Geographic Tongue

Geographic tongue is a benign, chronic condition of unknown cause. It is present in around 13% of the population and is more common in females.

As the name suggests in this condition there is a map-like appearance on the upper surface and sides of the tongue. It may occur in other areas of the mouth, as well.

Although geographic tongue may look alarming, it doesn't cause health problems and isn't associated with infection or cancer.

Clinical Features

• Erythematous areas with a white grey border (the irregular, smooth red areas are said to look like the outline of a map).
• The patches may vary in size, shape, and color.
• These patches come and go or change very quickly in days, weeks, or months
• Some patients report burning after eating certain food.
• Many people with geographic tongue have no symptoms.

Tooth Subluxation

A 27 year old male was seen in the emergency department following a trauma and bleeding from the mouth. On examination he was found to have teeth subluxation due to the trauma.

Tooth Subluxation. Note the presence of blood along the crevice of the gingival margin of both central incisors—an indication of subluxation following trauma. Mild displacement of the subluxated teeth is noted


Case Discussion: 
Tooth subluxation, the loosening of a tooth in its alveolar socket, is most commonly secondary to trauma; however, infection and periodontal disease may also produce subluxation.
Gingival lacerations and alveolar fractures are associated with dental subluxations. Gentle pressure to the teeth with a tongue blade or fingertip may produce movement, mild displacement, or blood along the crevice of the gingiva, all signs of subluxation.

A Patient With Black Discoloration of The Tongue

You are examining a a patient and discover the findings seen on the picture above. Which of the following conditions is this associated with?
A) Prolonged antibiotic use
B) Sjogren’s syndrome
C) Addison’s disease
D) Chronic gastroesophageal reflux
E) Malignant melanoma

The answer is

Description Of Mouth Ulcers With Pictures For Better Learning

Introduction: Ulceration in the  mouth is a common occurrence and it is important for the physician to distinguish between the simple benign ulcers from those which are malignant.

1. Traumatic: The diagnosis is usually obvious with the clinical history. Patients may have ill fitting dentures or sharp teeth. The ulcer usually heals when the precipitating cause is removed.

 

                                               Traumatic ulcer

2. Aphthous Ulcers: Patients present with small, painful ulcers, usually inside the cheeks or lips. They heal in about one week but others may occur while the initial ulcer is healing. It may be secondary to stress, inflammatory bowel disease or an underlying debilitating disease,
On examination they are white, small, circular, deep , painful ulcers with surrounding erythema.

                                                      Aphthous Ulcer

3. Infective: May be due to bacteria ( Acute ulcerative gingivitis), Viral ( herpes simplex), or fungal (Candidiasis) .

In Acute ulcerative gingivitis (also known as Vincent's angina) patients present with swollen gums with small ulcers, which may spread to the buccal mucosa. There may be bleeding from the gums along with constitutional symptoms like fever and malaise. There is associated tender lymphadenopathy.

                                                    Acute ulcerative gingivitis

Candidiasis is common and is seen in patients with diabetes, immunosuppresed states or debilitating

Disorders Of The Gum

Disorders of the gum are a common clinical finding and may be due to local disease or a manifestation of a systemic disease.

1. Bleeding From The Gums:
Causes include:

• Dental disease.
• Infection ( may be bacterial, viral or fungal) 
• Bleeding disorders.
• Use of anticoagulant drugs. 
• As a side effect of chemotherapy and radiotherapy. 

Clinical Features: Periodontal disease is probably the most common factor causing bleeding from the gums. Poor hygiene is usually obvious from the condition of the teeth . Infection may cause the patient to complain of red, inflamed gums, which bleeds spontaneously or on brushing the teeth. The patient may give history of malignancy for which they have undergone either chemotherapy with associated blood dyscariasis or local radiotherapy. 

2. Hypertrophy Of The Gums: 

Causes Include:

• Infection associated with dental disease
• Phenytoin
• Nifedipine 
• Cyclosporine

In Gingival hyperplasia the gum hypertrophy predominantly involves the interdental papillae.