Dr. ShahzaD HussainBDS, FCPS(r)

Oral & Maxillofacial SurgeryNishtar Institute Of Dentistry, Multan

SNDENTALCARE.CO

Diseases OF Lips??

Any Idea??...

Learning Outcomes? At the End oF this Discussion we will be able to Describe Which are the Diseases Of the Lips??1. Swelling? Generalized Localized1. Angular Cheilitis? 2. Lip Fissures?3. Allergic Cheilitis?4. Actinic cheilitis?5. Exfoliative 6. Perioral Dermatitis?7. Lick Eczema?8. Cheilocandidiosis

Swelling Of Lips? Swelling of lips

It May be

1. Generalized/Diffuse

2. Localized

Usually involves Perioral area of skin

Usually patients of Orofacial Granulomatosis and angioedema present with lip swelling.

Causes Of lip SwellingDIffuse Localized

1. Angioedema2. Oedema3. OFG4. Crohn’s Disease5. Haemengioma6. Lymphangioma

1. Mucocele2. Abscess3. Haematoma4. Salivary adenoma5. Basal Cell Carcinoma6. Squamous cell carcinoma7. Keratoacanthoma

Angular Cheilitis Angular Chelitis is the Inflammation of one or both

corners of mouth

Multifactorial disease

with

1. Local

2. Systemic factors

Inadequate Dentures

• Skin creasing with slivaleakage and maceration at corners of the mouth

• Host DefencesCompromised

Systemic Diseases or

Deficiencies

• Anemia

• Iron Deficiency, B12 or Folate Deficiency

• HIV

• Diabetes Mallitus

• Sjogresn’s Syndrome

Trauma

• S. Aureus Species

• Candida Species

Diagnosis?1. Complete Medical, social, Dental History

2. Complete Examinations Especially for anemia, ill fitting denture, denture and candidial infections.

3. Investigations?

1. Microbilogical:

1. Sampling? Smear, swab, oral rinse

2. Site? Angle, palate, fitting surface of denture

Blood Tests:

Complete Blood Count

Serum B12, ferritin, serum and red cell folate levels

Management Elimination of local factors

Denture Hygiene

Instruct patient to leave denture at night

Referral to medical specialist for underlying medical cause

Provision of antimicrobial therapy

1. Local

2. Systemic

Antimicrobial therapy Candida isolated

1. Nystatin pastilles (intraoral)

2. Nystatin ointment (corners)

S. aureus isolated

1. Fusidic acid cream (angles)

2. Mupirocine cream/fusidic acid cream (anterior nares)

Mixed infection

1. Miconazole gel/cream

Chlorhexidine mouthwash

Lip Fissures Less common

Midline of lower lip

Resistant to conservative treatment usually

Majority of these is due to Infections which may be S.aureus or candida albicans

Treatment principle is based on elimination of secondary cause of infection and then topical steroid Creams application.

Recurrence is common

Commonly seen in patients of down syndrome along with angular cheilitis as well as OFG

Allergic Chelitis Irritation and scaling of lips caused by allergy due to1. Lipsticks 2. Ointments 3. Foods 4. Moisturizes 5. Tooth pastes 6. Lipstick allergy may also be caused by straw sharing and

kissingMangement:1. Identification and removal of the cause of irritation2. Topical steroids cream can be used for short term

management

Actinic Cheilitis Solar keratosis

predominantly male patients

Prolonged exposure to sunlight either occupational or recreational may result this

Long exposure to sunlight

Lower lip more effected

Crusting and induration of the vermilion margin

May progress to carcinoma

Biopsy is necessary for complete assessment

Epithelial atypia is seen in this condition

Crusting and induration is due to fibrotic reaction of the connective tissues.

Treatment :

1. Excision by either lip shave operation

2. laser treatment

Exfoliative Chelitis Production of excess amount of keratin Involves vermilion border Brown scales are formed which may be removed by the patient or

may persist Reported to be exclusively in females Histology is simply hyperparakeratosis Not a malignant condition May be related to stress, no definite cause is known Various treatments have been used like local and systemic steroids,

cautery, cryosurgery and many others but all without success. Antidepressants have also been used with some success reported. Resolves itself usually.

PeriOral Dermatitis Relatively unommon

Young adult females

Erythematous rash on the facial skin around the mouth

Can be due to previous use of steroid creams or contact allergy

Clinical diagnosis

Treated with low potency steroid like 1% hydrocortisone

More tan one aetiological factor may be involved.

Lick Eczema Young children

Sharply deliniated zone of irritable scaly skin around the mouth

Treatment is to stop the habit of licking

Removable appliance

Cheilocandidosis Heavy candidial infection

Bilaterally

Lower lip

Ulcerated granular areas

Generally healthy patients with a previous history of local abnormality.

Early treatment with anti fungals is necessary.