Yellowish conditions of oral cavity
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Yellowish conditions of oral cavity
- 1. Differential diagnosis of yellow conditions of oral mucosa INDIAN DENTAL ACADEMY Leader in continuing Dental Education www.indiandentalacademy.com
- 2. INTRODUCTION Yellow lesions are relatively uncommon in oral cavity Yellow color may be caused by lipofuscin (the pigment of fat). It may also result from other causes. www.indiandentalacade my.com
- 3. Fordyce’s granules Fibrin clot Superficial abscess Superficial nodules of tonsillar tissue Yellow hairy tongue Acute lymphnodular pharyngitis Lipoma Lymphoepithelial cyst Epidermoid and dermoid cyst Pyostomatitis vegetans Jaundice or icterus Lipoid proteinosis Carotenemia Rarities Amyloidosis Cola nitida chewing Pseudoxanthoma elasticum Psoriasis www.indiandentalacade my.com
- 4. Fordyce’s granules • In 1896, Fordyce described whitish spots on the vermilion border of the lips, oral mucosa and, rarely, genital mucosa • Fordyce’s granules are considered as a developmental anamoly characterized by heterotrophic collections of sabeceous glands in oral cavity covered with intact mucosa. Pathogenesis: sebaceous glands in the mouth may result from the inclusion in the oral cavity of the ectoderm having some of the potentialities of the skin in the course of development. www.indiandentalacade my.com
- 5. • They appear as multiple , small, slightly raised granules that vary from whitish-yellow to a distinct yellow • They may occur in clusters or plaque like areas • 80% individuals have fordyce’s granules • They increase rapildy in number at puberty and continues to increase during adult life • Buccal mucosa-bilaterally • Retromolar pad area ,labial mucosa , gingiva frenum and palate • Solid nodules give the involved area a slightly cheesy feeling www.indiandentalacade my.com
- 6. d/d: Granules –focal collection of candida organisms Plaque like area- leukoplakia www.indiandentalacade my.com
- 10. Fibrin clot • Many ulcers in oral cavity ,such as apthous and traumatic ulcers form a fibrin clot • The RBC are leached out of the clot by saliva ,with the clot remaining as yellowish coating on the ulcer • The ulcer is further stained by food and micro oraganisms that may enhance yellow color www.indiandentalacade my.com
- 12. Superficial abscess • The superficial bacterial or mycotic abscess may appear as a yellow lesion • The yellow color is imparted by pus pooling below the thinned mucosa that is stretched over the enlarging abscess www.indiandentalacade my.com
- 13. Clinical finidings: • Pain • Superficial abscess may be single or multiple primarly involving the tooth bearing areas • A single abscess is a nodular or dome shaped swelling with a smoooth frequently reddened mucosa over the yellow pus • On palpation it is fluctuant & when aspirated yeilds pus • The surface may ulcerate and produce a sinus opening with resultant draining lesion www.indiandentalacade my.com
- 14. Superficial nodules of tonsillar tissue It is a discrete ,yellowish pink nodules distributed over the posterior wall of oropharynx These are nodes of lymphatic tissue that supplement the major tonsils composing waldeyers ring www.indiandentalacade my.com
- 15. clinical findings The nodes of tonsillar tissue are situated in the oropharynx They are usually 1 to 10 in number measuing 3 to 5mm in diameter www.indiandentalacade my.com
- 16. Superficial nodules of tonsillar tissue 2 pink nodular growth with normal surrounding tissue www.indiandentalacade my.com
- 17. Yellow hairy tongue Synonym: Lingua nigra, lingua villosa, lingua villosa nigra Hairy tongue is a harmless entity that occurs on the dorsum of the tongue in approx 0.15% Hypertrophy of filliform papillae Poor oral hygiene Contributory factors www.indiandentalacade my.com
- 18. c/f: Filliform -15mm Males-HIV & use of IV drugs Glossopyrosis Tickling sensation Gagging sensation Halitosis Bacterial and fungal growth play a role in the color of the tongue www.indiandentalacade my.com
- 19. d/d: • Hairy leukoplakia • Candidiasis www.indiandentalacade my.com
- 21. Acute lymphonodular pharyngitis It is manifested by whitish to yellowish papular lesions on soft palate and oropharynx Coaxsackie A10 virus c/f: Incubation period -5 days after exposure Children & young adults Sore thorat ,fever heachache,loss of apetatite The oral lesions appear on 3rd day Course of the disease runs from 4 to 14 days Oral lesions resolve in 6 to 10days after the onset of the symptoms www.indiandentalacade my.com
- 22. • The lesions are raised discrete papules 3 to 6 mm in diamter • The whitish to yellowish papules are surrounded by narrow zone of erythema • Surface are not vescicular and donot ulcerate • The nodules are extremely tender ,superficial and bilateral • Commonly seen on uvula soft palate ant tosillar pillars and post oropharynx www.indiandentalacade my.com
- 24. lipoma Most common benign neoplasm but seldom seen in oral cavity It is a benign ,slow growing neoplasm of mature fat cells found in subcutaneous tissue The first description of oral lesion was given in 1848 by roux – ”YELLOW EPULIS“ www.indiandentalacade my.com
- 25. Clinical features • Buccal mucosa ,muccobuccal fold • Tongue floor of the mouth and lip • morphogically - diffuse form superficial encapsulated Superficial form appear as single or lobulated painless lesion attached eighter a sessile or pedunculated base deeper lesions vary in contour and shape ranging from wellcontoured , wellldefined ,round swelling to a large illdefined lobulated mass • The color which often is yellow depends on the thickness of overlying mucosa www.indiandentalacade my.com
- 26. Non tender soft & cheesy in consistency but may be fluctuant • Usually superficial ,occasionally infilterates and gets fixed and therefore not freely movable • Deeply occuring lesions may produce only a slight surface elevation and may be well encapsculated more diffuse and less delineated than the superfical variety www.indiandentalacade my.com
- 29. Multiple head and neck lipomas Neurofibromatosis Gardner’s syndrome Encephalocraniocutaneous lipomatosis Multiple familial lipomatosis Proteus syndrome www.indiandentalacade my.com
- 31. Lymphoepithelial cyst • It is a result of cystic degeneration of epithelial inclusions in lymphoid aggregates in the oral cavity • It is a pseudo cyst of oral tonsil tissue • It arises from excretory ducts of the sublingual glands or occasionally from the ducts of the minor salivary glands www.indiandentalacade my.com
- 32. c/f: • Male predilection • 14 to 81 yrs • Asymptamatic • Non tender • Floor of the mouth and lateral border of the tongue • It is a solitary raised appears as yellowish white or white nodules with smooth surface • Diameter varies from mm to cm • It is mobile , superficial soft fluctuant and sharply delineated and on aspiration an amorphous coagulum predominantly keratin www.indiandentalacade my.com
- 34. • Lymphnode • Mucocele • Dermoid cyst • Sailolith • Neuroma • Lipoma www.indiandentalacade my.com
- 35. Epidermoid or dermoid cyst Epidermoid and dermoid cysts are developmental anamolies. They are bascically cystic teratomas resulting primarily from trapped germinal epithelium They are rare in the oral cavity www.indiandentalacade my.com
- 36. • Floor of the mouth , submaxillary and submental areas • Cysts may be found above or below mylohyoid muscle • The cysts may be in the midline or located laterally • 15 and 35 yrs • They may be slow growing or sudden onset .Nontender • The cyst is not fixed to the surrounding tissue • Superficial –yellow to white with smooth and non ulcerated surface • Consitency: soft to firm • Aspiration produces variety of materials in addition to typical starw colored cyst fluid www.indiandentalacade my.com
- 38. Histopathology • The lumen of the simple cyst is filled with cystic fluid or keratin and no other specialized structures – epidermoid cyst • lumen may contain other elements ,depending on the germinal potential of the originating epithelium If the lumen contains contain sebaceous materal and keratin –dermoid cyst If the lumen contains elements such as bone muscle or teeth -teratoma www.indiandentalacade my.com
- 39. • Ranula • Thyroglossal duct cyst • Cystic hygroma • Branchial cleft cyst • Cellulitis • Tumors • Lipoma www.indiandentalacade my.com
- 40. Pyostomatis vegetans • PV is an uncommon benign chronic mucocutaneous disease of unknown etiology characterized by miliary pustules that affect mucosal membranes • It is a highly specific marker for inflammatory bowel disease and its correct recognition may lead to the diagnosis of ulcerative colitis or Crohn’s disease www.indiandentalacade my.com
- 41. • The first reports of PV were documented by Hallopeau in 1898- pyodermite vegetans. • Males • Oral lesions are distinct and appear as multiple white or yellow friable pustules, with an erythematous and thickened mucosa that often ruptures, resulting in ulceration and erosions. • The oral mucosa may have a granular morphology but vegetating pustules undergo degeneration, ulceration and suppuration, leading to a folded, fissured “snail track” appearance www.indiandentalacade my.com
- 42. • The labial attached gingiva, soft and hard palate, buccal and labial mucosa, vestibule and tonsillar regions. • The floor of the mouth and tongue are usually spared • the filiform and fungiform lingual papillae may be atrophic • Peripheral eosinophilia has been reported in 90% of the cases www.indiandentalacade my.com
- 43. • The diagnosis of PV is founded on clinical features, association with inflammatory bowel disease, peripheral eosinophilia, negative culture of pus from lesions and histological features www.indiandentalacade my.com
- 44. • Generalized papillometosis • Pemphigus vegetans • Viral and fungal infection • Systemic drug reactions • Erythema multiforme • pemphigus vulgaris, bullous pemphigoid, acquired • epidermolysis bullosa, bullous drug eruption, • Herpetic infections, • Erythema multiforme, www.indiandentalacade my.com
- 46. “Snail-track” mucosal pustules on an erythematous base on maxillary gingiva www.indiandentalacade my.com
- 47. Jaundice Jaundice or icterus is the yellowish discoloration of the skin mucousmembrane and sclera of the eye that is produced by an increase in the blood level of bilurubin and the deposition of bile pigments in the tissue Serum bilurubin exceeds 2to 3 mg/100ml Hyperbilirubinemia www.indiandentalacade my.com
- 48. Reduced uptake of bilurubin –gilbert syndrome,acute ciral hepatitis congenita heartfailure and after portacaval shunt surgery Reduced excretion –viral hepatits, inflamatory granulometosa neoplastic infiletration of the liver www.indiandentalacade my.com
- 49. • Yellow tinge of eyes skin oral mucous membrane • Icterus is the first or sumtimes the only manifestation Omm-junction of the hard palate ad soft palate Pruritis pain and enlarged liver www.indiandentalacade my.com
- 53. Lipoid proteinosis • Lip is a rare, autosomal recessive disorder that presents in early infancy with hoarsness followed by pox like and acneform scars along with infilteration and thickening of skin and mucous membrane • It is a rare disease that severly affects the oral cavity with the formation of yellow white plaque on the oral mucosa • Disturbance of mucopolysachrides metabolism or an alteration in the formation of lipoprotein is transmitted as an autosomal recessive trait • Chief complaint-inability to cry, husky voice scaring mucopapular eruptions on the skin www.indiandentalacade my.com
- 54. Calcificaion of the hippocampal gyri may occur –pathognomic c/f: Present from birth Lips oral mucosa, face neck ,hands scrotum eyelids, knees and elbows Recurrent painful parotitis Gingival enlargment The yellowish white lesions are multiple The lesions are characterstically raised that are whitish to yellowish and have smooth nonulcerated surface 2mm to 0.5cm Fixed to underlying tissue Congenital absence of teeth and enamel hypoplasia www.indiandentalacade my.com
- 56. cArotenemia • This condition is due to a high plasma concentration of carotenes,(LIPOCHROME) mostly diet-related (carrots, oranges, etc) • there is a generalized yellowness of the skin and oral mucosa Excessive deposition of carotenoid (,Lipochrome) • Hyperlipidemia • Diabetes • Nephritis • Hypothyroidism • Metabolic disorder • Heaptic disease www.indiandentalacade my.com
- 57. c/f • It is a generalized yellowness of the skin and mucous membrane • History reveals that the patient has an extremey high intake of food contains large amounts of carotene www.indiandentalacade my.com
- 59. d/d • Jaundice- The absence of sclerae pigmentation and the carotene serum level permit a differential diagnosis with jaundice www.indiandentalacade my.com
- 61. References: • Normank.wood.paul w.goaz-differential diagnosis of oral and maxillofacial lesions-5th edition • Burkets oral medicine-11th edition • Oral pathology shafers-5th edition www.indiandentalacademy.com
Editor's Notes
- Accumulation of pus, aggregation of lymphoid tissue, exudation of serum, degeneration of blood pigments, lipid containing structures, neoplasms and extrinsic stains.
- Shafers pg 42
- Andidal over grwoth ,……..soft palate ….. Entrapment food debris b/w
- Culture
- Its color varies depending on its positon and thickness of overlying tissue
- It may vary from a simple cyst usually lined by stratifie squamous epithelium to a cyst composed of other germ layersand various types of epithelium
- Large numbers of small closely set papillary projections with a broad base usually on an erythematous mucosa Although the projections are red to reddish pink they may show tiny yellow pustules beneath the epithelium Painless Buccal&labial mucosa-lesions show may folds and papillary projections develop on these folds erthema is not so intense The yellow vescilces that develop in the papillary projection are pustules and if opened these vescicles discharge small amounts of purulent material This is the only disease known to produce an oral pustular eruption
- hemolysis,excess pigment production ,reduced hepatic uptake or decreased transport,conjugation and Biliary excretion of bilurubin
- Thalasemia Sicke cell anemia Pernicous anemia Polycythemia Neonatal jaundice
- Which is the result of a high intake of foods containing carotene pigments