4. Soft Tissue Changes Flashcards
What is the most common infection involving oral tissues in older adults
fungal infections
Two common diseases caused by fungal infections are
-denture stomatitis and angular chelitis
Other names for fungal infections
- Moniliasis
- Thrush
- Perleche
- Candidiasis
Why are fungal infections so common in the elderly
0Diminished immune function
- Increased use of antibiotics
- Change in pH and moisture levels
- Less good OH
What are the four different types of candida infections -
- Chronic (follows footprint of a denture)
- Atrophic (median rhomboid glossitis- erythematous)
- Pseudomembranous (thrush- creamy white plaques)
- Hyperplastic (candidal leukoplakia)
Fungal infections are what type of infection
opportunistic
What conditions favor the growth of an opportunistic organisms
- Antibiotics
- Immunosuppressive agents
- Cytotoxic meds
- Corticosteroids
- Diabetes
- HIV/AIDS
- Immune defects in cell-mediated immunity
Main things that lead to angular chelitis are
0Decreased vertical dimension (increases moisture accumulation)
- Vitamin B deficiency
- Steroid use (i.e inhalers)
What is unique about hyperplastic candidiasis clinically
will not wipe off.
What are the two variations of hyperplastic candida
- Plaque type candida
- Chronic Nodular Candida
Denture stomatitis is also called
papillary hyperplasia
Describe the difference between types I, II, and III denture stomatitis
I= Localized minor erythematous sites II= Major areas under denture III= Granular mucosa
List the different anti-fungal agents to manage candida
- Amphotericin B
- Nystatin
- Clotrimazole
- Ketokonazole
- Fluconazole
- Itraconazole
Amphotericin B comes in what forms
- Oral rinse
- Pastilles (troche)
Nystatin comes in what forms
- Oral rinse
- Pastilles (troche)
- Cream
Clotrimazole comes in what forms
- Oral rinse
- Pastilles (troche)
- Cream
What are the oral systemic drugs that combat candida
ketokonazole
fluconazole and Itraconazole
Caution anti-fungal use with what other types of meds and why
anti-arrhytmia drugs that prolong the QT interval
Shingles is the result of the reactivation of the _ virus
herpes zoster
Shingles (increases/decreases) with age
increases
Delayed treatment of shingles can lead to which can persist for how long
post herpetic neuralgia… months to years
T/F more than half the people with shingles >60 get post herpetic neuralgia
t
Involvement of the external auditory canal with shingles is called
Ramsay Hunt syndrome
What percent of patients with leukoplakia show dysplasia, CA in situ or invasive carcinoma
10-20%
What leukoplakia characteristics make you more suspicious of cancer
- large size
- Erythroplakia
- Varucous or ulcerative
Most common site of metastatic cancer is in mouth
mandible
T/F Oral manifestation of metastatic cancers are common
f-rare
Most common carcinoma metastases are
breast, prostate, lung, thyroid and kidney
Cause of papillary hyperplasia
unknown- thought to be caused by negative pressure on tissues (from denture or tongue in high palatal arch)
T/F Papillary hyperplasia is only seen in denture wearers
f
Treatment of appillary hyperplasia
reline or surgery with loop electrosurgery
Another name for epulus fissuratum is
fibrous hyperplasia
epulus fissuratum is caused by
chronic irritation
- **Overextended denture flanges
- Overextension may develop as the ridge changes
Treatment for epulus fissuratum is
Surgical removal of epulus
Replace the denture
The most common vesiculo-ulcerative diseases of the oral mucosa in elderly are
- Lichen planus
- Cicatricial (mucus membrane) pemphigoid
- Pemphigous vulgaris
What are the least common vesiculo-ulcerative diseases in elderly of the oral mucosa
- erythema multiforme
- chronic ulcerative stomatitis
Two types of lichen planus are
- Reticular
- Erosive
Lichen planus may be seen in assoc. with what other diseases
- Liver disease
- Diabetes
Erosive lichen planus is characterized by
ulceration and mucosal atrophy
Reticular areas at the periphery of the leison
What is needed to destinguish lichen planus from pemphigodi
-immunoflurescent
Treatment for lichen planus
- Asymptomatic reticular= NO TX
- Erosive= corticosteroids, tecrolimus
Cicatricial pemphiogid is more common in (men/women)
women
Cause of MMP
autoantibodies to basement membrane components
MMP may involve what other structures
- Conjunctiva
- nasal mucosa
Another name of MMP
desquamative gingivitis
Treatment of MMP
Hard to treat
- Topical steroids
- Systemic Dapsone
MMP has positive Nikolsky’s sign which means
separation of epithelium from BM (blow air on the tissue –>separation)
Main difference between LP MMP and PV is
location of the immune reaction
Location of the immune reaction of PV
between the epithelial cells (not the BM!!)
Clinical presentation of PV
multiple ulcers
Burning mouth syndrome is most commonly seen in what population
post-menopausal women
Other names for burning mouth syndrome
glossopyrosis, glossodynia and burning tongue syndrome
Typical presentation of burning mouth syndrome
- No visible oral lesions
- burning sensation
- Often anterior tongue and anterior palate, lips
Onset of burning mouth syndrome often follows
stressful event
Things the help burning mouth syndrome
- May use meds for neurogenic pain
- Avoid spicy foods
- Stop smoking
- Lidocaine viscous
Causes of burning mouth may be
-Xerostomia
-Anemia
-Andida
-Allergic stomatitis
-Migratory glossitis
ETC
