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404 Cards in this Set

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Oral Infections
What is the most common type of oral change?
Aphthous Minor
Minor, Herpetiform, or Major Aphthous: Lowest recurrence rate of the three types.
Aphthous Minor
Minor, Herpetiform, or Major Aphthous: Childhood/Late teens - 20s
Aphthous Minor and Major
Minor, Herpetiform, or Major Aphthous: Affects more females than males
All three
Minor, Herpetiform, or Major Aphthous: Affects 20% of the general population
Aphthous Minor
Minor, Herpetiform, or Major Aphthous: Affects non-smokers
Aphthous Minor and Major
Minor, Herpetiform, or Major Aphthous: Caused by - Inherited and immunodysregulation, mucosa decrease, and antigen increase
Aphthous Minor and Major
Minor, Herpetiform, or Major Aphthous: Trauma, stress, allergies provoke them
Aphthous Minor and Major
Minor, Herpetiform, or Major Aphthous: Single and maybe Multiple, but no more than 3-5 at once
Aphthous Minor and Major
Minor, Herpetiform, or Major Aphthous: Non-keratinized sites
Aphthous Minor
Minor, Herpetiform, or Major Aphthous: Lasts 5 days - 2 weeks
Aphthous Minor
Minor, Herpetiform, or Major Aphthous: Tx is Antibiotics and topical corticosteroids, Levamisole
Aphthous Minor
Minor, Herpetiform, or Major Aphthous: Looks a lot like herpes simplex
Herpetiform Aphthous
Minor, Herpetiform, or Major Aphthous: Most number of lesions of the three types
Herpetiform Aphthous
Minor, Herpetiform, or Major Aphthous: Most frequent recurrence of the three types
Herpetiform Aphthous
Minor, Herpetiform, or Major Aphthous: Young adults
Herpetiform Aphthous
Minor, Herpetiform, or Major Aphthous: Multiple, 50-100 at once
Herpetiform Aphthous
Minor, Herpetiform, or Major Aphthous: Sometimes on keratinized surfaces
Herpetiform Aphthous
Minor, Herpetiform, or Major Aphthous: Lasts 7-10 days, with recurrence
Herpetiform Aphthous
Minor, Herpetiform, or Major Aphthous: Tx is topical steroids
Herpetiform Aphthous
Minor, Herpetiform, or Major Aphthous: 2nd most common of the three types
Aphthous Major
Minor, Herpetiform, or Major Aphthous: Longest duration of the three types
Aphthous Major
Minor, Herpetiform, or Major Aphthous: Very painful, may scar because they are large and deep
Aphthous Major
Minor, Herpetiform, or Major Aphthous: Most common on labial mucosa and soft palate
Aphthous Major
Minor, Herpetiform, or Major Aphthous: Lasts up to 6 weeks, with recurrence
Aphthous Major
Minor, Herpetiform, or Major Aphthous: Cannot be treated with antibiotics
Aphthous Major
Minor, Herpetiform, or Major Aphthous: Tx is Non-systemic steroids, Orabase-Kenalog, Decadron, topical Tetracycline
Aphthous Major
Other than viral respiratory infections, what is the most common viral disease that affects humans?
Herpes Simplex I and II
What is the primary mode of transmission, during a/symptomatic?
Asymptomatic
What is another name for primary herpes simplex?
Acute Herpetic Gingivostomatitis
When does Primary herpes simplex usually occur?
1-5 years old
Which features ulcers on the gingiva: Aphthous ulcers or primary herpes simplex?
Primary Herpes simplex
Name the only place that Recurrent Intraoral Herpes Simplex can occur.
Mucosa that is bound to periosteum (gingiva and hard palate)
What often causes Recurrent Intraoral Herpes Simplex?
Dental treatment
Name the two diseases caused by varicella-zoster virus.
1 Chicken pox 2 Shingles
How does varicella-zoster usually enter the body?
Respiratory tract
Name the maculopapular eruption that occurs on the trunk and face first, then extremities.
Chicken pox
What are the oral manifestations of chicken pox?
Small vesicles on buccal mucosa, palate, and gingiva
Name the 3 type of aphthous.
1 Minor 2 Major 3 Herpetiform
T/F: Aphthous is more common in non-smokers.
TRUE!
Aphthous Minor or Aphthous Major: Duration 3-7 days
Minor
Aphthous Minor or Aphthous Major: Most common for of aphthous
Minor
Aphthous Minor or Aphthous Major: 3 to 10 mm in diameter
Minor
Aphthous Minor or Aphthous Major: May be up to several cm in diameter
Major
Aphthous Minor or Aphthous Major: May have genital lesions
Major
Apthous Minor or Aphthous Major: Etiology includes primary immunodysregulation, decrease of mucosal barrier, increase of antigenic exposure.
BOTH
Aphthous Minor or Aphthous Major: Mucobuccal fold most common site, also tongue, palate, labial mucosa and gingiva
BOTH
Trauma, endocrine conditions, psychic factors and allergic factors may precipitate this condition
Aphthous Minor and Major
Condition characterized by as many as 100 lesions averaging 1-3 mm in diameter.
Herpetiform Aphthous
This condition clinically resembles primary herpes.
Herpetiform Aphthous
Should you treat a patient with topical steroids if they present with primary herpes-like lesions?
Only if they've had multiple recurrence
What is the age and gender predilection for herpetiform aphthous?
Young adult, Female
Besides respiratory viral infections, what is the most common viral infection?
Herpes Simplex
Which HSV type affects predominantly face, lips and oral cavity?
HSV Type I
Which HSV type affects predominantly genitals and skin of lower body?
HSV Type II
HSV resides in cells of which origin?
Ectodermal
Primary HSV infection usually occurs at age?
Child, 1-10 y.o.
What percent of infections have clinical dz?
1-10%
What percent of the population display antibodies?
50-90%
How is HSV transmitted?
Direct contact with saliva or droplet carrying virus
Primary Herpetic Gingivostomatitis may be characterized by what 4 clinical features?
1 2-4 mm vesicles and ulcers 2 Bleeding/Painful ginigiva (early sign) 3 Painful, ragged ulcers 4 Pharyngotonsilitis (primary infection in adults)
How long do primary herpetic lesions last?
7-14 days
"Ballooning degeneration" and Lipshutz bodies (intranuclear inclusions) are characteristics of which infection?
Primary Herpetic Gingivostomatitis
What are 3 other synonyms for Recurrent Herpes Simplex?
1 Herpes Labialis 2 Fever Blister 3 Cold Sore
Which HSV infection usually occurs on the muco-cutaneous junction?
Recurrent Herpes Simplex
What is the usual progression of a Recurrent Herpes Simplex lesion?
1 Preceded by burning sensation 2 Swelling 3 Vesicle formation 4 Ulceration
How long does a Recurrent Herpes Simplex lesion last?
4-10 days
Where do Recurrent Intraoral Herpes Simplex lesions occur?
Mucosa bound to periosteum (hard palate and gingiva)
Which HSV lesion consists of multiple small painful ulcers, often are precipitated by dental Tx, and last 7-10 days?
Recurrent Intraoral Herpes Simplex
Name the virus that causes chickenpox.
Varicella-zoster virus
What is the probable entry point for the varicella-zoster virus?
Respiratory
What dz is characterized by maculopapular or vesicular eruptions on skin, seen in ages 5-9 usually, appear on trunk and face and then extremities and may leave scars?
Chickenpox
What are the 4 stages of chickenpox lesions?
1 Erythema 2 Vesicle 3 Pustule 4 Hardened crust
T/F: Chickenpox lesions are painless.
TRUE (diff. from HSV which are painful)
Which virus causes herpes zoster (shingles)?
Varicella-zoster virus
Which dz is characterized by very painful lesions, inflammation of dorsal root ganglia and is the recurrent form of chickenpox?
Herpes Zoster
Which dz is characterized by fever, pain and tenderness along nerve, migraine headache?
Herpes Zoster
Is herpes zoster displayed unilaterally or bilaterally?
Unilaterally
Which virus causes infectious mononucleosis?
Epstein-Barr virus
How is the Epstein-Barr virus transmitted?
Intimate contact, usually contaminated saliva
Lymphadenopathy, pharyngitis, hepatosplenomegaly, rhinitis, cough, etc. are characteristic of what dz?
Infectious Mono
What are 2 possible oral manifestions of infectious mono?
1 Petechiae on hard/soft palate 2 Possible ANUG
Which virus causes Herpangina (aphthous pharyngitis)?
Coxsackie group A, types 1-6, 10, 16, 22
What time of year and in what age group does herpangina occur?
Usually summer, children
Which virus causes Hand, Foot and Mouth Dz?
Coxsackie group A16
What is the age predilection for Hand, Foot and Mouth Dz?
Young children (5 mos to 5 yrs)
What dz is characterized by maculopapular, exanthematous and vesicular lesions of the skin (esp. hands, feet, legs and mouth)?
You better get this one!
What do the intraoral lesions look like in Hand, Foot and Mouth Dz?
Small, multiple vesicular lesions on hard palate, tongue and buccal mucosa
What dz is characterized by fever, malaise, conjuntivitis, photophobia and eruptive lesions on the skin and oral mucosa (rash)?
Measles (rubeola)
These spots occur on the buccal mucosa 2-3 days before skin rash and appear as bluish-white specks surrounded by a white margin.
Koplik's spots
What area of the body do measles rash first occur?
Face
Which mild viral illness is caused by togavirus?
Rubella (German measles)
Which dz can cause fetal deaths or Congenital Rubella Syndrome?
Rubella (German measles)
In Rubella, what do you call the small, discrete, dark-red papules that develop on the soft palate and arise about 6 hours after the first symptoms, but do not last longer than 12-14 hours?
Forchheimer's sign
What is the classic triad of Congenital Rubella Syndrome?
1 Deafness (80%) 2 Heart Dz 3 Cataracts
Which HPV types cause Condyloma Acuminatum?
HPV 6,11,16,18
Which dz appears clinically as solitary or multiple pinkish, sessile papules with pebbled surface?
Condyloma Acuminatum
Condyloma Acuminatum makes up about __% of all STDs.
20%
What fungal infection is a yeast-like infection caused by a common inhabitant of the oral cavity?
Candidiasis
This incection affects the young, debilitated persons, patients w/ chronic dz and diabetics, and is seen in overuse of antibiotics.
Candidiasis
Describe the clinical appearance of candidiasis.
Milk curds, white elevated plaque consist of fungal hyphae, bleed when wiped off
What is it called when the corners of the mouth are involved in a candida infection?
Angular cheilitis (Perleche)
Name the six types of candidiasis.
1 Pseudomembranous candidiasis 2 Erythematous Candidiasis 3 Median Rhomboid Glossitis 4 Angular Cheilitis 5 Chronic Hyperplastic Candidiasis 6 Mucocutaneous Candidiasis
What is the most recognized form of candidiasis, often assoc. with antibiotics, steroid use and immunosuppression?
Pseudomembranous Candidiasis
Where does Pseudomembranous candidiasis occur orally?
Buccal mucosa, hard palate, dorsal tongue
This form of candidiasis has red macules w/ burning sensation, often found in patients wearing dentures, after antibiotic therapy, and may have loss of filiform papillae.
Erythematous Candidiasis (Denture stomatitis)
Which type of candidiasis looks like geographic tongue and is asymptomatic?
Median Rhomboid Glossitis
Which type of candidiasis is associated with decreased VDO, has red fissured area at the corner of the mouth and is generally seen in older persons?
Angular cheilitis (Perleche)
This is the least common type of candidiasis. It has a white patch that cannot be removed (looks like leukoplakia) and occurs on the anterior buccal mucosa.
Chronic Hyperplastic Candidiasis
This form of candidiasis is seen in some patients with immunologic disorders and occurs on mucous membranes, skin, and nails. It has thick white plaques that don't wipe off.
Mucocutaneous Candidiasis
Name the disease that histologically features hyphae, viewable with 20% potassium hydroxide or PAS stain.
Candidasis
Name the most commonly used topical/systemic agent used to treat Candidiasis.
Nystatin
Name the disease acquired by inhalation of spores from bird excrete.
Histoplasmosis
Name the two common areas of the US to find Histoplasmosis infection.
1 Mississippi Valley 2 Northeastern US
What three clinical manifestations do Histoplasmosis and Infectious Mono have in common?
1 Splenomegaly 2 Hepatomegaly 3 Lymphadenopathy
What system does Histoplasmosis have a predilection to infect?
Reticulo-endothelial
What do oral lesions from Histoplasmosis look like?
Nodular/ulcerations on buccal mucosa, gingiva, tongue, palate, and lips
What fungus produces tuberculosis-like symptoms?
Blastomycosis
What do oral lesions from Blastomycosis look like? What two other diseases do they resemble?
Ulcerations of the tongue with irregular, rolled borders. Actinomycosis or Squamous Cell carcinoma
Why do you have to biopsy blastomycosis?
It has pseudoepithiomatous hyperplasia! (Just like granular cell tumor)
What fungus causes Valley Fever?
Coccidiomycosis
Name the area of the US where it is likely to find Coccidiomycosis.
Southwestern US
Name the two forms of coccidiomycosis infection.
1 Primary, non disseminated 2 Disseminated
Name the one clinical manifestation of primary coccidiomycosis infection. What two other skin diseases can be triggered?
Cough. 1 Erythema nodosum or 2 Multiforme
What is special about secondary coccidiomycosis infection?
It is bad, and 50% are fatal
Name the two bacteria that cause impetigo.
1 Strep pyogenes 2 Staph aureus
What disease causes fragile vesicles or long-lasting bullous lesions that are amber-colored?
Impetigo
What is the age predilection for impetigo?
Young children
What is the age predilection for scarlet fever?
Children
Name 3 oral manifestations of scarlet fever.
1 "stomatitis scarlatina" 2 Strawberry tongue (white), followed by 3 Raspberry tongue (red)
Name the specific bacteria that causes scarlet fever.
Group A Beta-hemolytic strep
Name the bacteria that causes syphilis.
Treponema pallidum
What two stages of syphilis are highly infectious?
Primary, secondary
Name the primary lesion fo syphilis.
Chancre
Name the three lesions of secondary syphilis.
1 Maculopapular rash 2 Mucous patches 3 Condylomata lata
During which syphilis stage might you have mild fever, hoarseness, dysphasia, inflamed tonsils, redness of soft palate (NOT hard)?
Secondary
Name the tertiary lesion for syphilis.
Gumma (painless, necrotic granuloma)
During which syphilis stage might you haveCNS, skin, CVS, skeleton, joint involvement?
Tertiary
During which syphilis stage might you see syphilitic glossitis in males, and perforation of the palate?
Tertiary
After which month of gestation can congenital syphilis be transmitted through the placenta?
4th month
Name the two types of congenital syphilis.
1 Generalized 2 Late congenital
Name the pathognomonic sign for generalized congenital syphilis.
Rhagades (cracking and healing with scars)
Name two other clinical manifestations of generalized congenital syphilis, besides the pathognomonic sign.
1 Snuffles (rhinitis) 2 Saddle nose (necrosis of nasal septum)
Name the three components of Late congenital syphilis' pathognomonic Hutchinson's triad.
1 Hutchinson's teeth (screwdriver incisors and mulberry molars) 2 Ocular interstitial keratitis 3 8th nerve deafness
How could gonococcal stomatitis affect the oral cavity (this is rare)?
Fellatio, etc.
Name 3 other diseases that gonococcal stomatitis may resemble.
1 Erythema multiforme 2 Erosive lichen planus 3 herpetic stomatitis
Name a disease that is a rapidly progressive infection by opportunistic bacteria, in immunocompromomised patients.
Noma
Name the periodontal disease that noma may begin as.
ANUG
Name the anaerobic, gram +, non acid-fast, filamentous bacteria that usually lives in the oral flora but can cause infections in wounds.
Actinomycosis
What disease is associated with "Sulfur granules"? What are sulfur granules?
Actinomycosis. Large yellowish clumps of bacteria that are in pus from abcesses
Name the disease that can cause lymphadenitis in children and is self-limiting.
Cat Scratch
Oral Manifestions of HIV and AIDS
Prior to HAART, this condition was often first seen in the late asymptomatic stage of HIV infection.
Hairy Leukoplakia
What is the etiology of hairy leukoplakia?
Epstein-Barr virus (seen only in immunocompromised host)
What are 4 clinical features that characterized hairy leukoplakia?
1 Usually bilateral 2 Rough, shaggy, dense leukoplakia that won't wipe off 3 Irregular borders w/ vertical extensions 4 Corduroy-like surface
What condition is usually bilateral and almost invariably involves the lateral borders of the tongue?
Hairy Leukoplakia
What are 4 histologic features of hairy leukoplakia?
1 Hyperparakeratosis 2 Acanthosis 3 Balloning of spinous cells 4 Minimal inflammation in supporting C.T. (good for Dx!)
List 6 predisposing factors for Simple Oral Candidiasis.
1 Immature immune system 2 Antibiotic therapy 3 Dentures (or retainers!) 4 Smoking 5 Poor OH 6 Debilitating systemic dz (usually in the elderly)
T/F: A person who gets Candidiasis for the first time should be considered to have HIV infection.
False-this is a very common oral infection in the general population.
Candidiasis in what specific region should be considered highly suspicious for being HIV-related?
Oropharynx
Erythema, white "curds" which wipe off leaving raw/bleeding surface, and white plaque-like areas that do not wipe off are clinical features of what oral infection?
Candidiasis
What are 2 histologic features of candidiasis?
1 Budding yeasts and pseudohyphae invading into superficial epith 2 Inflammation (primarily acute)
What malignant neoplasm derived from endothelial cells may be the first presentin sign of AIDS?
Kaposi Sarcoma
What are 2 etiological factors that may cause K.S.?
1 Infection by HSV-8 2 Immunocompromised host
Kaposi sarcoma is multicentric. What are the 4 primary areas that may be involved?
1 Skin 2 Mucous membrane 3 Lungs 4 GI tract
What is the single most common oral site for K.S.?
Palate (Ant. Max. gingiva is second)
What oral dz has well-circumscribed, red to purple, often flat lesions (early) or elevated (advanced) with no surface ulcerations expected?
Kaposi Sarcoma
What is the Dx technique used to establish a definitive Dx?
Biopsy
Name 2 HIV-associated Perio diseases.
1 Linear Gingival Erythema 2 Necrotizing Ulcerative Periodontitis
What perio dz has markedly reddened gingiva, out of proportion to plaque levels?
Linear Gingival Erythema
What perio dz may be focal or generalized, may or may not have color changes, pronounced attachment loss, possible spontaneous exfoliation of teeth, necrosis, sloughing of bone and/or soft tissue and spontaneous bleeding ulcerations? (is that enough hints for you?!!)
Necrotizing Ulcerative Periodontitis
Name 3 Herpes family viruses that may have more frequent reactivation in HIV-AIDS patients.
1 HSV 2 Herpes zoster 3 Cytomegalovirus (usually retinitis, oral is rare)
What is the most common deep (invasive) fungal infection in the AIDS population?
Histoplasmosis
T/F: Non-Hodgkin Lymphoma is common in AIDS patients.
TRUE (and oral lesions are common)
What is the prognosis for and HIV+ person with non-Hodgkin Lymphoma?
POOR
Oral Manifestations of Skin Disease
Name the term used for a group of inherited conditions in which two or more - of hair, sweat glands, teeth, and nails fail to develop
Ectodermal Dysplasia
What are three oral manifestations of ectodermal dysplasia?
1 Hypodontia 2 Abnormal-shaped teeth 3 Tapered anterior crowns
What is the mode of transmission for white sponge nevus?
Autosomal dominant
When does white sponge nevus appear?
Birth or childhood
Where is the most common site for white sponge nevus?
Buccal mucosa
Name the disease that histologically features hyperparakeratosis and acanthosis.
White Sponge nevus
Name 3 skin diseases with oral manifestations that are discussed in other sections of oral path.
1 White sponge nevus 2 Peutz-Jegher 3 Hereditary Hemorrhagic Telangiectasia
Name the most common skin disease with oral manifestations.
Lichen Planus
What is the etiology of lichen planus?
T-cell mediated autoimmune process
What liver disease is often associated with lichen planus in Mediterranean countries?
Hepatitis C
What is the age and gender predilection for lichen planus?
Middle age women
What are the four skin symptoms (4 P's) of lichen planus?
1 Purple 2 Pruritic 3 Polygonal 4 Papules
What are the 3 most common places on the skin for lichen planus to be found?
1 Flexor surfaces of wrists 2 Inner surface of knees 3 Inner surface of thighs
What is the most common location for lichen planus of the oral cavity?
Buccal mucosa.
What are the four types of lichen planus?
1 Reticular 2 Plaque form 3 Atrophic 4 Erosive
What is the most common type of lichen planus?
Reticular
Reticular or Erosive Lichen Planus: Have striae of Wickham
Reticular
Reticular or Erosive Lichen Planus: Asymptomatic
Reticular
Reticular or Erosive Lichen Planus: Usually bilateral buccal mucosa
Reticular
Reticular or Erosive Lichen Planus: Painful
Erosive
Reticular or Erosive Lichen Planus: Striae around an ulcer
Erosive
Reticular or Erosive Lichen Planus: Might look like squamous cell carcinoma, pemphigus, or pemphigoid
Erosive
Reticular or Erosive Lichen Planus: Desquamative gingivitis
Erosive
Which disease histologically features hyperkeratosis, saw-tooth rete ridges, basilar cell destruction, lymphocytes lined up at basement membrane, and eosinophilic coagulum?
Lichen Planus
What is the etiology of the Pemphigus family?
Autoantibodies to desmosomes, causing spinous layer to fall apart
What is the most common type of Pemphigus?
Pemphigus vulgaris, because vulgaris means common
What is the age and ethnic predilection for Pemphigus?
Adults around 50, and Jew.
Pemphigus starts out as a rapid ______, which ruptures to leave behind __________.
Bullae/vesicle, ulcerations
What skin area is most often affected by Pemphigus?
Torso
Which two diseases are positive for Nikolsky's Sign?
1 Pemphigus family 2 BMMP
Which usually presents first for Pemphigus family, oral or skin conditions?
Oral
Which disease histologically features acanthoLYSIS, Tzanck cells, suprabasilar vesicles, and "rows of tombstones"?
Pemphigus
What is the best to confirm diagnosis of Pemphigus?
DIRECT immunofluorescence, though indirect can be used
What is the full name for BMMP, and what is a synonym for BMMP?
Benign Mucous Membrane Pemphigoid. Cicatricial Pemphigoid
What is the etiology of BMMP?
Antibodies to the basement membrane
What is the age and gender predilection for BMMP?
Older age (50-60), females
Which blisters last longer, pemphigus or BMMP?
BMMP
What are the three locations for BMMP?
1 Oral mucosa 2 Eyes 3 Genitalia
Which disease histologically features subepidermal vesicles, hemidesmosomes involved, no acantholysis and Tzank cells?
BMMP
Name the 3 diseases that may present with desquamative gingivitis.
1 Pemphigus family 2 BMMP 3 Erosive Lichen planus
What is the age predilection for bullous pemphigoid?
Older age (60)
What is the etiology of erythema multiforme?
Unknown (HA). But, maybe hypersensitivity to a… something (viral lesions? GI conditions? Radiation therapy?).
What is the age and gender predilection for erythema multiforme?
Young adults, male
What is the classic skin lesion of erythema multiforme?
Target lesion
What is the oral presentation of erythema multiforme?
Bloody, crusty, ulcerative, painful macules/papules
Name the two syndromes associated with erythema multiforme.
1 Stevens Johnson 2 TEN - Toxic Epidermal Necrosis
Name the four body parts affected by Stevens Johnson.
1 Skin (less than 10%) 2 Oral cavity 3 Eyes 4 Genital urethritis (GROSS!)
What percent of the body or more must be affected by erythema multiforme to be called Toxic Epidermal Necrosis?
30%
What are the three types of Lupus Erythematosus?
1 Systemic lupus erythematosus 2 Chronic cutaneous lupus 3 Subacute cutaneous lupus
What is the age and gender predilection for Systemic LE?
Middle age (30-40) WIMMEN
Name four clinical features of Systemic LE.
1 Butterfly rash 2 Kidney failure 3 Libman-Sacks warty vegetations on heart 4 Oral lesions
Which type of Lupus Erythematosus has few or no symptoms?
Chronic cutaneous lupus
T/F: Chronic cutaneous LE is on sun-exposed skin.
TRUE
T/F: Chronic cutaneous LE has butterfly rash.
TRUE
What skin disease manifests in the oral cavity as white/red plaques and possible ulcerations, which are uncommon?
Psoriasis
What disease features scaly papules on most of the skin?
Psoriasis
What is the age predilection for psoriasis?
Children/Young adult (10-30)
What skin disease can resemble geographic tongue?
Psoriasis
How do you get Epidermolysis Bullosa?
Inherited
Name the disease that has blistering mucocutaneous problems.
Epidermolysis Bullosa
What are the four basic types of Epidermolysis Bullosa?
1 Simplex 2 Junctional 3 Dystrophic 4 Acquisitia
Which type of Epidermolysis Bullosa will have a blister anywhere you put pressure?
Simplex
Which three types of Epidermolysis bullosa are inherited?
1 Simplex 2 Junctional 3 Dystrophic
Which type of Epidermolysis Bullosa is autoimmune?
Acquisitia
Which two types of Epidermolysis bullosa features blisters at birth?
1 Junctional 2 Dystrophic
Which disease may cause fingernails to be lost?
Epidermolysis Bullosa
Name 4 oral manifestations of Epidermolysis bullosa.
1 Gingival erythema 2 Anodontia 3 Enamel hypoplasia 4 Bulla/vesicle formation
Name the disease that is caused by excess collagen deposition.
Scleroderma
What is the age and gender predilection for scleroderma?
Middle age (30-50), female
What skin disease features widened PDL and condylar resorption?
Scleroderma
Besides oral conditions, what are 3 clinical manifestations of scleroderma?
1 Organ failure 2 Raynaud's phenomenon 3 Neuralgia/paresthesia
What is the term used for localized scleroderma?
Coup de saber, which involves a solitary patch of skin only
What is the age and gender predilection for Reiter's syndrome?
Young adults, MALE!
What is the etiology of Reiter's syndrome?
Immunologically mediated, after exposure to something like dysentery or VD
What is the classic triad of Reiter's syndrome?
1 Nongonococcal urethritis 2 Arthritis 3 Conjunctivitis
What do oral lesions of Reiter's syndrome look like?
Erythematous papuls and ulcerations
How do you get Darier's disease?
Inherited (Autosomal dominant)
What is the age predilection for Darier's disease?`
Teens (10-20)
Name 4 extraoral clinical manifestations of Darier's disease.
1 Rough texture due to accumulated keratin 2 Foul odor 3 Pits/keratoses on palms/soles 4 Longitudinal lines and ridges on nails
What do oral lesions of Darier's disease look like?
White, flat papules, cobblestone in appearance
What is the solitary version of Darier's disease?
Warty Dyskeratoma
What is the age predilection for Warty Dyskeratoma?
Older than 40 (Warty forty)
Syndromes of Dental Interest
Name 13 diseases that are autosomal dominant
1 Crouzons 2 Aperts 3 Treacher Collins 4 Cleidocranial dysplasia 5 Marfan Syndrome 6 Pachyonychia Congenita 7 Gardner's 8 Peutz-Jeghers 9 Multiple Hereditary Hemorrhagic Telangiectasia 10 Basal Cell Nevus Syndrome 11 Hereditary Ectodermal Dysplasia 12 Von Recklinghausen's 13 Cowden Syndrome
Name the one syndrome that is autosomal recessive.
Papillion Lefevre Syndrome
What 5 features are common to both Crouzon's and Apert Syndrome?
1 Ocular proptosis (bug eyes) 2 Maybe "cloverleaf" skull 3 Hypertelorism (wide-spaced eyes) 4 Hypoplastic maxilla 5 Malocclusion
How is Crouzon Disease transmitted?
Autosomal dominant
What is the cause for the symptoms of Crouzon's Disease?
Premature closing of cranial sutures
Name two things that Crouzon has that Apert's does not.
1 Brachycephaly 2 Trigonocephaly
How is Apert Syndrome transmitted?
Autosomal dominant
Name 4 extraoral and 5 oral-related things that Apert has that Crouzon's does not.
1 Acrobrachycephaly 2 Down-slanting of lateral palpebral fissures 3 Mental retardation 4 Syndactyly. (Oral - 1 Mandibular prognathism 2 Cleft soft palate 3 Bifid uvula 4 Gingival thickening 5 Shovel shaped incisors
How is Treacher-Collins Syndrome transmitted?
Autosomal dominant
What disease features mandibular micrognathia, causing "bird-like appearance"?
Treacher-Collins Syndrome
What disease features zygomatic atrophy?
Treacher-Collins Syndrome
What disease features coloboma (notched lower eyelid) and downward slanting of lower eyelid?
Treacher-Collins Syndrome
What disease features external/internal ear defects?
Treacher-Collins Syndrome
What disease features disrupted collagen maturation leading to bone with thin cortex, fine trabeculation, and diffuse osteoporosis?
What disease features blue sclera and dentinogenesis imperfecta/opalescent dentin?
Osteogenesis Imperfecta
How is Cleidocranial Dysplasia transmitted?
Autosomal dominant OR spontaneous
What disease features absence or hyposplasia of clavicles?
Cleidocranial Dysplasia
What disease features brachycephaly, hypertelorism WITH frontal/occipital bossing?
Cleidocranial Dysplasia
What disease features a lack of secondary cementum?
Cleidocranial Dysplasia
What disease features tons of supernumerary teeth (42 in the mandible!)?
Cleidocranial Dysplasia
Name the triad of symptoms for Pierre Robin Syndrome.
1 Cleft palate (= cleft bird mouth) 2 Mandibular micrognathia (= tiny bird, peep peep) 3 Glossoptosis (= bird choking on tongue by begging for food)
How is Marfan Syndrome transmitted?
Autosomal dominant
What disease features abnormally soluble collagen?
Marfan Syndrome
What disease features tall, slender stature with large hands and fingers?
Marfan Syndrome
What disease features cardiovascular defects such as aortic dilation and mitral valve prolapse?
Marfan Syndrome
What disease features high arched palate, bifid uvula and malocclusion?
Marfan Syndrome
What disease features a small maxilla/mandible, and high arched palate, resulting in malocclusion?
Down's Syndrome
What disease features somewhat smaller than usual teeth, with short roots?
Down's Syndrome
What disease features macroglossia and fissured tongue?
Down's Syndrome
What disease features bone replacement by vascular tissue, then fibrous tissue?
Massive osteolysis
What disease features North Carolina and no treatment?
Hi BID - Hereditary Benign Intraepithelial Dyskeratosis
Name the 2 clinical manifestations of Hereditary Benign Intraepithelial Dyskeratosis.
1 White sponge nevus-like 2 Foamy, gelatinous eye plaques
How is Pachyonychia Congenita transmitted?
Autosomal dominant
What disease features loss of nails due to keratin accumulation?
Pachyonychia Congenita
What disease features oral lesions with thickened white plaques on lateral/dorsal tongue?
Pachyonychia Congenita
What disease features hyperkeratosis of hands and feet, plus hyperhydrosis?
Pachyonychia Congenita
How is Gardner's syndrome transmitted?
Autosomal dominant
What disease features colorectal polyps that may turn malignant (adenocarcinoma)?
Gardner's Syndrome
What disease features multiple osteomas?
Gardner's Syndrome
What disease features epidermoid cysts of the skin, coupled with increased thyroid carcinoma?
Gardner's Syndrome
What disease features slight increase in supernumerary/impacted teeth (this is NOT cleidocranial dysplasia)?
Gardner's Syndrome
How is Peutz-Jeghers Syndrome transmitted?
Autosomal Dominant
What disease features freckles and polyps leading to intrassusception, which may transform to adenocarcinoma?
Peutz-Jeghers Syndrome
How is Multiple Hereditary Hemorrhagic Telangiectasia transmitted?
Autosomal Dominant
What disease features epistaxis due to iron-deficiency anemia (nose bleeds)?
Multiple Hereditary Hemorrhagic Telangiectasia
What disease features vascular proliferation of tissues of the brain and face (port wine stain)?
Sturge-Weber
What disease features meningeal angiomatosis, convulsions, and mental retardation, along with calcifications in the brain?
Sturge-Weber
How is Basal Cell Nevus syndrome transmitted?
Autosomal Dominant
What disease features multiple odontogenic keratocysts?
Basal Cell Nevus Syndrome
What disease features multiple basal cell carcinomas of the skin?
Basal Cell Nevus Syndrome
What disease features rib anomalies, plus palmar/plantar pits?
Basal Cell Nevus Syndrome
What disease features mild hypertelorism and intracranial calcifications?
Basal Cell Nevus Syndrome
How is Cowden Syndrome transmitted?
Autosomal dominant
What disease features multiple small papules on the skin, gingiva, tongue, and buccal mucosa (not Peutz-Jehger)?
Cowden Syndrome
What disease features increased thyroid disease, such as goiter/adenoma?
Cowden Syndrome
What disease features increased breast cancer?
Cowden Syndrome
What disease features increased GI polyps?
Cowden Syndrome
What disease features hypermobility of joints, elastic skin, and abnormal collagen?
Ehlers-Danlos
What disease features papyraceous scarring?
Ehlers-Danlos
What disease features severe periodontal disease (tooth lost by 4 and 14 years old)?
Papillion-Lefevre
What disease features hyperkeratosis of hands and feet, in the first few years of life?
Papillion-Lefevre
Salivary Gland Diseases
What is the single-most common sign of salivary gland disease?
Swelling
What is the second-most common sign of salivary gland disease?
Pain
Pain and swelling may be signs of what three things, when it comes to salivary gland disease?
1 Infection 2 Obstruction 3 Neoplasia
Name 4 BASIC causes of xerostomia.
1 Problem at salivary center 2 Problem at autonomic pathway 3 Reduced salivary gland function from organic disease 4 Alterations in fluid/electrolyte balance
Name the two clinical terms used for swollen areas filled with mucus. When do you use which?
1 Mucocele 2 Ranula (floor of the mouth)
The majority of clinical mucoceles are…
Mucous escape reactions
What is the etiology of a Mucous Escape Reaction?
Mucous leaks into CT following a rupture in the duct system, and is seen as "non-self", so inflammation begins
What is the most common location for a mucous escape reaction?
Lower lip
Where is the most Uncommon location for a mucous escape reaction?
Upper lip, or hard palate
How do you differentiate a mucous escape reaction from an irritation fibroma?
Mucous escape reactions are more translucent, and have been present for days/weeks. Irritation fibromas have been there for months
What disease histologically features a cavity lined by granulation tissue/fibrous CT, filled with mucous, and with foamy histiocytes and neutrophils?
Mucous escape reaction
What is the etiology of a Mucous Retention cyst (Salivary duct cyst)?
Trauma to duct causes injured lining, closing off the duct and allowing for mucous to collect
What is the age predilection for Mucous retention cysts?
Adults around 50, and Jew.
How do you differentiate a mucous escape reaction from a mucous retention cyst?
Mucous escape reaction is caused by trauma; mucous retention cysts will not have a traumatic history
What disease histologically features a cavity lined by epithelium, without inflammation?
Mucous retention cyst
What disease is a stone in salivary duct or gland?
Sialolithiasis
What is the etiology for sialolithiasis?
Debris gets stuck in the duct, and normal calcium salt levels contribute to deposition and increase in size of stone
Name 3 predisposing factors to sialolithiasis.
1 Xerostomia 2 Infection 3 Foreign material
What disease is characterized by pain/swelling of the affected gland and increase in swellling at mealtimes?
Sialolithiasis
What is the most common place to find a sialolith? Why (3)?
Wharton's duct. 1 Long 2 Tortuous 3 Floor of the mouth
How do you differentiate between a sialolith and lymph node swelling?
Sialoliths change size throughout the day, lymph nodes do not
What disease is defined as inflammation of the salivary gland?
Sialadenitis
What is the most important/most common viral infection that causes sialadenitis?
Mumps
Name the most common bacterial infection that causes sialadenitis.
Strep species
Name two reasons why recent surgery may cause sialadenitis.
1 Low fluid intake 2 Anticholinergic drugs
Name 4 non-infectious causes of sialadenitis.
1 Sjogren's 2 Sarcoidosis 3 Radiation therapy 4 allergens
How do you differentiate between sialadenitis and sialolithiasis?
Sialadenitis will produce cloudy, thick, or purulent discharge when the gland is milked; stones will not produce any discharge
What disease histologically features neutrophils and exudate in the ducts/acini?
ACUTE sialadenitis
What disease histologically features patchy/diffuse infiltrates of lymphocytes and plasma cells?
CHRONIC sialadenitis
Name the inflammatory salivary gland disease that may be caused by dry, windy, sunny weather.
Cheiltis glandularis
Name the two clinical manifestations of cheilitis glandularis.
1 Eversion/swelling of the lip 2 Tiny red dots on the mucosa
What is the age and gender predilection for cheilitis glandularis?
Middle-aged men
What other disease may be seen with cheilitis glandularis (Jany's favorite)?
Actinic cheilitis
Name 4 more common causes of xerostomia.
1 MEDICATIONS 2 Aging 3 Smoking 4 Mouth breathing
Name 6 oral effects of xerostomia.
1 Shift to more cariogenic flora (like Candidasis, the single-most common opportunistic infection) 2 Increased risk of caries 3 Increased periodontal disease 4 Difficulty eating/swallowing 5 Atrophic glossitis (bald tongue) 6 Dried mucosa/mucosal atrophy
What is the best treatment for xerostomia? What other treatments are in the patient's best interest?
Eliminate underlying cause. Frequent checkups/caries prevention regime
What autoimmune disorder is characterized by uni/bilateral swelling of the parotid glands?
Benign Lymphoepithelial Lesion
Is Benign Lymphoepithelial lesion painful?
No, painless usually
What disease histologically features proliferation of lymphocytes (and looks like a lymph node), with atrophic/fibrosis of acini?
Benign Lymphoepithelial Lesion
Name the three clinical features of Primary Sjogren's syndrome. Name the three clinical features of Secondary Sjogrens.
Both have 1 Xeropthalmia 2 Xerostomia. Primary has Serologic evidence of autoimmune disease (rheumatoid, antinuclear antibodies, or anti-SS-A/B, Sjogren specific antibodies). Secondary has clinical features diagnostic for rheumatoid arthritis, SLE, polymyositis, scleroderma, or biliary cirrhosis.
What is the age and gender predilection for Sjogren's syndrome?
Middle-aged WOMEN (80-90%)
Where can you biopsy to diagnose for Sjogren's syndrome?
Minor glands of the lip, since they reflect the state of major glands (parotid is too hard to get to)
Which salivary gland disease requires a multidisciplinary approach?
Sjogren's syndrome
What disease is a very uncommon, non-inflammatory condition with asymptomatic salivary gland enlargement, most often in the parotids, caused by hormonal disorders/drugs/alcohol?
Sialadenosis (Sialosis)
Name the disease that is spontaneous necrosis of acini.
Necrotizing Sialometaplasia
Where is the most common site for necrotizing sialometaplasia?
Palate
What disease histologically features necrosis of minor glands, plus metaplasia of salivary ducts, with pseudoepitheliomatous hyperplasia?
Necrotizing Sialometaplasia
What is the etiology of Necrotizing Sialometaplasia?
Local ischemia
Why should a biopsy be done for something that looks like necrotizing sialometaplasia?
To rule out malignancy
What is the most common, most important salivary gland tumor?
Benign Mixed Tumor
What is the age predilection for Benign Mixed Tumor?
Adults 30-50
What is the most common site for Benign mixed tumor? What about minor salivary gland site?
Parotid. Palate (usually centered between midline and gingiva)
Name the disease that is a lumpy, slow-growing, painless swelling.
Benign Mixed Tumor
Why is a Benign mixed tumor so lumpy?
NO encapsulation!
What disease histologically features inner lining cells/outer myoepithelial cells, intermingled with mucoid/myxoid/chondroid tissue?
Benign Mixed Tumor
Name the benign tumor with epithelial cystic structures surrounded by a lymphoid stroma.
Warthin's Tumor
Where is the most common location for a Warthin's tumor? Are Warthin's usually (uni/bilateral)?
Parotid. Bilateral
What is the age and gender predilection for Warthin's tumor?
Older MEN (5x more common in men)
What disease histologically features inner layer of eosinophilic epithelial cells/outer layer of polygonal epithelial cells, benign lymphoid tissue/germinal centers, and a capsule?
Warthin's Tumor
If Richards shows a picture of a swelling on the upper lip, what should you write?
Canalicular Adenoma
What is distinctly unusual about the age predilection for canalicular adenomas?
They are more common in the 60+ group, which benign tumors RARELY are. Most tumors over 60 years old are malignant!
What disease histologically features strands of epithelial cells arranged in double rows?
Canalicular Adenoma
What is the most common malignant salivary gland tumor overall (and most common for parotid and minor glands)?
Mucoepidermoid carcinoma
What is unique about the behavior of mucoepidermoid carcinomas?
They vary GREATLY in their behavior, from benign to very very aggressive
What is 'oddball' about the age predilection for mucoepidermoid carcinomas?
It affects 20-40 years old, which is RARE for malignant tumors
What disease histologically features squamous cells, mucus-secreting cells, and infiltrating islands of epithelium?
Mucoepidermoid carcinoma
T/F: Mucoepidermoid carcinoma does NOT have a capsule.
TRUE
What ratio determines the behavior of mucoepidermoid carcinomas? Increase of which component is more likely to be bad?
Epidermoid: Mucus. More epidermoid = more likely to be bad
What very rare tumor resembles serous acinar cells, with no age predilection?
Acinic Cell Carcinoma
Which malignant salivary gland tumor is uniquely fixed (not fluctuant)?
Acinic Cell Carcinoma
What disease histologically features mass of epithelial cells that look like normal acinar cells, with clear cytoplasm?
Acinic Cell Carcinoma
What is the most common of the rare group of malignant mixed tumors?
Carcinoma-ex-mixed tumor, which is a benign tumor that turned malignant
What is the name for a true mixed tumor where the tumor is both epithelial and mesenchymal?
Carcinosarcoma
What is the single-most common malignant salivary gland tumor in the submandibular glands?
Adenoid Cystic Carcinoma
What is the age predilection for Adenoid cystic carcinoma?
Middle-age
Which disease histologically features cells forming cystic spaces (looks like colloid), with a typical "swiss cheese" pattern?
Adenoid Cystic Carcinoma
T/F: Adenoid Cystic Carcinoma does NOT have a capsule.
True, invades like crazy
What malignant tumor is notorious for invading along neurovascular bundles?
Adenoid Cystic Carcinoma
What disease will you live with for several years, but eventually die of because it is hard to cure and metastasizes?
Adenoid Cystic Carcinoma
What is the age predilection for polymorphous low-grade adenocarcinoma?
Middle-older age
What is the most common site for polymorphous low-grade adenocarcinoma?
Palate
Name the disease that histologically features bland, uniform cells, "indian filing" of cells, perineural invasion and some 'swiss cheese'.
Polymorphous low-grade adenocarcinoma