Gingival (Gum) hyperplasia/hypertrophy

About

Not always clear whether it is hyperplasia or hypertrophyCan only be confirmed by determined by biopsy which is not always doneGingival enlargement is preferred terminology.

Causes

Vincent’s angina, ScurvySodium Valproate, Nifedipine, CiclosporinAcute Myeloid leukaemia (M5) – may regress after treatmentPregnancy, Oral contraceptive pill.

Clinical

May be bleeding enlarged gumsAnaemia – ? AMLKnown epilepsy.

Management

Specialist review of medications as appropriateGood dental care.

Burket’s Oral Medicine by Michael Glick

Angular Stomatitis/Cheilitis

Introduction

Stomatitis is inflammation of the mouth. Cheilitis is inflammation of the lip. Angular stomatitis in the painful ‘split’ at the corner of the mouth ‘labial commissure’

About

Commonly seen in edentulous elderlyCan be secondary candidal infection

Aetiology

MalnutritionElderly – poorly fitting denturesB12/6 or Folate or Iron deficiencySeborrhoeic dermatitis

Clinical

Fissuring of the skin and even ulceration at the corners of the mouthOften painful with evident redness and symptoms

Differential Diagnosis

Oral cancer if persisting, atypical symptoms

Investigations

FBC, ESR, B12, Folate, Ferritin for Megaloblastic anaemia (B12/folate deficiency)

Management

Assessment for new dentures and wearing them will possibly help.Vioform-hydrocortisone cream (hydrocortisone 1%, clioquinol 3%) will reduce inflammation and treat staphylococcal or Candida infection.

Reference: Burket’s Oral Medicine by Michael Glick.