Diseases of the Oral Mucosa
Most oral mucosal diseases involve microorganisms (Table 32-1).
Table 32-1 Vesicular, Bullous, or Ulcerative Lesions of the Oral Mucosa
Lip and oral
Heals that spontaneously in 10– days.
Definitions and scope of pediatric dentistry
Pediatric dentistry is an age-defined specialty that provides
both primary and comprehensive preventive and therapeutic
oral health care for infants and children through adolescence,
including those with special health care needs.1
To become a pediatric dental specialist, a dentist must satisfactorily
complete a minimum of 24 months in an advanced
education program accredited by the Commission on Dental
Accreditation of the American Dental Association (ADA).
Ulcers Ulceration is the most common oral mucosal lesion. Although there are many causes, the host and pattern of lesions, including the presence of systemic features, narrow the differential diagnosis (Table 32-1). Most acute ulcers are painful and self-limited. Recurrent aphthous ulcers and herpes simplex infection constitute the majority. Persistent and deep aphthous ulcers can be idiopathic or seen with HIV/AIDS. Aphthous lesions are often the presenting symptom in Behçet's syndrome (Chap. 320).
The lack of understanding of the mechanisms whereby the above aetiological
factors (genetic and environmental) interact to initiate the complex pathobiology of
schizophrenia is the key reason for the relative lack of progress in the development of novel
drug treatments. All the antipsychotic medication that is currently in use (first and second
generation) is all predicated on the so-called ‘Dopamine Hypothesis’ (discussed below) and
share a common putative mechanism of action, namely dopamine antagonism.
Chapter 124. Sexually Transmitted Infections: Overview and Clinical Approach (Part 19)
Ulcerative Genital or Perianal Lesions: Treatment
Immediate syndrome-based treatment for acute genital ulcerations (after collection of all necessary hdiagnostic specimens at the first visit) is often appropriate before all test results become available, because patients with typical initial or recurrent episodes of genital or anorectal herpes can benefit from prompt oral antiviral therapy (Chap.
Candidiasis: Treatment Treatment involves removing any predisposing factors such as antibiotic therapy or chronic wetness and the use of appropriate topical or systemic antifungal agents. Effective topicals include nystatin or azoles (miconazole, clotrimazole, econazole, or ketoconazole). The associated inflammatory response accompanying candidal infection on glabrous skin can be treated with a mild glucocorticoid lotion or cream (2.5% hydrocortisone).
A 73-year-old man with stable coronary artery disease, hypertension, and chronic renal
insufficiency presents with recurrent atrial fibrillation at 80 to 90 beats per minute.
His symptoms include shortness of breath and fatigue. He has had atrial fibrillation
twice in the past year; with each episode, electrical cardioversion resulted in
marked improvement in his symptoms. His echocardiogram shows symmetric left
ventricular hypertrophy with evidence of diastolic dysfunction. His medications include
warfarin and metoprolol (25 mg twice daily).
Synthetic progestogens (administered orally or parenterally) are recommended as first-line ther-
apy for the management of troublesome hot flushes. If oral therapy is used, it should be given
for 2 weeks, and re-started, if effective, on recurrence of symptoms.
Men starting long-term bicalutamide monotherapy ( 6 months) should receive prophylactic
radiotherapy to both breast buds within the first month of treatment. A single fraction of 8 Gy
using orthovoltage or electron beam radiotherapy is recommended.
Magnesium deficiency is very often present and quite severe. Hyperreflexia, muscle twitches, myocardial
irritability, poor stamina and recurrent tight muscle spasms are clues to this deficiency. Magnesium is
predominantly an intracellular ion, so blood level testing is of little value. Oral preparations are acceptable for
maintenance, but those with severe deficiencies need additional, parenteral dosing: 1 gram IV or IM at least
once a week until neuromuscular irritability has cleared.
Pituitary and other endocrine abnormalities are far more common than generally realized.