Oral and dental conditions

Cemento-osseous dysplasias are benign fibro-osseous jaw lesions, common in African women aged 40–50 years and usually found incidentally; odontomas are tooth-tissue hamartomas often causing a missing permanent tooth. Treat cemento-osseous lesions only if symptomatic or infected, and enucleate odontomas.

Oral Kaposi's sarcoma is an HHV-8-related vascular tumour, usually in advanced HIV and sometimes its first sign, appearing as red to purple patches, nodules or masses on the palate and gums. Test for HIV, start ART, and use local surgery with oncology referral for chemotherapy or radiotherapy in advanced disease.

Malignant salivary gland tumours (mucoepidermoid, acinic cell and adenoid cystic carcinoma, carcinoma ex-pleomorphic adenoma, adenocarcinoma) present as firm masses, sometimes with pain, ulceration or facial palsy. Investigate with ultrasound, CT/MRI and FNAC, and treat by wide excision and neck dissection followed by chemotherapy and/or radiotherapy.

TMJ dislocation is displacement of the mandibular condyle in front of the articular eminence, leaving the mouth stuck open with preauricular pain and a palpable hollow. Reduce it manually (Hippocratic technique) with sedation if needed, apply a Barton bandage and soft diet, and refer chronic or late dislocations for surgery.

Many systemic diseases show oral signs and change how dental treatment is given: diabetes, cardiovascular disease, HIV, blood disorders, gastrointestinal, kidney, liver and autoimmune diseases. Check control of the disease (glucose, BP, platelets, INR), adapt anaesthesia and medicines, and coordinate with the physician.