Disease OF The Mouth

By Dr. Osman Bukhari

Functions OF the Mouth -Mastication -Swallowing -Digestion -Speech Normal Oral Comensal Organism -Fusiform bacilli -Spirochetes -Bacteria (e.g. Strept.viridians) -Candida

*Troubles Occur with poor Oral hygiene & Immunosuppression.

*Bactraemia may have its source in the oral cavity specially following dental manipulations

Oral Ulcers associated with

1- ROU:

-Affect 30% of population

-Recurring shallow ulcers

-May be multiple

-Aetiology unknown? Autoimmune

-Precipitated by emotional stress

*Treatment

-Chlorhexidise Mouth wash

-Topical steroids

-Rarely systemic C/S & Azathiosprine

2-Syestamic disorders (Crohns, UC, SLE, Behcets, Immunodefiency )

3-Dermatological disorders (Erythema

multiform, Lichen Planus, pemphigus

vulgaris,dermatitis herpetiformis )

4- Viral Infection (Herpes simplex,

Coxsackie's virus, HIV.)

5- Bacterial disease (Syphilis, T.b)

6- Drugs (Cytotoxic drugs, antibiotics,

penicillanmine & gold)

7-Truma (ill fitting teeth, sharp teeth & teeth brushing)

8- Neoplasia (Squamous Ca)

9-Fungal infection (Candidiasis)

10- Leukoplakia (Idiopathic, alcohol, smoking & HIV)

11- Nutritional deficiency (malnutrition & mal- absorption, Niacin, B2,& B12)

Diseases of the esophagus

-25CM in Length from cricoid's cartilage to

LOS.

-Double muscle layer

*Upper striated

*Lower smooth

-Epithelial layer

*Upper Squamous

*Lower columnar

-Upper sphincter formed by Cricophayrygeus muscle

-Lower sphincter (L.O.S) : physiological zone of increased tone just above the gastro-esophageal Junction below the diaphragm

Symptoms & Sign

OF

Esophageal

Disease

1- Heart burn

2- Regurgitation

3- Dysphagia

4-Odynophagia

5- Loss of weight

6-Anaemia

Investigation

1- Ba swallow

2- Endoscopy

3- Manometry

4-24 hour PH monitoring

Dysphagia

Causes:-

1-Painful oral legions

2-Neuromuscular disease

-Motor neurone disease

-C.V.A

-Systematic sclerosis

-Dermatomyocystis

-Diffuse Esophageal spasms

-Diabetes Mellitus

-Chogas

-Myasthenia graves

3-Extrinsic pressure

-Pharyngeal pouch

-Goitre

-Ca bronchus

-Enlarged L-Node

-Aortic aneurysm

-Enlarged Lt Atrium

4-Intrinsic Esophageal disease:

-Ca esophagus

-Stricture (Benign or Malignant)

-Esophageal rings & webs)

-Plumer Vinsons

-Candida & Herpes simplex

5-Forign body

6-Globus hystercus

Gastro Esophageal Reflux Disease (GROD) & Oesophagitis -Transient gastro esophageal reflux is a

normal event in 30% of people without symptoms

- Symptoms occur with prolonged contact of gastric contents with esophageal mucosa when anti reflux mechanisms fail

Anti reflux mechanisms

1-Competent L.O.S which is tonically contracted & relaxes only during swallowing. Tone is increased with high intra abdominal & intra-gastric pressures.

2-Flap valve like intra-abdominal esophagus

3-Fundal mucosal folds

4-Diaphragmatic orifice

5-Secondry esophageal peristalsis clearing

refluxate & neutralizing acid by saliva

Factor associated with impaired efficiency of LOS & GORD:-

1-Impaired efficiency of L.O.S & low tone

associated with H.H, systemic sclerosis &

following Cardioyotomy & dilatation

2-Low L.O.S tone due to dietary factor & habbits (Fatty meals, Caffeine, alcohol,

chocolate & smoking)

3-Decreased secondary esophageal peristalsis & clearance of refluxate

4-Impaired gastric emptying following GOL

obstruction, fatty meals, heavy meals, &

drugs like anti-cholinergic, CCB, & nitrates

5-High intra abdominal pressure with Ascitis, obesity, straining, heavy weight lifting, pregnancy & bending down

*When anti reflux mechanism fail persistence exposure of the lower esophagus to acid & pepsin results in esophagitis

Clinical feature

1-Heart burn: increased after heavy meals, hot drink, lying flat &stooping 2-Water brush relieved by anti acids 3-Regurgitation + aspiration lead to chocking, cough & nocturnal asthma 4-Odynophagia 5-Dysphagia : transient with spasm & persistent if there is stricture

6 Haematemesis & iron deficiency anemia 7-A typical chest pain which may mimic angina if

severe (due to spasm) Diagnosis: 1-Clinical 2-Esophagoscopy (Oesophagitis, Stricture

&excludes malignancy) 3-Radio isotope labelled Tc to demonstrate reflux 4-24 hour PH monitoring, most accurate test for

reflux .

Complications 1-Peptic stricture following long standing Oesophagitis & ulceration 2-Barretts esophagus (20%). It is pre malignant 3-Iron deficiency anemia

Treatment 1-Avoid precipitating factor e.g. Alcohol & smoking

2-Reduction of weight & avoid heavy meals

3-Raise foot of bed (15cm)

4-Anti acids, H.R.A & P.P.I in severe cases

5-Prokinetics (Cisapride & metoclopride)

6-Diltation for stricture

7-Surgry (Repair of H.H & Fundoplication) if

there is no response to medical treatment or

if the patient is unwilling to take it or if major symptoms of oesophagitis is trouble- some