CONTENTS

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Definition Infectious diseases
Bacterial diseases Viral disesases Fungal disease

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Deficiency disease Diseases of bones and joints Diseases of the skin Conclusion References
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DEFINITION:
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Disease: Any deviation from or interruption of the normal structure or function of any part, organ, or system (or combination) of the body that is manifested by a characteristic set of symptoms and signs and whose etiology, pathology and prognosis maybe known or unknown.

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Disorder: A derangement or abnormality of function; a morbid physical or mental state.

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Syndrome: A set of symptoms that occur together. In genetics, a pattern of multiple malformations thought to be pathogenetically related.

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e. such evidence as perceptible to the examining physician. ´ Symptom: any subjective evidence of a disease or of a patient·s condition i.Sign: Any objective evidence of a disease i. ´ 5 .e. such evidence as perceived by the patient.

Infectious diseases BACTERIAL I ECTI 6 .

´ Caused by streptococcal organisms of beta hemolytic type that elaborate an erythrogenic toxin. ´ .SCARLET FEVER Scarlet fever occurs predominantly in children in winter months.

The coating of the tongue is removed it appears deep red and glistening and smooth--Raspberry tongue. The clinical termination of the disease is the desquamation of the skin 8 . Mucosa of the palate appears congested and the throat is often fiery red Tongue exhibits a white coating and fungiform papillae are edematous and hyperemic.SCARLET FEVER: y y y y Oral Manifestation: ´stomatitis scarlatinaµ. projecting above the surface as small red knobs--Strawberry tongue.

chills. 4. Incubation period of 3-5days. 3. Scarlet skin rash appears on the 2nd or 3rd day. TREATMENT: Antibiotics will ameliorate the disease and will aid in controlling the possible complications. fever and vomiting. ´ . Microorganism enters the body through pharynx. 2. Patient exhibits severe pharyngitis. tonsillitis. headache.Clinical features 1.

Sore throat Mild redness and edema of pharynx. Droplet infection or direct contact. malaise. headache. 10 . C/F: initially listelessness. fever and occasionally vomiting.DIPHTHERIA: ´ ´ ´ ´ ´ ´ ´ ´ Acute contagious disease. Cornybacterium diptheriae or Klebs-Loffler bacillus. Cervical lymphadenopathy. Resides in URT.

. ulcerated areas of the mucosa and covering the tonsils . Soft palate may become paralysed . gelatinous-appearing exudate which contains dead cells. A false membrane. there is formation of ´diptheric membraneµ. leukocytes and bacteria overlying necrotic. grayish. thick fibrinous.´ ´ ´ ´ Oral Manifestation: Characteristically. Patients have a peculiar nasal twang and may exhibit nasal regurgitation. pharynx and larynx .

TUBERCULOSIS ´ ´ ´ ´ ´ Mycobacterium tuberculosis and rarely M. 12 . Clinical features: Episodic fever and chills. Gradual loss of weight accompanied by persistent cough with or without accompanied hemoptysis. Easy fatigability and malaise. bovis.

nodular or papillary proliferation of the gingival tissue. deep or superficial. Tuberculuos gingivitis. . but the most common is tongue followed by palate. They r irregular. lips. buccal mucosa.´ ´ ´ ´ Oral Manifestation Lesions may occur at any site on the OMM.unusual form of TB which may appear as a diffuse hyperemic. painful which tends to increase in size slowly. gingiva and frenula.

´ Oral Manifestation: Generally consisted of small tumor like mass ´lepromas which develop on tongue. Tendency to break down and ulcerate. leprae.LEPROSY caused by M. lips and hard palate. Gingival hyperplasia with loosening of teeth has also been described. ´ 14 . ´ Ridley and Jopling have divided leprosy into 2 polarized group: ´ tuberculous leprosy (TT) ´ lepromatous leprosy (LL).

branched. since they are highly invasive. suppurative and fibrosing disease caused by anaerobic. The soft tissue swellings eventually develop into 1 or more abscess which tend to discharge upon a skin. nonacidfast.ACTINOMYCOSIS ‡ Chronic granulomatous. ‡ Common inhabitant of the oral cavity even in the complete absence of any clinical manifestations of specific infection. y Actinomycosis israeli Cervicofacial actinimycosis Abdominal actinimycosis Pulmonary actinimycosis y y Cervicofacial actinimycosis: the most common form of the disease. 15 . filamentous bacteria. ‡ Thus extraction of thr teeth or abrasion of the mucosa may precede the infection. gram ² positive . ‡ Trauma plays a role in some cases by initiating a portal of entry for the organisms. liberating pus containing sulfur granules.

Elevated. Such a lesion on the lip may have a brownish. ulcerated nodule showing local induration and producing regional lymphadeniti.SYPHILIS: ´ ´ ´ ´ ´ ´ ´ Treponema pallidum. The chancre has been demonstrated to develop on the site of fresh extraction wound.This lesion is called as the chancre. 16 . Acquired Syphilis: Primary stage. acquired or congenital. crusted appearance.

17 .SYPHILIS: ´ ´ ´ ´ ´ Secondary or Metastatic stage-commence in about 6 weeks. Usually multiple. Occur most commonly on tongue. Often ovoid surrounded by an erythematous halo. grayish ²white plaques overlying an ulcerated surface. gingiva or buccal mucosa. The oral lesions are known as ´mucous patchesµ highly infectious. Serological reaction is positive. painless.

SYPHILIS: ´ ´ ´ ´ ´ ´ Tertiary lesions. cause perforation by sloughing of the necrotic mass of tissue. Intraoral gumma most commonly involves the tongue and palate. Gumma is chief localized tertiary lesion and occurs most frequently in the skin and mucous membranes. involves the cardiovascular system and central nervous system non-infectious. Appear as firm nodular mass in tissue which may subsequently ulceralate and inacas eof the lesion of the palate . 18 .also called as ´late syphilisµ.

saddle nose.SYPHILIS: y y y y y y y Congenital (Prenatal) Syphilis: frontal bossing. rhagades and saber shin. relative protuberance of mandible. mulberry molars. 19 . short maxilla.

eighth nerve deafness and interstitial keratitis. hypoplasia of the incisors and molar teeth. 20 .SYPHILIS: ´ ´ ´ ´ Hutchison·s triad.

Lip may develop acute painful ulceration. limiting motion. the gigniva may become erythematous with or without necrosis. erosive and bullous lichen planus and herpetic stomatitis.GONORRHEA: y y y y y y y It is primarily a venereal disease. Tongue may present red. 21 . Oral Manifestation: (Schmidt et al) pointed out the similarities of gonococcal stomatis with erythema multiforme. with similar lesions on the buccal mucosa and palate. dry ulcerations or become glazed and swollen with painful erosions . Gonococcal pharyngitis and tonsillitis fever and regional lymphadenopathy.

WEGENER'S GRANULOMATOSIS: ´ ´ ´ ´ ´ necrotizing granulomas of the upper and lower respiratory tracts. The gingivitis The "strawberry" appearance of the large and necrotic tongue ulcerations 22 . Oral Manifestation: oral cavity involvement occurs in more than 50% of patients.

23 . The prognosis is poor.LETHAL MIDLINE GRANULOMA y y y y y caused by nonHodgkin's lymphoma or polymorphic nasal stuffiness total destruction of the entire palate and severe facial mutilation. mimics malignancy.

24 . the result of some minor trauma to the tissues most frequently on the gingiva. Etiology: originally believed to be a botryomycotic infection. Some lesions have a brown cast if hemorrhage has occurred into the tissues. It is deep red or reddish purple.PYOGENIC GRANULOMA: y y y y y response of the tissues to a non specific infection. also found on the lips tongue and buccal mucosa and occasionally on other areas.

VIRAL I ECTI 25 .

y the primary infection is accompanied more frequently by severe systemic manifestation and occasionally is fatal.HERPES SIMPLEX: y y y It is an acute infectious disease. lips. usually affecting the face. Herpes virus hominis are derived There are two immunologically different types of HSV: Type I. oral cavity and upper body skin. 26 . Type II usually affects the genitals and skin of the lower body.

HERPES SIMPLEX: Disseminated herpes simplex of the newborn: y uncommon disease y These infants usually manifest the disease by the fourth to seventh day of life. y Surviving infants usually show residual neurologic involvement. y usually die on the 9th to 12th day of life. 27 .

28 . yellowish. It rarely occurs before the age of 6 mo. fluid filled vesicles develop. Shortly.HERPES SIMPLEX: ´ ´ ´ ´ Primary herpetic stomatitis: both children and young adults.

herpetic labialis and stomatitis: ´ The lesion may develop either on the lips or intraorally. 29 .HERPES SIMPLEX: Recurrent or secondary. These vesicles are generally small.

RECURRENT APHTHOUS STOMATITIS: Painful recurring solitary or multiple ulcerations of the oral mucosa. Precipitating factors: y Trauma. Endocrine conditions. y 30 . Allergic factors. Immunologic abnormality. Etiological factors: y Bacterial infectionStreptococcus sanguis. Psychic factors. vitamin B12 or folic acid deficiency. Iron.

MORBILLI) ´ ´ fever malaise. Oral manifestation: koplik·s spots 31 . photophobia. lacrimation and eruptive lesion of the skin and the oral mucosa. cough.MEASLES (RUBEOLA. conjunctivitis.

Disease commonly occurs in women in first trimester blindness deafness and enamel hypoplasia 32 .RUBELLA (GERMAN MEASLES) ´ ´ ´ No koplik·s spots and should not be confused with rubeola.

making swallowing difficult. 33 . trachea. tongue is swollen and painful.SMALL POX (VARIOLA) ´ Ulceration of the oral mucosa and pharynx. esophagus etc.

34 . small blister like lesions on the oral mucosa including the buccal mucosa. tongue.CHICKENPOX (VARICELLA): ´ Oral manifestations include. gingiva and palate.

pharynx etc. tongue. Painful vesicles may be found in buccal mucosa. . Zona): inflammation of dorsal root ganglia. Oral manifestation: trigeminal nerve. larynx.y y y y Herpes zoster (Shingles.

vomiting. Salivary gland involvement causes pain on mastication. chills. in 70% cases bilateral parotid involvement seen. dizziness. Complication: other organs may beaffected. . fever.´ ´ ´ ´ ´ ´ Mumps: It is an acute contagious viral infection The symptoms include headache.

CANDIDIASIS: candida albicans. C. crusei etc. Classification: Acute y Acute Pseudomembranous oral candidiasis y Acute atrophic oral candidiasis y y y y Chronic Chronic hyperplastic oral candidiasis Chronic mucocutaneous oral candidiasis Chronic atrophic oral candidiasis . tropicalis. C.

.DISEASES OF BONES AND JOINTS ´ Bone is a dense calcified tissue which is specifically affected by a variety of diseases. some characteristically are congenital while others develop in early childhood. young adulthood or even in later life.

Oral Manifestation: .OSTEOGENESIS IMPERFECTA: ´ ´ ´ ´ It is a serious disease of unknown etiology (congenita or Vrolik·s type) (tarda or Lobstein·s type or gravis or levis or osteopsathyrosis).

teeth and jaws. shoulder girdle.CLEIDOCRANIAL DYSPLASIA: y y y y y abnormality of the skull. High. narrow arched palate over-retention of deciduous The root of the tooth is usually short absence or paucity of cellular cementum. .

Fractures of the jaw.OSTEOPETROSIS: y y y y y benign dominantly inherited malignant recessively inherited form. Oral Manifestation: the medullary spaces are reduced marked predilection for the development of osteomyelitis This is a complication of dental extraction. .

OSTEITIS DEFORMINS: ´ ´ ´ ´ Paget in 1877 Clinical Features: Pathologic fractures are common leontiasis ossea. .

Teeth become loose and migrate.´ ´ ´ Oral Manifestation: maxillary enlargement. inability to wear their dentures .

FIBROUS DYSPLASIA OF BONE: ´ Polyostotic Fibrous Dysplasia: it can be of 2 types« « Jaffe·s type Albright·s ´ ´ Oral manifestation: expansion and deformities of the jaws .

FIBROUS DYSPLASIA OF BONE: y y y y Monostotic Fibrous Dysplasia: children especially in the maxilla and is impossible to eradicate without mutilating radical surgery. zygomatic bone and floor of the mouth. Oral manifestation: severe Mostly involves the maxillary sinus. .

.INFLAMMATORY DISTURBANCES OF THE TM JOINT: ´ ´ Arthritis Due to Specific infection: It may follow a dental infection or an adjacent cellulitis or osteomyelitis. Clinical Features: severe pain of the joint. Healing results in ankylosis of the joint.

fatigability.INFLAMMATORY DISTURBANCES OF THE TM JOINT: ´ ´ Rheumatoid Arthritis: hypersensitivity reaction to bacterial toxins Clinical Features: slight fever. swollen joints. with pain and stiffness .

INFLAMMATORY DISTURBANCES OF THE TM JOINT: ´ Rheumatoid Arthritis in Children (Still·s Disease): may cause a malocclusion of the class II div I type with protrusion of maxillary incisors and an anterior open bite. .

history. the oral features are variable in their appearance and a careful phys­ical examination. oral manifestations of nutri­tional disorders reflect the initial sign of a deficiency. Rather.DEFICIENCY DISEASES: y The mouth is a sensitive indicator of nutritional status because of the assorted hard and soft tissues of the oral cavity and the specific nutritional needs of each. Frequently. The severity of oral involvement is generally not proportional to the nutritional shortage. and a high degree of suspicion are required to diagnose specific disorders. laboratory studies. nor are there oral clinical characteristics specific to any one nutritional disorder. .

Nonspecific superficial oral ulcerations Secondary infection with candidiasis Patients with poorly controlled gastrointestinal diseases may also develop zinc deficiency .ZINC DEFICIENCY y y y y y y Acrodermatitis enteropathica The disease manifests shortly after birth symmetric skin eruption. and resembling psoriasis. Angular cheilitis.

which is soluble either in fat or water and ordinarily is needed in only minute quantities to act as a cofactor in a variety of metabolic reactions. As is seen with vitamin A and vitamin D their role is more hormonal than as a cofactor.VITAMIN DEFICIENCIES: y y A vitamin is usually defined as an organic substance not made by the body. . They are called as diseases in a negative sense rather than in a positive sense. The avitaminoses are due to the absence of the minute amount of the biologically important materials rather than the presence of certain biologically active materials.

xerophthalmia. night blindness. xerostomia and burning of the mucous membranes. is atypical in structure. . too. are the result of squamous metaplasia of the minor and major salivary glands. The dentin. higher caries score. enamel matrix is arrested and/ or poorly defined. and keratomalacia.VITAMIN A: y y y y epithelial cells fail to differentiate.

causes pronounced changes in the permanent dentition char­acterized by enamel pitting and hypoplasia.VITAMIN D: y y y one of a number of compounds ofhydroxylated cholecalciferols. . best thought of as a hormone.

delayed eruption and misalignment of teeth in the jaw.RICKETS y y y y y y y premature infants being at the highest risk. Oral Manifestations: developmental abnormalities of dentin and enamel. the metaphysis and the shaft. higher caries index abnormally wide predentin zone and much interglobular dentin. . The changes in the bones are found in epiphyseal plate.

OSTEOMALACIA ´ it is the adult equivalent of juvenile (vitamin D deficient) rickets. .

VITAMIN D RESISTANT RICKETS y y y y y y also known as familial hypophophatemia Oral Manifestations: widespread formation of globular. hypocalcified dentin. common invasion of the pulp by microorganisms without demonstrable destruction of the tubular matrix. periapical involvement of normal appearing teeth development of multiple gingival fistulas .

absence of cementum. Oral Manifestation: loosening and premature loss of deciduous teeth.HYPOPHOSPHATESIA y y y y It is a hereditary disease first recognized by Rathbun in 1948. gingivitis. so that there is no sound functional attachment of the tooth to the bone by periodontal ligament. .

.PANTOTHENIC ACID ´ Glossitis and angular chelitis can be caused by a deficiency in pantothenic acid.

Dam factors VII XI and X.VITAMIN K y y y y y y y In 1929. hypoprothrombinemia due to poor placental lipid transmission. Oral ecchymosis on the palate and buccal mucosa may also be commonly observed. Oral Manifestation.gingival bleeding. Hypoprothrombinemia gingivae are the most frequent oral site of involvement. .

and diffusely reddened oral mucous membrane. .BIOTIN: y y y frequently reported in individuals consuming large quantities of raw eggs dry and crusted lips patchy atrophy of the tongue papillae resembling geographic tongue.

. Oral Manifestation.VITAMIN C ´ ´ ´ ´ ´ More than 50% of patients with scurvy develop a hemorrhagic gingivitis. Aphthous-like ulcerations and hemorrhages periodontal destruction and alveolar bone degeneration premature loss of teeth.In infants the enlarged tissue may cover the clinical crowns of the teeth.

gingiva and lips. . mucous membrane.VITAMIN B COMPLEX ´ The oral signs of deficiencies of the B vitamins occur primarily in the oral soft tissues: the tongue.

THIAMIN y y Beriberi is characterized by multiple neuritis. floor of the mouth and the palate. often associated with congestive heart failure. generalized edema and sudden death oral manifestations: vesicular eruption on the buccal mucosa. .

RIBOFLAVIN y y y y y y y Glossitis The filiform papilla become atrophic tongue is magenta in appearance that is easily distinguished from cyanosis. Deep lesions usually leave scars on healing. and crusted fissures at the corners of the mouth . Burning and pain are generally mild Angular cheilitis Deep. moist.

most prominently involving the neck and hands. beefy-red surface. dementia.NIACIN y y y y y pellagra. . severe gingivitis diarrhea. Niacin leads to the formation of nicotinic acid amide that leads to the formation of coenzyme I and coenzyme II. and a marked photosensitivity.

pyridoxine. pyridoxal. resemblance to pellagrous stomatitis. The lesions are painful and the tongue often assumes a purplish and atrophied ap­pearance. The fungiform papillae may remain unchanged or enlarge . angular cheilitis and a diffuse glossitis.PYRIDOXINE y y y y y it is actually a complex of three related substances. pyridoxamine.

folic acid inhibitors such as methotrexate or those with various gastrointestinal diseases. diarrhea and microcytic anemia.FOLIC ACID y y y y y glossitis. The papillas on the tongue disappear one by one with the filiform papilla being the first. Pain and burning of the tongue . results in prominent mucous membrane changes.

chronic infectious diseases.AMYLOIDOSIS y y y represents a heterogeneous group of disorders Primary systemic amyloidosis affect the tongue along the lateral borders of the tongue. Secondary amyloidosis is more common than the primary. and Mediterranean fever. preceded by rheumatoid arthritis. .

The tongue appears reddened.ANEMIAS ´ Glossitis may be the first sign of folate or vitamin B-12 deficiency. producing a smooth ("bald") appearance. . and the papillae are atrophic.

and foul-smelling breath also occur. is a childhood disease that consists of the triad of diabetes insipidus. is most common in infants and is characterized by widespread involvement of the viscera. lytic bone lesions. Hand-Schüller-Christian disease. periodontitis. gingivitis. and proptosis. Oral symptoms include large ulcerations. . potentially leading to death. and subsequent tooth loss.LANGERHANS HISTIOCYTOSIS: y y Letterer-Siwe disease. Gingival inflammation and ulcerated nodules. Oral manifestations include irregular ulcerations of the hard palate. difficulty in chewing. ecchymoses.

Ocular and cutaneous manifestations are common.SARCOIDOSIS: ´ Sarcoidosis is an idiopathic systemic disease characterized by bilateral hilar lymphadenopathy and noncaseating granulomas in the lungs. .

SARCOIDOSIS: y Oral manifestations multiple. labial mucosa. biopsy results reveal noncaseating granulomas surrounded by multinucleate giant cells along with lymphocytic infiltrate. nodular. uveitis. and facial nerve palsy. Rarely. and palate. salivary gland involvement is a possibility. Although less common. Heerfordt syndrome may arise if symptoms include parotid gland swelling. leading to tumor-like swellings. buccal mucosa. xerostomia. painless ulcerations of the gingiva. sarcoidosis may involve the tongue .

and others. hydroxychloroquine. beta-blockers. NSAIDs. diuretics. Inhaled steroids .MULTISYSTEM CONDITIONS ´ ´ ´ ´ ´ Amyloidosis Aphthous stomatitis Lichen planus Common drugs that cause lichenoid reactions include ACE inhibitors.

Patients may develop malabsorption and subsequent malnutrition. constipation. and fever. . This disease is slightly more prevalent among white males.CROHN¶S DISEASE ´ idiopathic disorder that involves the entire GI tract with noncaseating granulomas. Fissures or fistulas may occur in persons with chronic disease. abdominal pain. and fissures. Symptoms of Crohn disease include intermittent attacks of diarrhea.

(3) aphthous ulcers. gingival. .CROHN¶S DISEASE y y y y y y y Orofacial symptoms (1) diffuse labial. (2) cobblestoning of the buccal mucosa and gingiva. (4) mucosal tags. or mucosal swelling. and (5) angular cheilitis. Oral granulomas may occur without characteristic alimentary involvement (orofacial granulomatoses).

in the oral cavity as aphthous ulcerations or superficial hemorrhagic ulcers .ULCERATIVE COLITIS y Ulcerative colitis is an inflammatory condition with some similarities to Crohn disease. sparing the muscularis. it is restricted to the colon and is limited to the mucosa and submucosa. Lesions in the colon consist of areas of hemorrhage and ulcerations along with abscesses.

5. . secondary to its lower mineral content. develops caries much more quickly.GASTROESOPHAGEAL REFLUX DISEASE (GERD) y Regurgitation of gastric contents (pH 1-2) reduces the pH of the oral cavity below 5. Erosion of the enamel exposes the underlying dentin. Exposed dentin is often sensitive to temperature changes and.

This is especially suggestive if it occurs in the absence of inflammation. The coagulation pathway is one such system.CHRONIC LIVER DISEASE ´ Chronic liver disease impacts many systems of the body. . The liver synthesizes many of the clotting factors necessary for hemostasis. can be manifested in the mouth as petechiae or excessive gingival bleeding with minor trauma.

. The association between hepatitis C and oral lichen planus is controversial.CHRONIC LIVER DISEASE ´ ´ hepatitis C is the leading infectious cause of chronic liver disease worldwide.

They are the most common (80% of all canker sores) and usually last about 7-10 days. Minor sores have a diameter of 1millimeter (mm) to 10mm. Canker sores are very common. Canker sores are also medically known as aphthous ulcers or aphthous stomatitis. They also usually heal within 7-10 days. Canker sores are generally classified into three groups based on size. Major sores (10% of all canker sores) have a diameter of greater than 10mm and they may take anywhere between 10-30 days to heal. Herpetiform ulcers (10% of all canker sores) are formed by a cluster of multiple small individual sores (less than 3mm). but it is more commonly seen in teenagers. Women are slightly more likely than men to have recurrent canker sores. . This partially explains why family members often share the condition. They may leave a scar after they heal. It can occur at any age. Genetic studies show that susceptibility to recurrent outbreaks of the sores is inherited in some patients.APTHOUS STOMATITIS: y y y y y Canker sores are small ulcer craters in the lining of the mouth that are frequently painful and sensitive. About 20% of the population (one out of five people) have canker sores at any one time.

yellowish depressions surrounded by an area of erythema. a person has only one or a few canker sores at a time. The size varies from 1-3 mm (aphthous minor. such as the tongue or the inside lining of the lips and cheeks. and the sores are rarely associated with other diseases. while others may have a continuous series of canker sores. and at the base of the gums. the sores heal within two weeks without scarring. These ulcerations are round. . Pharmacologic agents are among the most common causes of recurrent aphthous lesions. however. crateriform. Generally. The ruptured sores are covered by a thin white or yellow membrane and edged by a red halo. can develop the condition. Some common culprits include nonsteroidal antiinflammatory drugs (NSAIDs). Usually. approximately 15% of cases). The ulcers begin as small oval or round reddish swellings that usually burst within a day. nicorandil. Some people have only one or two episodes a year. but any drug can potentially produce an aphthous-like reaction. The frequency of canker sore recurrences varies considerably. commonly known as canker sores. Fever is rare. approximately 80% of cases) to larger than 1 cm (aphthous major. Patients may have outbreaks of multiple ulcerations at one time. Children as young as 2 years old. These are usually quite painful but typically are self-limiting and resolve in 7-10 days for aphthous minor and 1421 days for aphthous major lesions.y y y Canker sores are usually found on the movable parts of the mouth. Most people experience their first bout with canker sores between the ages of 10 and 20. ACE inhibitors.

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The most common adverse effect of many medications is dry mouth (hyposalivation or xerostomia). The reasons for this vary from medication to medication but can range from dehydration (eg, with diuretics) to anticholinergic activity (eg, with some antidepressants). Dry mouth has a number of consequences, including altered taste, increased risk of fungal infection, increased caries risk, and increased prevalence of traumatic ulceration due to lack of lubrication. Patients with severely impaired salivary flow also have difficulty with eating, swallowing, and speech. The former can result in decreased food intake and poor nutrition. Numerous management options are available for decreased salivation, which are beyond the scope of this chapter. These range from the simple, such as increased hydration, to the complex, such as systemic procholinergic agents to increase salivary production

REFERENCES:
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Shafer, Hine, Levy; A Textbook of Oral Pathology; 4th edition Cawson R.A., Odell E.W.; Essentials of oral Pathology and Oral Medicine Sapp J.P., Eversole L.R., Wysocki G.P.; Contemporary oral and Maxillofacial Pathology Saraf S., Textbook of Oral Pathology; 1st edition Eversole L.R., Clinical Outline of Oral Pathology; 3rd edition Stewart R.E.; pediatric Dentistry, Scientific Foundation and Clinical Practice; 1st edition Jeffrey M Casiglia;Oral Manifestations of Systemic Diseases Xiaojing Li; Systemic Diseases Caused by Oral Infection; Clinical Microbiology Reviews, October 2000, p. 547-558, Vol. 13, No. 4. Clong;Oral Manifestations of Systemic Diseases www.google.com www.medicineworld.org www.scienceclarified.com

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