12. Immune-mediated Disorders of the Oral Mucosa Flashcards
•
Structural organization of SSE
From bottom to surface
– Stratum ____ (Basal or germinative layer)
– Stratum ____ (Spinous layer)
– Stratum ____ (Superficial layer, stratum corneum, keratin layer)
• Bulk of SSE > stratum \_\_\_\_ • In oral mucosa > non-ketatinized or para > the surface is stratum \_\_\_\_ ○ Para: \_\_\_\_ palate, attached gingi, \_\_\_\_ (both non and para for tongue, para are at tips, while valleys are non-keratinized)
basal
spinosum
superficiale
spinosum
superficiale
hard
tongue
Lichen planus
• Type ____ hypersensitivity reaction
• Immune-mediated disorders - type IV • Type I - anaphylaxis - mediated by \_\_\_\_ • Type II - antibody-antigen - disrupts functionality (\_\_\_\_) • Type III - \_\_\_\_ deposition - antibodies bind to antigen, but what causes diseases it activates PMNs which cause the damage • Type IV - \_\_\_\_, lymphocytes - delayed type hypersensitivity reaction ○ Poison ivy, contact allergy, latex ○ LICHEN PLANUS IS TYPE \_\_\_\_, not sure what cells are reacting to • Lesion in skin - purple, pruitic, polygonal and papular
IV IgG myasthenia gravis immune complex cell-mediated IV
Oral lichen planus
• Reticular
– Usually ____
– Interlacing white lines (____)
– History of waxing and waning
• Erosive
– ____
– Ulcerated mucosa
– May be restricted to ____
• \_\_\_\_ always warrants therapy - ulcerations; may see white striations, but often times you don't
asymptomatic wickham's striae symptomatic gingiva erosive
- Reticular LP
* ____ striations, lace-like pattern
white
• LP of ____ tongue
○ Disregard hyperkeratosis in middle, but peripherally you see ____-like pattern
dorsal
lace
- LP of lips
- ____
- Esthetically displeasing, but not concerning as clinicians; doesn’t really warrant ____
asymptomatic
treatment
- ____ LP
- Tongue, buccal mucosa
- May see ____ (middle) surrounding the ulceration
erosive/ulcerating
striations
Desquamative gingivitis
• Non-specific ____ term
– Gingiva appears ____ and ulcerated
• May be due to variety of different diseases
desquamative gingivitis is NOT a diagnosis; there is an array of diseases that manifests with same ____ manifestation; most common one being erosive LP
if you have PT who has focal or diffusively, peeling painful raw gums, it’s called ____ gingivitis- it’s a descriptive term not a diagnosis
NOT a diagnosis, just a description term
like the terms leukoplakia and erythroplakia ( white or red lesion)
clinical
clinical
desquamative
Desquamative gingivitis
so we are adding ____ to this Differential Diagnosis list this List will grow as we learn more disorders.. as we move to D2 year we will keep on adding on to the list.
erosive lichen planus
Biopsy
- Excisional
- Incisional
Biopsy of ulceration MUST include portion of adjacent intact ____
• Excisional is \_\_\_\_
mucosa
curative
- L: look at basal layer, you don’t see prominent basal cells; they undergo ____ degeneration > undergo damage
- M: pink circlular structures > ____ bodies, or civatte bodies > represent apoptotic cells > epi cells
- R: inflam infiltrate > loads of ____ > at the interface bt the epi and connective tissue
hydropic
colloid
lymphocytes
Basement membrane
• Lymphos are recruited via chemokines and other chem mediators, and these cells are typically \_\_\_\_ (cyto T) > physically damaging the epithelium > some cells undergo apoptosis (\_\_\_\_ bodies) • Treatment with \_\_\_\_ > prevent the formaiton/syntehsis of lymphocytes > how you treat LP ○ If lesion is localized/diffsue > skin mucosal lesion: systemic steroid; oral cavity: topical steroid, liquid or cream form ○ High potency, int potency, low potency § High: \_\_\_\_ § Int: \_\_\_\_
CD8+ colloid steroids clobetzole fluocinode
LP-like lesions Lichenoid mucositis – \_\_\_\_ allergy – \_\_\_\_ allergy Systemic conditions – \_\_\_\_ erythematosus – Graft vs host disease
• Arises as lichen planus clinically > LM > umbrella of diagnoses ○ Contact: \_\_\_\_, peppermint, metal/alloy/gold ○ Drug: \_\_\_\_, hypertension, and some for transplant rejection prevention * Drug reaction - \_\_\_\_ - hypothyroidism * Discoid lupus/lupus erthematosus * GvH disease > can mimic LP clinically, but \_\_\_\_ it's different
contact drug lupus cinnamon hyperthyroid
synthryoid
microscopically
Lichenoid mucositis
• Medications
• Flavoring agents
• Dental materials
• Interface reaction, and you have a \_\_\_\_ infiltrate > lympho's are wrapped around BV deep within the tissue • Superficial, and a \_\_\_\_ perivascular (in LP you do not see the deep perivascualr infiltrate) > here, you see, auotomatically you're thinking some kind of a reaction (due to drug, contact, etc.) ○ \_\_\_\_ taking is critical (cinnamon, peppermint, meds) ○ Still treated with roids • Have to understand cause - if you can link to medication (\_\_\_\_) > changing the medication • If restoration > do not replace unless you have to > \_\_\_\_ first, if doesn't go away > may warrant reevaluation for that tooth
perivascular deep history temporally treat
- L: ____ restoration
* R: chewing cinnamon gum > erosive lichenoid pattern involving ____ of tongue
gold
dorsum
Desquamative Gingivitis
Erosive lichen planus
Lichenoid mucositis
Graft vs host disease
• And \_\_\_\_, can manifest with desquamtive gingivitis ○ Gums are peeling red and raw
lupus
Hemidesmosomes
• Physically attach ____ cells to basement membrane
• Cytokeratin molecules in cytoplasm are connected to ____
– Via Bullous pemphigoid ____ and ____ (BP230 and BP180) and ____
• Extracellular domain of integrin crosses plasma membrane to bind ____ in basement membrane
• Protein structures that link basal cells to BM ○ Linked from within via \_\_\_\_ • Hemidesmosome composed of proteins that link cytokeratin within cell; cytokeratin binds to PB230, 180 and plectin and all binds to integrin a6b4 which crosses cell membrane into external environment (basement membrane, binding laminin 5) ○ Any protein disruption > detachment
basal intergin alpha6beta4 230 180 plectin laminin 5 cytokeratin
Benign mucous membrane pemphigoid
- ____, vesiculobullous disease
- Similar to Type ____ hypersensitivity
- ____ women
- Usually limited to ____ membranes
- Lesions heal with scarring
- ____ consult is mandatory
- Vesiculobullous - blisters - separation of epi from connective tissue > will rupture giving rise to ulceration
- TII > ____ generated unknwon > binds antigen (any of proteins within hemidesmo) > destruction of hemidesmo and reuslting in separationf rom CT
- Mucuous membranes, not just oral cavity (can be ocular, genital, etc.); very rarely you will get ____ lesions
- ____ pemphigoid > another word for scar (heal with scarring, esp in eyes)
autoimmune II older mucous ophtlamology
antibody
skin
sicotritial
