Diseases Of Oral Cavity And Salivary Glands 2024-2025 PDF

DISORDERS OF ORAL CAVITY AND SALIVARY GLANDS Prof. Dr. Gamze YURDAKAN ÖZYARDIMCI LEARNING OBJECTIVES Defines disorders related to oral mucosa and structures in the mouth Explains the causes and developmental mechanisms of inflammatory and neoplastic diseases of the oral mucosa and other...

DISORDERS OF ORAL CAVITY AND SALIVARY GLANDS Prof. Dr. Gamze YURDAKAN ÖZYARDIMCI LEARNING OBJECTIVES Defines disorders related to oral mucosa and structures in the mouth Explains the causes and developmental mechanisms of inflammatory and neoplastic diseases of the oral mucosa and other structures in the mouth, defines its importance from a public health perspective. Defines the differential diagnosis principles in these diseases. Defines the developmental mechanisms, histomorphological features and clinical reflections of neoplastic and nonneoplastic diseases of the salivary 16.09.2024 2 16.09.2024 3 16.09.2024 4 16.09.2024 5 DISEASES OF TEETH AND SUPPORTING STRUCTURES CARIES Focal demineralization of tooth structure (enamel and dentin) Reason: Acids generated during the fermentation of sugars by bacteria Source: Processed and refined foods 16.09.2024 6 16.09.2024 7 DISEASES OF TEETH AND SUPPORTING STRUCTURES Important point: Oral hygiene and flouridation 16.09.2024 8 DISEASES OF TEETH AND SUPPORTING STRUCTURES What role does fluoride play in caries prevention? Fluoride is incorporated into the crystalline structure of enamel, forming fluoroapatite, which is resistant to degradation by bacterial acids 16.09.2024 9 DISEASES OF TEETH AND SUPPORTING STRUCTURES Gingivitis Gingivitis is inflammation involving the squamous mucosa, gingiva, Poor and associated oral hygiene soft tissues Dentalsurrounding plaque andthe teeth. calculus bacteria salivary proteins desquamated epithelial cells 16.09.2024 10 DISEASES OF TEETH AND SUPPORTING STRUCTURES Chronic gingivitis: Gingival erythema, edema, and bleeding Prevalence: Adolescence Protection (reversible) : Regular brushing and flossing 16.09.2024 11 DISEASES OF TEETH AND SUPPORTING STRUCTURES Periodontitis Periodontitis is an inflammatory process that affects the supporting structures of the teeth (periodontal ligaments), alveolar bone, and cementum. 16.09.2024 12  Periodontitis destruction of periodontal ligament and alveolar 16.09.2024 Tooth bone loss 13  DISEASES OF TEETH AND SUPPORTING STRUCTURES Facultative Gram-positive organisms (healthy) Anaerobic and microaerophilic Gram- negative bacteria (harmful) Aggregatibacter (Actinobacillus) actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia 16.09.2024 14 ORAL INFLAMMATORY LESIONS Aphthous Ulcers (Canker Sores) Superficial mucosal ulceration 10-20 years of age Painful Recurrence Familial, celiac disease, inflammatory bowel disease, and Behçet disease 16.09.2024 15 ORAL INFLAMMATORY LESIONS Herpes Simplex Virus Infections Herpes simplex virus type 1 and herpes simplex virus type 2 A self-limited primary infection Host resistance compromise 16.09.2024 16  ORAL INFLAMMATORY LESIONS  Asymptomatic primary infection (2-4 age)  10-20 % acute herpetic gingivostomatitis  Latent HSV-1  Reactivation: is known as Cold sore or recurrent herpetic stomatitis  Reason for reactivation: Trauma, allergies, exposure to ultraviolet light and extremes of temperature, upper-respiratory tract 16.09.2024infections, pregnancy, 17  ORAL INFLAMMATORY LESIONS (HSV infection) Transmission: From mucosa to trigeminal ganglion , axonal transport ,infection: Recurrent latency At the site of the first inoculation or in the adjacent mucosa innervated by the same ganglion Formation: A group of small vesicles Location: lips (herpes labialis), nasal orifices, buccal mucosa, gingiva, and hard palate Prognosis: Healing or 16.09.2024 18 ORAL INFLAMMATORY LESIONS (HSV infection) Morphologically, the infected cells become ballooned and have large eosinophilic intranuclear inclusions. Adjacent cells commonly fuse to form large multinucleated polykaryons 16.09.2024 19 ORAL INFLAMMATORY LESIONS Oral Candidiasis (Thrush) Candidiasis is the most common fungal infection of the oral cavity. Candida albicans (normal component of oral flora) Immunosuppression Conditions predisposing The specific to the disease: strain of C. albicans The composition of the oral microbial flora (microbiota) BROAD-SPECTRUM ANTIBIOTICS 16.09.2024 20  ORAL INFLAMMATORY LESIONS (Oral Candidiasis )  Clinical forms: Pseudomembranous, erythematous, and hyperplastic  Pseudomembranous= Trush  Superficial infection  Deep infection can happen to people with severe immunosuppression 16.09.2024 21 PROLIFERATIVE AND NEOPLASTIC LESIONS OF THE ORAL CAVITY Fibrous Proliferative Lesions Chronic Fibroma:irritation Reactive submucosal connective nodular tissue that fibrous tissue hyperplasia forms Fibroma when: Buccal mucosa along the bite line treatment: Complete surgical excision and Removal of the source of irritation 16.09.2024 22  Oral cavity irritation 16.09.2024 fibroma 23 PROLIFERATIVE AND NEOPLASTIC LESIONS OF THE ORAL CAVITY Pyogenic granuloma Inflammatory lesion On the gingiva of children, young adults, and pregnant women (pregnancy tumor) 16.09.2024 24  PROLIFERATIVE AND NEOPLASTIC LESIONS OF THE ORAL CAVITY Proliferation of immature vessels Epithelial ulceration Regression and mature into Dens fibrous mass or Develop into peripheral ossifying fibroma Treatment: Complete surgical 16.09.2024 25 PROLIFERATIVE AND NEOPLASTIC LESIONS OF THE ORAL CAVITY Leukoplakia and Erythroplakia: Leukoplakia is defined by the World Health Organization as “a white patch or plaque that cannot be scraped off and cannot be characterized clinically or pathologically as any other disease.” Lichen planus and candidiasis are not considered 16.09.2024 mucosa. 26  PROLIFERATIVE AND NEOPLASTIC LESIONS OF THE ORAL CAVITY Prevalance for age: 40-70 Predominance 2:1 male Risk factor: Tobacco use Malignant transformation risk: High in erythroplakia Precancerous 16.09.2024 27 PROLIFERATIVE AND NEOPLASTIC LESIONS OF THE ORAL CAVITY Hyperkeratosis Dysplastic changes in the epithelium Carcinoma in situ 16.09.2024 28 SQUAMOUS CELL CARCINOMA 95% of cancers of the oral cavity Aggressive epithelial malignancy Multiple primary tumors «Field cancerization» Chronic mucosal exposure to carcinogens such as alcohol or tobacco 16.09.2024 29 SQUAMOUS CELL CARCINOMA Pathogenesis: exposure to carcinogens -alcohol and tobacco (both smoked and chewed) use. with high-risk variants of human infection papillomavirus HPV (HPV)(type vaccine16) (in the future, beneficial ?) TP53 and RAS mutation Location: the ventral surface of the tongue, floor of the mouth, lower lip, soft palate, and gingiva. 16.09.2024 30 The HPV-related tumors tend to occur in the tonsillar crypts 16.09.2024 31  SQUAMOUS CELL CARCINOMA Early stage: Like a simple wound Advanced stage: Ulcerated and protruding masses with irregular and hardened Early stage borders. SCC Advanced stage SCC 16.09.2024 32  SQUAMOUS CELL CARCINOMA Histologic patterns range from well-differentiated keratinizing neoplasms to anaplastic, sometimes sarcomatoid tumors. Local invasion: Cervical lymph nodes Distant metastases: Mediastinal lymph nodes, lungs, and liver. 16.09.2024 33 DISEASES OF SALIVARY GLANDS Parotid, submandibular, and sublingual gland NONNEOPLASTIC DISORDERS Xerostomia Sialadenitis Mucocele SjögrenPleomorphic Syndrome NEOPLASMS Adenoma Warthin Tumor Mucoepidermoid CarcinomaAdenoid cystic 16.09.20 3 24 4 DISEASES OF SALIVARY  Dry mouth GLANDS Xerostomia  Decrease in the production of saliva  Older than 70 years of age Reasons: A side effect of (anti-cholinergic, medications anti-depressant/anti- psychotic, diuretic, anti-hypertensive, sedative, muscle relaxant, analgesic, and anti-histaminic agents) Sjögren’s syndrome Radiation therapy Fissures and ulcerations in the oral 3 cavity, the papillae of the tongue, 5  Dental caries, candidiasis, difficulty in swallowing and speaking 16.09.20 24  DISEASES OF Sialadenitis SALIVARY Inflammation of the salivary gland GLANDS Reasons: Trauma, viral or bacterial infection, or autoimmune disease Viral: Mumps, salivary gland enlargement, mononuclear inflammatory infiltrate, self- limited infection in children, pancreatitis and orchitis in adults Bacterial: Staphylococcus aureus and Streptococcus viridans. Predisposing factor: Dehydration, decreased secretion, ductal 3 7  Sialolithiasis, gross and microscopic feature 16.09.20 24  DISEASES OF SALIVARY GLANDS Mucocele The most common inflammatory lesion of the salivary glands Blockage or rupture of a salivary gland duct Toddlers, young adults, and older adults Fluctuant swelling of the lower lip 16.09.2024 39  DISEASES OF SALIVARY GLANDS (Mucocele)  Histologic feature: A cyst-like structure, surrounded by fibrous connective tissue containing macrophages, mucins, and inflammatory cells  Treatment: Complete excision of the cyst and 16.09.2024 40  DISEASES OF SALIVARY GLANDS Sjögren Syndrome Dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia) Autoimmune disorder Primary form: Sicca syndrome Secondary form: Associated with another autoimmune disease (Rheumatoid arthritis) Pathogenesis? Viral infection? Tissue self-antigen release? 16.09.2024 41  DISEASES OF SALIVARY GLANDS Involvement (Sjögren ofSyndrome) lacrimal and salivary gland Lymphocytic infiltration (CD4+ helper T cells, plasma cells, and some B cells) Two ribonucleoprotein antigens: Anti- SS-A,antibody High SS-A anti-SS-Blevel disease early onset, longer disease duration, and extra glandular manifestations Another antibody: rheumatoid factor, ANAs 16.09.2024 42  DISEASES OF SALIVARY GLANDS Periductal (Sjögren andSyndrome) perivascular lymphocytic infiltration Germinal center formation Fibrosis and atrophy in the acini B-cell lymphoma risk 16.09.2024 43 DISEASES OF SALIVARY GLANDS (Sjögren Syndrome)  Drying of the corneal epithelium  Inflammation  Ulceration  Atrophy 16.09.2024 44 16.09.2024 45 SALIVARY GLAND NEOPLASMS 65% to 80% in the parotid, 10% in the submandibular gland, and the remainder in the minor salivary glands, including the sublingual glands Probability of malignant tumor (X) The size of the gland (70% to 90% of sublingual tumors are cancerous) Adult age, more common in women A biopsy must be taken for definitive diagnosis 16.09.2024 46 SALIVARY GLAND NEOPLASMS PLEOMORPHIC ADENOMA 60% of tumors in the parotid A painless, mobile discrete mass Recurrence 16.09.2024 47  SALIVARY GLAND NEOPLASMS (PLEOMORPHIC ADENOMA) Benign tumor A mixture of ductal (epithelial) and myoepithelial cells Both epithelial and mesenchymal differentiation (myxoid, hyaline or cartilage and bone structure) Untreated tumor transformation (malignant Malignant mixed tumor or carcinoma ex pleomorphic adenoma) Capsule(+) Poorly developed capsule= protrusions into16.09.2024 the surrounding tissues 48 SALIVARY GLAND NEOPLASMS Warthin Tumor (Papillary Cystadenoma Lymphomatosum) Lymphocytes  The second most common salivary gland tumor  Benign  Parotid gland  Between the ages of 50-70, more common in men  10% multifocal, %10 bilateral  Smoking***  Superficial, encapsulated mass  Histologic feature: Cystic cavities, Oncocytic cell two rows of cells, lymphocyte (with (abundant mitochondria) germinal center), oncocytic cell  2% recurrence 16.09.2024 49 SALIVARY GLAND NEOPLASMS Mucoepidermoid Carcinoma Most common form of primary malignant tumor of the salivary glands 60-70% in the parotids, but the majority of malignant tumors of minor salivary glands Capsule(-), invasion(+), big tumor Gross: Cystic area, mucus Histologic feature: mixtures of squamous cells, mucus-secreting cells, and intermediate cells Clinical course and prognosis depend on16.09.2024histologic grade 50 SALIVARY GLAND Malignant glandular NEOPLASMS Adenoid structure cystic carcinoma  The minor salivary glands, especially the palatine glands  Slow growing, poorly capsule(+), invasion(+)  Recurrence (+)  Bone, liver, and brain metastasis 16.09.2024 Perineural invasion 51  References Robbins Basic Pathology; Kumar V. Abbas A. : Aster J. Copyright © 2018 by Elsevier Inc. Board Review series Pathology 5th Ed. Schneider A. Szanto P. Copyright © 2014 Lippincott Williams & Wilkins, a Wolters Kluwer business Understanding Pathophysiology El-Hussain M. Power –Kean K. Zettel S. Copyright © 2018 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. 16.09.2024 52 16.09.2024 THANK YOU FOR YOUR ATTENTION 53