Diseases of the Mouth & Salivary Glands

1. Diseases of the Mouth & Salivary Glands

2. Causes of Oral Ulceration • Aphthous: • Idiopathic • Pre-menstrual • Infection: • Fungal e.g. Candidiasis • Bacterial e.g. Vincent’s angina, Syphilis • Viral e.g. herpes simplex • GIT diseases: • Crohn’s disease • Celiac disease • Dermatological conditions: • Lichen planus dermatitis herpetiformis • Pemphiguserythemamultiformi • Pemphegoid

3. Causes of Oral Ulceration - cont. • Drugs: • Hypersensitivity e.g. Steven’s Johnson syndrome NSAID losartan ACE inhibitor cytotoxic • Systemic diseases: • SLE • Behcet’s disease • Neoplasia: • Carcinoma • Leukemia • Kaposi’s Sarcoma

4. Oral ulceration in patient with aplastic anemia

5. Aphthous ulceration

6. Deep ulcers in patient with Behcet Disease

7. Oral thrush

8. Chronic oral candidiasis Acute oral candidiasis

9. Herpes Simplex

10. Angular Stomatitis & atrophic glossitis in patient with IDA Angular Stomatitis

11. Stevens Johnson’s syndrome

12. Lichen planus

13. Peutz Jegher syndrome

16. Scurvy

17. Gingival hypertrophy due to phenytoin therapy

18. Lead poisoning

19. Yellow staining of teeth due to Tetracyclin therapy

20. Gastro-Esophageal Reflux Disease

21. Definitions • Gastro-Esophageal Reflux Disease (GERD): • It is a chronic disorder which describes any symptomatic or histopathologic alteration resulting from episodes of gastro-duodenal reflux into the esophagus and/or adjacent organs more than twice/week for more than 2 months

22. ERD Erosive Reflux Disease 1/3 NERD Non Erosive Reflux Disease 2/3 Definitions

23. Symptoms • Typical: • Heartburn • Acid regurgitation • > 2x/week • > 4 to 8 weeks

24. Esophageal: Non-cardiac chest pain Non-obstructive dysphagia Globus hystericus Pulmonary: Asthma Chronic cough Hemoptysis Bronchitis Bronchiectasis Recurrent pneumonia Symptoms-Atypical

25. Otorhinolaryngological: Hoarseness Throat cleaving laryngitis Sinusitis Otolagia Oral Etching of dental enamel Halitosis Symptoms-Atypical

26. Epidemiolgy

27. Shubbar & Taka

28. Increasing Prevalence: • 197615% • 198844%

29. Pathogenesis • Transient lower esophageal sphincter (LES) relaxation • Hypotensive LES • Delayed Esophageal clearance • Delayed gastric emptying • Salivary function • Tissue resistance

30. Diagnosis

31. 1-History • Age • Alarm features • Dysphagia • Odynophagia • Weight loss • GI bleeding • Nausea &/or vomiting • Family history of cancer • Nocturnal reflux

32. Indications: Age over 40 years-old Alarm features Atypical symptoms Useful in: Grading Hiatus hernia Ulcer or stenosis Barrett’s Esophagus Endoscopy -ve endoscopy is seen in 2/3 of GERD

33. 24 hrs pH Recording • Indications: • Atypical symptoms • NERD who do not respond to PPI • When esophagitis is not demonstrated in the pre-operative endoscopic examination . IMPEDANCE testing

34. Management

35. Symptoms Antacids/Alginates Proton pump inhibitor Full dose Good response Poor response Proton pump inhibitor Maintenance dose Reconsider diagnosis Consider pH Monitoring H2 receptor Antagonists Normal Fundoplication Antacids

36. Behavioral modifications in the treatment of GERD • Elevation of the headboard of the bed (15 cm) • Ingestion of the following foods in moderation & based on symptom correlation: fatty foods, citrus, coffee, chocolate, alcoholic & carbonated beverages, mint, tomato-based products.

37. Behavioral modifications in the treatment of GERD • Special care with at risk medications: anticholinergics, theophylline, tricyclic antidepressants, Ca channel blockers, B-Adrenergic agonists, alendronate. • Avoidance of lying down for 2 hrs after meals • Avoidance of large meals • Drastic reduction in, or cessation of, smoking. • Reduction of body weight if overweight

38. Surgical treatment • Indications: • No response to medical treatment including atypical symptoms. • Continuous maintenance treatment is required especially in patients younger than 40 year old. • Financial impediment

39. Complications • Barrett’s esophagus • Stenosis • Ulcer • Bleeding