[MUSIC] In this module, we'll discuss various oral mucosal diseases that could affect the oral cavity. First I'll talk a little bit about common oral anomalies, things that aren't truly diseases or disorders, but rather common oral findings that may be different than what you would normally see. We'll follow this up with common oral mucosal diseases, diseases that do affect the oral cavity. The final segment of this module, we will discuss oral leukoplakia, oral erythroplakia and oral cancer. Leukoplakia and erythroplakia have been described as pre or rather potentially malignant oral diseases. In this slide we see a very common condition of the tongue. We call this benign migratory glossitis. It's more conventionally referred to as geographic tongue. Although the first picture, or the prior picture, looked rather significant, often we'll see just subtle variations of normal. Occasionally we can see this condition of geographic tongue in areas that are not the tongue at all. In this picture, we're viewing the junction of the hard and soft palate. You'll notice the red area of tissue with the white around it. Almost similar to what we would see on the tongue, but an area distinct from the tongue. Another very common oral anomaly is something we call linea alba, or white line. This is a white line that is formed where the teeth abrade the inside of the cheek. This is often at the area where the upper teeth and the lower teeth meet. It is very, very common condition and seen in most of our patients. Occasionally, a patient will be referred in to me for bluish pigmentation underneath the tongue. This also is a very common condition, and this is a condition that's caused by varicosities underneath the tongue. That's right, varicose veins. Occasionally we can also see varicosities in other areas, but it is more common to see them underneath the tongue. Another common condition that we see is what dentists will refer to as bony exostoses, or sometimes referred to as tori, which are benign growths of bone in various areas of the mouth. We can see them in the roof of the mouth or we can see them in the lower jaw. Most commonly seen in the lower inside of the jaw, where the tongue rests. The next variation of normal is what we see here, and that is some lingual tonsillar tissue. This is the posterior area and the posterior lateral border of the tongue. This is quite commonly seen bilaterally, and once again, is a normal representation of normal tissue. Let's now move into some of the common oral mucosal disorders. The ones that I'd like to cover in this segment are the ones that we most commonly see. That is, herpetic infections, sometimes commonly referred to as the cold sore or the fever blister. We will then talk a little bit about aphthous ulceration, more commonly referred to as the canker sore. And finally we will talk a little bit about Candidasis, which is a yeast infection, sometimes referred to as thrush. Lastly, we will talk about a very common chronic oral mucosal disorder known as lichen planus. So let's go ahead and take a look at some of these oral mucosal disorders. First, let's talk a little bit about Herpes simplex. Herpes is a viral infection that can occur in the mouth. It has two representations, both in a primary fashion as well as a recurrent fashion. The primary fashion often is associated with significant and severely painful oral ulcerations. Most commonly, it will result in peeling of the gums, a term we refer to as herpetic gingivostomatitis. The recurrent form of herpes is often ones that we will see, and that is the cold sore or the fever blister. Herpes, being a virus, has an incubation period of days to up to about two weeks. So if someone is exposed to the Herpes virus, it's usually within days to up to about two weeks that they'll first present with lesions or sores in their mouth. Once again, it's often an ulcerative eruption, but sometimes we might even see little tiny vesicles. These are clear, fluid-filled blisters in the mouth that quickly ulcerate, causing significant amounts of discomfort. In this slide we see a young fella who has lesions on his lip, both upper and lower lip, which are ulcerated, inflamed and extremely painful. If we look inside the mouth, we can see some vesicles, which are these tiny little blisters, and also some areas of erosion. In this slide, we illustrate what is often seen in patients with primary herpetic infection, that being a peeling of the gum tissues. We call this herpetic gingivostomatitis. Now let's take a look, a little bit, at the recurrent lesions. What we see here on this slide is the most common recurrent presentation of herpes, that being recurrent herpes labialis. As I mentioned earlier, Herpes can also recur intra-orally, as we see on this slide. When it does, we often associate shallow ulcers with a serpiginous border, which gives you a sense that these tiny vesicles have coalesced and caused a rather large ulcer.
