Pati Aji Achdiat, dr., SpKK, M.

Kes
Structure and disorder on the mouth is
important mark for diagnosis mouth
disease and could be a part from systemic
disorders

Examination  inspection and palpation

Sistematically: lips, sulcus ginggivobuccal, buccal

mucous, ginggival, tooth, palatum mole, durum,
tounge and oropharynx
• Lesion (+)  other organ should be
checked (nose, eye, genital and
anogenital)
• Supporting examination: lab, chest x-
ray, histopathological examination
 Acute necrotizing ulcerative
gingivitis (Vincent’s gingivitis)

 All ages, mainly adolescent, 2nd and 3rd decade

 Etiology??  spirochaeta bacterial infection
 Predisposing factors: poor oral hygiene,
calculus, smokers
 Precipitating: psychical stres
 • Symptoms: pain, spasme on around
teeth, defect sense of taste
• Constitutional symptoms: febris

Clinical Manifestations:

• Necrotizing papilla interdental with ulcerative

• and ginggival bleeding
• White-grayish pseudomembrane on ginggival
• Lymphadenopathy in chronical case
• Treatment:
– Debridemant with curettage pull up
necrotic tissue with lavage by hydrogen
peroxide + warm water
– Systemic therapy:
• Antiobiotic: penicilin, metronidazole
• Analgetic
• Preventif:
– Avoid irritant food
– Smokers
– alcohol
 Syphilis
• Etiology: Treponema pallidum
• Chancre: inoculation place for T.pallidum
• Predilection: Lips, ginggival, tongue,
oropharynx
• Clinical sign on genital:
– Ulcerative  painful (-)
– Induration (+)
– Prominent border
• Untreatment  secondary syphilis (6 months)
– Febris , malaise, headache, anorexia,
papulosquamous eruption, painful pharynx
– Mouth: multiple mucous patches, oval, white
grayish lesion with redness halo, pain (-)
• Syphilis tersier
– After latent period  3-12 year
– signs: membrane mucous : gumma
• Lesion: tumor, pain (-), ulcerative,
necrotic tissue
– Locations: pallatum durum, mole,
septum nasal, pharynx, larynx,
tongue
– Complications: glossitis chronic and
CA of tongue
Congenital syphilis:
• rhagadic scars
• upper and M1 central incicors permanent
teeth
• Lower incisors uncommon
• Hutchinson incisors.
• treatment:
– Benzatin Penisilin 2,4 million unit im
single dose
ulcerative
Secondary syphilis
Hutchinson
 TUBERCULOSIS
• TBC on mouth: uncommon
• Primerly inoculation TBC: nodul with
ulcerative, regional adenopathy
• Secondary TBC wih oral lesion 
uncommon. Expansion from TBC
larynx and gastrointestinal
• Signs: lesion  ulcerative: oval,
irregular border, granulomatous nodul
• Locations: tongue, buccal mucous and
ginggival
• Treatment:
– Rifampicin 10 mg/kgBW
– Ethambutol 25 mg/kg BW
– INH 5-10 mg/kg BW
– Pyrazinamid 20-35 mg/kg BW