PENATA LAKSANAAN LESI NON

INFEKSI JARINGAN LUNAK RONGGA

MULUT
BY
DYAH INDARTIN SETYOWATI

BAGIAN ILMU PENYAKIT MULUT RUMAH SAKIT GIGI DAN MULUT

UNIVERSITAS JEMBER
 LINEA ALBA BUCCALIS

It is present at the far more prevalent in women,

occlusal line on the both side of the buccal
mucosa.
hardening of the mucosa inside of the mouth due
to excess keratin deposition.
It is more frequently seen in adults than in
children.
Women are more likely to develop the condition
from biting behaviors.
Advise the patient to remove the
irritant or irritants that cause the
condition:
 Examples include the cessation
of habits, such as cheek biting
and aggressive oral hygiene, or
adjustment of orthodontic
elements, including uneven teeth,
dentures and other appliances
 FORDYCE SPOT
 The incidence of Fordyce
spots, also known as Fordyce
glands,
 increases with age, being
more common in adults than
in children
 The prevalence in adults is 70
to 80% .
 The male to female ratio is
approximately

 Fordyce spots are enlarged sebaceous glands that can occur on various body
parts such as the lips, oral mucosa, penis, and, labia.

 Some authors suggest that Fordyce spots are ectopic/heterotopic sebaceous

glands.
 Clinically : papula, multiple (grouped), (pinhead-
sized), creamy yellow, asymptomatic
The lesions are usually bilateral and symmetrical

mainly for esthetic reasons, treatment options :

include micro-punch surgery, electrodesiccation, cryotherapy,

ablative laser, photodynamic therapy, topical bichloracetic
acid, topical tretinoin, and oral isotretinoin
ANKYLOGLOSSIA

AG (more commonly called “tongue-tie”) is a

congenital anomaly characterized by an
abnormally short lingual frenum

Differences of opinion regarding its

definition, clinical significance, need for
surgical intervention, and timing of treatment

Otolaryngologists, oral surgeons,

pediatricians, speech therapists, and lactation
consultants may all voice different opinions
regarding the various aspects of AG
The frenotomy procedure is defined as the cutting or division of
the frenum.
The procedure may be accomplished without local anesthesia and
with minimal discomfort to the infant. The discomfort associated
with the release of thin and membranous frena is brief and quite
minor.
The authors, however, highly recommend the use of topical
anesthetic gel for pain control and to alleviate any parental
concerns.
BIFID TONGUE

Bifid Tongue is a rare disorder, usually

bifid occurs on the tip of the tongue
explosion imperfection of the tongue
tongue fusion

 Surgical correction of the defect was undertaken

under local anesthesia
 The median parts of the defect were freshened and
the tongue was reconstructed by suturing the
muscles in layers.
patient likes to suck his tongue and get the tongue towards the place already
CRENATED TONGUE

 Crenated tongue (also called scalloped tongue, pie crust

tongue,lingua indentata, or crenulated tongue)

 The oral mucosa in the area of crenation is usually of normal

color, but there may be erythema (redness) if exposed to a
high degree of friction or pressure.

 Crenated tongue is usually asymptomatic and harmless.

 The tongue is pressed against the lingual surfaces (the side

facing the tongue) of the dental arches, or from any cause
of macroglossia (enlarged tongue), which in itself has many
causes such as Down syndrome.

 There no special treatment in this case……KIE

 FISSURED TONGUE (SCROTAL OR PLACATED TONGUE)
• DEEP GROOVES ALONG THE DORSAL AND LATERAL ASPECTS OF THE TONGUE

• AETIOLOGY
• UNKNOWN
• MAY INHERITED

• DIAGNOSIS:
• CLINICAL APPEARANCE TREATMENT
• NO SPECIFIC TREATMENT.
• BRUSH THE TOP SURFACE OF TONGUE (OH)
• ANALGESIC MW WITHOUT ALCOHOL
 FISSURE TONGUE

Patients with fissured tongue who have no symptoms

need to be motivated to clear the fissured area to
minimize the accumulation of food and bacterial waste.

Treatment given to patients in this case is mulitvitamin,

topical nystatin, and topical benzidamin hydrochloride
in the form of mouthwash.
 GEOGRAPHIC TONGUE
• GEOGRAPHIC TONGUE (BENIGN MIGRATORY GLOSSITIS OR ERYTHEMA MIGRANS) AN INFLAMMATORY CONDITION OF
THE TONGUE
AETIOLOGY.
• POORLY UNDERSTOOD AND TENDS TO RUN IN FAMILIES
• VITAMIN B DEFICIENCIES, ALLERGIES, HORMONAL CHANGES, STRESS, OR DIETS HIGH IN SUGAR OR PROCESSED FOODS
 Treatment given to patients in this case is
mulitvitamin, topical nystatin, and topical
benzidamin hydrochloride in the form of
mouthwash
• PATIENTS WERE ALSO GIVEN
MULTIVITAMINS AS SUPPORTIVE THERAPY

• MULTIVITAMINS CONTAINED ARE VITAMIN

E, VITAMIN C, VITAMIN B COMPLEX, FOLIC
ACID, AND ZINC.
• THIS DRUG SERVES TO ACCELERATE THE
HEALING AND REGENERATION OF CELLS.
• PATIENTS ARE INSTRUCTED TO CONSUME
HEALTHY AND NUTRITIOUS FOOD,
MAINTAIN ORAL HYGIENE,
 MEDIAN RHOMBOID GLOSSITIS
MEDIAN RHOMBOID GLOSSITIS IS A
YEAST INFECTION IN THE MOUTH
CAUSED BY A TYPE OF FUNGUS CALLED
CANDIDA.
THIS CONDITION WAS ONCE THOUGHT TO
REPRESENT A DEVELOPMENTAL DEFECT.
ALSO KNOWN AS CENTRAL PAPILLARY
ATROPHY AND POSTERIOR MIDLINE
ATROPHIC CANDIDIASIS—IS A TYPE OF
ERYTHEMATOUS CANDIDIASIS UNIQUE TO
THE MIDLINE POSTERIOR TONGUE. IT
OCCURS IN AS MANY AS 1% OF ADULTS.
• .
 COATED TONGUE (FURRED TONGUE)
THE ENTIRE HEALTHY TONGUE MUCOSA MAY APPEAR COATED IN A WHITISH OR YELLOWISH LAYER
AETIOLOGY
POOR ORAL HYGIENE
FEBRILE ILLNESSES
DEHYDRATION
SOFT DIET

Diagnosis
Clinical examination
Can be scraped off
Treatment
■ Brushing or scraping the tongue
■ Rinse with peroxidase or sodium bicarbonate MW
■ Treat the underlying factors
 BLACK HAIRY TONGUE (HAIRY TONGUE)

• A BENIGN COMMON ORAL CONDITION

THAT GIVES THE TONGUE A DARK FURRY
APPEARANCE
• AETIOLOGY:
• POOR ORAL HYGIENE
• HEAVY SMOKING
• REGULAR USE OF MOUTH WASH
• BISMUTH MEDICATIONS
• RADIATION OF HEAD AND NECK
Diagnosis
Cytologic smears (gram or PAS)
Culture swab Treatment

Brushing or scraping the tongue

Topical antifungal therapy
 FRICTIONAL KERATOSIS
• FRICTIONAL KERATOSIS IS ONE OF THE MOST COMMONLY ASSOCIATED TRAUMATIC ORAL LESIONS WHICH
IS MOSTLY ASSOCIATED WITH CHRONIC TRAUMA BY SHARP EDGES OF THE TOOTH.
• MANY OF THEM ARE HARMLESS AND DO NOT REQUIRE ANY TREATMENT.
• BUT STILL A SMALL MINORITY ROUGHLY 4% ARE POTENTIALLY DANGEROUS
• IF THE LESION AFTER MONITORING FOR 6 WEEKS STILL PERSISTS, BIOPSY HAS TO BE PERFORMED
TONGUE CLEANER
 LINGUAL VARICOSITIES (SUBLINGUAL VARICES)

SUBLINGUAL VARICES ARE VASCULAR DILATATIONS

WHICH GENERALLY ARE ASYMPTOMATIC, BENIGN,
LOCALIZED TO VENTRAL AND POSTEROLATERAL TONGUE
AETIOLOGY
UNKNOWN
SUBLINGUAL VARICES ARE USUALLY SEEN AFTER AGE 40
AND THE INCIDENCE INCREASES BY AGE

Treatment is not necessary in sublingual varices.

However, surgical treatment might be a good
option for the cases who are exposed trauma
frequently, and the ones with cosmetic issues. No
treatment was applied to the patient. Follow up
of the patient still goes on.
TORUS PALATINUS

Torus Palatinus exostosis is a benign pathology, more

common in women, and rare appearance after age 50;
being asymptomatic in most patients, the finding is usually
casual, hence the importance that general practitioners,
dermatologists, dentists and pathologists are familiar with
this disease, in order to make a correct diagnosis and
management, avoiding perform surgical unnecessary
treatments
TORUS MANDIBULA
 ORAL PIGMENTATION
ORAL PIGMENTATION MAY BE PHYSIOLOGIC OR PATHOLOGIC.
PATHOLOGIC PIGMENTATION CAN BE CLASSIFIED INTO EXOGENOUS AND
ENDOGENOUS

EXOGENOUS PIGMENTATION COULD BE INDUCED BY DRUGS,

TOBACCO/SMOKING, AMALGAM TATTOO OR HEAVY METALS INDUCED.

ENDOGENOUS PIGMENTATION CAN BE ASSOCIATED WITH ENDOCRINE

DISORDERS, SYNDROMES, INFECTIONS, CHRONIC IRRITATION, REACTIVE OR
NEOPLASTIC
• EXOGENOUS PIGMENTATION 1. Bistmuth
1. GIT ( GASTRO INTESTINAL TRACT) 2. Amalgam Tatoo
3. Graphit Tatoo
2. INHALATION 4. Timah /plumbum
3. INJECTION 5. Argyria
6. Mercurialism
7. Arsenic
8. Minosiklin
• MELANIN
• THERE ARE FOUR PIGMENTS WHICH CONTRIBUTE TO THE NORMAL COLOR OF THE SKIN AND
MUCOSA.
• MELANIN
• CAROTENOIDS
• REDUCED HB
• OXYGENATED HB.

• OF THESE FOUR PIGMENTS, MELANIN IS THE MOST IMPORTANT. MELANIN IS AN ENDOGENOUS

NONHEMATOGENOUS PIGMENT. IT IS PRODUCED BY MELANOCYTES IN THE BASAL LAYER OF THE
EPITHELIUM AND IS TRANSFERRED TO ADJACENT KERATINOCYTES VIA MEMBRANE-BOUND
ORGANELLES CALLED MELANOSOMES.

• MELANIN INDUCED PIGMENTATION CAN BE EITHER BLACK, GRAY, BLUE OR BROWN IN COLOR.
FACTORS AFFECTINGS MELANOSENESIS

• INCREASED SUN EXPOSURE

• DURGS
• HORMONES
• GENETIC CONSTITUTION
• WHEN MELANOCYTES ARE ACTIVATED BY ULTRAVIOLET LIGHT ETC.
• MELANIN (SCHEMATICALLY SHOWN AS GRANULES) IS FORMED AROUND THE NUCLEUS
AND STORED IN SMALL ORGANELLES KNOWN AS MELANOSOMES.
• MELANOSOMES ARE TRANSPORTED ALONG MICROTUBULES AND ACTIN FILAMENTS TO
THE CELL PERIPHERY.
• SUBSEQUENTLY, MELANOSOMES BIND TO THE PLASMA MEMBRANE AND TRANSFERS
MELANOSOMES TO KERATINOCYTES AND HAIR MATRIC CELLS, RESULTING IN SKIN AND
HAIR BLACKENING
 DRUGS
• PIGMENTATION CAN BE PRODUCED BY
VARIOUS DRUGS LIKE, HORMONES, ORAL
CONTRACEPTIVES, CHEMOTHERAPEUTIC
AGENTS LIKE CYCLOPHOSPHAMIDE,
BUSULFAN, BLEOMYCIN AND
FLUOROURACIL, TRANSQUILIZERS,
ANTIMALARIALS LIKE CLOFAZAMINE, Laboratory studies have shown that these
CHLOROQUINE, AMODIAQUINE, ANTI- drugs may produce a direct stimulatory effect
MICROBIAL AGENTS LIKE MINOCYCLINE, on the melanocytes
ANTI-RETROVIRAL AGENTS LIKE Cotrimazole was the most common drug
ZIDOVUDINE AND ANTIFUNGALS LIKE associated to oral pigmentation followed by
tetracyline
KETACONAZOLE.
• TOBACCO
• TOBACCO HABITS ARE PRACTICED IN DIFFERENT FORMS, AND MANY OF THESE HABITS ARE
SPECIFIC TO CERTAIN AREAS OF INDIA.
• GINGIVAL PIGMENTATION IN CHILDREN HAS BEEN LINKED TO PASSIVE SMOKING FROM
PARENTS AND OTHER ADULTS WHO SMOKE.
• IN THEIR CLINIC PATHOLOGICAL STUDY REPORTED THAT THE INTENSITY OF THE PIGMENTATION
WAS MORE IN THE LABIAL MUCOSA THAN IN THE BUCCAL MUCOSA.
 Smoker’s Melanosis

• DIFFUSE MACULAR MELANOSIS OF BUCCAL MUCOSA, PALATE, LATERAR TONGUE, FLOOR OF

THE MOUTH IS USUALLY SEEN AMONG THE SMOKERS
• TOBACCO SMOKE PRODUCTS STIMULATES THE MELANOCYTES AND CAUSES
HYPERPIGMENTETION. INCREASED PRODUCTION OF MELANIN, WHICH MAY PROVIDE A
BIOLOGIC DEFENCE AGAINST THE NOXIOUS AGENTS PRESENT IN TOBACCO SMOKE
• CLINICALLY LESIONS ARE BROWN, FLAT AND IRREGULAR SOME ARE GEOGRAPHIC OR MAP
LIKE IN CONFIGURATION
• INTENSITY OF PIGMENTATION APPEARS TO BE TIME AND CLOSE RELATED HISTOLOGICALLY
BASILAR MELANOSIS WITH MELANIN ISOBSERVED
• HEAVY METALS
• INCREASED LEVELS OF HEAVY METALS (E. G., LEAD, BISMUTH, MERCURY, SILVER,
ARSENIC AND GOLD) IN THE BLOOD ARE COMMONLY KNOWN TO CAUSE
ORAL MUCOSAL DISCOLORATION.
• VARIOUS METALS CAUSE VARIOUS TYPES OF PIGMENTATION. FOR EXAMPLE,
PIGMENTATION DUE TO LEAD POISONING ALSO CALLED AS PLUMBISM
APPEARS AS A BLUE-BLACK LINE ALONG THE MARGINAL GINGIVA KNOWN AS
BURTONIAN LINE.
• OCCUPATIONAL EXPOSURE TO HEAVY METAL VAPORS IS THE COMMON CAUSE
OF PIGMENTATION IN ADULTS. THE MOST COMMON CAUSE IN THE PAST WAS,
TREATMENT OF SYPHILIS WITH DRUGS CONTAINING HEAVY METALS, SUCH AS
ARSENICALS FOR SYPHILIS
• BISTMUTHISM
• BISTMUTH USED IN THE TREATMENT EG: DIARRHEA IN THE LONG TERM • CAUSES BLUE, GRAY ON MUCOSA •
• CAUSES METAL TASTE •
• CAUSES NECROTIC ULCERATIVE GINGIVITIS I •
• INCREASES BISTMUTH LINE ON PAPILLAE INTERDENTAL AND BLUE LINES ON THE GINGIVA

Maintain oral hygiene •

Replace drugs
containing bistmuth
• AMALGAM TATTOO
Clinical features:
• ETIOLOGY & INCIDENCE: • Black or blue is a small dot
• ESPECIALLY IN ADULTS •Usually located on the lower or lower ridge part
of vestibule
• PARTICLES OF AMALGAM OR ASH
• Asymptomatic, usually radiopaque
CAN COALESCE IN WOUNDS AFTER
• Diagnosis: • Differentiate with melanoma
TOOTH EXTRACTION OR
microscopic
APICOECTOMY AND UNDER THE
• Treatment: exsisi when needed
MUCOSA
• AMALGAM TATTOO IS CAUSED BY THE PRESENCE OF METALLIC MATERIAL IN THE ORAL TISSUES
• AMALGAM TATTOOS ARE PAINLESS, GREY-BLUE MACULES THAT RANGE IN SIZE ROM A FEW
MILLIMETERS TO GREATER THAN 1 CM

• THE GINGIVAL AND ALVEOLAR MUCOSA ARE THE MOST COMMON SITES OF INVOLVEMENT
• NO SIGNS OF INFLAMMATION ARE PRESENT AT THE PERIPHERY OF THE LESION
 GRAPHITE
• SOMETIMES, GRAPHITE MAY BE INCORPORATED INTO THE
ORAL MUCOSA THROUGH ACCIDENTAL INJURY WITH A
GRAPHITE PENCIL WHICH IN TURN CAUSE PIGMENTATION.
• THIS KIND OF LESION COMMONLY OCCURS IN CHILDREN.
• CLINICALLY, IT APPEARS AS AN IRREGULAR GRAY TO
BLACK MACULE IN THE ANTERIOR PALATE REGION.
• MALIGNANT LESIONS LIKE MELANOMA SHOULD BE
DIFFERENTIATED FROM THESE LESIONS AS MELANOMA
TOO COMMONLY OCCURS ON THE PALATE
Graphic Tatto
• GRAPHIC TATTOO OCCUR ON THE PALATE
REPRESENTING TRAUMATIC IMPLANTATION
FROM A LEAD PENCIL
• THE LESIONS ARE USUALLY MACULAR, FOCAL
AND GRAY OR BLACK IN COLOUR

Microscopically
Graphite resembles amalgam in tissue although special stains can
segregate the two
 PLUMBISM
• EXPOSURE TO LEAD IN EXCESSIVE
DOSES CONTAINED IN PAINT OR
WATER PIPE • STRIKING CHANGE IS A
LEAD LINE THE BLACK GRAY WITHIN
THE EDGE OF THE GUMS BECAUSE
SULFIDE TIN PRECIPITATE. • ON THE
MUCOSA OF THE CHEEK AND
TONGUE IN THE SHAPE OF A MACULA
GRAY
Treatment:
• Determine toxic sources
• Keep away from toxic sources
• Reversible plumbism
• Diagnosis: • Clinical examination / red
blood cells shows basophilic stippling on
grains red blood is mottled because of
lead poisonin
HEMANGTIOMA
•Hemangioma regresses as the patient ages
•The lesion may be flat or slightly raised
•Hemangioma is a benign proliferation of the endothelial cells that line vascularchannels
•Varies in colour from red to bluish purple depending on the type of vessels involved

VASCULAR MALFORMATION
• Vascular malformation is A structural anomaly of blood
vessels without endotilial proliferation
• Vascular malformation persists throughout life
Haemangioma VM
TERIMAKASIH