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26 Cards in this Set

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Terminology: Erosive Lesions
Denuded areas that occur above the basal cell layer of the epithelium
Terminology: Ulcer
Lesion penetrates the epithelium and extends into dermis:
-- Often exhiit a red halo/border w/ yellow center (fibrinous exudate covering ulcer)
-- often caused by trauma


Traumatic Ulcers
Traumatic Ulcers
* Location: Localized to area of trauma
* Description: Have a crater-like appearances with some fibrinous exudate
* Repeated injury may produce scar or thickened, keratinized, white tissue.
* Treatment: remove source of injury
* Types of trauma: Factitial (self-induced) latrogenic (treatment caused) injury
Traumatic Ulcers: Necrotizing Sialometaplasia
Traumatic Ulcers: Necrotizing Sialometaplasia
* Salivary gland ischemia causing necrosis of tissue
* cause: usually trauma in the area (ie. surgery or local anesthesia)
* Location: junction of hard and soft palate
* treatment: only for pain
* will heal in several weeks-months
* may be confused w/ carcinoma.
Ulcers from Infectious Agents: Syphilis
Ulcers from Infectious Agents: Syphilis
*Cause: Spirochete Trepenema Pallidem Through Direct Contact w/ Primary Lesion.
* 3 Stages:
-- primary stage - chancre
-- secondary stage - mucous patches and flu-like symptoms
-- tirtiary stage - gummatous lesion
* Treatment: Penicillin
Ulcers from Infectious Agents: Gonorrhea
Ulcers from Infectious Agents: Gonorrhea
* Cause: Bacterium Neisseria gonorrhoeae
* Location: genital tract, mouth, rectum, oral pharynx (most common site), tonsils (pustular lesions), and tongue.
* Stinging and burning may occur on tongue.
* Treatment: Antibiotics
Ulcers from Infectious Agents: Actinomycosis
Ulcers from Infectious Agents: Actinomycosis
* Cause: Chronic bacterial disease.
* Description: an abscess and yellow pus-like drainage w/ sulfur granules, sometimes draining externally.
* Develops in relation to trauma, surgery, or other dental procedures.
* Treatment: Penicillin

Ulcers from Infectious Agents: Necrotizing Ulcerative Gingivitis (NUG)
Ulcers from Infectious Agents: Necrotizing Ulcerative Gingivitis (NUG)
* AKA: " Trench Mouth"
* Cause: Spirochetes, fusobacteria and streptococi.
* This causes: bleeding, ulceration, tissue necrosis, and pain.
* Description: Grey psudomembrane that forms over necrotic gingiva.
* contributors to severity: stress, improper nutrition, and poor oral hygiene.
* Distinguishing Factor: Fetid Odor
* Treatment: Debridement, proper diet, rest, stress reduction, and antibiotics.

* Oral Irrigating devices and ultrasonic instrumentation are contraindicated.
Deep Fungal Infections
Deep Fungal Infections
* Occur through tears in tissue
* Affect people w/ compromised immune systems and lowered resistance to pathogens
* Diagnosis: requires testing - refer
* Extraoral - usually ulcerative
* Intraoral - ulcerative w/ indurated lesions
Immune System Disorders: Aphthous Ulcers
Immune System Disorders: Aphthous Ulcers
* Etiology: Still questioned
* Factors: stress, trauma, food allergies, genetic predisposition, V B12 deficiencies, and hormonal fluctuations.
* Cause: may be hypersensitivity reaction, autoimmune response, and trauma w/ chemical mediators involved.
* Location: Nonkeratinized tissue (buccal/labial mucosa, ventral tongue, floor of mouth), soft palate and oropharynx
* More common in non-smokers.
Recurrent Aphthous Ulcers
Recurrent Aphthous Ulcers
Type 1: RAU minor
Type 2: RAU major
Type 3: Herpetiform RAU

* Classified by lesion size and dispersion
* NOT contagous
* AKA canker sore
* MOST COMMONLY SEEN oral lesion

RAU Minor
* Most common of the 3
* Tingling or burning sensation reported
* Develop w/in 24-48hrs
* Last 7-10 days
* Painful
* Crater-like ulcer w/ white or yellow fibrinous membrane w/ red halo less than 1cm
RAU Major
RAU Major
* Lesions are much larger, 1-3 cm
* Deeper and more crater-like w/ irregular border. May last several years.
* Extensive lesion causes scarring
* aka "Sutton's Disease"

Herpetiform RAU
Herpetiform RAU
* Smaller, 1-3mm in cluster formation (10-100)
* More frequent in women and later in life.
* Usually on non-keratinized surfaces.
Treatment for / durations of Aphthus Ulcers
* Chlorhexidine Gluconate Rinse:
* Topical Corticosteroid gels (kenalog or orabase)
* Tetracycline rinses
* usually last 7-10 days regardless of treatment
* Major may last several weeks w/ scarring
Behcet Synderome
Behcet Synderome
*Inflammatory disorder of unknown cause
* occur in 30-40 year olds
* Triad lesions: RAU minor, Genital ulcers, and ocular lesions.
* Similar to aphthus ulcer
* recurrent, painful lesions
* Treatment: topical steroids and Cyclosporine
Reiter's Synderome
Reiter's Synderome
* Develops after exposure to VD or GI infection
* Affects men more than women
* Triad: arthritis, urethritis, conjunctivitis
* One half Pts have oral ulcers.
* Treatment: Non-steroidal agents
Erythema Multiforme (EM)
Erythema Multiforme (EM)
* TARGET LESIONS
* Associated with exposure to:
-- HSV
-- TB
-- Histoplasmosis
-- Other fungal infections
-- Medications such as sulfonamides, penicillin and barbiturates.
Steven Johnson Synderom
Steven Johnson Synderom
* Severe Form of Erythema Multiform
* Locations: Oral cavity Conjunctiva, Genitalia, and skin (erythematous papules that enlarge to vesicles or bulla
Hypersensitivity Reactions: Stomatitis venenata
* Mucosal Version of contact dermatitis
* Symptoms: ulcers, srythema or swelling occuring w/in 24-48 hours of contact
Hypersensitivity Reactions: Stomatitis Medicamentosis
* Reaction to medications such as penicillin
* aka: fixed drug reaction
* Symptoms: ulcers, vsicles, skin rashes and lymphadenopathy

Hypersensitivity Reactions:
Hypersensitivity Reactions:
* Caused by new/previously used products
* Majority are delayed reactions mediated by sensitized T lymphocytes
* Intraoral symptoms: ulcers, erythema, vesicles, or tissue sloughing
other symptoms: urticaria (hives) and edema
Lupus Erythematosus
Lupus Erythematosus
Autoimmune disease and type III Hypersesneitivity reaction
* Cause: sunlight, hormones, cigerettes, certain medications, viruses (ie, epstein-barr)
* Affects: skin, organs (mainly kidneys) joints, and serous membranes
* may be extremely erythematic and painful
* oral lesions present in all forms in in 25-40%
Chrohn Disease
Chrohn Disease
* Chronic GI desase
* associated w/ aphthus ulcers and pyostomatitis vegetans
* Genetic component (etiology unknown)
* Intestinal discomfort weight loss, and fever w/ periods of remission
* Vit. D deficiency association
* colon cancer risk
* poor absorption of vit. B, Folic acid, iron, and other nutrients
Squamous cell carcinoma: factors
Squamous cell carcinoma: factors
* Lifestyle choices
* Environmental influences
* Genetic factors
* infections, particularly by viruses
* Sunlight, alcohol, diet, stress, chemical exposure
* Infections including syphilis, candidiasis, and HPV
* Chronic inflammation in the body
Squamous Cell Carcinoma (SCC)
Squamous Cell Carcinoma (SCC)
* Tonsillar cancer implicated w/ HPV 16
* Base of tongue and tonsil crypts make visualization difficult
* May be erythroplakia, speckled erythroleukoplakia, or field carcinogenesis.