PIGMENTED LESIONS OF THE ORAL CAVITY
PIGMENTATION:
THE TERM PIGMENTATION OF THE ORAL MUCOSA IS APPLIED TO WIDE RANGE OF LESIONS OR CONDITIONS FEATURING A CHANGE OF ORAL TISSUE
PIGMENTATION IS OF TWO TYPES
1) ENDOGENOUSPIGMENTATION: PIGMENTS ARE WIH IN THE BODY
EX : MELANIN,HEMOGLOBIN,HEMOSIDERIN
2) EXOGENOUS PIGMENTATION:IN THIS TYPE PIGMENTS ORIGINATE OUTSIDE THE BODY
IT MAY BE DUE TO
ACCIDENTAL PIGMENTATION,: GRAPHITE TATOO,CHARCOAL TOOTH POWDER
IATROGENIC PIGMENTATION: AMALGAM TATOO
HEAVY METAL PIGMENTATION:BISMUTH,LEAD,ARSENIC
CLASSIFICATION:
ENDOGENOUS PIGMENTATION:
1) HEMANGIOMA:
IT IS A BENIGN PROLIFERATION OF ENDOTHELIAL CELLS
CONGENITAL IN ORIGIN
CLINICALFEATURES:
SIGNS: EARLIEST SIGN IS BLANCHING OF INVOLVED SKIN FALLOWED BY TELANGECTASES AND
THEN A RED MACULE
USUALLY SEEN IN CHILDREN
IT APPRERS AS DEEP RED OR BUISH RED IN COLOR
IT IS COMMON ON TONGUE FALLOWED BY LIPS ,BUCCALMUCOSA AND PALATE
DIFFERENTIAL DIAGNOSIS:
MUCOCELE,RANULA,CYST:THE HEMANGIOMA BLANCHES AND MAY EMPTIED BY THE
APPLICATION OF PRESSURE, WHICH FORCES BLOOD FROM THE VASCULAR SPACES AND IT IS
NON FLUCTUANT WHERE AS MUCOCELE AND RANULA ARE FLUCTUANT AND CANT BE EMPTIED
ANEURYSM:NO PULSE DETECTED IN HEMANGIOMA WHERE AS IN ANERYSM IS RUBBERY NON
FLUCTUANT ,DOMELIKE,BLUISH NODULES WITH A USUALLY DISCRENABLE THROBBING
TREATMENT:
INTRALESIONAL INJECTION OF SODIUM TETRADECYL SULPTHATE
CRYOSURGERY
2) VARIX AND VARICES:
VARIX IS ENLARGED AND CONVOLUTED VEIN ,ARTERY OR LYMPHATIC VESSEL.
IT IS AN ACQUIRED BENIGN VASCULAR LESION,GENERALLY ASYMPTOMATIC AND DOES NOT REQUIRE TREATMENT
ORAL VARIX IS MORPHOLOGICALLY COMPOSED OFONE TO THREE EXTENSIVE
TORTUOUS BLOOD VESSELS AND LINED BY FLAT MATURE EPITHELIUM
DEFINITION:
VARIX IS FOCAL DILATATON OF VEIN OR GROUP OF VENULES
VARICES IS PATHOLOGICAL DILATATION OF VEIN OR VENULES
CLINICAL FEATURES:
SITE:SEEN MAINLY ON TONGUE,LIP,CHEEK
COLOR:RED OR PURPLE IN COLOR
MARGINS AND SHAPE: IT HAS SHARPLY DELINEATED BORDERS AND A SMOOTH ,ROUNDED
SURFACE CONTOUR
CAVIAR TONGUE: WHEN MANY SUBLINGUAL VEINS INVOLVED IT IS KNOW AS CAVIAR TONGUE
DIFFERENTIAL DIAGNOSIS:
HEMANGIOMA: HEMANGIOMA IS USUALLY CONGENITAL AND HAS A TENDENCY TO REGRESS
SPONTANEOUSLY,WHERE AS VARIX ARISES IN OLDER INDIVIDUALS AND ONCE FORMED
DOESNOT REGRESS
RANULA,CYST: CANT BE EMPTIED BY DIGITAL PRESSURE
ANEURYSM: RARE AND DEMONSTRATE PULSE
NEVI: DOESNOT BLANCH UP ON PRESSURE
MANAGEMENT:
LESION CAN BE EXCISED INCLUDING ELECTRO OR CRYO SURGERY
INTRALESIONAL INJECTION OF 1% SODIUM TETRADECYL SULPHATE
KAPOSI’S SARCOMA:
ALSO KNOWN AS ANGIORETICULOENDOTHELIOMA
CLINICAL FEATURES:
CAN OCCUR AT ANY AGE BUT MOST COMMON IN 5TH AND 6TH DECADES
COMMON IN MALES
APPEARANCE: MULTICENTRIC NEOPLASTIC PROCESS THAT MANIFESTSAS MULTIPLE RED OR PURPLE MACULES OR IN ADVANCED STAGES AS NODULES
THE LESIONS PROGRESS AND BECOME DARKER AND MAY COALESCE OR FORM CLUSTERS OF SINGLE NODULES
AIDS ASSOCIATED:ITS MORE COMMON IN HEAD NECK REGION
TIP OF NOSE IS MORE COMMON
IT CAN INVOLVE LYMPHNODES,SOFT TISSUE OF EXTREMETIES AND GIT
CLINICAL TYPES:
1.CLASSIC TYPE: MULTIPLE BLUISH PURPLE MACULES AND PLAQUES ARE PRESENT ON THE SKIN OF THE LOWER EXTREMITIES
2.ENDEMIC: IT IS AGAIN DIVIDED INTO FOUR TYPES
A)BENIGNNODULAR TYPE
B)AGGRESSIVE TYPE
C)FLORID FORM
D)UNIQUE LYMPHADENOPATHIC FORM
3)IATROGENIC TYPE
4)AIDS RELATED
ORALMANIFESTATIONS:
SITE:MUCOSA OF PALATE,GINGIVA AND TONGUE
APPEARANCE:NODULES OR MACULES WITH MUCOSAL ULCERATION IN SOME OF THE MATURE CASES
COLOR:RED TO PURPLE
SYMPTOMS: PAIN,DYSPHAGIA,DIFFCULTY WITH MASTIGATION
PALPATION: THE LESION DOESNOT BLANCH WITH PRESSURE
DIFFERENTIAL DIAGNOSIS:
HEMANGIOMA:IT BLANCHES ON PRESSURE
PURPURA: MULTIPLES PAPULES ON THE SOFT PALATE
NEVI: NOT AGGRESSIVE LESION
MELANOMA: IT IS NOT MULTICENTRIC PROCESS
MANAGEMENT:
RADIOTHERAPY
SURGICAL ERADICATION
SYSTEMIC CHEMOTHERAPY
INTRALESIONAL USE OF VINBALSTINE
3) ANGIOSARCOMA:
IT IS A RARE MALIGNANCY OF VASCULAR ENDOTHELIUM WHICH MAY
ARRISE FROM EITHER BLOOD OR LYMPHATIC VESSELS
ORAL LESIONS ARE RARE
THEY ARE RAPIDLY PROLIFIRATIVE AND THERE FORE PRESENT AS
NODULARTUMORS
ORAL ANGIOSARCOMAS ARE COMMON IN MANDIBLE
THEY APPEAR AS RED BLUE OR PURPLE IN COLOR
HERIDITARY HEMORRHAGIC TELANGECTESIA:
CAUSE: GENETICALLY TRANSMITTED DISEASE INHERETED AS AN AUTOSOMAL DOMINANT TRAIT
SITE: VERMILION BORDER, LIPS, TONGUE,BUCCALMUCOSA
CLOR:RED OR BROWN
SHAPE AND SIZE: MULTIPLE ROUND OR OVOID ,0.5CM IN DIAMETER
MANAGEMENT: ELECTROCAUTERY
MELANOTIC MACULE:
ETIOLOGY:
GENETIC:GENETIC PREDISPOSITION IS SEEN IN MOST OF THE CASES
RACIAL: MOST LIKELY RACIAL IN ORIGIN
ENVIRONMENAL FACTORS:SMOKE INDUCED,DRUG INDUCED, HORMONE
INDUCED OR SPONTANEOUS
CLINICAL FEATURES:
AGE:MIDDLE AGED PEOPLE AND COMMON IN FEMALES
SITE:VERMILION BORDER OF LOWER LIP
SOMETIMES IT OCCUR ON GINGIVA,PALATE AND BUCCAL MUCOSA
COLOR:BLACK TO BROWN TO BLUE GRAY
SIZE: 1CM IN DIAMETER
SHAPE: OVAL AND IRRREGULAR IN OUT LINE
DIFFERENTIAL DIAGNOSIS:
MELANOPLAKIA:LARGER AND OCCUR IN BLACKS
AMALAMTATOO: ASSOCIATED WITH JUXTAPOSITIONED AMALGAM FILLING
ECCYMOSIS:IT HAS BROWNISH COLOR AND IT USUALLY DISAPPEARS WITHIN FEW DAYS
FLAT NEVI: VERY RARE IN ORAL CAVITY
FOCALMELANOSIS: IT IS NOT SEEN AS PIGMENTED LESIONS
MANAGEMENT:SURGICAL EXCISION
PIGMENTED NEVUS:
IT IS CONGENITAL OR BENIGN IN ORIGIN
ORAL NEVI ARE RARE
It IS USUALLY BUT NOT NOT ALWAYS PIGMENTED
THERE ARE FOUR TYPES
INTRAMUCOSAL
JUNCTIONAL
COMPUND
BLUE NEVUS
CLINICAL FEATURES:
AGE:APPEAR AFTER BIRTH
SITE: PALATE,GINGIVA,BUCCALMUCOSA AND LIP
COLOR:BLUE OR BLACK
SIGNS: THEY DONOT BLANCH UP ON PRESSURE
DIFFERENTIAL DIAGNOSIS:
VASCULAR LESIONS
AMALGAMTATOO:DUE TO AMALGAM RESTORATIONS
MELANOMA: RARE IN ORAL CAVITY
MANAGEMENT:EXCISIONAL BIOPSY
MELANOMA:
ALSO KNOWN AS MELANOSARCOMA
MALIGNANT NEOPLASM OF MELANOCYTIC ORIGIN THAT ARRISES FROM BENIGN LESION OR DENOVO FROM MELANOCYTES
GROWTH PHASE:
RADIAL GROWTHPHASE AND VERTICAL GROWTH PHASE
TYPES: SUPERFICIAL SPREADING
NODULARMELANOMA
LENTIGO MALIGNA MELANOMA
ACRAL LENTIGENOUS MELANOMA
CLINICALFEATURES:
AGE:40 TO 50 YEARS OF AGE
SITE:PALATE AND MAXILLARY GINGIVA
COLOR: BROWN TO BLACK MACULE
SYMPTOMS:RELATIVELY SOFT ON PALPATION
DIFFERENTIAL DIAGNOSIS:
ORALMELANOTIC MACULE
ECCHYMOSIS
MELANOPLAKIA
PIGMENTED FIBROMA
MANAGEMENT:
SURGICAL EXCISION
RADIOTHERAPY
INTRALESIONAL INJECTION OF INTERFERON AND POLY VALENT MELANOMA ANTIGEN VACCINE
ECCHYMOSIS AND PETECHIAE:
THESE ARE PURPURIC SUBMUCOSAL AND SUBCUTANEOUS HEMORRHAGES
PETECHIAE ARE MINUTE PINPOINT HEMORRAHGES
ECCHYMOSIS IS LARGER THAN 2CM IN DIAMETER
CLINICAL FEATURES:
SITE:COMMON ON LIPS AND FACE
COLOR:BRIGHT RED MACULE
DIFFERENTIAL DIAGNOSIS:
AMALGAM TATOO
INFECTIOUS MONONUCLEOSIS
PHYSIOLOGICALPIGMENTATION:
DEFINED AS LOCALISED SYMMETRIC HYPERPIGMENTATION COMMONLY SEEN ON ATTCHED GINGIVA
ETIOLOGY:
GENETIC
MECHANICAL,CHEMICAL AND PHYISICAL STIMULATION
ACTIVITY OF MELANOCYTES
AGE FACTORS
CLINICALFEATURES:
AGE: SEEN AT ANY AGE
SITE: ATTACHED GINGIVA
COLOR:BROWN TO BLACK TO BLUE
SOMETIMES TONGUE IS ALSO PIGMENTED
A RELATED TYPE OF POST INFLAMATORY PIGMENTATION IS OCCASIONALLY SEEN FALLOWING
MUCOSAL REACTION TO INURY
DIFFERENTIAL DIAGNOSIS:
SMOKERSMELANOSIS
PEUTZ JEGHERS SYNDROME
MELANOMA
TREATMENT:
GINGIVAL SURGERY
CRYOTHERAPY
SMOKER’S MELANOSIS:
ETIOLOGY:
SMOKING :EFFECT OF NICOTINE ON MELANOCYTES LOCATED OLONG BASAL CELLS OF THE
LINING EPITHELIUM OF ORAL MUCOSA
NICOTINE DIRECTLY STIMULATES MELANOCYTES TO PRODUCE MORE MELANOSOMES WHICH
RESLUTS IN NCREASED DEPOSITION OF MELANIN PIGMENT AS BASILAR MELANOSIS WITH
VARYING AMOUNTS OF MELANIN INCONTINENCE
POLY CYCLIC AMINES IN TOBACCO STIMULATES MELANOCYTES
CLINICAL FEATURES:
IT INCREASES WITH AGE
SEEN ON ANTERIOS MANDIBULAR GINGIVA,PALATE,BUCAL AND COMMISURAL
MUCOSA,INFERIOR SURFACE OF TONGUE AN LIP MUCOSA
BLACK BROWN IN COLOR
DIFFERENTIAL DIAGNOSIS:
DRUG INDUCED MELANOSIS
PEUTZ JEGHERS SYNDROME
ADDISONS DISEASE
MANAGEMENT: CESSATION OF SMOKING
DRUG INDUCED PIGMENTATION:
ANTIMALARIAL DRUGS SUCH AS QUINACRINE,CHLOROQUINE AND HYDROXYCHLOROQUINE
CAN CAUSE INTRAORAL MELANIN PIGMENTATION
CLINICAL FEATURES:
SITE:HARDPALATE
COLOR: GRAY IN COLOR
MINOCYCLINE CAN ALSO CAUSE PIGMENTATION
BIRTH CONTROL PILLS CAN BE ASSOCIATED WITH BROWN PIGMENTATION OF FACIAL SKIN AND
PERIORAL REGION
PHENOLPHTHLEIN ASSOCIATED WITH WELL CIRCUMSCRIBED AREA OF HYPERPIGMENTATION
ON SKIN AND ORAL MUCOSA
DIFFERENTIAL DIAGNOSIS:
ADDISONS DISEASE
SUPERFICIAL SPREADING MELONOMA
TREATMENT: WITHDRAWL OF DRUG
HEMOCHROMATOSIS:
KNOWN AS BRONZE DISEASE
IT IS A TETRAD OF LIVER CIRROSIS,DIABETES,CARDIAC FAILURE,AND BRONZE SKIN
COLOR BLACK IN COLOR SEEN AT THE JUNCTION OF HARD AND SOFT PALATE
EXOGENOUS PIGMENTATION:
1) AMALGAM TATOO:
ALSO CALLED AS LOCALISED ARGYROSIS
ETIOLOGY:
MAY BE CONDENSED IN THE ABRADED GINGIVA DURING ROUTINE AMALGAM RESTORATIVE
WORK
DURING REMOVAL OF OLD FILLING
RETROGRADE AMALGAM FILLNG
DURING EXTRACTION
CLINICAL FEATURES:
SITE: GINGIVA AND ALVEOLAR MUCOSA
AGE: BELOW 12YRS ,FEMALES
APPEARANCE:FLAT MACULE OR SOMETIMES SLIGHTLY RAISED LESION WITH
MARGINS BEING WELL DEFINED OR DIFFUSE IN OTHER
COLOR:BLUE TO BLAK IN COLOR
DIFFERENTIAL DIAGNOSIS:
SUPERFICIAL HEMANGIOMA:IT BLANCHES ON PRESSURE
NEVUS AND MELANOMA: RARE IN ORAL CAVITY .IT HAS BROWN COLOR COMPARED TO TATOO WHICH HAS BLUE COLOR
MANAGEMENT: SURGICAL EXCISION
2)BISMUTHISM:
ETIOLOGY:
MEDICINAL USE OF BISMUTH
OCCUPATIONAL EXPOSURE OF BISMUTH
MECHANISM:
PIGMENTATION IS PRODUCED BY ACTION OF HYDROGEN SULPHIDE ON THE
BISMUTH COMPOUND
THE HYDROGEN SULPHIDE IS FORMED THROUGH BACTERIAL DEGRADATION OF
ORGANIC MATERIAL OF FOOD RETENTION
CLINICAL FEATURES:
SYMPTOMS: VAGUE GIT DISTURBANCES,NAUSEA,BLOODY DIARRHEA,BISMUTH GRIPPE AND JAUNDICE
BISMUTH LINE:SOMETIMES IN LONG BONES,WHITE BANDS OF INCREASED
DENSITY APPEAR IN THE ENDS OF DIAPHYSES IMMEADIATELY ADJACENT TO THE
EPIPHYSEAL LINES ,CALLED AS BISMUTH LINE
ORALMANIFESTATIONS
SYMPTOMS: PATIENT COMPLAINS OF METALLIC TASTE
INDREASED SALIVATION WITH BURNING SENSATION IN THE MOUTH
ULCERATIVE GINGIVOSTOMATITIS IS VERY COMMON
SIGNS: EXTREAMELY PAINFUL SHALLOW ULCERATIONS ARE SEEN AT CHEEKMUCOSA IN MOLAR REGION
TONGUE IS FREQUENTLY ENLARGED AND SORE
BISMUTHLINE: BLUE BLACK LINE APPERAS TO BE WELL DEMARCATED TO EYE ON GINGIVAL PAPILLA
PAPER TEST : IT WILL INDICATE WHETHER THE PIGMENTATION IS ACTUALLY IN GINGIVAL TISSUE OR NOT
MANAGEMENT:
REMOVAL OR STOPPAGE OF THE HABIT
ORAL HYGIENE MAINTANANCE
TOPICAL ANAESTHETICS LIKE LIGNOCAIN HYDROCHLORIDE
PLUMBISM OR LEAD POISONING
ETIOLOGY:
INGESTION OF LEAD BASED PAINT
LEAD IN ILLICIT ALCOHOL
OCCUPATIONAL EXPOSURE
LEAD IN GASOLINE
MECHANISM:
ABSORPTION OF LEAD FROM ALIMENTARY TRACT,LUNGS AND ,IT IS MODULATED BY VIT D AND CALCIUM STATUS OF THE INDIVIDUAL
LEAD IS TAKEN UP BY CIRCULATING ERYTHROCYTES AND BOUND TO REACTIVE SULPH HYDRYL GROUPS OF PROTEINS
FROM THE CIRCULATION,LEAD IS TRANSFERRED TO ALL SOFT TISSUES AND IN HIGH CONCENTRATION IT WILL INHIBITMETABOLIC PATHWAYS
IN THE RED CELLS,LEAD INHIBITS ENZYMES ASSOCIATED WITH HEMOGLOBIN SYNTHESIS
HENCE ABNORMAL ACTIVITY OF THE ENZYMES OCCUR
CLINICAL FEATURES:
NERVOUS SYSTEM: INACUTE POISOININGS DEMYELENATION AND AXON DEGENERATION OCCURS
LEAD ENCEPHALOPATHY,CEREBRAL PALSY,MENTAL RETARDATION,SEIZURES,WRIST OR FOOT
DROP AND FATIGUE OCCUR
GIT:NAUSEA,VOMITING,CONSTIPATION OCCURS
BONE:CHANGES ARE SEEN IN RATE OF BONE DEPOSITION AND RESORPTION
ORALMANIFESTATIONS:
SYMPTOMS: METTALIC TASTE,EXCESSIVE SALIVATION AND DYSPHAGIA
BURTOLIAN LIN E IS SEEN WHICH IS GRAY BLACK IN COLOR AND IS SEEN ABOVE THE GINGIVAL MARGIN
SIGNS:PALLOR OF LIP,POOR MUSCLE TONE AND THE FACE APPEAR ASHEN IN COLOR
TREMOR OF TONGUE MAY BE SEEN
THERE IS BILATERAL ENLARGEMENT OF PAROTID GLAND
MANAGEMENT:
USING OF CHELATING AGENTS SUCH AS EDTA AND DMPS,DMSA
MERCURIALISM:
ALSO CALLED AS PINK DISEASE.SWIFT DISEASE,DERMATO POLYNEURITIS
ETILOGY:
MEDICINAL USE OF MERCURY
MERCURY IN DENTAL AMALGAM
MERCURY IN PAINTS
MERCURIAL DIURETICS
CLINICAL FEATURES:
AGE: IT OCCURS MOST FREQUENTLY IN YOUNG INFANTS
GIT: DIARRHEA,NAUSEA,ABDOMINAL PAIN
NERVOUS SYMPTOMS: HEADACHE,INSOMNIA,TREMORS OF FINGERS AND TONGUE
RENAL SYMPTOMS:SEVERE INTAOXICATION CAN LEAD TO DEATH
HAIRS AND NAILS: NAILS ARE SHED COMPLETELY
TEETH LOST PERMANENTLY
ALOPECIA IS ALSO PRESENT
RAW BEEF APPEARANCE:THE SKIN OF HANDS,FEET,NOSE,EARS AND CHEEK BECOMES CLAMMY
RED OR PINK AND HAS A COLD CLAMMY FEELING
SKIN: THE AFFECTED SKIN PEELS FREQUENTLY DURING THE COURSE OF THE DISEASE
PATIENTS MAY ALSO HAVE MACULO PAPULAR RASH WHICH IS EXTREMELY PRURITIC
SEVERE SWEATING,EXTREME IRRITABILITY,PHOTOPHOBIA, WITH
LACRIMATION,INSOMNIA,MUSCULAR WEAKNESS,TACHYCARDIA,HYPERTENSION
ORALMANIFESTATIONS:
VISCID SALIVA
METTALIC TASTE
BLUE GRAY IN COLOR AND PAINFUL GINGIVA
ULCERATIVE STOMATITIS
TONGUE IS ENLARGED AND PAINFUL
SALIVARY GLAND AND LYMPH NODES MAY SWOLLEN
LIPS ARE DRY.CRACKED
BRUXISM IS COMMON FINDING
TEETH MAY EXFOLIATE
NECROSIS OF BONE IS SEEN
MANAGEMENT:
ATROPINE OR BELLADONA TO CONTROL SALIVARY FLOW
USE OF CHELATING AGENT SUCH AS BAL,DSMA,AND DMPS
4) ARGYRIA OR SILVER POISONING:
ALSO KNOWN AS ARGYROSIS
ETIOLOGY:
MEDICINAL USE
PHOTOGRAPHIC FILMS
OCCUPATIONAL EXPOSURE
MECHANISM: SILVER IS DISSEMINATED IN THE BODY AND IT ACCUMULATES AS SUB EPITHELIAL DEPOSITS IN THE SKIN
CLINICAL FEATURES:
PIGMENTATION IS SEEN THROUGHT THE GINGIVA
SLATE BLUE SILVER LINE ALONG THE MARGINS
ORALMUCOSA EXHIBITS A DIFFUSE BLUISH BLAK DISCOLORATION
MANAGEMENT:
REMOVAL OF THE CAUSE
5) ARSENIC POISOINING:
OCCURS DUE TO ARSENIC POISONING
ETIOLGY:
INDUSTRIAL EXPOSURE
MEDICINAL USE
CLINICAL FEATURES:
SYMPTOMS:CHRONIC GASTRITIS AND COLITIS,KERATOSIS OF PALMS OF THE HAND AND SOLES OF FEET
HYPERPIGMENTATION:DIFFUSE MACULAR HYPERPIGMENTATION IS SEEN ON THE
SKIN OF THE PATIENT THIS OCCURS DUE TO INCREASE IN MELANIN
PIGMENTATION
ARSENICAL KERATOSIS:THESE ARE PREMALIGNANT SKIN LESIONS WHICH CAN OCCUR IN ARSENIC POISONING
ORALMANIFEATATIONS:
ORAL TISSUES ARE EXTREMELY PAINFUL AND EXCESSIVE SALIVATION
SEVERE GINGIVITIS
NECROTISING ULCERATIVE STOMATITIS
DEEP RED IN COLOR
MANAGEMENT:
ANAESTHETIC OINTMENT
CHELATING AGENTS SUCH AS BAL AND DMSA
GOLD POISONING:
ALSO KNOWN AS AURIC STOMATITIS
ETIOLOGY:MEDICINAL USE: GOLD IS USE FUL FOR THE TREATMENT OF
RHUMATOID ARTHRITIS,LUPUS ERYTHEMATOUS AND LEPROSY
CLINICAL FEATURES:
DERMATITIS,PURPURA,ALOPECIA,LOSS OF NAILS,AND MALIGNANT NEUTROPENIA
CHRYIASIS: SLATE BLUE DISCOLORATION OF SKIN OCCUR IN GOLD POISONING…
ORAL MANFESTATIONS
SITE: IT INCLUDES BUCCAL MUCOSA LATERAL BORDER OF TONGUE ,PALATE AND PHARYNX
SYMPTOMS: METALLIC TASTE
STOMATITIS CAN OCCUR
SIGN: VESICULATION AND ULCERATIONS OF THE ORAL MUCOSA
MANAGEMENT; REMOVAL OF THE CAUSE
USE OF ALKALINE MOUTH WASHES
COPPER PIGMENTATION:
RESULTS DUE TO CHRONIC COPPER INTAKE WHICH MAY BE ASSOCIATED WITH DEVELOPMENT OF ANEMIA
BLUISH GREEN LINE IS SEEN ON GINGIVA AND ON TEETH KNOWN AS CLAPTON LINE
TOOTH DISCOLORATION MAY OCCUR DUE TO ETCHING OF ENAMEL BY COPPER SALTS
CHROMIUM PIGMENTATION:
DUE TO CHROMIUM INGESTION PATIENT EXPERIENCES BURNING,SORENESS,DRYNESS OF MOUTH ASSOCIATED WITH SWEELING OF TONGUE
THERE IS PAINFUL ULCERATION OF THE NASAL SEPTUM WHICH RESULTS IN PROLIFERATION
TEETH MAY GET ETCHED AND SHOW DEEP ORANGE COLOR
ZINC: OCCUPATIONAL HAZARD IN MOLTEN BRASS WORKERS AND ELECTRIC ARC WORKERS
ASSOCIATED WITH CHLLS,RIGORS,FEVER ,SWEATING,AND RAPID PULSE
NAUSEA VOMITING,DRYNESS,BURNING OF THE UPPER RESPIRATORY TRACT AND METALLIC TASTE ARE SEEN
BLUISH GREY LINE ON GINGIVA IS SEEN
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