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94 Cards in this Set
- Front
- Back
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ACUTE ORAL ULCERATIONS - DAMM - FRIDAY FEB 16
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what should be the first step in all cases?
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divide and conquer - determine whether disease is acute or chronic
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what is the course of acute lesions (time in arising and healing)?
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arise rapidly (1-2 days), normally heal in 10-14 days
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how do chronic ulcerations tend to develop?
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initally, with minimal involvement, and slowly enlarge - most have been present for months before patient presents
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what information should be obtained before making a differential diagnosis (2)?
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1) extraoral lesions; 2) listing of all medication (prescription and over the counter)
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RECURRENT APHTHOUS ULCERATIONS
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how common are these?
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most common oral lesions encountered by health professional - approximately 20 percent of population has positive history - prevalence as high as 55% in populations under stress
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what type of immune response is thought to be responsible for initiation of the ulceration?
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cell-mediated immune response (early RAU similar to delayed hypersensitivity)
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what is the prototypical and most common form of recurrent aphthous ulceration?
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minoraphthous ulceration (MiRAU)
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where do these arise?
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on nonkeratinized movable mucosa
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what do they look like?
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they have yellow fibrinopurulent membranes, surrounded by erythematous halos
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how large are they and what is the normal course?
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2-10mm and usually heal without scarring within 10-14 days
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how many occur at a time?
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from one to one hundred
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what conditions may be ruled out in severe or nonresponsive cases that can cause lesions clinically identical to RAU (list)?
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blood dyscrasia, nutritional deficiencies (zinc, folate, B12, iron), Behcet's syndrome, Crohn's disease, Celiac sprue, AIDS, and every one of the other acute ulcerative conditions
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HERPANGINA
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what is herpangina, and what causes it?
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a specific viral infection which can be caused by any one of a number of strains of Coxsackie virus
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who does it normally occur in?
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young children 9but can occur in older patients)
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how does the immune system function against these viruses?
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complete immunity to a strain develops, but an individual can have the disease several times from different strains
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what will affected patients present with (5)?
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1) sore throat; 2) fever (low-grade); 3) headache; 4) abdominal pain; 5) sometimes vomiting
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what do these lesions look like, and where do they occur (3)?
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closely resemble RAU, and most commonly occur on; 1) the soft palate; 2) pharyngeal wlal; 3) tonsilar pillars
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how long do they typically take to heal?
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a week
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HAND, FOOT, AND MOUTH DISEASE
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who gets hand, foot, and mouth disease?
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typically children, but adults can as well
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what is this disease characterized by (type of rash)?
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erythematous, maculopapular rash of the skin
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what areas are involved?
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hands, feet, legs, arms, buttocks
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what symptoms can occur (list)?
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anorexia, low-grade fever, coryza, lymphadenopathy, diarrhea, nausea, and vomiting
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what are the principal symptoms in most patients (over 90%)?
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oral lesions
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what do the lesions resemble?
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RAU
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where do they occur (3)?
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1) tongue; 2) palate; 3) buccal mucosa
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how long does it take for this infection to resolve?
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10-14 days
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HERPES SIMPLEX INFECTIONS (ORAL)
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what % of population has antibodies against HSV-I?
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70-90%
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what may happen to patients upon initial exposure to the virus (2)?
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1) develop subclinical infection; 2) develop primary herpes infection
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what is the most common pattern for primary herpes infection?
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acute herpetic gingivostomatitis
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what do primary herpes infections begin with (2)?
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1) high fever; 2) lymphadenopathy
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what are they followed by, and in how long?
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diffuse oral lesions in a few days
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what happens to the gingiva in all cases (3)?
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1) pain; 2) enlargement; 3) erythema
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where in the gingiva are ulcers not uncommon, that can distinguish this form of gingivitis from those which are plaque related?
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ulcerations of midfacial free marginal gingiva
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what is the progression of vesicular lesions like?
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multiple fragile vesicles develop and rapidly ulcerate - observation of intact vesicles are rare - these lesions frequently cluster and coalesce
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what size are these lesions, and what may they resemble?
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they vayr in size from a few millimeters to a centimeter and may resemble RAU closely (especially herpetiform variety)
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what is the clue to the diagnosis?
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involvement of bound mucosa, especially the gingival changes
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where was it said these lesions can extend?
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past the wetline and involve the vermilion border of the lips
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if the diagnosis is in question, what test can be beneficial?
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a cytological smear (if performed within 3 to 5 days)
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what are therapeutic attemts most often directeed toward?
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palliation
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what happens to the virus after the initial infection?
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it is sheltered in the nerve ganglia which innervate the area, contained by cell mediated immune response
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what have been associated with increased frequency of recurrent infection (list)?
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old age, pregnancy, allergy, trauma, respiratory illness, menstruation, underlying systemic disease, or malignancy
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what is involvement of the lips and perioral skin known as?
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herpes labialis
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what precedes the clinically evident portion of the infection?
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prodromal symptoms, which include burning, stinging, soreness, parasthesia and/or redness of the affected area
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what follows prodromal symptoms in recurrent infection?
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appearance of vesicles which rupture and form a brown crust
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what are vesicles like?
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filled with clear liquid, small (few mm), cluster, and coalesce
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what may complicate the course (2)?
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1) significant edema; 2) occasional secondary infections
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is recurrent herpes labialis normally unilateral or bilateral?
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unilateral (but can be either)
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how long can the virus survive in gauze?
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up to five hours
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where else may the virus infect (above the waist) and what is this known as?
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herpetic whitlow - virus may infect any unprotected finger and result in very painful recurrences to the affected digit
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what is secondary herpes known as when it occurs within the oral cavity?
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recurrent herpetic stomatitis
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in the immunocompetent patient, where can recurrent herpes be seen?
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only on the keratinized mucosa which is bound to bone
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what is this information convenient in helping us distinguish, and why?
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it is exactly opposite from MiRAU which occurs almost exclusively on movable mucosa
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what do lesions begin like, in recurrent herpetic stomatitis, and how do they develop?
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begin as pinpoint areas of erythema, which develop central zones of fibrin - lesions tend to cluster and coalesce
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are they usually unilateral or bilateral?
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usually localized and unilateral
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how long do ulcerations of recurrent herpetic stomatitis take to heal?
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5-7 days
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HERPES ZOSTER
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how is herpes zoster like recurrent herpes?
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it is a recurrence of a previously received infection, chickenpox, and the virus resides in sensory nerve ganglia
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who does this disease affect, and what are the presenting symptoms (3)?
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adults - 1) fever; 2) malaise; 3) pain - all along course of involved nerves
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where do vesicles occur?
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follow nerves, unilateral and anatomic
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what do intraoral lesions look like initially, and what happens to them?
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initially white, opaque vesicles, that ultimately rupture and form ulcerations that may resemble RAU
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ERYTHEMA MULTIFORME
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what type of disorder is EM and what is the cause?
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acute diffuse ulcerative condition of unknown cause
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where in the body can it involve (2)?
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1) skin; 2) any mucosal surface
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what are two common triggering events?
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1) viral infections (most commonly HSV); 2) allergen exposure (often to medications)
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what age/sex most commonly gets EM?
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young adult males
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what type of skin lesions occur (3)?
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1) macules; 2) papules; 3) vesicles
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where do they occur (3)?
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1) extremities; 2) face; 3) neck
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what is the classic lesion?
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a macule which exhibits alternating rings of varying shades of erythema - "bull's eye" or "target" lesion
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can oral lesions be seen in the absence of other lesions?
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yes
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how serious are EM oral lesions?
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out of all acute oral ulcerative conditions, primary herpes and EM produce worst symptoms - patients often bring a relative to speak for them
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where do oral lesions of EM predominantly present?
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on movable mucosa (but not limited to this location)
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what do the individual oral lesions appear as, and what size are they?
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large zones of irregular epithelial necrosis
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what happens to the epithelium?
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it sloughs, leaving a large, painful erosion
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are these lesions normally solitary or multiple?
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often numerous and diffuse
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can involvement extend past the wetline onto the vermillion border?
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yes
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what is it called when lesions involve the skin and mucosal surfaces of eye, mouth, and genital areas?
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Stevens-Johnson Syndrome
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