Department of oral medicine

PRODUCTION OF XRAYS

By
Nishanth John A
Final year
 CONTENTS

Introduction
Epidemiology
Etiology
Clinical features
Oral manifestations
Histologic features
Differential diagnosis
Malignant transformation
Management
Conclusion
 INTRODUCTION

XRAYS
an electromagnetic wave of high energy and very short
wavelength, which is able to pass through many materials opaque
to light.
 HISTORY

On November 8, 1895, German physics professor Wilhelm Röntgen stumbled

on X-rays while experimenting with Lenard tubes and Crookes tubes and
began studying them.
Röntgen discovered their medical use when he made a picture of his wife's
hand on a photographic plate formed due to X-rays. The photograph of his
wife's hand was the first photograph of a human body part using X-rays.
 XRAY MACHINE

The primary components of an x-ray machine are the x-ray tube and
its power supply. The x-ray tube is positioned within the tube head,
along with some components of the power supply
Often
the tube is recessed within the tube head to improve the quality of the
radiographic image. The tube head is supported by
an arm that is usually mounted on a wall. A control panel allows the
operator to adjust the time of exposure and often the energy and
exposure rate of the x-ray beam.
 X RAY TUBE

An x-ray tube is composed of a cathode and an anode situated within

an evacuated glass envelope or tube ( Fig. 1-7 ). Electrons stream from
a fi lament in the cathode to a target in the anode, where they produce
x rays. For the x-ray tube to function, a power supply is necessary to
(1) heat the cathode fi lament to generate electrons and (2) establish
a high-voltage potential between the anode and cathode to accelerate
the electrons toward the anode.
 ANODE

The anode consists of a tungsten target embedded in a copper stem

(see Fig. 1-7 ). The purpose of the target in an x-ray tube is to convert
the kinetic energy of the colliding electrons into x-ray photons.
The conversion of the
kinetic energy of the electrons into x-ray photons is an ineffi cient
process with more than 99% of the electron kinetic energy converted
to heat.
 POWER SUPPLY

The primary functions of the power supply of an x-ray machine are

to (1) provide a low-voltage current to heat the x-ray tube fi lament
and (2) generate a high potential difference between the anode and
cathode.
 TUBE VOLTAGE

A high voltage is required between the anode and cathode to give

electrons suffi cient energy to generate x rays. The actual voltage used
on an x-ray machine is adjusted with the autotransformer
BREMSSTRAHLUNG RADIATION
 ORAL M

Three types:
Reticular (
whitelines,papules)
Atrophic
(erythematous)
Erosive (ulcerated
and bullae)

Buccal mucosa 80%, tongue 65%, lips 20%, gingiva, floor of

the mouth, palate less than 10%
 Reticular
consisting of radiating white or grey, velvety, thread like papules in the linear annular
or retiform arrangement forming typical lacy, reticular patches, rings and streaks over
the buccal mucosa, lips, tongues, palate.
Tiny elevated dots is frequently present at the intersection of the, also known as the
striae of wickham.
Burning sensation,vesicles and bulla formation.
 Erosive
vesicular or bullous form of the disease may clinically resemble erosive lichen
planus when the vesicles rupture.
Eroded ulcerated lesions are irregular in size and shape appear as raw, painful
areas.
 Atropic
Smooth, red ,poorly defined areas, often but not always with peripheral striae
evident.

Hypertropic

Well circumscribed ,elevated white lesions resembling leukoplakia

 HISTOLOGIC FINDINGS

Hyperparakeratosis
Hyperorthokeratosis
Thickened granular layer
Destruction of basal cells
Rete pegs – saw tooth appearance
Increased intraepithelial T- cells
Colloid bodies formation
Max joseph spaces
DIFFERNETIAL DIAGNOSIS

Leukoplakia
Lupus erythematosus
Pempigus
Erythema multiforme
Syphilis
INVESTIGATION

Biopsy
Ana test
PAS staining
Immunoglobulin assay
 TREATMENT

There is no cure
Principal aims :
* resolution of painfull symptoms, lesions.
*reduction of risk of oral cancer.
*maintenance of good oral hygine

Corticosteroids are given both systemic and topically

Steroids are more usefull in management of OLP
 TOPICAL STEROIDS

0.05% clobetasol propionate

0.1 or 0.5% of betamethasone valerate

Safer, long-term use needs follow up

Causes adrenal suppresion
 SYSTEMIC STEROIDS

Daily dose of prednisone 40-80mg for initial 5-7 days gradually withdrawl over 2-4
weeks
 RETINOIDS : Topical 0.1% vit A . Systemic : etretinate 25 – 75mg,day
relapse after discontinuation.

CYCLOSPORIN – Reducesthe proliferation and function of T-lymphocytes

.
GRISEOFULVIN – treatment of erosive Lp.
 SURGERY

Surgical excision, cryotherapy, CO2 laser, and ND:YAG laser have been used.

LASER
308nm excimer laser has been used
Painless
Bloodless
 PHOTOCHEMOTHERAPY

Ultraviolet A with wavelength of 320 – 400nm,after the injection of psoralen

UVA was applied to lesions after 2hrs the injection of psoralen
After 2months most of the lesion have been improved,remission time : 2-17
months.
DRAWBACK : risk of squamous cell carinoma
 CONCLUSION

OLP is a chronic condition that is immune mediated and characterised by

episodic exacerbations and remission
Topic steroids is the first line of treatment
Regular and long term follow up of patients and to screen for malignancies is
recommended