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Dimitrios Andreadis

Oral Medicine Specialist - Dentist

Oral Medicine and Dentistry

Every day we are faced with a multitude of lesions of the mouth that need investigation and differential diagnosis as they are due to dental causes and are not part of a systemic disease. Some of them are:

A. Fibroma-hyperplasias from irritation in any part of the mouth (+gum): This is damage of reactive reasoning, due to injury to the mucous membrane from the teeth, either due to some problematic occlusion-sealing, or from a sharp point or broken end of a tooth. Clinically, it appears as a small tumor that is usually painless.

Β. Inflammatory reactions of the oral mucous membrane due to prosthetic-restorative materials such as amalgam fillings (“black” coloured), or extended prosthetic restorations with destruction of the outer “white” material and contact of their metal surfaces with the oral mucosa: The continuous contact of the mucous membrane with amalgam fillings, mainly oxidized, can cause hypersensitivity reactions. Clinically, irregular white areas, redness and sometimes sores, accompanied by a burning sensation and/or pain, etc. are observed.

C. Amalgam Tattoo of the oral mucosa: This is the entry of amalgam into the tissues either from tiny pieces of amalgam that break off and remain in the alveolus or shavings from the removal of an amalgam filling. Clinically, it is an asymptomatic circumscribed lesion with a blue-black color. The deposit is more frequent on the gums, the cheek and the floor of the mouth.

D. Pyogenic granuloma: This is a reactive lesion of the vascular history that develops in the alveolus after extraction. It is caused by bone or dental debris left in the socket after extraction.

E. Intraoral and extraoral fistula in abscesses of dental origin: It is the result of necrosis of the tooth and creation of an apical abscess. It has the appearance of a small tumor in the gums that oozes pus and blood periodically.

F. Denture Stomatitis: In this case the mucous membrane under the denture appears erythematosus due to the strong presence of the Candida albicans fungus. It occurs exclusively in the oral mucosa in an area that occupies the limits of a mobile prosthetic restoration worn by the patient. It is usually asymptomatic or there may be a burning sensation.

G. Allergic contact reactions:

  1. Allergic stomatitis from various dental materials and foods: rare allergic reaction of the mucous membrane due to e.g. acrylic. The mucous membrane at the contact points of the denture is very red and swollen with a strong burning sensation.

H. Damage from mechanical causes:

  1. Traumatic oral sore: this is a frequent damage to the oral mucosa. The causes that create sores in the mouth are tooth roots, broken teeth, bad fillings, sharp foreign bodies, hard foods, etc. It can be created in any place, but most often it is found on the sides of the tongue, the cheek, the lips, the gums and the palate.
  2. Traumatic hematoma: Mechanical injury to the oral mucous membrane can cause a vessel to rupture and extravasate blood that diffuses into the tissues causing a hematoma. Clinically it is a red, irregular, and painless lesion that is usually limited.
  3. Injury from a toothbrush: Injury to the mucous membrane can also be caused by a toothbrush, mainly with hard bristles, when strong movements are made. Clinically, superficial erosions covered by a whitening pseudomembrane are observed.
  4. Papillary hyperplasia of the palate: It is seen in people who wear permanent complete dentures and is located exclusively on the palate. It is the result of inflammatory hyperplasia of the mucous membrane, due to abnormal mechanical pressures from the dentures and poor oral hygiene.
  5. Folds in the gums due to poorly made or old dentures whose flaps cause irritation of the mucous membrane that over time create nodules-swellings that cannot go away.
  6. Finally, there are cases where patients report pain in the temporomandibular joints, inability to open the mouth, clenching-grinding teeth during the night as well as a multitude of symptoms that affect their quality of life. In these cases of bruxism, as it is called, the therapeutic approach focuses on alleviating the symptoms and protecting the teeth and joints by making and fitting special splints (“braces”) for daily use that apply to the teeth, and are worn by the patient during the night, as it has been found that the clenching of the teeth due to stress intensifies in the evening hours.