09 Allergic & immunologic diseases

Question 1

transient lingual papillitis

Answer 1

-unknown cause -elevated, painful fungiform papillae -red, white, or yellow color -resolve on own

Question 2

recurrent aphthous stomatitis

Answer 2

-one of most common oral lesions -possibly from allergies, genetics, nutrition, hormones, trauma, stress -associated with: behcet’s syndrom, celiac disease, cyclic neutropenia, inflammatory bowel disease, reiter’s syndrome, sweet’s syndrome -minor, major, herpetiform -treat with topical corticosteroids, injection of triamcinolone acetonide

Question 3

minor aphthous ulcerations

Answer 3

-fewest recurrences -shortest duration -on nonkeratinized tissue (buccal/labial) -3-1mm, 7-14 days, 1-5 lesions -painful

Question 4

major aphthous ulcerations

Answer 4

-longest duration -2-6 weeks to heal -1-3cm, 1-10 lesions -labia, soft palate, tonsillar fauces -scarring possible

Question 5

herpetiform aphthous ulcerations

Answer 5

-most frequent recurrence -many lesions, 1-3mm, 7-10 days

Question 6

behcet’s syndrome

Answer 6

-multisystem disorder -oral lesions first manifestation (soft palate/oropharynx) -followed by genital and ocular lesions, CNS involvement -diagnose with oral lesions + 2 other symptoms (genital, eye, skin lesions, or positive pathergy) -treat with corticosteroids, colchicine, or dapsone

Question 7

sarcoidosis

Answer 7

-multisystem granulomatous disorder (noncaseating granulomas) -10-17X more in blacks -bimodal age range, 25-35 & 45-65 -dyspnea, dry cough, chest pain, fever, malaise, fatigue, arthralgia, weight loss -lungs, lymph nodes, skin, eyes, salivary glands -associated with lofgren’s syndrome, heerfordt’s syndrome -60% resolve spontaneously, treat with corticosteroids, methotrexate, chlorambucil, azathioprine

Question 8

orofacial granulomatosis

Answer 8

-idiopathic abnormal immune response -multinucleated giant cells and granuloma -must rule out sarcoid, crohn’s, fungus infection, foreign body reaction

Question 9

melkersson-rosenthal syndrome

Answer 9

-orofacial granulomatosis + facial paralysis + fissured tongue

Question 10

allergic contact stomatitis

Answer 10

-acute: burning, red, edema, itching, stinging, tingling -chronic: erythematous, white, hyperkeratotic, erosions in affected zone -treatment: remove allergen, antihistamine, topical anesthetic and corticosteroid -common from artificial cinnamon flavoring and resembles plasma cell gingivitis

Question 11

perioral dermatitis

Answer 11

-inflammatory skin disease of circumoral area -topical corticosteroid worsens -90% women -treat with metronidazole

Question 12

lichenoid contact stomatitis

Answer 12

-from dental restorative material -1:1,000,000 for amalgam -hypersensitivity after 10-14 days -similar to lichen planus

Question 13

angioedema (quincke’s disease)

Answer 13

-diffuse edematous swelling -subcutaneous and submucosal connective tissue -GI or respiratory tract -mast cell degranulation, histamine release (IgE reaction) -treat with PO antihistamine or IM epinephrine