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49 Cards in this Set
- Front
- Back
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Vesiculoulcerative Lesions
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-benign mucous membrane pemphigoid
-lupus erythematosus -chronic ulcerative stomatitis -pemphigus vulgaris -chronic ulcerative stomatitis |
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Clinicial Checklist if you suspect erosive lichen planus:
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1. review med hx for meds which can cause a lichenoid drug reaction (cinnamon)
2. Remove plaque and calculus and check response to therapy 3. biopsy representative areas and submit tissue for both light and immunofluorescence microscopy |
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Submitting biopsies of tissue expected to be erosive lichen planus
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-one sample if formalin
-one sample in Michel's solution (will be supplied by the lab) -the biopsy should be taken so that both lesional and normal tissue are sampled |
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Direct Immunofluorescence
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-in the vesiculoulcerative lesions, the antigens that are displayed on the cells or basement membrane include: IgG, IgA, C3, IgM, fibrinogen
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Oral Cancer Misdiagnosis rate for dentists
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-15-64%
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High Risk patients for oral cancer
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-over age 50
-heavy smokers/drinkers -patients with existing leukoplakias from smoked or smokeless tobacco use |
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In conclusion for diagnosis
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-obtain a diabnosis
-expedite treatment based on the diagnosis -educate the patient -follow-through! |
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Candidiasis
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-MOST COMMON oral fungal infection in-humans
-high as 50% of the general population carry the organism in their mouths without clinical evidence of infection -with increasing age, the number of people who are carrying Candida within their mouths asymptomatically increases |
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Candidiasis continued
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-with candidiasis, there is a complex host-organism interaction resulting in a range of clinical presentations, extending from mild superficial mucosal involvement to fatal disseminated disease in patients with severe immunocompromise
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Clinical forms of Candidiasis
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1. Pseudomembranous
2. Erythematous 3. Hyperplastic 4. Atrophic (denture stomatitis) |
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Candidiasis causes
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-most usual are wearing of prosthesis and previous or current antibiotic use
-if these two conditions are ruled out, systemic sources of candidiasis should be considered |
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Systemic Implications
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1. Diabetes mellitus
2. Immunocompromise (AIDS, chemotherapy) 3. sjogren syndrome 4. xerostomia due to meds 5. respiratory problems resulting in mouth breathing 6. asthma |
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Rx's for Candidiasis
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-Diflucan: 15 tabs-100 mg
-take two the first day and one each day after until gone -Clotrimazole oral troches. 50 tabs- 10 mg -dissolve slowly in mouth 5 times each day until all tablets are used -Nystatin (Mycostatin pastilles) 50 tabs- 200,000 units -dissolve slowly in mouth 5 times daily until all tablets are used. |
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Pagets disease of Bone
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-called Osteitis Deformans
-"Cotton Wool" Bone appearance -Hat and dentures may no longer fit -Histo: Dense bone with prominent reversal lines -leontiasis ossea (Lion face) |
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Langerhans Cell Disease
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-birbeck granules
-friable gingiva - |
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Central Giant Cell Granuloma
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-radiolucency, most frequently in the mandible
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Cherubism
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-autosomal dominant inheritance
-bilateral multilocular radiolucencies -usually resolve after puberty -Histology: Same as CGCG |
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Central Hemangioma
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-honeycomb appearance
-check for bruits -do not extract teeth -perform angiogram |
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Benign Fibro-Osseous Lesions of the Jaws
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-developmental: Fibrous dysplasia
-Neoplastic: central ossifying fibroma -reactive: cemento-osseious dysplasia |
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Diagnosis of BFO lesions ...
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without a radiograph is asking for trouble
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Fibrous Dysplasia
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-classic ground glass appearance of involved bone
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Central ossifying fibroma
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-well-circumscribed radiolucency with or without radiopacities
-variant: juvenile ossifying fibroma -can frequently be removed by shelling out |
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Juvenile Ossifying Fibroma
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-aggressive variant of central ossifying fibroma
-usually occurs in first decade of life -may be quiescent for long periods of time and then show rapid growth -high recurrence rate: 30-50% |
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Cemento-osseous dysplasia
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-Periapical cemento-osseous dysplasia
-focal cemento-osseous dysplasia -florid cemento-osseous dysplasia -Radiographic appearance: Mixed radiolucent/radiopaque with defined rather than diffuse borders |
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Florid Cemento-osseous dysplasia
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-most frequently in middle-aged African American females
-reactive lesion of periodontal ligament origin -MOST COMMON lesion of alveolar bone |
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FCOD Diagnostic Criteria
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-focal RL/RO area in jaws
-surgical findings of easily fragmented hemorhagic mass of gritty tissue removed from bone with difficulty -gross-multiple hemorrhagic fragments of bone with variable consistency -histologic pattern of cellular mesenchymal tissue with intermixed calcifications |
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Treatment for FCOD
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-radiographic follow up
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Treatment for COF (central ossifying fibroma)
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-conservative total surgical removal
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Osteogenesis imperfecta
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-blue sclerae of the eye
-associated with dentinogenesis imperfecta |
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Cleidocranial dysplasia
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- can bend their shoulders all kinds of ways
-focal osteoporotic bone marrow defect |
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Metastatic Malignancy in the jaws
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-remember, the metastatic malignancy in the jaw may represent the first time that anyone has knowledge about the neoplasm.
-Referral to an oncologist for a workup to determine the location of the primary and the extent of involvement of other sites is imperative! |
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Osteonecrosis associated with bisphosphonates
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-bisphosphonates are now being widely used in the treatment of metastatic disease of the bone and in the treatment of osteoporosis
-100,000 cases of bone mets per year in the US |
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Malignancies most commonly metastasizing to bone
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-breast
-prostate -lung -kidney |
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Degree of Bone involvement in malignant disease
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-50% of these malignancies manifest bone involvement
-100% of patients who die from these cancers have bone metastases |
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Primary Lytic Malignancy of Bone
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-multiple Myeloma
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Complications in patients with metastatic bone disease
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-pain
-pathologic fracture -spinal cord compression -hypercalcemia |
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Role in decreasing osteoclast-mediated lysis of bone
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-Rampant use of pamidronate and Zoledronic acid has occured in oncology practices within the past several years
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Guidelines of the American Society of Clinical Oncology
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Standard of care for:
1. Hypercalcemia associated with malignancy 2. Metastatic osteolytic lesions associated with breast cancer and multiple myeloma in conjunction with antineoplastic chemotherapeutic agents |
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Bisphosphonates Mechanism of action
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-ability to localize to bone and inhibit osteoclast function (of resorbing bone)
-bind to exponsed mineral around resorbing osteoclasts -not metabolized, resulting in high concentrations over long periods of time -internalized by the osteoclasts causing diruption of resorption |
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Specific agents
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-pamidronate and zoledronic acid- administered by infusion
-alendronate and risedronate-oral preparations indicated only for the treatment of osteoporosis |
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Typical oral presentation
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-non-healing extraction socket or exposed jawbone
-progression to sequestrum formation associated with localized swelling and purulent discharge -usually at the site of previous tooth extraction |
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Cessation of bisphosphonate treatment
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-has NOT had a major impact on the disease process
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Recommendations for the dentist
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-avoid implants or oral surgery except in emergency situations
-maximize oral hygiene and periodontal status -carefully follow small traumatic ulcerations consdier the use of chlorhexidine |
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bone turnover markers
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-peptide bound cross links of type 1 collagen, the cross linked carboxy and amino telopeptides of type 1 collagen (NTX, CTX) released into circulation during resorption
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Trade and generic names
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-zometa = zoledronic acid
-aredia = pamidronate -fosamax = alendronate -actonel = risedronate -boniva = ibandronate |
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BRONJ: (bisphosphonate related osteonecrosis of the jaw) major characteristics
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-radiographic: sclerotic lamina dura, poorly defined RL, RO sequestrae
-clinica: exposed bone, pain, swelling, purulence, fistulas, sequestration, tooth loss, pathologic fx, paresthesia |
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Health issues related to bisphosphonates
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-conjectivitis
-esophageal tumors -unusual fractures of the thigh bone |
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Osteoporosis
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-affects more than 44 million americans age 50 or over
-34 million more may have osteopenia -8 out of 10 people with osteoporosis are women. Postmenopausal women are at the greatest risk |
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Osteoporosis Risk factors
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-female, advanced age, estrogen deficiency
-Hx of fracture after age 50, cacasion, low body weight and body mass index -family hx, smoking excess alcohol consumption |
