Common Lesions of the Oral Soft Tissues

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Chapter 307 Common Lesions of the Oral Soft Tissues

Oropharyngeal Candidiasis

Oropharyngeal infection with Candida albicans (thrush, moniliasis) (Chapter 226.1) is common in neonates from contact with the organism in the birth canal or breast. The lesions of oropharyngeal candidiasis (OPC) appears as white plaques covering all or part of the oropharyngeal mucosa. These plaques are removable from the underlying surface, which is characteristically inflamed and has pinpoint hemorrhages. The diagnosis is confirmed by direct microscopic examination on potassium hydroxide smears and culture of scrapings from lesions. OPC is usually self-limited in the healthy newborn infant, but topical application of nystatin to the oral cavity of the baby and to the nipples of breast-feeding mothers will hasten recovery.

OPC is also a major problem during myelosuppressive therapy. Systemic candidiasis (SC), a major cause of morbidity and mortality during myelosuppressive therapy, develops almost exclusively in patients who have had prior oropharyngeal, esophageal, or intestinal candidiasis. This observation implies that prevention of OPC should reduce the incidence of SC. The use of oral rinses of 0.2% chlorhexidine solution, plus systemic antifungals may be effective in preventing OPC, SC, or candidal esophagitis.

Aphthous Ulcers

The aphthous ulcer (canker sore) is a distinct oral lesion, prone to recurrence. The differential diagnosis is noted in Table 307-1. Aphthous ulcers are reported to develop in 20% of the population. Their etiology is unclear, but allergic or immunologic reactions, emotional stress, genetics, and injury to the soft tissues in the mouth have been implicated. Aphthous-like lesions may be associated with inflammatory bowel disease, Behçet disease, gluten-sensitive enteropathy, periodic fever-aphthae-pharyngitis-adenitis syndrome, Sweet syndrome, HIV infection (especially if ulcers are large and slow to heal), and cyclic neutropenia. Clinically, these ulcers are characterized by well-circumscribed, ulcerative lesions with a white necrotic base surrounded by a red halo. The lesions last 10-14 days and heal without scarring. Over-the-counter palliative therapies, such as benzocaine and topical lidocaine, are effective, as well as topical steroids. Tetracycline has been shown to have benefit with severe outbreaks, but caution is necessary in pregnant women and young children to prevent tetracycline tooth staining during a child’s tooth development.

Table 307-1 DIFFERENTIAL DIAGNOSIS OF ORAL ULCERATION

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CONDITION COMMENT
COMMON
Aphthous (canker sore) Painful, circumscribed lesions; recurrences
Traumatic Accidents, chronic cheek biter, or after dental local anesthesia
Hand, foot, mouth disease Painful; lesions on tongue, anterior oral cavity, hands, and feet