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106 Cards in this Set
- Front
- Back
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Three types of exogenous pigmentation |
tattoos heavy metals (lead, silver, bismuth) drug-related- antimalarails, minocycline, estrogen, laxatives, tranquilizers, AIDS-related meds, others) |
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Physiological pigmentation |
racial pigmentation -normally symmetric and affects gingiva (endogenous) |
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Smoker's melanosis |
increased melanin production for protection - affects anterior facial gingiva - will disappear after quitting (endogenous) |
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Ephelis |
(freckle) first appear in childhood and become less prominent with time - more prominent after sun exposure (endogenous) |
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Actinic Lentigo |
aka solar lentigo, age spots, liver spots - irregular brown macule(s) from chronic UV damage - often on hands, arms, face - no treatment necessary (do not become malignant) |
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Oral Melanotic Macule |
- solitary, well-demarcated, uniformly pigmented, brown macule often found on lip (but can be anywhere intraorally) - some appear blue or black - biopsy to rule out melanoma; otherwise remove for esthetics |
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Oral Melanoacanthoma |
Benign, reactive, darkly pigmented, flat or slightly rasied lesion on buccal mucosa - biopsy to rule out melanoma; otherwise no treatment - often in black females - normally larger than oral melanotic macules, and normally on buccal mucosa not the lip (also reactive not from sun exposure) |
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Acquired Melanocytic Nevus |
aka mole most common intraoral nevus - most are on gingiva or palate, but not papillary like skin nevi - must biopsy to rule out melanoma |
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Blue nevus |
2nd most common nevus seen in mouth - seen more frequently in children and young adults - blue macule almost always on palate - biopsy to rule out melanoma |
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Melanoma |
brown to black macule with irregular borders (20% are barely pigmented) - acral lentiginous subtype is most common intraorally - poor prognosis |
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What syndromes have pigmentation associated with them? (4) |
Peutz-Jeghers Syndrome McCune-Albright Syndrome Addison's Disease Neurofibromatosis |
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Peutz-Jeghers Syndrome |
Uncommon syndrome characterized by intestinal polyposis and dark, freckle-like lesions of the extremities and periorificial areas - increased risk of adenocarcinoma, and tumors in various organs - dark macules of the lips, buccal mucosa and tongue |
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McCune-Albright Syndrome |
-Polyostotic fibrous dysplasia - Cafe-au-lait pigmentations with rough borders - Multiple endocrinopathies - may have oral pigmented macules |
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Addison's Disease |
(hypoadrenocorticism) - don't produce enough cortisol from destruction of adrenal cortex, or decreased production of ACTH - fatigue, irritability, depression, hypotension - diffuse brown macules on oral mucosa (often first presentation of disease) |
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Neurofibromatosis |
- neurofibromas - cafe-au-lait macules with smooth borders) - optic gliomas - Lisch nodules - bony lesions - axillary freckling |
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end of lecture 1 |
d |
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What do Vesiculobullous Dz's affect? |
speech, nutrition, oral hygiene (present similar to ulceration and desquamative gingivitis) |
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Erythema Multiforme (EM) |
- presents as ulcerative, "blood crusted" lips and target lesions on skin |
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What causes Erythema Multifome? |
auto-immune, or allergy to drugs (sulfonamides, barbituates, or PCN) or infection with HSV, mycoplasma, pneumonia |
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What is Erythema Multiforme (EM) called when there is involvement of the lips, eyes and genitals? |
Stevens-Johnsons syndrome |
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What is EM called when there is sloughing of large amounts of skin & mucosa? |
Toxic Epidermal Necrolysis (TEN) / Lyell's Disease |
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How to treat EM? |
corticosteroids sometimes antivirals before corticosteroids |
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Pemphigus frequency age antibodies to: blister: Nikolsky sign Immunofluorescence Mucosa involvement Histology Tx Prognosis |
Vulgaris - rare - younger pts (middle age) -desmosomes (desmoglein 3) - intraepithelial (superficial) - yes to Nikolsky - circular IF - common mucosal involvement - tombstone appearance - steroids and immunosuppressants - die without treatment |
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Pemphigoid frequency age antibodies to: blister: Nikolsky sign Immunofluorescence Mucosa involvement Histology T xPrognosis |
Bullous pemphigoid common older pts hemidesmosomes subdermal (deep) linear IgB IF rare mucosal involvement floating histology steroids decent prognosis, you will be okay |
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Lichen Planus. what is it? |
common inflammatory disease - white striae (Wickham's striae), white plaques, desquamative gingivitis - skin lesions: purple, polygonal, papules |
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Chronic Ulcerative Stomatitis |
-clinically similar to lichen planus - non-responsive to treatment - unique DIF pattern |
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Epidermolysis Bullosa (EB) |
inherited disorder - causes blistering and scarring (hemorrhagic bullae) - young age - defect in attachment of epithlial cells |
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Three types of Epidermolysis Bullosa (EB) |
1. Simplex - mild. mutation in genes for keratin 5, 14 2. Junctional - severe/fatal. Skin sloughing. gene mutation encoding laminin, integrin, Type 17 collagen - dental abnormalities 3. Dystrophic - type 7 collagen defeicit - presents with oral lesions |
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Dental abnormalities seen in Epidermolysis Bullosa (EB) |
- microstomia - increased caries mitten deformity of hands |
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EB histo |
1. Simplex: Intraepithelial clefting 2. Junctional- Subepithelial clefting 3. Dystrophic- Subepithelial clefting |
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Epidermolysis Bullosa ACQUISITA (EBA) |
same name and clinical features as EB, but has self antigen attack EB has no encoding for specific proteins |
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end of lecture 2 |
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Lymphoid hyperplasia |
-reactive enlargement of lymphoid tissue in response to an antigen - this includes, acute lymphadenopathy (tender, freely moveable lymph nodes) chronic (ton-tender, rubbery, freely moveable lymph nodes), enlarged tonsils, and intraoral lymphoid hyperplasia (discrete, non-tender swelling in mouth) |
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Hemophilia A |
deficiency of factor 8 - pt's have abnormal PTT - will have uncontrolled bleeding and hemarthrosis |
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Hemophilia B |
aka Christmas disease - deficiency of factor 9 - clinically similar to hemophila A |
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Von Willebrand's Disease |
-Abnormal bleeding time and PTT - cutaneous and mucosal bleeding (GI, epistaxis), menorrhagia |
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Sickle Cell Anemia |
- disorder of hemoglobin synthesis - abnormal beta-globin chain causes sickling of RBC puts pt at increased risk of osteomyelitis, asymptomatic pulpal necrosis, and prolonged paresthesia - will have "hair-on-end" appearance in lateral skull radiograph |
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Thalassemia |
Group of inherited disorders of hemoglobin synthesis affecting either alpha or beta globin chains Thal. minor is not clinically significant Thal. major- large spleen, bone marrow hyperplasia, frontal bossing, lymphadenopathy, "hair-on-end" appearance in radiograph |
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Aplastic Anemia |
-hematopoeitic stem cells do not produce adequate numbers of blood cells - likely to have gingival hemorrhage and petechiae |
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Neutropenia |
-decrease in the number of circulating neutrophils to less than 1500/mm^3 - oral ulcerations without erythematous halo |
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Agranulocytosis |
absence of cells of the granulocytic series - leads to deep, punched out ulcerations, NUG-like lesions |
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Cyclic Neutropenia |
Rare, idiopathic disorder characterized by episodes of neutropenia lasting 3-5 days and recurring every 18-21 days - typically presents in childhood - ulcerations with or without red halo, often have severe perio disease too |
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Thrombocytopenia |
below 150,000 platelets/mm^3 - can be from drugs, malignancy, SLE, HIV, TTP, ITP - often detected by oral lesions (petechiae, ecchymoses, hematomas) |
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Leukemia |
malignancy of hematopoeitic stem cells - myeloid or lymphoblastic/lymphocytic, acute or chronic - petechiae, spontaneious gingival hemorrhage, canddiasis, loosening of teeth - osteolysis of bone on radiograph (may mimic periapical pathology) |
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Langerhans Cell Histiocytosis |
proliferation of Langerhans cells may have loosening of teeth or a gingival mass three types: Monostotic/Polystotic- bone lesions (no visceral involvement, good prog.) Chronic disseminated histiocytosis- (hand-Schuller-Christian disease)- involves bone, viscera, and skin, bad prog. Acute disseminated histiocytosis- (letterer-Siwe disease)- prominent skin, visceral, and bone marrow involvement, affects infants, poor prog. |
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Hodgkin Lymphoma |
Malignant lymphoproliferative disorder of Redd-Sternberg cells - lymphadenopathy, oral involvent is rare |
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Non-Hodgkin's Lymphomas |
oral findings common - non-tender, diffuse, boggy swelling of hard palate or alveolar process - mass in lymph node, or sometimes extranodal |
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Burkitt's Lymphoma |
African Burkitt's- associated with EBV -affects mainly children, normally jaws American Burkitt's- 20% associated with EBV - often abdominal mass, but can affect jaws rapid growing tumor that can lead to destruction of alveolar bone |
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Angiocentric T-Cell Lymphoma |
a rare neoplasm that aggressively destroys midline structures of the palate and nasal fossa - pt will have nasal stuffiness and pain - swelling of soft and hard palate followed by destruction by a deep, necrotic ulcer |
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Plasmacytoma |
neoplasm of plasma cells in bone or soft tissue - well-delineated, soft, non-tender mass. - will have swelling, pain, loosening of teeth (basically just a tumor that can occur in mouth) - well-defined or ragged unilocular radiolucency |
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Multiple Myeloma |
Cancer of plasma cells. (multiple masses; when only one mass is present it is called plasmacytoma). - typically older, black, males. - multiple, punched-out or ragged radiolucencies (on lateral film, also jaw typically involved) - poor prognosis |
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Graft-vs-Host Disease |
develops in recipients of bone marrow transplant - Acute GVHD- within 100 days of transplant (presents as rash on skin, and/or sloughing) - Chronic GVHD- more than 100 days after transplant oral lesions: may resemble lichen planus - burning sensation - xerostomia common |
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End of lecture 3 |
1 |
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Ectodermal Dysplasia |
-dysplasia, or aplasia of skin, hair, nails, teeth, and/or sweat glands - Hypohidrotic ED is best known type (x linked) - pt's will have oligodontia or hypodontia, abnormal shaped crowns, and xerostomia |
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White Sponge Nevus |
aka Cannon's Disease - inheritied skin disorder characterized by a keratin defect. - shows up at birth or early childhood - will have asymptomatic, bilateral, thick, corrugated plaques often on buccal mucosa - no treatment |
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Hereditary Benign Intraepithelial Dyskeratosis |
keratinization disorder affecting a tri-racial isolate of people from north carolina - lesion develop during childhood - thick, corrugated white plaques on the buccal and labial mucosae (other sites too potentially) - also may have thick opaque plaque in eye -no treatment for oral lesions |
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Dyskeratosis Congenita |
Oral lesions - start as bullae then erode to form leukoplakic lesions which are premalignant - also have abnormal skin pigmentation |
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Xeroderma Pigmentosum |
Rare skin condition caused by a defect in DNA repair - Squamous cell carcinomas of lower lip and tip of tongue are common |
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Darier's Disease |
aka Keratosis Follicularis - inherited condition affecting the skin, mucous membranes, and nails - leads to multiple yellow to brown "greasy" crusted papules all over body. worsen in summer and may be itchy - will have flat-topped papules on hard palate and alveolar mucosa (may resemble IPH or nicotine stomatitis) - may have parotid enlargement |
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Hereditary Hemorrhagic Telangiectasia |
aka Osler-Weber-Rendu Syndrome - hereditary disorder characterized by telangiectasias and other vascular malformations - pts. have numerous small red lesions on skin and mucous membranes - oral lesions often on lips, tongue, and buccal mucosa - epistaxis (nose bleed) is common - can develop fistulas in lungs, liver or brain |
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Tuberous Sclerosis |
Uncommon disease characterized by benign tumors and hamartomas of the CNS, skin, and other organs, with mental retardation, and seizures (look like moles all over the body in pictures) Oral- - enamel pitting - fibrous papules - diffuse gingival enlargement - intraosseous fibrous proliferation |
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Multiple Hamartoma Syndrome |
aka Cowden Syndrome - Inherited syndrome characterized by multiple hamartomas of the skin, breast, thyroid, GI, GU, and brain due to mutation in the PTEN gene. - multiple papules of the skin, common around mouth, nose and ears - 80% will have papules of the gingiva, dorsal tongue, and buccal mucosa |
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Erythema Migrans (aka?) |
Geographic tongue, Benign Migratory Glossitis - Common, benign condition characterized by multiple, well-demarcated atropic patches which primarily affect the tongue but may be seen elsewhere -treatment: none. if symptomatic, treat with topical corticosteroids and avoid trigger foods |
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Reiter's Syndrome |
-Immunologically-mediated condition with a classic triad of non-gonococcal urethritis, arthritis, and conjunctivitis - mostly young males - may have Balanitis circinata- skin lesions of glans penis - some pt's will have erythematous lesions on the buccal mucosa or palate, and/or painless shallow ulcers - no treatment, lesions often regress spontaneously |
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Psoriasis |
Common chronic, inflammatory skin disease characterized by increased proliferative activity of keratinocytes - Symmetrical, well-demarcated, salmon-colorplaques with silvery-white scales that wax and wane. get better with sun exposure - Auspitz's sign- punctate bleeding spots when lesions are wiped off - Oral lesions rare, but should parallel skin lesions Histo: elongated rete ridges, and neutrophilic microabscesses |
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Lupus Erythematosus |
The most common "collagen vascular" disease in the U.S. 3 main types: - Systemic Lupus Erythematosus (SLE) - Chronic Cutaneous Lupus Erythematosus (CCLE, Discoid Lupus) - Subacute Cutaneous Lupus Erythematosus (SCLE) Treatment: avoid sun exposure, NSAIDS, antimalarials, immunosuppressive drugs - topical corticosteroids for oral and cutaneous lesions |
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SLE |
-Characteristic, photosensitive, malar rash - if have oral lesions will be non-specific (lichenoid, ulcerative, desquamative gingivitis) |
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CCLE |
Oral lesions are clinically identical to erosive lichen planus |
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SCLE |
Skin lesions are the most prominent |
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Systemic Sclerosis |
aka Scleroderma - autoimmune condition resulting in desne deposition of collagen in various tissues/organs - mostly females, adult onset - Raynaud's phenomenon (episodes wehre fingers, toes white/blue from reduced blood flow) - resorption of distal phalanges, ulceration of fingertips - "mask-like" or "mouse" facies - fibrosis of the lungs, heart, kidneys, and GI tract can lead to organ failure - Oral: microstomia, ankyloglossia, dysphagia and xerostomia - widening of PDL on radiograph, and resorption of psoterior ramus, coronoid process and/or condyle - prog. poor |
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CREST syndrome |
-May represent a mild variant of scleroderma - Calcinosis cutis (calcium deposits in the skin), Raynaud's phenomenon, esophageal strictures, Sclerodactyly, and Telangiectasia |
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Follicular Cysts of the Skin |
aka Epidermoid cyst, pilar cyst - Epidermoid cyst most common - Nodular, fluctuant, keratin-filled cyst that arises from the hair follicle epithelium, frequently following trauma or inflammation - common in acne-prone sites - Multiple epidermoid cysts are seen in pt's with Gardner syndrome |
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end of lecture 4 |
d |
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Mucopolysaccharidosis |
lack of enzyme to process GAGs - often leads to mental retardation, course facial features, stiff joints, corneal clouding, macroglossia, gingival hyperplasia example: Hunter Syndrome, Hurler syndrome treatment: replace deficient enzyme |
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Hunter Syndrome |
nodular skin lesions, hypertrichosis, deafness, pulmonary hypertension (type of mucopolysaccharidosis) |
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Hurler Syndrome |
gargoylism: hypertelorism, depressed nasal bridge, macroglossia, wide-spaced teeth, dwarf stature |
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Lipid Reticuloendothelioses what are the three? |
lipid storage diseases (inherited, prominent in Ashkenazi Jewish ancestry) Gaucher Niemann-Pick Tay-Sachs |
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Gaucher Disease |
-most common lipid reticuloendothelioses - lack of glucocerebrosidase - macrophages are nonfunctional, accumulate in bone marrow - bone pain, hepatosplenomegaly - mandible may show ill-defined radiolucency |
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Niemann-Pick Disease |
- accumulation of sphingomyelin or defective cholesterol processing - 2 types: 1. Neuronopathic- retardation, spasticity, hepatosplenomegaly death within first two decades 2. Visceral- hepatosplenomegaly, survive into adulthood |
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Tay-Sachs Disease |
some forms mild, survive into adulthood - severe infantile form shows progressive neuronal degeneration, blindness, retardation, death in first decade |
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Jaundice |
- accumulation of bilirubin in tissue causing yellow discoloration (especially eyes) - increased serum bilirubin leads to hemolytic anemias, liver disease -causes: alcoholic cirrhosis, hep B, malignancy, hepatotoxic drugs |
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Amyloidosis |
extracellular deposition of proteinaceous material - seen most often in older males - systemic form most often presents with oral changes - macroglossia hepatosplenomegaly, fatigue - use rectal mucosal & labial salivary gland biopsy to diagnose |
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Vitamin A deficiency |
blindness, dryness of skin, poor wound healing |
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Vit B1 (thiamin) deficiency |
Beriberi, Wernicke's encephalopathy- mental deterioration, vomiting |
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Vit. B2 (Riboflavin) deficiency |
Glossitis, cheilitis, sore throat, mucosal edema, erythema, normocytic, normochromic anemia, seborrheic dermatitis of skin |
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Vit. B3 (Niacin) deficiency |
Pellagra- dermatitis, diarrhea, dementia, death. dermatitis develops in sun-exposed areas. tongue- red, smooth, and raw |
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Vit. C deficiency |
Scurvy, poor wound healing, perio dz, scorbuitic gingivitis (gingival ulceration and bleeding) |
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Vit D deficiency |
defective skeletal development; loss of lamina dura and fibrous dysplasia-like appearance in radiographs ("ground-glass" radiodensity) |
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Vit. K deficiency |
gingival bleeding |
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Iron Deficiency Anemia |
most common anemia, females more than males - fatigue, palpitations - angular cheilitis, atrophic glossitis, mucosal atrophy |
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Plummer-Vinson Syndrome |
Iron deficiency, glossitis, dysphagia (esophageal webs) - Scandinavian women, 30-50 yrs -spoon shaped nails -premalig. process, increased incidence oral and esophageal SCC |
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Pernicious anemia |
malabsorption of Vit. B12 (lack of intrinsic factor) - older northern europeans - patchy areas of mucosal erythema & atrophy |
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Pituitary Dwarfism |
anterior pit. does not release enough GH - small stature - small maxilla and mandible - delayed tooth eruption - tooth size is reduced proportionally to skeletal size |
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Acromegaly |
excess GH secretion - Post epiphyseal plate closure - most due to secretory adenoma of pituitary - often have diabetes, coarse facies, mandibular prognathism, macroglossia, diastema |
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Hypothyroidism |
decrease thyroid hormone - failure of normal growth, Cretinism in infants, Myxedema in adults - lethargy, dry skin, thick lips, tongue enlargement - delayed eruption of teeth - low levels of T4 |
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Hyperthyroidism |
aka Grave's Disease - exoptthalmos, enlarged thyroid - thyroid storm - treatment: radioactive iodine (destroys gland), surgery |
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Hypoparathyroidism |
reduced PTH: aka DiGeorge Syndrome, endocrine-candidiasis syndrome -delayed tooth eruption - low calcium levels in blood (since not enough PTH to tell it to leave bones) Chvostek's sign: upper lip twitches when facial nerve is tapped below zygomatic process - Treatment: Vit. D precursor, calcium supplement |
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Hyperparathyroidism |
- chronic high serum calcium in primary - low serum calcium in secondary (failing kidney, not converting vit. D to active form) - Stones, bone, abdominal groans - resorption of phalanges, and loss of lamina dura |
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Cushing's Syndrome |
adrenal hypercorticalism (chronic high cortisol levels) - Moon faces, hirsuitism, poor wound healing, abdominal striae, osteporosis - hypertension, depression, muscle wasting, hyperglycemia |
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Addison's Disease |
adrenal hypocorticalism (low cortisol) - Autoimmune destruction of adrenal gland - orally, diffuse patchy brown pigmentation from excess melanin production - Treatment: steroid replacement therapy |
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Diabetes Mellitus |
most manifestations associated with type I (insulin dependent diabetes mellitus) - xerostomia - gingivitis, perio dz - poor healing - sialadenosis- enlarged parotid glands - oral candidiasis |
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Hypophosphatasia |
rare, metabolic bone disease - reduced alkaline phosphatase - bone changes resemble rickets -premature exfoliation of primary and perm. teeth (they have reduced cementum) |
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Vitamin D-resistant Rickets |
more males (x-linked), short stature, bowing of legs - large pulp chambers, pulp frequently non-vital |
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Crohn's Disease |
Chronic granulomatous inflammatory dz along all GI tract - teenagers, Jewish ancestry - abdominal cramping, nausea, diarrhea, malnutrition - orally: cobblestone appearance, linear ulcerations; IFH-like, granulomatous ulcers |
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Pyostomatitis Vegetans |
unusual expression of inflam. Bowel dz, crohn's dz, or ulcerative colitis - orally: yellowish elevated linear pustules - "snail trail" ulcerations |
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Uremic Stomatitis |
complication of renal failure - increased urea in blood, saliva - leads to painful oral crusts and plaques on buccal mucosa, tongue & FOM - ammonia or urine odor on breath - delayed clotting |
