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The disease, characterized by swollen tonsils with white spots is referred to as tonsillitis (angina).
Tonsillitis or commonly referred to as angina (quinsy), is an infectious disease, affecting lymphadenoid ring of the throat. Fusospirochetal tonsillitis is usually being provoked by spirochetes and fusiform bacteria.
Sometimes tonsillitis is accompanied by such virulent blood diseases, as agranulocytosis and leucosis. As long as tonsils feature good blood supply and thick innervations, their inflammation involves rapid and intense process of swelling, which in its turn causes tightening of nerve endings.
Therefore, observing any such symptoms, it is required to try manually to feel the lymph nodes, located on the neck since fusospirochetal tonsillitis usually leads to their enlargement. To some extent, tonsillitis in the presence of blood diseases is a form of complication, resulting from decreased immune resistance of the organism.
Thus, practically all cases of swelling of tonsils and white spots on them, constitute sufficient ground for qualified otolaryngological examination, with subsequent effective therapy that will help in preventing possible complications. These bony growths appear to have a genetic link, but environmental situations tend to make them larger.  Bruxism (tooth grinding) and ice chewing especially seem to make them worse.
Exostoses, the growths directly adjacent to the teeth, can make it more difficult to keep the teeth clean, since the bone’s overgrowth makes it more difficult to position a toothbrush and floss properly around the teeth for good home care. For these reasons, it is especially important for patients that have tori to keep their teeth and gums in excellent shape.  Many people have had tori most of their life with no problem, and just assumed everyone had the same thing! In cases where tori or exostoses are in the way for a prosthesis, a minor surgical procedure is used to remove them so that the complete denture or partial denture can be fabricated without problems.  Mandibular tori and exostoses can be removed by most general dentists, while a palatal torus is often referred to an oral surgeon when a complete denture is needed. The oral cavity includes the lips, gingivae, retromolar trigone, teeth, hard palate, cheek mucosa, mobile tongue, and floor of the mouth.
The oral vestibule is bounded externally by the lips and the cheek mucosa and internally by the alveolar processes and the teeth. The longer upper lip and shorter lower lip are connected to each other by the labial commissures at the corners of the mouth. The cheeks are a musculomembranous structure and are limited superiorly and inferiorly by the upper and lower vestibules, anteriorly by the labial commissure, and posteriorly by the retromolar trigone and the intermaxillary commissure.[4] The inner surface of each lip is connected in the middle line to the corresponding gum by a fold of mucous membrane, the labial frenulum. The retrocommissural region is situated between the labial commissure and the opening of Stensena€™s duct (the drainage duct of the parotid gland), located opposite the second upper molar (see the images below). The buccinator muscle forms the muscular framework of the cheek and is also a muscle of facial expression. The gingiva (or gum) is a fibroepithelial mucosal tissue that surrounds the teeth and covers the alveolar jawbone.
Deciduous teeth (also referred to as primary or temporary teeth) are the first to emerge in the oral cavity and are progressively replaced by the permanent (or adult) dentition.
The occlusal (or masticatory) surface of molars and premolars is characterized by pointed structures named cusps. The hard palate is concave, and this concavity is occupied mostly by the tongue when it is at rest. The anterior two thirds of the hard palate is formed by the incisive bone, or premaxilla, and the palatine processes of the maxilla. The soft palate marks the beginning of the oropharynx and is the movable posterior third of the palate. When the soft palate is relaxed, its anterior surface is concave and its posterior surface is convex. The velum is prolonged by a median free process termed the uvula and 2 bilateral processes termed the palatoglossal and palatopharyngeal arches or pillars, which join the soft palate to the tongue and pharynx, respectively.[7] The fauces represent the space between the cavity of the mouth and the oropharynx.
The palatine tonsils are located in the tonsillar sinuses (or fossae) of the oropharynx, which is bounded by the palatoglossal and palatopharyngeal arches and the tongue.
The sublingual papillae (also referred to as caruncles or folds) can be identified on both sides of the frenulum in the anterior part of the floor of mouth when the tip of the tongue is raised (see the image below).[7] The excretory duct of the submandibular gland (Whartona€™s duct) runs in the floor of the mouth along the medial border of the sublingual gland to pierce the surface of the mouth at the paramedian sublingual caruncle. The tongue is a mobile muscular organ that occupies the major part of the oral cavity and part of the oropharynx. The major salivary glands are large paired exocrine glands that communicate with the mouth and pour their secretions into its cavity. Because food is physically broken down in the oral cavity, this region is lined by a protective, nonkeratinized, stratified squamous epithelium, which also lines the inner surface of the lips.[8] The oral cavity proper is lined by a masticatory mucosa (gingiva and hard palate), a lining mucosa (lips, cheeks, alveolar mucosal surface, floor of the mouth, inferior surface of the tongue, soft palate), and a specialized mucosa (dorsal surface of the tongue).
The inner lip (interior vermilion) is lined with a stratified squamous, nonkeratinized epithelium. The underlying lamina propria is a thick papillary layer of loose connective tissue that contains blood vessels, nerves that send axon endings into the epithelium, and encapsulated sensory endings in some papillae. The distinct submucosa of the lining mucosa contains large bands of collagen and elastic fibers that bind the mucosa to the underlying muscles. Beneath the enamel and around the pulp lies the dentin, which makes up the bulk of each tooth. The fourth dental tissue, cementum, and consists of a thin layer of calcified tissue covering the dental root. The basic structure of a salivary gland is that of a branching duct that has the principal secretory cells (the acinar cells) at the proximal ends of the branches and an opening into the oral cavity at the other end of a single collecting duct. The abluminal cells are myoepithelial cells in the acinus and intercalated duct and basal cells in the striated and excretory ducts. The oral cavity is scattered with 500-1000 minor salivary glands within the mucosa and submucosa of the cheeks, lips, floor of the mouth, hard and soft palates, retromolar trigone, and tongue; the anterior hard palate and gingivae are devoid of these glands. The lobules of the minor salivary glands are 1-5 mm in size and are separated from one another by connective tissue.
In the tongue, lips, and buccal mucosa, lobules of salivary gland tissue are located beneath the mucosal epithelium and within the deeper skeletal muscles. The movements of the mandible are mainly produced by the 4 muscles of mastication: the masseter, temporalis, lateral pterygoid, and medial pterygoid muscles.
The temporalis is a broad triangular muscle that originates from the floor of the temporal fossa and from the deep surface of the temporal fascia.
The lateral pterygoid muscle is a 2-headed triangular muscle that has 2 distinct origins: the infratemporal surface and crest of the greater wing of the sphenoid and the lateral surface of the lateral pterygoid plate. The medial pterygoid muscle is also a 2-headed muscle; it originates from the medial surface of the lateral pterygoid plate and the pyramidal process of the palatine bone and from the maxillary tuberosity. Blood is supplied to the oral vestibule and oral cavity via branches of the external carotid artery (facial, maxillary, and lingual).
The angular artery, a terminal branch of the facial artery, supplies the superior part of the cheek.[7] The facial vein provides venous drainage to the lips.
The maxillary artery is the larger of the 2 terminal branches of the external carotid and supplies the cheek mucosa, teeth, gingivae, and palate. The pterygopalatine portion of the maxillary artery branches into the posterior superior alveolar artery, the infraorbital artery, the artery of the pterygoid canal, the pharyngeal branch, the descending palatine artery, and the sphenopalatine artery. The posterior superior alveolar artery supplies the maxillary molar and premolars and the adjacent gingiva. The deep facial vein, which originates from the pterygoid venous plexus, drains most of the areas supplied by the maxillary artery.
The lingual artery, its branches, and the lingual veins provide circulation to the tongue and the floor of the mouth. All lymphatics from the head and neck drain directly or indirectly into the deep cervical lymph nodes. The skin of the cheeks drains to parotid and submandibular lymph nodes.[11] The upper lip and the lateral parts of the lower lip drain to the submandibular lymph nodes. Both surfaces of the lower gingivae and the outer surface of the upper gingivae drain into submandibular lymph nodes. Sensory innervation to the lips, cheeks, gingivae, teeth, hard palate, and floor of the mouth is provided by the trigeminal nerve (cranial nerve V), more specifically the maxillary (V2) and mandibular (V3) divisions of this nerve.
The maxillary nerve (V2) leaves the cranium through the foramen rotundum in the sphenoid and enters the pterygopalatine fossa, where it gives off branches to the pterygopalatine ganglion and enters the inferior orbital fissure. The posterior and middle superior alveolar nerves arise from the maxillary nerve, and the anterior superior alveolar nerve arises from the infraorbital nerve. The mandibular nerve (V3) descends through the foramen ovale into the infratemporal fossa and divides into the auriculotemporal, inferior alveolar, lingual, and buccal nerves. The inferior alveolar nerve enters the mandibular foramen, passes through the mandibular canal, and forms the inferior dental plexus. Fordyce granules are visible sebaceous glands that are not associated with a hair follicle. Torus palatinus and torus mandibularis are benign bony outgrowths of the palate and mandible (see the image below).
Torus palatinus is found in the midline of the hard palate, and torus mandibularis is found on the lingual surface of the anterior mandible, primarily in the premolar region.
Oral cancer is more likely to occur in leukoplakia and erythroplakia (see the image below). Oral cavity cancers, most of which are squamous cell carcinomas, account for around 3% of all cancers (see the image below).
Salivary gland neoplasms make up 6% of all head and neck tumors and most commonly appear in the sixth decade of life (see the image below).
Medscape Reference thanks Ravindhra G Elluru, MD, PhD, Associate Professor, Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine; Pediatric Otolaryngologist, Department of Otolaryngology, Cincinnati Children's Hospital Medical Center, for the video contribution to this article. The authors wish to thank Dr Owen Woods and Dr Marie-Helene Geoffroy for their notable contributions to the multimedia in this article.
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Fungiform papillae: They are scattered all over the tongue, but are typically found on the sides and tip of the tongue.
Transient lingual papillitis or lie bumps: It is a local inflammatory disorder that typically affects fungiform papillae present on the tongue’s dorsal area. Excessive smoking:Constant smoking can cause tongue irritation thereby facilitating enlargement of tongue papillae. Gastrointestinal disorders: Enlarged papillae can arise as a symptom of different conditions of the gastrointestinal system such as acid reflux disease or GERD, and ulcerative colitis, etc. If enlarged papillae persist for more than 2 weeks, then visit an oncologist for verifying the present of oral cancer.
Transient lingual papillitis associated enlarged papillae usually vanish on their own without treatment.
Oral medicines as well as use of topical creams can help remedy canker sores related enlarged papillae. Following good oral hygiene that involves daily brushing of the teeth and tongue as well as flossing is vital. Smoking can not only cause enlarged papillae, but can also pose increased threat to oral cancer. Thrush, yeast, or other fungal infections can be alleviated by gargling the mouth with a diluted solution of tea tree oil.
Oral infections and enlarged papillae can be prevented by drinking soup consisting of garlic, ginger, and pepper, two times a week.
Postmenopausal spotting refers to spotting or discharge of tiny specks of blood after menopause. The intercostal muscles are situated between the ribs and are made of many muscle groups like the transverse and subcostal thoracic muscles and the external and internal intercostal muscles. The color, shape, and texture of your stool can tell a lot about what is going on inside your body. This type of the disease was first described by three scientists at a time, namely Simanovsky, Vincent, and Plaut Thus it has different names in different countries. These pathologies involve swelling of tonsils, but in this case white spots in nothing but fur, covering profound ulcers. This can explain the condition of sore throat and painful swallowing (due to mechanical irritation of tonsils). Streptococcus usually provokes pronounced immune response in the form of fever, deterioration of general well-being, etc. But even if this appeared to be impossible, it is better to consult a specialist in order to exclude this unpleasant pathology. Viral tonsillitis is normally less threatening and has more chances of recovery (in case of adequate treatment under the care of a specialist).
The major salivary glands are in close relation with oral cavity structures, although they are not part of the oral cavity.
When the teeth are in occlusion, the vestibule communicates with the oral cavity proper via the intermaxillary commissure behind the last molar teeth.
It is covered by the buccal fat pad, which smoothes the cheek contour by filling in the depression and the anterior border of the masseter.
It is composed of a dense outer cortex (known as the cortical plate) and looser inner trabecular (or medullary) bone.
It is the portion of mucosa that lies behind the third molar tooth, covering the anterior ramus of the mandible. Each tooth is composed of a crown, which is the exposed portion above the gumline, and a root, which is embedded in the jawbone. The hard palate is subdivided into the primary and secondary palates.[7] The primary palate is separated from the secondary palate by a small depression behind the central incisors termed the incisive fossa, where the incisive foramen opens.
They are bounded superiorly by the soft palate, inferiorly by the root of the tongue, and laterally by the pillars of the fauces. Its main functions are pushing food into the oropharynx during swallowing and forming words during speaking, although it is also implicated in mastication, taste, and oral cleansing.[7] The macroscopic and microscopic anatomy, musculature, nerve supply, and vasculature of the tongue are specifically addressed elsewhere (see Tongue Anatomy). It consists of a stratum basale (a single layer of cells on basal lamina), a stratum spinosum (several cells thick), and a stratum superficiale (the most superficial layer). It also contains the many minor salivary glands of the lips, tongue, and cheeks, which are predominantly mucous. The pulp is a fibrovascular tissue containing odontoblasts whose purpose is innervation, vascularization, and repair. The dentin consists of calcified tissue containing numerous microscopic channels known as dentinal tubules, which harbor odontoblastic processes.
The apical portion of the tooth is covered by cellular cementum, whereas the remainder is covered by acellular cementum.
This mucosa has a keratinized and, in some areas, a parakeratinized stratified squamous epithelium.
In the palatine raphe, the mucosa also adheres firmly to the periosteum, and no submucosa exists.
Four morphologically and functionally varying segments exist in each basic salivary gland unit: acinus, intercalated duct, striated duct, and excretory duct. Acinar cells may be serous or mucous, depending on the chemical composition of the saliva produced by a specific gland. In the tongue, Blandin and Nunn glands are located on the anterior ventral portion and are of the mucous type. The deep portion originates from the inferior surface of the zygomatic arch and descends almost vertically to insert onto the lateral surface of the ramus.
It inserts on the tip and medial surface of the coronoid process and on the anterior border of the ramus of the mandible. The upper head inserts onto the joint capsule and articular disc of the temporomandibular joint.
It branches out into the superior and inferior labial arteries 1 cm lateral to the corner of the mouth.
It arises behind the mandibular neck and is at first embedded in the substance of the parotid gland.
The infraorbital artery supplies the maxillary canines and incisors and the skin of the infraorbital region of the face. Lymph from the central part of the lower lip drains to the submental lymph nodes.[7] Lymph from the mucous membrane of the cheek drains to submandibular nodes and to upper deep cervical nodes.
The inner surface of the upper gums is drained with the vessels of the hard and soft palates to the upper deep cervical lymph nodes. They can sometimes be found in the submucosa lateral to the corner of the mouth and in the cheeks opposite the molar teeth.
Tori of the oral cavity occur in 3% to 56% of adults and are more common in women, Asians, and Inuits. Patients with tori are asymptomatic unless the torus interferes with denture placement or eating.
Both conditions are diagnoses of exclusion, representing, respectively, a white patch and a fiery red patch that cannot be categorized as any other disease. In some regions in the world, such as Southeast Asia, they account for up to 30-40% of all malignancies. Cleft lip and palate occur approximately once every 1000 Caucasian births, and isolated cleft palate occurs once every 2000 births. Cleft palate may be complete, with extension into the nasal cavity, or submucosal, with a preserved palatal mucosa. Most salivary gland tumors arise in the parotid and submandibular glands, and fewer than 10% of tumors arise in the minor salivary glands. Topics are richly illustrated with more than 40,000 clinical photos, videos, diagrams, and radiographic images. The articles assist in the understanding of the anatomy involved in treating specific conditions and performing procedures.


Check mild interactions to serious contraindications for up to 30 drugs, herbals, and supplements at a time. Plus, more than 600 drug monographs in our drug reference include integrated dosing calculators. Thin, long, and v-shaped, the filiform papillae help detect sour taste and act as an abrasive cover for the tongue.
They are usually caused due to a viral infection, which in turn can be the result of bacterial or other viral propagation in the body.
Discomfort and pain can be managed via home remedies such as application of ice cubes or cold compresses on the affected parts of the tongue, and drinking cold liquids.
Thrush infections can be treated with home remedies like daily intake of yogurt and application of yogurt on the infected areas of the tongue. Any enlargement of the papillae, infection, or swelling arising due to tongue trauma can be eased by application of glycerin on the affected region. JUVEDERM VOLUMATM XC is a deep or subcutaneous injection administered for cheek augmentation in people above the age of 21.
It is an uncommon hereditary postnatal neurological condition of the brain’s gray matter which almost entirely affects girls but exceptional cases have shown to affect boys also. It is therefore advisable that you take a moment to check on your discharge every day before you flash the toilet. A stone can cause a blockage of the flow of saliva, which can lead to pain and swelling of the affected salivary gland. Tonsillitis involves the risk of such complications, as abscess, lymphadenitis, sepsis, rheumatism, polyarthritis and pyelonephritis.
Depending on its volume and consistency, pointing to the level of the advancement of the process, it is common to distinguish between catarrhal, lacunar and follicular types of tonsillitis. As long as it mostly affects young people and is proved to be droplet spread, it became popular as the a€?kissing diseasea€?.
Whereas, Vincenta€™s angina supposes almost no clinical symptoms, though it involves insignificant swelling of tonsils and appearance of white membranes, covering the ulcers.
The tongue is part of the oral cavity; its anatomy is specifically described elsewhere (see Tongue Anatomy).
A horizontal slightly elevated streak (called the linea alba or occlusal line) traverses this region. The area of cortical bone that lines the dental socket (or alveolus) is called the lamina dura. The base of the triangle is posterior to the last inferior molar tooth; the apex is in continuity with the tuberosity of the maxilla behind the last upper molar tooth. The permanent dentition consists of 32 teeth: 12 molars (including 4 so-called wisdom teeth or third molars), 8 premolars (or bicuspids), 4 canines, and 8 incisors.
The secondary palate presents a midline elevated suture line termed the median or palatine raphe. It is marked by a median raphe and is continuous with the roof of the mouth and the mucous membrane of the nasal floor (see the image below).
The epithelium of the lining mucosa is nonkeratinized, although in some places it can be parakeratinized. The cementum is bound to the alveolar bone via specialized connective tissue fibers, which form the periodontal ligament. The underlying lamina propria contains blood vessels and nerves (sensory receptors and Meissnera€™s corpuscles).
In the other regions of the hard palate, a submucosa that contains thick collagenous bands extending from the mucosa to the bone underlies the lamina propria. The superficial portion arises from the zygomatic bone anterior to the temporozygomatic suture and descends inferiorly and posteriorly to insert onto the angle of the mandible. The descending palatine artery descends through the palatine canal and divides into the greater and lesser palatine arteries to supply the mucosa and glands of the hard and soft palate.
The mental nerve is another branch of the plexus that supplies the skin and mucous membrane of the lower lip and the vestibular gingiva of the mandibular incisors.
Treatment is reserved for symptomatic patients and is accomplished by surgical removal from underlying cortical bone with osteotomes or burrs. Kernohana€™s classification is the system that is most widely used to classify cleft lip and palate according to disease severity.
Primary cleft palate is anterior to the incisive foramen, and secondary cleft palate is posterior to it. Most minor salivary gland tumors are malignant, usually manifesting as painless masses on the palate or floor of the mouth. Customize your Medscape account with the health plans you accept, so that the information you need is saved and ready every time you look up a drug on our site or in the Medscape app.
All these factors can increase the risk of tongue irritation and infection, consequently resulting in enlarged papillae.
Sponsored link Juvederm Voluma is an injectable gel composed of hyaluronic acid gel, containing lidocaine, a local anesthetic in small quantity. Although exercise constitutes the most important part of losing weight, one makes considerate amount of changes in the eating habits and lifestyle as a whole.
Characteristic clinical attributes involve small hands, feet and a reduced head growth rate. Therefore, swollen tonsils with spots are an alerting symptom, urging the patient to visit an otolaryngologist. In the case these bacteria have necrotizing effect, it is appropriate to speak about fusospirochetal gingivitis (Vincenta€™s angina).
The palatine tonsils, soft palate, tongue base, and posterior pharyngeal walls are part of the oropharynx; the oropharynx is not part of the oral cavity.
The retromolar trigone is bounded laterally by the gingival buccal sulcus and medially by the anterior tonsillar pillar. Parakeratinized epithelium is similar to keratinized epithelium, except that the superficial cells do not lose their nuclei.
Bilateral contraction of this muscle causes protraction of the mandible and depression of the chin.
Alcohol and tobacco use are widely accepted risk factors, and there is increasing evidence for the role of human papillomavirus (HPV) in the development of this disease. Isolated cleft palates may be associated with syndromes such as Pierre-Marie-Robin sequence, Stickler syndrome, Treacher-Collins syndrome, Apert syndrome, 22q11 anomalies, and many others. Diagnosis is made through fine-needle aspiration biopsy, and primary treatment is surgical.
Easily compare tier status for drugs in the same class when considering an alternative drug for your patient.
Persistent cases need to be checked by a doctor who will diagnose the underlying cause and prescribe relevant remedy. The presence of abundant nerves in the affected region means that patients may occasionally feel pain. Hence an extreme instance of oral thrush can also lead to canker sores and enlarged papillae.
Ignoring the sensation of foreign body in the throat while swallowing, as well as bad breath, one can easily leave out this serious disease. A weakened immune system and hereditary conditions are other uncommon causes of mouth ulcers.
However, it can lead to complete decomposition of the affected tonsil, as well as to the proliferation of the infection onto the lower tissues. If tongue is lifted, floor of mouth is visible with ducts that empty saliva of submandibular glands into mouth.
It also contains enzymes in the saliva which break down some of the starch and fat in your food.
The submandibular glands are under the floor of your mouth - one on each side - and drain saliva up into the floor of your mouth. However, in about 2 in 10 cases, the stone does not show on an X-ray and other tests may be needed.
The test done may be one of the following: A scan such as a CT scan, ultrasound scan or MRI scan. In this test a very thin tube (endoscope) with a tiny light and camera at the tip is inserted into the salivary duct.
If a stone is seen, then a tiny basket or pair of grabbers attached to the tube is used to grab the stone and pull it out. In some cases, where the stone is rather large, the stone is broken up first and the fragments are then pulled out.
This is a relatively new treatment for salivary stones (although it has been used for many years to treat kidney stones).
Sometimes shock waves are used to break up a large stone when therapeutic sialendoscopy is done to make smaller fragments which can be more easily removed. An operation to remove the whole gland may be an option for people who develop recurring or multiple stones.



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