Mouth Soreness

INTRODUCTION

Key facts and checkpoints

• Dental trauma or neglect is an important cause of many oral mucosal disorders, such as ulceration, bleeding gums and hyperplasia

• Non-healing oral ulcers warrant biopsy to exclude SCC

• If oral mucosal carcinoma is suspected, palpate the lesions to check for induration or a firm discrete edge and check regional lymph nodes

• Persistent erythroplasia or leukoplakia persisting for >3 wks after injury (e.g. sharp tooth surface or partial denture) should be biopsied

• Consider EBV infection with unusual faucial ulceration and petechial haemorrhages of soft palate

• Recurrent aphthous ulceration ( 38) is the most common oral mucosal disorder

GINGIVITIS

Features

• Red, swollen gingivae adjacent to teeth (see Fig. M1)

• Bleeds with gentle probing

• Halitosis

• Usually no pain

• Dental plaque accumulation with calculus (bacterial biofilm)

• Invariably secondary to local factors (e.g. poor oral hygiene, incorrect tooth brushing)

PERIODONTITIS

This is a sequel to gingivitis and shows periodontal ligament breakdown with recession or periodontal pocketing and alveolar bone loss. There is possible loosening of teeth and periodontal abscess formation (Fig. M1).

An underlying medical condition must be suspected.

Treatment of both gingivitis and periodontitis

• Meticulous dental treatment (e.g. plaque removal)

• Chlorhexidine 0.12–0.2% aqueous solution as a mouthwash 8–12 hrly for 10 d

• Systemic antibiotics for periodontal abscess formation (e.g. amoxicillin 250 mg (ο) tds for 5 d—drug of choice) but rarely required

ORAL DYSAESTHESIA

The classic chronic burning sensation of the oral cavity appears to have a neuropathic and/or psychological basis. Symptoms include:

• altered sensitivity: burning pain or ‘raw’ sensation

• altered taste: sweet, salty or bitter

• altered saliva ...