Oral manifestations in leprosy: General survey of oral conditions as determined in the National Leprosarium

Abstract

Smears made from oral and extraoral lesions and sections obtained from tissue constitute a useful aid to diagnosis. Stained by Ziehl-Neelsen's carbolfuchsin method, they reveal the presence of organisms morphologically and tinctorially resembling the bacillus Hansen. In many cases swollen and enlarged lips accompany severe cases of leproma lingually or maxillary anterior teeth. Nerve affection in leprosy is of the ascending type affecting the terminal branches of the fifth and seventh cranial nerves. There is an interrelationship between nodular and nerve leprosy. (1) The more the nodular type is manifested, the less show symptoms of the nerve type. (2) Nerve lesions are associated with comparative paucity in the number of bacilli; consequently the earlier lesions are of the nerve type. Partial obstruction may be caused by healing of ulcers resulting in the buttonhole mouth, as it does in the region of the epiglottis, fauces and focal cords. It may be so severe that tracheotomy has to be performed to prevent the patient from dying of asphyxia. Perforation of the palate has occurred in many cases in leprosy, but it may be looked upon as a result of accompanying syphilis. Periodontoclasia is present in all three types of leprosy. It is more prevalent in cases which the nodular type predominates, due apparently to association with mouth ulcers and leprous granuloma. There seems to be more pyorrheal absorption in cases in which the nerve type predominates. It must be remembered that bone absorption is a lesion of the nerve type, so prevalent in hands and feet, and it is etiologically due to constant infiltration and inflammation of the nerves, resulting in interference with nerve function. It has been observed that complete repair of secondary lesions in the mouth has occurred following extraction of infected teeth. Restoration of teeth lost as a result of leprous degeneration, such as paralysis, leproma and ulcerations, and extensive absorption requires skill, for mouths having undergone such degenerative changes present quite a diversity of form and deviation from normal. The severity of bone atrophy is increased by various lesions affecting the mucous membrane of the oral cavity. Ninety-eight per cent of cases that show oral leprous lesions, radiographically reveal bone atrophy of the alveolar process. Many theories have been advanced as to the etiology of muscular and bone atrophy in lepers, but it is my opinion that bone and muscular atrophy are caused by constant infiltration and inflammation of the nerves, resulting in interference with nerve functions.