorsal and lateral tongue mucosa of 1% to 2.5% of the population, with one report of up to 12.7% of the population. The tongue is often fissured, especially. in elderly individuals. In the American population, a lower prevalence was reported among Mexican Americans (compared with Caucasians and African Americans) and cigarette smokers. When other oral mucosa, beside the dorsal and lateral tongue, are involved, the term migratory stomatitis (or ectopic geographic tongue) is preferred. In this condition, lesions infrequently involve also the ventral tongue and buccal or labial mucosa. They are rarely reported on the soft palate and floor of the mouth.

Oral cancer

An example of oral cancer.

Oral cancer may occur on the lips, tongue, gums, floor of the mouth or inside the cheeks. The majority of cancers of the mouth are squamous cell carcinoma. Oral cancers are usually painless in the initial stages or may appear like an ulcer. Causes of oral cancer include smoking, excessive alcohol consumption, exposure to sunlight (lip cancer), chewing tobacco, infection with human papillomavirus, and hematopoietic stem cell transplantation. The earlier the oral cancer is diagnosed, the better the chances for full recovery. If you have a suspicious mass or ulcer on the mouth which has been persistent, then you should always get a dentist to look at it. Diagnosis is usually made with a biopsy and the treatment depends on the exact type of cancer, where it is situated, and extent of spreading.

Others

Burning mouth syndrome

Burning mouth syndrome (BMS) is a disorder where there is a burning sensation in the mouth that has no identifiable medical or dental cause. The disorder can affect anyone but tends to occur most often in middle aged women. BMS has been hypothesized to be linked to a variety of factors such as the menopause, dry mouth (xerostomia) and allergies. BMS usually lasts for several years before disappearing for unknown reasons. Other features of this disorder include anxiety, depression and social isolation. There is no cure for this disorder and treatment includes use of hydrating agents, pain medications, vitamin supplements or the usage of antidepressants.

Halitosis

Bad breath (halitosis) is a sign or a symptom rather than a specific pathology. It has many causes including smoking, alcohol, poor care of dentures, gum disease, chronic lung disease, breathing through the mouth, sinusitis, liver disease, diabetes, pregnancy, not brushing or flossing on a regular basis. Medications that cause dryness in the mouth can also cause bad breath. These include antidepressants, anti histamines and antipsychotics. The best way to prevent bad breath is to brush teeth frequently, clean the tongue, keep the nose and sinus clean and drink adequate water.

External links

• British Society of Oral & Maxillo-facial Pathologists Website
• Academy of Oral and Maxillofacial Pathology Website