General practitioner's pathology case 6.
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As part of a larger study aimed at surveying the clinical, histological and immunohistochemical features of filiform atrophy and geographic and fissured tongue, this work presents the clinical findings of three patient groups and controls. 200 individuals were examined; 18 (9%) had atrophic tongue, 15 (7.5%) geographic tongue and 53 (26.5%) fissured tongue; further, 12 (6%) had hyperkeratotic lesions of the tongue and 102 (51%) subjects had no tongue lesions. According to the anamnestic information, patients with atrophic or geographic tongue seemed to have a stronger tendency toward allergy than subjects in other groups, while patients with atrophic tongue had more abnormalities of the heart and circulatory system. These tongue forms did not show any association with smoking or drinking habits, but hyperkeratotic lesions (leukoplakia, lichen planus, hairy tongue) of the tongue were clearly associated with moderate and heavy smoking. Atrophic, geographic and fissured tongue seem to be specific changes of the lingual mucosa; patients with these changes did not have more changes elsewhere on the oral mucosa than the controls. Patients with atrophic tongue had lowered rates of saliva secretion. Histologically, heavy inflammation was noted in fissured tongue. In geographic tongue, inflammation was moderate and in atrophic tongue often only mild. Each tongue form seems to have its own typical histological morphology.
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This article discusses the approach to diagnosis and management of disorders of the tongue. These disorders include glossodynia, geographic tongue and smooth tongue, fissured tongue, and black hairy tongue and furred tongue. A brief review of the examination of the tongue is also included.
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The field of oral medicine is fundamental to the practice of general medicine as well as dentistry, oral surgery, and other special fields of medicine concerned with diseases of organs beneath the oral cavity. Disorders of the oral mucosa may reflect many dermal and internal diseases, and may focus the physician's diagnostic attention to systemic pathological conditions which otherwise could be misdiagnosed. As to their morphological appearance, however, the oral mucosa shows other forms of reactivity than the skin. When the dermal and oral manifestations of many skin diseases are compared the influence of distinct local factors on the intraoral clinical picture becomes evident. This comparative view, as well as the dermatologist's practical experience that many dermatoses either spread to, or even are restricted to the oral mucosa, may explain why most dermatologists are very interested in oral diagnosis. In this report, the interdisciplinary view and some aspects of clinical stomatology are stressed which are of actual interest in oral diagnosis and therapy. The following topics are dealt with: Diseases with aphthous lesions, Allergic reactions to drugs, Pemphigus and pemphigoid disorders, Oral infections by Candida albicans, Melkersson-Rosenthal syndrome, Lingual anomalies of different types, Leukoplakias.
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Lesions of the oral mucosa are frequently described in association with psoriasis, particularly in the pustular type. Controversy surrounds the question whether mucosal lesions can be considered as oral manifestation of psoriasis. Two patients presented with concurrent pustular psoriasis and mucosal lesions with the characteristic picture of geographic tongue. Histopathology of the mucosa showed typical features of psoriasis such as marked acanthosis, clubbing of the rete ridges, focal parakeratosis and neutrophilic infiltrates. There was parallel improvement of the skin and the mucosal lesions with systemic retinoid treatment. On the basis of the histopathological features and the clinical course we favour the hypothesis that geographic tongue is an oral manifestation of pustular psoriasis.
A 66 year old patient presented with a nine month history of recurrent oral ulcerations involving the tongue. We diagnosed chancriform pyoderma and a previously not identified multiple myeloma with secondary immunoglobulin deficiency. Clinically and histologically we excluded a necrotizing ulcerative stomatitis as found in individuals with cellular immunodeficiency as in late-stage HIV-infection. On culture only Neisseria catarrhalis was found. Chancriform pyoderma is often associated with local bacterial infections, especially Staphylococcus aureus. The most common sites are the genitalia and periorbital region; involvement of the oral mucosa is uncommon. To the best of our knowledge, this is the fourth reported case with tongue lesions. The multiple myeloma-associated immunoglobulin deficiency might have facilitated the oral manifestations of chancriform pyoderma.
The oral complications of diabetes mellitus are generally considered to be no more than inevitable annoyances and, as such, have been the subject of relatively few scientific and clinical studies. This review highlights both the known correlations between oral disease and diabetes mellitus, such as those involving supporting tissues and oral mucosa, and those that are still a matter of debate, such as dental caries. In all cases, we carefully analyzed the pathogenesis of the disorder with a view to establishing a possible therapeutic approach, an aspect that currently appears to be overlooked. In view of the fact that the treatment of certain oral conditions, in particular periodontal disease, has been reported to improve metabolic control in diabetic patients, we conclude that diabetes mellitus-related oral diseases deserve adequate recognition and further investigation.
Data on the prevalence of adverse effects from dental cast alloys and on the characteristics of the related patient groups are scarce. Therefore, the aim of the present study was to investigate patients in a defined part of Germany attributing oral complaints or symptoms to dental cast alloys. All dentists in the area of Eastern Bavaria (with 1 million inhabitants) were asked to send corresponding patients to our department during a 3-year period. Out of this collection, patients with complaints or symptoms in the oral cavity were recruited and characterized with regard to number, age and sex distribution, type of subjective complaints and objective intraoral symptoms, and allergy status based on an alloy analysis. Patients reporting to our department with suspected local adverse effects from dental cast alloys represented 0.01% of the population. Thirty-four percent of the patients were 50-59 years old, with females prevailing (76%). A great variety of subjective complaints was reported, which mainly resembles those reported by patients with adverse effects attributed to other dental materials like amalgam or denture base materials. The main objective intraoral symptoms were gingivitis, anomalies of the tongue (lingua plicata, lingua geographica), discoloration of the gingiva, redness of the palate or tongue and lichenoid reactions of the oral mucosa. In not more than 10% of the patients, allergy was diagnosed as contributing to the complaints or symptoms.