Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
239 Cards in this Set
- Front
- Back
|
Humans are the only natural reservoir for what class of viral disease
|
Herpes
|
|
|
How long does a herpes infection last
|
Lifelong
|
|
|
How does type 1 herpes spread
|
saliva or contact with active oral lesion
|
|
|
What is common presentation of herpes simplex at early age
|
Acute Primary Gingivostomatitis
|
|
|
What are the clinical signs of acute primary gingivostomatitis?
|
fever, coalescing vesicles, shallow ulcerative, cervical lymphadenopathy, resolves in 1-2 weeks
|
|
|
What condition in young people can be confused for desquamative gingivitis?
|
acute primary gingivostomatitis
|
|
|
What age group experiences acute gingivo stomatitis?
|
6mo-5yrs
|
|
|
What are some trigger factors for reactiviation recurrent (secondary) herpetic infection?
|
stress, UV light, allergy, trauma, hormone change, malignancy
|
|
|
Would you treat recurrent herpes with steroids?
|
NO, stupid fucking idiot.
|
|
|
What are the stages of a recurrent herpes infection?
|
Papules --> vesicles --> rupture --> multiple coalescing ulcers
|
|
|
What are the sites for recurrent herpes?
|
Vermillion border and adjacent skin (labialis), intraoral NONMOVABLE mucosa (hard palate, gingiva), finger (herpetic whitlow), on the Eye
|
|
|
What does herpes mean in latin? and why?
|
to creep. moves down sensory neuron, creates tingling feeling
|
|
|
What is the characteristic histology of herpes simplex
|
infected cells are multinucleated. TZANK cells
|
|
|
what tests are used to diagnose herpes simplex
|
exfoliated cytology (smear), cytopathological effect (CPE)
|
|
|
Treatment of herpes simplex
|
PREVENT OCULAR HERPES, primary: supportive, topical anesthetics
Secondary: OTC: 10% docosomal cream (abreva) • Acyclovir (tablets or ointment), valcyclovir • *ONLY EFFECTIVE DURING PRODROME PHASE (first 48 hrs) • *IV mode for immunocomprised pts |
|
|
When is an antiviral effective in the treatment of herpes simplex?
|
during the prodrome phase, first 48hrs
|
|
|
Diagnosis of chicken pox
|
CPE in smear
|
|
|
Treatment for chicken pox
|
Avoid aspirin (reye's syndrome)
|
|
|
Complications of chicken pox
|
encephalitis, reye's, birth defects
|
|
|
Where does varicella zoster lay dormant?
|
latent in the dorsal spinal ganglion (geniculate)
|
|
|
what are the precipitating causes of shingles.
|
drugs, debilitation, malignancy
|
|
|
Stages of shingles
|
pain --> prodrome ---> oral lesions -> skin lesions terminate at midline
|
|
|
Complications of shingles
|
Ramsey-hunt syndrome:
-cutaneous zoster in ear canal -facial paralysis -hearing deficits -vertigo |
|
|
Treatment of shingles
|
valacyclovir
|
|
|
difference between exanthemous and enanthemous
|
ex- skin, en- mouth
|
|
|
what is an enanthem
|
a viral rash
|
|
|
Causitive virus of Mono
|
epstein barr virus
|
|
|
Diseases assoc. with EBV
|
infectious mono, oral hairy leukoplakia, burkitt's lymphoma, nasopharyngeal carcinoma
|
|
|
Signs of mono
|
Lymphnode enlargement: 90% of time
Tonsilitis: 80% Palatal Petichia ANUG Thrombocytopenia |
|
|
diagnosis of MONO
|
WBC elevated with lymphocytes
Downy cells Also seen in leukemia and lymphoma |
|
|
Disease in neonates and HIV positive adults
Near universal exposure by 50 yrs old Latency – resides in salivary glands, endothelium, macrophages and lymphocytes Reactivation under immune compromised conditions |
Cytomegalovirus
|
|
|
tooth defects assoc. with CMV
|
Diffuse enamel hypoplasia
Attrition Dentin discoloration |
|
|
histology of Cytomegalovirus
|
Infected cells enlarged w. large cellular inclusion
|
|
|
Enterovirus
Multiple coxsackie A virus strains Oral lesions In oropharynx, soft palate, tonsilar pillars Soar through and fever |
Herpangina
|
|
|
What are the oral lesions that occur with Rubeola (measles)?
|
Koplick spots
Precedes skin rash Blue-white macules in labial, buccal mucosa Enamel hypoplasia in severe cases |
|
|
what disease causes post-inflammatory pigmentation
|
rubeola (measles)
|
|
|
a finding of Warthin-Finkleday Giant Cells indicates what disease?
|
Rubeola (measles)
|
|
|
Oral lesions
Forchheimer’s sign Dark-red papules on soft palate at same time of skin rash |
Rubella (German Measles)
|
|
|
Rubella (German Measles) classic triad
|
Classic triad
Deafness (80%) Heart disease Cataracts |
|
|
A complication of this disease is Orchitis (testicles)
|
mumps (parotitis)
|
|
|
What is the #1 malignancy in the head and neck for AIDS patients?
|
kaposi sarcoma
|
|
|
Where is Kaposi sarcoma seen in the mouth?
|
attached gingiva, hard palate
|
|
|
What condition does kaposi's sarcoma resemble
|
pyogenic granuloma
|
|
|
What are theoral conditions that typically lead to AIDS diagnosis
|
candidiasis, oral hairy leukoplakia, bi-lateral parotid gland swelling,
|
|
|
This is an intraoral side effect of some HIV drugs
|
HPV in mouth (condyloma acuminatum)
|
|
|
What are the causative organisms of Impetigo?
|
strep pyogenes, staph aureus
|
|
|
Erysipelas is what sort of infection? Who does it affect?
|
Infection of dermis
Strep pyogenes Clincal Common in young, elderly or diabetic Greater in face and legs |
|
|
What are the differing symptoms of viral and bacterial pharyngitis?
|
Streptococci:
Fever, dysphagia, tonsillar hyperplasia, redness, petechiae, cervical lymphadenopathy, tonsillar exudates Viral: Rhinitis, laryngitis, bronchitis, conjunctivitis, cough, hoarsemess, exanthem, diarrhea |
|
|
What are the causitive organisms of pharyngitis?
|
25% - Group A, beta hemolytic streptococci
Rest are viral |
|
|
What is Scarlet Fever?
|
Systemic infection produced by group A, beta hemolytic strep
|
|
|
What is the oral enanthems and exanthems of scarlet fever?
|
Oral Enanthem:
White Strawberry tongue (first 2 days) RED Strawberry tongue (4th and 5th day) Exanthem developes: Circumoral palor Classic rash “sunburn with goose pimples” ALSO Pastia’s lines (transverse red streaks) if left untreated |
|
|
Pastia’s lines (transverse red streaks) are characteristic of what UNTREATED condition?
|
Scarlet fever
|
|
|
calcified structures in enlarged tonsillar crypts packed with desquamated keratin, bacteria and organic debris
|
tonsillolith
|
|
|
A patient with tonsillolithiasis will show a radiopacity where on a pano radiograph?
|
Radiopaque object superimposed on midportion of ascending ramus
|
|
|
Humans are sole reservoir for this bacterial disease which
produces lethal exotoxin causing tissue necrosis |
Diphtheria
|
|
|
What are the clinical oral finding for diphtheria?
|
Mainly associated with mucous membranes
Oropharyngeal exudates; yellow-white thin film becomes adherent thick gray Soft palate, uvula, larynx, trachea effected Desquamation can lead to airway obstruction and death Patient presents with Bull neck Enlarged cervical lymph nodes with edematous neck enlargement |
|
|
Diphtheria can spread to what TWO locations?
|
Myocarditis -> dyspnea, CHF
Neurologic palatal paralysis and peripheral polyneuritis |
|
|
What is the causitive agent of Syphilis?
|
Treponema pallidum
|
|
|
what is the lesion of primary syphilis?
|
Chancre
Nonspecific painless ulcer or rarely pyogenic granuloma-like proliferation |
|
|
what are the characteristic clinical findings of secondary syphilis?
|
Sign is a diffuse macula-papular cutaneous rash, intraoral, palmar, or plantar
Oral lesions (%30 occurance) Mucous patch Gray necrotic mucosa White patches that may become confluent Condyloma lata Papillary growth Usually anal-genital Tongue, lip, buccal mucosa and palate |
|
|
What percent of the time does tertiary syphilis develop?
|
30% of the time
|
|
|
What are the oral lesions assoc. with tertiary syphilis?
|
Oral lesion
Gumma – particularly on the palate Atrophic glossitis – luetic glossitis Diffuse atrophy, loss of dorsal papillae May be pre-malignant |
|
|
What is charcot's triad and what is it associated with?
|
triad:
Tabes dorsalis – slow degeneration of nerves carrying sensory info Paresis – weakened motor ability Plegia – complete paralysis assoc. with tertiary syphilis and latent syphilis |
|
|
What are the three paterns of latent syphilis?
|
Cardiovascular – effects are most prominent
Gummatous – large area of tissue destruction Neural (will experience Charcot’s triad) |
|
|
What are the intraoral findings of congenital syphilis?
|
Hutchinson’s incisors and mulberry molars
|
|
|
What is Hutchinson's triad?
|
1. Teeth
Hutchinson’s incisors and mulberry molars 2. Interstitial keratitis of the eyes Cornea opacification blindness 3. 8th nerve deafness |
|
|
Frontal bossing (unusually prominent forehead) and high arched palate
Saddle nose Higoumenaki’s sign (enlarged clavicle adjacent to sternum) Saber shin (bowing of tibia) Clutton’s joint (enlarged knee) all characteristic of what? |
congenital syphilis
|
|
|
what is used to diagnose congenital syphilis?
|
FTA-abs – Fluorescent Treponema Antibody absorption
TPHA- Treponema Pallidum Hemagglutination Assay (if both positive then lifelong infection) |
|
|
Most common sign: urethral discharge in men
50% women asymptomatic Dissemination Arthritis dermatitis syndrome Can occur in oropharynx As a result of felatio |
Neisseria Gonorrhea
|
|
|
What are characteristics of primary and secondary TB?
|
Primary disease:
Fever, pleural effusion Secondary disease: Apex of lung lesions Progressive cough and chest pain Consumption Scrofula: Involvement of lymph nodes of neck Lupus vulgaris: Skin involvement Miliary: Dissemination through blood |
|
|
What is the histopathology of TB?
|
Tubercle or granulomatous inflammation with caseating necrosis
Special stains show presence of acid fast bacilli |
|
|
What is often the first site effected in Leprosy (Hansen's disease)?
|
nasal or oropharyngeal mucosa
|
|
|
What animals are naturally susceptable to leprosy?
|
armadillos
|
|
|
What are the two histological patterns of Leprosy?
|
Tuberculoid and Lepromatous
|
|
|
What are the two clinical classifications of Leprosy?
|
Paucibacillary – corresponds to TB histo
Multibacillary – corresponds to lepromatous histo |
|
|
What are the oral signs seen in leprosy?
|
Hard and soft palat, labial maxillary gingival and buccal mucosa
Yellow-red firm papules that ulcerate and become necrotic Scarring and fixation Tongue; begins and erosion; becomes nodules Macrochelia *In children, max tooth enamel hypoplasia Granulomatous involvement of nasal cavity with palatal perforation Facial paralysis |
|
|
What are the Facies leprosa – triad of facial bone destruction?
|
Ant. Nasal spine
Ant. Max alveolar ridge Endonasal inflammatory changes |
|
|
What is NOMA (cancrum oris)?
|
an opportunistic infection predisposed by malnutrition, malignancy, immunodeficiency the begins as ANUG
|
|
|
What is Actinomycosis
|
Clinical
Draining fistula contains colonies in exudates that look like sulfur granules (yellow) Abscess Indurated or “wooden” with soft central area – “lumpy jaw” |
|
|
What is the most common cause of chronic regional lymphadenopathy in children
80% of cases <21 yrs old |
cat scratch disease
|
|
|
What are the clinical findings of cat scratch disease?
|
Submandibular lymphadenopathy and fever
Oculoglandular syndrome of Parinaud – small soar on conjunctiva causing red eye, swollen lymphnodes around ear |
|
|
Skin lesions of cat scratch disease can mimic what condition?
|
kaposi's sarcoma
|
|
|
what are the diagnostic tests for cat scratch disease?
|
Previous test – Hanger-Rose skin test (reinjection from sterile fluid gathered from infected lymphnode, similar to TB skin test)
Current test – indirect fluorescent antibody test |
|
|
what is the most common oral fungal infection in US?
|
Candida albicans
|
|
|
What are the dimorphic forms of candida? which is infectious?
|
Hyphae – infectious form, can penetrate membranes
Yeast (spore) |
|
|
White plaques that look like cottage cheese
Wipes off with gauze leaving a red mucosa Most common with immunocompromised (HIV) Secondarily to antibiotics or corticosteroid use; or immunocompromised (HIV, leukemia, chemotherapy) Common in infants (called thrush) |
acute - pseudomembranous candidiasis
|
|
|
Acute atrophic – “antibiotic sore mouth”
MOST common with antibiotic use Patient undergoes consistant pain Chronic atrophic may be asymptomatic |
Erythmatous candidiasis
|
|
|
What are the causitive agent and the clinical findings of denture stomatitis?
|
Type of erythmatous candidiasis.
Erythema and petechia under denture base Asymptomatic usually Secondary to patient failing to remove denture and/or lack of proper hygiene Fungal organisms reside in denture pores. |
|
|
treatment and differential dx of denture stomatitis
|
Must treat mouth AND denture (treat denture with BLEACH), treat mouth with Nystatin or fluconazole
Differential diagnosis – rule out methyl methacrylate allergy or poorly fitting denture |
|
|
Describe Median rhomboid glossitis (aka central posterior tongue)
|
type of erythematous candidiasis
Well-defined asymptomatic, red, flat or papules Symmetrical shape Mid-dorsum, posterior 1/3rd of tongue @ junction with anterior 2/3 = tuberculum impar *historically thought to be developmental *often comes back after antifungal treatment |
|
|
appearance, causative agents and commonly affected population for Angular cheilitis (perleche)
|
Red, fissured cracks in mucosa at labial commissures
Often contains staph aureus besides C. albicans Older patients usually Causes Moist skin environment (macerated skin) Older people with loss of vertical dimension of occlusion (VDO) Ortho patients |
|
|
this fungal condition comes from sucking or licking lips
|
Cheilocandidiasis
|
|
|
How does the chronic hyperplastic form of oral candidiasis present?
|
Presents as clinical leukoplakia (white)
Does NOT wipe off with gauze Differential diagnosis Looks like oral hairy leukoplakia seen in HIV+ patients |
|
|
What is the histological finding in Candidiasis?
|
PAS positive stain shows hyphae (this confirms candidiasis)
|
|
|
What are treatments for oral candidiasis?
|
Nystatin (mycostatin): Lozenges
Fluconazole (e.g., Diflucan): Systemic For serious infections only TREAT DENTURE WITH BLEACH |
|
|
Most common systemic fungal infection in U.S.
|
histoplasmosis
|
|
|
location in US commonly infected with histoplasmosis
|
mississippi and ohio river valleys
|
|
|
What is the oral lesion associated with histoplasmosis and what is the differential diagnosis?
|
Solitary painful irregular ulcer with indurated borders that looks clinically like oral cancer
Non-healing ulcer (diff dx oral cancer |
|
|
treatment for oral histoplasmosis?
|
Treatment – GET A BIOPSY
|
|
|
Histology of histoplasmosis
|
Granuloma with multinucleated giant cells
|
|
|
this fungal infection has Acute and chronic type
Occurs more in men (probably occupational, not genetic) Diff. dx: oral cancer BECAUSE it is a non-healing ulcer |
blastomycosis
|
|
|
causitive agent is Coccidioidomycoses immitis.
Common in Desert soil of southwest U.S. Most people have asymptomatic or mild flu symptoms Skin lesions on mid face possible |
Coccidioidomycosis (San Joaquin Valley fever)
|
|
|
Most common life threatening fungal infection in AIDS
Pigeon in the host |
Cryptococcus neoformans
|
|
|
Diabetics with ketoacidosis and immune-compromised patients are especially susceptable to these TWO fungal infections that may lead to PALATAL perforation.
|
Zygomycosis and Asperigillosis
|
|
|
What is the fungal diff diagnosis for syphlitic gumma on palate?
|
zygomycosis
|
|
|
Histopathology of zycomycosis?
|
Large hyphae block blood flow causing massive necrosis distal to obstruction
|
|
|
Common protozoa that mainly overgrows in immune-compromised
*developing fetus can get toxoplasmosis via mother. Can cause blindness, mental retardation Comes from cat feces |
Toxoplasma gongii
|
|
|
This fungal infection that can cause palatal perforation can be introduced to the sinus via endo or extraction
|
aspergillosis
|
|
|
“white line”
On the buccal mucosa usually bilateral at the level of the plane of occlusion |
linea alba
|
|
|
Chronic nibbling habit
Females 2:! Bilateral, ragged surface with tissue tags |
morsicatio
|
|
|
Morsicatio of the tongue may mimic what condition?
|
*Lesions on tongue may mimic oral hairy leukoplakia
|
|
|
What is the most common oral pathology
|
traumatic ulceration, either iatrogenic or facticial
|
|
|
meaning of facticial injury
|
something someone does to themselves to cause injury or ulceration
|
|
|
Slow healing, deep ulcer on side of tongue, mimics cancer
Can be a facticial injury. Takes weeks to months to completely resolve Benign Patients are immunocomprimised |
Eosinophilic ulceration – aka TUGSE
Aka Traumatic ulcerative granuloma with stromal eosinophilia – TUGSE |
|
|
histology of TUGSE
|
Numerous eosinophils scattered among the fascicles of skeletal muscle and histiocytes, Granulation tissue
|
|
|
biopsy of what ulcerative condition can insight a healing response?
|
eosinophilic ulceration, aka TUGSE
|
|
|
“white line”
On the buccal mucosa usually bilateral at the level of the plane of occlusion |
linea alba
|
|
|
Same as TUGSE but specific to neonates
Nursing neonate or infant with erupted anterior mandibular primary incisors causing a traumatic ulcer on the anterior ventral tongue |
Riga-Fede disease
|
|
|
sources of electrical and thermal burns
|
Electrical
Commonly on the lips from biting electrical wire Thermal Ice damage from trying to relieve tooth pain Pizza burn |
|
|
Chronic nibbling habit
Females 2:! Bilateral, ragged surface with tissue tags |
morsicatio
|
|
|
Morsicatio of the tongue may mimic what condition?
|
*Lesions on tongue may mimic oral hairy leukoplakia
|
|
|
What is the most common oral pathology
|
traumatic ulceration, either iatrogenic or facticial
|
|
|
meaning of facticial injury
|
something someone does to themselves to cause injury or ulceration
|
|
|
Slow healing, deep ulcer on side of tongue, mimics cancer
Can be a facticial injury. Takes weeks to months to completely resolve Benign Patients are immunocomprimised |
Eosinophilic ulceration – aka TUGSE
Aka Traumatic ulcerative granuloma with stromal eosinophilia – TUGSE |
|
|
histology of TUGSE
|
Numerous eosinophils scattered among the fascicles of skeletal muscle and histiocytes, Granulation tissue
|
|
|
biopsy of what ulcerative condition can insight a healing response?
|
eosinophilic ulceration, aka TUGSE
|
|
|
Same as TUGSE but specific to neonates
Nursing neonate or infant with erupted anterior mandibular primary incisors causing a traumatic ulcer on the anterior ventral tongue |
Riga-Fede disease
|
|
|
sources of electrical and thermal burns
|
Electrical
Commonly on the lips from biting electrical wire Thermal Ice damage from trying to relieve tooth pain Pizza burn |
|
|
common chemical facticial injuries with medicaments
|
Aspirin – classic, toothache with direct application
Mouthwash, hydrogen peroxide burns |
|
|
Common iatrogenic chemical and mechanical injuries
|
bleach used in endo, cotton roll burns
|
|
|
What are the two acute changes seen with radiation and chemotherapy?
|
mucositis, desquamation and ulceration (reversible)
& salivary gland hypofunction (irreversible) |
|
|
What is hypogeusia?
|
decreased sense of taste
|
|
|
Caused by fibrosis of bone vasculature
Mandible is MOST often affected **prevent post-radiation extractions Will occur almost certainly with > 65 Gy (6,500 rads) |
osteoradionecrosis
|
|
|
Treatments of radiation complications
|
Chlorhexidine – 0.125%, milk of magnesia, attapulgite (kaopectate) rinse
|
|
|
Pathologic effects of chemotherapy
|
mucositis,
bone marrow supression: anemia and immunocomprimisation Thrombocytopenia can cause hemorrhage Agranulocystosis – can cause infection opportunistic infections such as herpes simplex and candidiasis |
|
|
What do bisphosphonates do?
|
inhibit osteoclast activity and interfere with angiogenesis.
|
|
|
which delivery method caries a higher risk of BIONJ? IV or PO?
|
IV
|
|
|
What are the causes of meth mouth?
|
xerostomia, bruxism, poor oral hygiene
|
|
|
What can occur from High Epi LA close to major blood vessel
|
anesthetic necrosis
|
|
|
what is the name for persistant flaking of vermillion border
|
exfoliative cheilitis
|
|
|
Types of submucosal hemorrage, sizes
|
Petechiae – pinpoint
Mononucleosis – can cause these on palate Purpura – larger than petechia Ecchymosis – greater than 2 cm Hematoma – elevated mass |
|
|
Clinically present as Black, blue or gray macules
Well defined border, irregular shape or diffuse with lateral spread Gingiva, buccal mucosa most often *can also be seen apically from endo with silver point |
amalgam tattoo
|
|
|
diagnosing amalgam tattoo
|
May see particles on radiograph
Biopsy may be necessary to confirm dx |
|
|
treatment of heavy metal poisoning is accomplished how?
|
with chelating agent (ex. EDTA)
|
|
|
Bluish black line on free marginal gingival
Advanced perio disease Tremor of tongue upon thrusting Excessive salvation Metallic taste |
Lead line (Burton’s) from lead poisoning
|
|
|
What is Acrodynia, Pink’s disease?
|
mercury poisoning in chitlins
|
|
|
most frequent symptoms of gold poisoning?
|
pruritus (most common), dermatitis
|
|
|
What is Argyria?
|
systemic silver poisoning, skin blue or gray
|
|
|
Increased melanin on gingival where cigarette smoke goes
Mostly in women Will fade away if source removed |
Smokers Melanosis
|
|
|
This drug causes pigmentation in mouth.
Anti-malarial Used to treat lupus erythematous Blue-black on palate |
Chloroquinone
|
|
|
Anti-acne medication
Deposited in bone Blue-gray band above facial attached ginigiva near MGJ, broad band on hard palate |
Minocyclin
|
|
|
Aka Cutright lesion
Secondary to denture trauma |
Reactive Osseous and Chondromatous Metaplasia
|
|
|
Most frequent site for oral ulceration with bone sequestration
|
lingual surface of the posterior mandible along the mylohyoid ridge
Most usually unilateral |
|
|
Dome-shaped, faint radiopacitiy that appears to arise from floor of maxillary sinus
Inflammatory fluid (serum, NOT mucin) accumulated under maxillary sinus mucosa with sessile elevation Most often seen secondary to odontogenic or sinus infection, allergy Not true cyst, just accumulation of fluid under epi lining |
Antral Pseudocyst
|
|
|
True cyst traped in bone from maxillary sinus epithelium following surgery.
|
True sinus mucocele (aka Surgical Ciliated Cyst)
|
|
|
What is Cervicofacial Emphysema and what are common causes?
|
Forced air into subcutaneous space or fascia due to:
Iatrogenic compressed air Prolonged or difficult extraction |
|
|
What is mycospherulosis?
|
Condition cause by Topical antibiotic, petroleum-tetracycline based
Foreign body causes granulomatous inflammation Iatrogenic, used to be placed in extraction site. |
|
|
What are the 3 types of RAS?
|
Minor, Major, Herpetiform
|
|
|
What is the common feature of all types of RAS?
|
do NOT go through vesicular phase before becoming ulceration
|
|
|
What are the 3 etiologies of RAS?
|
Immune problems, Factors decreasing mucosal barrier (Trauma, iron, vit B12, folate deficiency), Increase in antigen exposure (strep, herp, adenovirus, CMV)
|
|
|
whats the most common form of RAS?
|
Minor (80%)
|
|
|
RAS occurs on what type of mucosa (with the exception of herpetiform)?
|
movable (herpetiform can also occur on hard palate and attached gingiva
|
|
|
What condition has 1-5
2 mm - 1 cm diameter painful ulcers on movable mucosa Heal in 7-10 days without scarring Pain disproportionate to size of ulcer |
minor aphthous ulcers
|
|
|
Sutton’s disease; PMNR is also a name for what?
|
Major aphthous ulcer stomatitis
|
|
|
which form of RAS experience scarring?
|
Major
|
|
|
Large and deep ulcers
1-3 cm diameter 4-6 weeks to heal Number of lesions: 1-10 |
major RAS
|
|
|
Crop of aphthae as seen with herpes simplex infection
Small, 1-3 mm As many as 100 at one time Clinically confused with herpes simplex infection because of crop of lesions (HARDEST TO DIAGNOSE CLINICALLY, CAN OCCUR ON HARD PALATE OF GINGIVA) |
Herpetiform aphthous ulcer
|
|
|
Histology of RAS
|
Nonspecific ulcer
Fibrinopurulent membrane Acute and chronic inflammation Granulation tissue No causative organisms present or cultured |
|
|
What things would you instruct a patient to avoid so as not to percipitate aphthous ulcers?
|
Tell patient to use toothpaste without sodium lauryl sulfate, and avoid chocolate, peanuts, corn oil, citrus products
|
|
|
Treatments of RAS
|
OTC film formers
OTC and Rx cauterizing agents (Aluminum hydrate; Debacterol) Topical steroids Systemic steroids Systemic steroid sparer Azathioprine (Imuran) Used in tandem with systemic steroid to enhance the effect of the steroid while using a smaller amount of steroid Major Ulcers may need intralesional injections Kenalog 40 mg/ml suspension in tuberculin syringe Deposit 1 ml solution at ulcer’s margins, several locations |
|
|
Difference between gels and ointments
|
Gels are used for oral path treatment, ointments and creams are used for dermatology most often.
|
|
|
What is a systemic steroid sparer and what does is treat?
|
Systemic steroid sparer
Azathioprine (Imuran) Used in tandem with systemic steroid to enhance the effect of the steroid while using a smaller amount of steroid to treat RAS |
|
|
What is the triad associated with behcet's disease?
|
oral, genital, and ocular lesions
|
|
|
Very miserable and life threatening disease whose centerpiece is aphthous ulcers and vasculitis
|
Behcets
|
|
|
Diagnosis requirments for Behcet's
|
3 episodes of oral lesions in one year plus (2) of the following:
Recurrent genital lesions Eye lesions Skin lesions |
|
|
Sarcoidosis occurs most commonly in what population?
|
african american 10:!
|
|
|
What are the symptoms of Sarcoidosis?
|
Dyspnea, dry cough, chest pain, fatigue, joint aches, weight loss BUT
20% no symptoms with first sign on chest radiograph Bilateral hilar lymphadenopathy Oral Lesions Mass or era of granularity with ulcers – red, purple, brown Buccal mucosa may occur ‘cobblestone’ Salivary glands - - -> xerostomia |
|
|
Histology of Sarcoidosis
|
Granulomatous inflammation
Asteroid bodies – star shaped inclusions in giant cells Schaumann bodies – calcifications WILL NOT FIND CAUSITIVE ORGANISM |
|
|
What disease has a histology of asteroid bodies and schaumann bodies?
|
sarcoidosis
|
|
|
Diagnosing sarcoidosis
|
Skin – Kviem test (screening)
Subcutaneous injection of antigen from human sarcoid tissue Lab Elevated serum angiotension converting enzyme (ACE) Chest radiograph Bilateral hilar lymphadenopathy |
|
|
What is the rarest color and 2nd rarest color of intraoral lesion?
|
brown is rarest, black is second rarest
|
|
|
This is a unifying term for a variety of clinical dx with granulomatous inflammation
|
orofacial granulomatosis
|
|
|
diseases that can mimic orofacial granulomatosis
|
chronic granulomatous disease, crohn's, sarcoidosis, TB, foreign material, allergy
|
|
|
Most frequent site for orofacial granulomatosis
|
lips. Nontender persistent swelling of one or both lips
Called: Cheilitis granulomatosum |
|
|
Cheilitis granulomatosum is a sign present in what syndrome?
|
melkerson-rosenthal.
Fissured tongue Facial paralysis Cheilitis granulomatosum **ALL 3 DO NOT NEED TO BE PRESENT AT THE SAME TIME |
|
|
What are the three signs of Melkerson Rosenthal?
|
Fissured tongue
Facial paralysis Cheilitis granulomatosum **ALL 3 DO NOT NEED TO BE PRESENT AT THE SAME TIME |
|
|
What is the triad for wegener's granulomatosis?
|
Necrotizing granulomatous inflammation appears in upper airway
Glomerulonephritis Vasculitis |
|
|
True or false, Wegener's granulomatosis can cause palatal perforation.
|
True
|
|
|
What two conditions can show signs of "Strawberry ginigivitis"?
|
Wegener's and scarlet fever
|
|
|
Diagnosis of wegener's
|
Indirect immunofluorescence to serum antibodies against cytoplasm of neutrophils
c-ANCA (cytoplasmic anti-neutrophil cytoplasm antibody) Positive IF 90-95% of the time |
|
|
What is the difference between indirect and direct immunofluorescence?
|
indirect - take blood
direct - take tissue |
|
|
What is the term for an oral allergic reation to a systemic drug?
|
Stomatitis medicamentosa
|
|
|
What allergic condition can mimic these conditions:
Erythema multiforme Anaphylactic stomatitis Fixed drug eruption Lichenoid or lupus-like eruptions Pemphigus-like eruptions |
stomatitis medicamentosa
|
|
|
What is the stepwise process of an anaphylactic reaction?
|
Allergen drug enters systemic circulation and binds to IgE-mast cell complexes
Histamine release - - - > vascular permeability - - - > edema |
|
|
what is the most common drug to trigger anaphylaxis?
|
antibiotics
|
|
|
What is a fixed drug eruption and what are common drugs that it occurs with?
|
breakouts that reoccur at same anatomical site every time.
ASA (aspirin) Sulfa Tetracycline Clinical Zones or redness or ulcerations Bilateral, symmetrical lesions Especially on tongue and buccal mucosa |
|
|
What is the term for allergic contact reaction in the mouth?
|
stomatitis venenata
|
|
|
What are common triggers for stomatitis venenata?
|
food, toothpastes, dental materials (amalgam), flavorings, cinnamon oil
|
|
|
What is the common presentation of an amalgam allergy?
|
A chronic lichenoid type lesion on buccal mucosa, marginal gingiva, or lateral tongue (1-2% of Hg allergic people will have allergic reaction to amalgam)
|
|
|
This is the name for an Allergic reaction to something that mimics rosacia.
common causes are Tartar control toothpaste, mouthwash Topical steroids WORSEN There is a spared area circumorally |
perioral dermatitis
|
|
|
What are the two forms of Angioedema? (Quincke's disease)
|
Hereditary and Acquired
|
|
|
What is the pathophysiology of angioedema (quincke's disease)?
|
Patients lack C-1 esterase inhibitor enzyme allowing complement cascade to degenerate mast cells and release histamine.
DENTAL TRAUMA CAN PRECIPITATE CONDITION |
|
|
Main cause of nicotine stomatitis.
|
HEAT, not cigarrettes perse
|
|
|
What is the clinical presentation of nicotine stomatitis?
|
red punctate spots around minor salivary glands on palate
|
|
|
Is nicotine stomatitis premalignant?
|
No
|
|
|
What is smokeless tobacco keratosis?
|
white (keratin) chemical burn from smokeless tobacco
|
|
|
what is the primary carcinogen in tobacco products?
|
nitroso-nornicotine (product of combustion)
|
|
|
What is the common etiology of oral submucous fibrosis? Where is it common and what is a common intraoral finding?
|
Common in southeast asia and indian ocean basin due to use of areca leaf tobacco chewing
HIGH PREVALENCE OF ORAL CANCER, 50% HOSPITALIZATIONS Soft palate is dense |
|
|
This is a Common cutaneous premalignant lesion caused by UV radiation
|
Actinic keratosis
or Actinic chelitis if occurs on the lips |
|
|
85% of oral cancers are preceded by what condition?
|
leukoplakia
|
|
|
This common form of leukoplakia occurs on gingiva around areas of missing teeth
|
Frictional keratosis or alveolar ridge keratosis (ARK)
|
|
|
what are the danger areas for leukoplakia/oral cancer?
|
lateral tongue and floor of mouth
|
|
|
true or false, 85% of leukoplakias prove to be severe dysplasia or invasive cancer
|
false, 85% of oral cancers are preceded by leukoplakia
|
|
|
this is a red plaque that wont wipe off and 91% prove to be severe dysplasia or invasive oral cancer
|
erythroplakia
|
|
|
What are some histologic features of dysplasia?
|
nuclear:cytoplasmic ratio is high, nucleolus is hyperchromatic
|
|
|
how are the mild/mod/severe grades of dysplasia classified?
|
Mild – bottom 3rd
Mod – middle 3rd Severe – superficial 3rd |
|
|
what defines carcinoma in situ?
|
from basal layer to surface layer affected/abnormal
|
|
|
what allows for metastasis of epithelial dysplasia?
|
breaking of the basement membrane
|
|
|
true or false, All cancers proceed through each step (mild/mod/severe) of dysplasia.
|
false
|
|
|
What is the concept of "committed mucosa"?
|
mucosa that, even when removed, will grow back cancerous
|
|
|
WWhat is the most common cancer in the mouth
|
squamous cell carcinoma (95%)
|
|
|
what are the premalignant lesions associated with SCC in the mouth
|
leukoplakia, erythroplakia, leukoerythroplakia
|
|
|
what is the average 5yr survival rate for SCC in mouth?
|
59% 5 yr survival rate
|
|
|
annual incidence and mortality for oral cancer
|
30,000 new cases/yr
7,500 deaths/yr |
|
|
what are 5 etiologies of oral cancer?
|
tobacco, alcohol (synergy 16x risk), sanguinaria, HPV (associated with oropharyngeal cancer NOT oral cancer), plummer-vinson syndrome (severe form of iron def. anemia)
|
|
|
High risk sites for oral cancer
|
Lower lip (good prognosis 95% survival rate)
tongue (50% of all intraoral cancer, prognosis worse the further back it goes), floor of mouth, soft palate |
|
|
what is the growth pattern of verrucous carcinoma and what is a major oredisposing factor for it.
|
exophitic (good prognosis), large broad-based papillary (cauliflower like) leukoplakia
Highly associated with smokeless tobacco |
|
|
what is the difference between grading and staging of SCC, which is of greater prognostic importance?
|
Histopathologic grades of SCC
Well dif Moderately differentiated Poorly diff Undifferentiated Staging (MORE IMPORTANT) TMN T= size M = metastasis N = node involvment |
|
|
most common type of skin cancer?
|
basal cell carcinoma (does not occur in mouth)
|
|
|
squamous papillomas and verruca vulgaris are induced by what condition? Which is more common? What's the clinical difference?
|
Induced by HPV, squamous papilloma more common (3% of oral lesions), verruca vulgaris is slightly spikier than papilloma
|
|
|
This condition should set off a red flag if seen in children.
|
Condyloma acuminatum.
|
|
|
This is the most common pigmented lesion intraorally (after amalgam tattoo)
|
Oral melanotic macule (focal melanosis)
|
|
|
What is the most common tumor of humans?
|
Melanocytic Nevi (mole)
|
|
|
what is the most common site for intraoral melanocytic nevi?
|
palate and maxillary gingiva (also most common site for intraoral melanoma)
|
|
|
How does a blue nevus arise?
|
melanocytes get stuck during migration from neural crest, appear blue in mouth (second most common intraoral nevus)
|
|
|
what is the fastest growing cancer in US and world wide? Is the primary cause of cancer death in 25-30 yr olds
|
melanoma
|
|
|
risk factors for melanoma and ABCD's
|
red/blonde hair
A-asymmetry B-border irregularity C-color variation D- diameter >6mm |
|
|
what are the two spreading patterns of melanoma, which is more common and which has a worse prognosis?
|
Superficial spreading
70% of skin melanoma Nodular melanoma Bad prognosis |
|
|
most common sites for oral melanoma?
|
palate and max gingiva (80%)
|
