NK nestor d. Karas, DDS,MD
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Oral Pathology
 
What is Oral Pathology?
Oral and maxillofacial pathology is the specialty which deals with the identification, nature, and management, of diseases affecting your oral and maxillofacial reasons. Oral pathology investigates the causes, effects and processes of oral and maxillofacial diseases.
What are Signs of Oral and Maxillofacial Diseases?
Your gums should normally look smooth and coral pink in color. If you notice a change in this appearance, it could be an early development of a pathological process.
The most serious pathological disease is oral cancer. Here are some signs that could indicate the beginning of a pathologic process or cancer:
White and Red patches in the mouth (see Figure 1)
Sore(s) that bleed easily or fails to heal
Thickening or a lump on your gums inside your mouth
Difficulty swallowing or chewing
Constant sore throat or rasping
 
Figure 1: White patches (leukoplakia) and Red patches (erythroplasia)
You can notice these changes on your cheeks, lips, face, neck, tongue, palate, and gum tissue around your teeth. You may not experience pain with these signs.
Should I Check for Oral Pathologies?
You should check your mouth monthly and look for changes like the ones listed above. You should never ignore suspicious sores or lumps. Contact Dr. Karas immediately if you notice changes in and around your mouth.
Types of Oral Diseases
 
Burning Mouth/Tongue Syndrome:
What is it?
Burning mouth syndrome is characterized by an abnormal sensation of the lining of the mouth that patients describe as their mouth feels as though it has been scalded. Some patients may have a decreased ability to taste or everything tastes bitter or salty. The lining of the mouth appears normal.
What causes it?
There is no known cause. This disease is not related to anything serious, like cancer or AIDS. Also, this disease is not contagious.
How is it treated?
Unfortunately, there is no medically proven treatment for burning mouth syndrome.
How Long Does it Last?
Half of affected patients, the condition will resolve over time. However, there is no way of predicting how long the sensation will last.
Oral Candidiasis:
What is it?
Oral Candidiasis is an infection of the lining of the mouth caused by a yeast-like fungal organism, Candida albicans. The yeast uses the dead cells on the mouth’s lining for food. This organism also causes vaginal yeast infections.
Who gets it?
Candidiasis is most common in very young or older age groups.
What causes it?
Antibiotics kill off the competing bacteria in your mouth which makes it possible for the yeast to take over. Patients who wear dentures are more likely to have yeast in their mouths. Immune system problems can also cause a tendency for yeast infection.
What are the symptoms?
You may notice a burning or itching sensation. However, the yeast infection can be asymptomatic.
What does it look like?
You may notice a red or white appearance to the lining of the mouth. The corners of the mouth may also show redness or cracking. There is a type of candidiasis that appears as white flecks resembling cottage cheese.
How is it treated?
Antifungal drugs are used to treat this infection. For people who wear dentures, the dentures must be disinfected by soaking them over night in a mild bleach solution. Do not put partial dentures in a bleach solution – there is a special disinfecting solution for partial dentures.
Cicatricial Pemphigoid:
What is it?
Cicatricial pemphigoid is an uncommon blistering disease that affects the mucous membranes (the moist linings of the mouth, eyes, nose, throat, and vagina). This disease begins in one or two areas and can spread to other areas if left untreated.
Who gets it?
This condition primarily affects middle-aged or older adults, and is more common in women than men.
Can I spread this disease?
No, this condition is an unusual allergic reaction. The body is actually allergic to itself, the immune system is destroying invading organisms and in confusion starts attacking the lining tissues of the body itself.
Why do I need to diagnose pemphigoid?
The most serious issue with this disease is possible blindness if the lining of the eye is concerned. The word “cicatricial” means scarring, the scarring that results can lead to blindness if not diagnosed early and treated properly. About one in four people will develop pemphigoid in their eyes.
How is it treated?
Drugs that suppress the immune reaction are commonly used for treatment. Pemphigoid cannot be cured. The symptoms can be controlled with the right medication. The goal of your treatment is to ensure the sores and blisters are under control so you can lead a normal life.
Geographic Tongue:
What is it?
Geographic tongue is seen as reddened areas on and around the sides of the tongue. These areas usually have a white/yellow-white, raised line around the edges. The tongue is often sensitive (a scalded feeling) to spicy, hot, or acidic foods.
What causes it?
No one knows the cause, but we do know it is not a serious problem.
Is it contagious?
Anyone can develop geographic tongue, but because we know this is not any sort of infection, it is not contagious.
 
Is there a cure?
No, most patients will experience this condition as a mild irritation.
Hairy/Coated Tongue:
What is it?
This is a harmless condition, but can be annoying and is seen rather often. Patients with this condition are almost always adults (men or women).
What causes it?
Keratin, which is dead skin cells (the same material that forms our hair and fingernails) forms at the top of our tongues and is normally knocked off and swallowed when we eat. Normally the amount of keratin produced balances with the amount knocked off. However, sometimes this balance is upset and the condition known as “coated tongue” results. Keratin may not be knocked off as quickly as seen with denture wearers who consume a softer, less abrasive diet. Some people will develop this problem because the produce too much keratin which is due to an irritation of the tongue due to smoking tobacco or drinking hot beverages. The accumulation of keratin on taste buds gives the tongue a “hairy” appearance.
What’s the difference between coated and hair tongue?
The only difference is the degree of keratin accumulation; coated tongue, the accumulation is not as severe as hairy tongue.
 
Is it contagious?
No, this is not an infection.
Is there a cure?
The most effective treatment is daily use of a tongue scraper. Also, stopping any habits that increase the production of keratin by causing irritation can also reduce the problem.
Leukoplakia:
What is it?
Leukoplakia is white patches in the mouth which cannot be rubbed off or diagnosed as any other condition or disease. This disease is important because over time these white patches will transform to oral cancer.
Who gets it?
Leukoplakia is most commonly found in older men, but women can also develop this problem. This condition is very uncommon in people under the age of 40.
What causes it?
A direct cause cannot be identified; however, many patients diagnosed with leukoplakia use tobacco, usually in the form of cigarettes. Often a biopsy is needed to diagnose this problem.
How is it treated?
A biopsy will determine whether leukoplakia is precancerous or not. A number of factors determine the treatment of leukoplakia. If the leukoplakia is diagnosed as “mild” we recommend that the patient stop smoking and the linking re-evaluated periodically. For those diagnosed with a “moderate” or severe” condition, the white patch needs to be removed to prevent the development of oral cancer. Removal can be done using a traditional scalpel excision, liquid nitrogen application, electrocautery, or laser surgery.
 
In most cases leukoplakia are cured once they are removed. However, sometimes lesions can grow back. For those patients who smoke, the chance of leukoplakia returning is increased. We always recommend periodic re-evaluation.
Lichen Planus:
What is it?
Lichen planus is a benign condition that the lining or the skin of the mouth. Sometimes both areas will be affected. This condition is not caused by infection or any identifiable habit (foods, smoking, etc.). We believe the immune cells are attacking the skin or mouth lining.
What does it look like?
Lichen planus appears small, red-purple, itchy, flat-topped bumps that arise in clusters on the skin. In the mouth it can look like white lines that appear on the inside of the cheeks commonly, or less commonly will form as painful sores on the cheeks, tongue, and gums.
Who gets it?
This is most common in patients between the age of 30 and 60, and men are affected slightly less than women.
Can it be cured?
Because this condition is not an infection, antibiotics are ineffective. We can however, control the symptoms using a powerful topical surface anti-inflammatory drug. We recommend starting treatment by applying only a small amount of the medication to the areas that are uncomfortable at least four times a day, especially after meals and at bedtime. Medicine application should reduce once the sores start to heal and medication should be stopped completely once you feel comfortable.
Aphthous Ulcerations:
What is it?
Recurrent aphthous ulcerations (“canker sores”) are a common condition that affects the tissue lining of the mouth. Patients typically develop one to five very painful sores that last 10 – 14 days.
Who gets it?
Anyone can develop these lesions.
Is it contagious?
Recurrent aphthous ulcerations is not contagious. This condition is frequently confused with herpes. All research has shown that this condition is not related to any bacterial, viral, or fungal infection. These lesions are like an allergic reaction, but the body is sort of allergic to itself. The immunes system gets confused and starts to attack the body itself. Some patients relate the onset of the lesions to things like stress, the menstrual cycle, or minor injury to the lining of the mouth.
How are they treated?
A medication similar to cortisone, only much stronger needs to be used at the earliest sign of the lesion development at least four to five times per day.
Can they be cured?
No, but the frequency of the attacks can be reduced once the cycle of lesions has been interrupted by treatment.
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This material does not constitute medical advice. It is intended for informational purposes only.Please consult a physician or dentist for specific treatment recommendations.