--- module: 057-01 language: en chapter: 57 title: "Oral and Dental Disease, Salivary Function, and Maxillofacial Warning Signs" module_title: "Foundations" source_sha256: c7a2ed52518f9f8230d174a85edae3d8edaf80156a2bdcf7fcb49eaf3e5913da --- # Oral and dental disease foundations ## Orientation ### Oral health shapes nutrition, speech, infection, chronic disease ### Dental disease can reach deep neck, sepsis, airway ### Oral lesions reveal systemic disease ### Respect pain, anxiety, trauma, disability, culture ## Structure, saliva, and microbiome ### Enamel over dentine around vascular pulp ### Periodontal ligament anchors roots to alveolar bone ### Glands secrete water, mucus, bicarbonate, minerals, amylase ### Parasympathetic: abundant watery saliva ### Sympathetic: altered protein composition ### Saliva buffers, remineralises, clears, restrains microbes #### Low flow: caries, candidiasis, periodontal disease #### Causes: anticholinergics, opioids, radiation, polypharmacy ### Plaque is an organised biofilm #### Frequent fermentable carbohydrate demineralises enamel #### Repeated low pH produces cavitation #### Fluoride promotes remineralisation ## History and examination ### Pain site, triggers, night pain, swelling, discharge ### Immediately check airway, drooling, voice, neck, toxicity ### Inspect face, palpate joints, nodes, glands, neck ### Measure mouth opening ### Inspect every mucosal surface to posterior pharynx ### Note induration, fixation, mobility, fluctuance, pus ## Caries, pulpitis, and abscess ### Early caries may be painless ### Reversible pulpitis: brief provoked pain ### Irreversible pulpitis: spontaneous or lingering pain #### Root-canal treatment or extraction ### Necrosis permits apical infection #### Periapical abscess may drain through a sinus ### Source control central, antibiotics selective #### Repeated courses delay cure and select resistance ### NSAIDs and paracetamol often beat opioids ### Ludwig angina from mandibular molar infection #### Bilateral submandibular and sublingual cellulitis #### Floor swelling, tongue elevation, drooling #### Airway planning precedes supine imaging ## Periodontal disease ### Gingivitis: superficial, no attachment loss, reversible ### Periodontitis: pockets, attachment and bone loss #### Risk: smoking, diabetes, immune dysfunction, genetics #### Recession, mobility, tooth loss ### Plaque removal, debridement, risk-factor control ### Glycaemia and periodontal health interact ### Brushing bleeding signals inflammation #### Disproportionate bleeding: platelets, clotting, liver, marrow ## Oral mucosal disease ### Aphthae: recurrent shallow ulcers, no vesicles #### Severe forms: deficiency, coeliac, bowel disease ### Recurrent herpes on keratinised mucosa ### Candidiasis: removable plaques, erythema, cheilitis #### Treat predisposing factors too ### Red lesions carry greater dysplasia risk ### Persistent lesion needs urgent review and biopsy ### Carcinoma: tobacco, alcohol, papillomavirus ### Widespread blistering with systemic signs is urgent ### New focal pigmentation needs evaluation ## Salivary-gland disease ### Bacterial sialadenitis: painful gland, fever, pus #### Hydrate, stimulate, massage, antibiotics, drain ### Stones mostly in submandibular duct #### Meal-related pain and swelling ### Bilateral persistent enlargement has systemic causes ### Sjogren: dry mouth and eyes, caries, lymphoma ### Parotid tumours mostly benign #### Pain, fixation, facial weakness suggest malignancy #### Specialist sampling preserves surgical planning ## Dental trauma and bleeding ### Start with airway, spine, haemorrhage, vision ### Avulsed permanent tooth: hold crown, replant #### Never replant primary teeth ### Malocclusion, lip numbness, diplopia suggest fracture #### Avoid blind nasal instrumentation ### Post-extraction bleeding: pressure, packing, sutures #### Check antithrombotic indication before reversal ### Dry socket: clot loss, no spreading infection ## Temporomandibular and facial pain ### Joint or muscle pain, clicking, restricted opening ### Explanation, physiotherapy, non-opioid analgesia ### Locking, trauma, asymmetry prompt imaging ### Trigeminal neuralgia: brief electric attacks ### Jaw claudication with visual symptoms: arteritis ## Prevention and complex care ### Fluoride, interdental cleaning, less frequent sugar ### Treat oral disease before radiation or antiresorptives ### Osteonecrosis risk: oncology doses plus extraction ### Endocarditis prophylaxis only for high-risk cardiac cases ### Complexity rarely justifies neglecting care