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The mouth and salivary glands 

The mouth and salivary glands

The mouth and salivary glands

T. Lehner

and S.J. Challacombe

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date: 24 April 2017

Stomatology is the branch of medicine that deals with oral diseases of both hard and soft tissues. For historical reasons and due to the rather technical aspects of treatment of teeth, dentistry has been separated from the main body of teaching medicine. This has created a curious anomaly in the training of doctors, namely that oral diseases receive low priority in teaching, and yet many systemic diseases are associated with oral symptoms and signs.

Dental caries, caused by bacterial action, is one of the most common human diseases and causes considerable misery: it results from the interaction of dietary sugars with cariogenic bacteria. Chronic gingivitis and periodontal disease are also very common diseases of the oral cavity which are related to accumulation of dental plaque; host factors related to immunological responses to mixed organisms or specific microbes, e.g. Porphyromonas gingivalis, may be involved. Chronic periodental disease is the most important cause of dental loss in adults. Host factors, including smoking, diabetes mellitus, and genetic determinants increase susceptibility to periodontitis.

Acute oral infections include fusospirochaetal gingivitis (Vincent’s gingivitis or necrotizing ulcerative gingivitis), a bacterial infection responsive to antimicrobial therapy that requires differentiation from herpetic gingivostomatitis, caused by herpes simplex virus type 1, which may respond to early treatment with aciclovir. However, the most common oral lesion is recurrent aphthous stomatitis, the treatment of which is fraught with difficulties.

Immunodeficiency (e.g. related to iatrogenic immunosuppression) can be associated with many oral infections, e.g. HIV recurrent herpetic lesions, or oropharyngeal candidiasis. Early manifestations of HIV infection are often found in the mouth, with oral candidiasis, Kaposi sarcoma or periodontal disease.

The oral cavity is affected in diverse diseases of the skin such as pemphigus vulgaris, benign pemphigoid, lichen palnus, erythema multiforme and Stevens–Johnson syndrome, in autoimmune rheumatic or vasculitic disorders (e.g Sjögren’s syndrome, Behçet’s disease, Wegener’s granulomatosis), in various internal conditions (e.g. Crohn’s disease, ulcerative colitis, coeliac disease). Oral cancer may involve the lips, cheeks, tongue, gums and oropharynx and a variety of tumours affect the salivary gland.

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