8 Red Lesions Flashcards
also known as red lesions
REACTIVE HYPERPLASIAS
a group of fibrous connective tissue that commonly occur in oral mucosa secondary to injury
REACTIVE HYPERPLASIAS
→ usually a chronic process
→ usually painless because the nerve does not proliferate with the hyperplastic tissue
REACTIVE HYPERPLASIAS
during mastication, these lesions may become secondarily
ulcerated
REACTIVE HYPERPLASIAS
True or false
REACTIVE HYPERPLASIAS has no known etiology
True
overexuberant repair; a stimulus causes the tissues repair
itself excessively
REACTIVE HYPERPLASIAS
What does it mean if the REACTIVE HYPERPLASIAS has a color Lighter than surrounding tissues?
high collagen
What does it mean if the REACTIVE HYPERPLASIAS has a color Red?
increased granulation tissue
Treatment of REACTIVE HYPERPLASIAS
treatment:
o removal or modification of the irritating factor
o surgical excision
usually caused by a minor trauma to the tissues providing a pathway for the invasion of non-specific types of microorganisms
PYOGENIC GRANULOMA
usually caused by calculus or any foreign material within the gingival crevice
PYOGENIC GRANULOMA
tissues respond to low virulence organisms by overzealous proliferation of vascular type of connective tissues
PYOGENIC GRANULOMA
hormonal changes of puberty and pregnancy also modify reparative response to injury
PYOGENIC GRANULOMA
HISTOLOGIC FEATURES
→ lobular mass of granulation tissues
→ neutrophils
PYOGENIC GRANULOMA
CLINICAL FEATURES
→ not pus-producing
→ reddish
o indicates that it is made of hyperplastic granulation tissue
→ usually found in the gingiva
→ prominent capillaries
PYOGENIC GRANULOMA
Txt of PYOGENIC GRANULOMA
→ removal of any local etiologic factors
o if calculus, perform oral prophylaxis
→ surgical excision
seen exclusively in the gingiva between the 1st permanent molars and the incisors
PERIPHERAL GIANT CELL GRANULOMA
→ presumed to arise in the PDL or from the periosteum
PERIPHERAL GIANT CELL GRANULOMA
→ occasionally cause resorption of the alveolar bone because of
the presence of the giant cells → more in females than in males
→ size is usually 1 cm in diameter
PERIPHERAL GIANT CELL GRANULOMA
HISTOLOGIC FEATURES
→ hyperplastic granulation tissues
→ chronic inflammatory cells
PERIPHERAL GIANT CELL GRANULOMA
HISTOLOGIC FEATURES
→ neutrophils
→ abundant multinucleated giant cells
PERIPHERAL GIANT CELL GRANULOMA
RADIOGRAPHIC FEATURES
→ cup-shaped radiolucency if on edentulous ridges
PERIPHERAL GIANT CELL GRANULOMA
Txt. Of PERIPHERAL GIANT CELL GRANULOMA
→ removal of local factors or irritants
→ surgical excision
→ also called:
Focal Fibrous Hyperplasia
Hyperplastic Scar
PERIPHERAL FIBROMA
increase in fiber tissues
Focal Fibrous Hyperplasia
highly collagenous, relatively avascular
Hyperplastic Scar
CLINICAL FEATURES
→ found in gingiva, anterior to permanent molars
→ can either be:
o pedunculated with a stem
o sessile mass
PERIPHERAL FIBROMA
→ color is similar to surrounding tissue
→ rarely causes erosion of the alveolar bone
PERIPHERAL FIBROMA
Txt of PERIPHERAL FIBROMA
→ removal of etiologic agent
→ surgical excision (including PDL, if involved)
TYPES of PERIPHERAL FIBROMA
→ has (3) types:
o Peripheral Ossifying Fibroma
o Peripheral Odontogenic Fibroma
o Giant Cell Fibroma
→ calcified islands seen are presumed to be bone
PERIPHERAL OSSIFYING FIBROMA
→ a gingival mass
PERIPHERAL OSSIFYING FIBROMA
bone is found in an encapsulated proliferation of plumped benign fibroblasts and chronic inflammatory cells typical location
PERIPHERAL OSSIFYING FIBROMA
composed of well-vascularized, non-encapsulated fibrous connective tissue
PERIPHERAL ODONTOGENIC FIBROMA
→ usually non-ulcerated
→ distinguishing feature:
o presence of strands of odontogenic epithelium from PDL
PERIPHERAL ODONTOGENIC FIBROMA
→ the color is lighter than the surrounding tissues, signifying high collagen content, high fibrous connective tissues
IRRITATION FIBROMA
a very common reactive hyperplasia found in the buccal mucosa, tongue, or lower lip
→ usually painless, broad base swelling
IRRITATION FIBROMA
IRRITATION FIBROMA may be part of an autosomal dominant syndrome which is
either
o multiple hamartoma syndrome
o Cowden syndrome
HISTOLOGIC FEATURES
→ collagen overproduction
→ fibroblasts in collagen matrix
IRRITATION FIBROMA
Txt of IRRITATION FIBROMA
TREATMENT
→ surgical excision
→ recurs if area is traumatized nodule at commissure
most cases are non-specific
GENERALIZED GINGIVAL HYPERPLASIA
an unusual tissue response to chronic inflammation associated
with local factors such as plaque, calculus, or bacteria
GENERALIZED GINGIVAL HYPERPLASIA
→ hormonal changes and drugs can also potentiate effects on
local factors through gingival tissues
o hormonal changes include: pregnancy, puberty, and
menopause
o drugs appear to have a regulating effect on fibroblast
metabolism or growth rate
GENERALIZED GINGIVAL HYPERPLASIA
an anticonvulsant drug used to control seizure disorders
Dilantin (Phenytoin)
irreversible damage; surgical procedure must be done to treat the condition
Dilantin (Phenytoin)
→ immunosuppressive drug used for transplant patients and treatment of alopecia
→ reversible damage; if medication is stopped, changes will reverse
Cyclosporine
→ calcium channel blocker used for treatment of angina and arrhythmias
→ reversible damage
Nifedipine
also known to occur in patients with leukemia
o there is spontaneous pooling of blood in the mouth is
expected
GENERALIZED GINGIVAL HYPERPLASIA
→ other forms include:
o idiopathic hyperplasia
o hereditary gingival fibromatosis
GENERALIZED GINGIVAL HYPERPLASIA
CLINICAL FEATURES
→ increase in bulk of free and attached gingiva, especially the interdental papilla
→ lost stippling or gingival margins become rolled and blunted
GENERALIZED GINGIVAL HYPERPLASIA
consistency of GENERALIZED GINGIVAL HYPERPLASIA either:
Soft & Spongy
Firm & Dense
typical generalized gingival hyperplasia
A. Soft & Spongy
B. Firm & Dense
A
idiopathic hyperplasia & hereditary gingival fibromatosis
A. Soft & Spongy
B. Firm & Dense
B
HISTOLOGIC FEATURES
→ abundant collagen deposition
→ fibroblasts increase in number
GENERALIZED GINGIVAL HYPERPLASIA
HISTOLOGIC FEATURES
→ capillaries may increase and are prominent
→ in leukemic enlargements, atypical and immature white blood
cells (malignant infiltrate)
GENERALIZED GINGIVAL HYPERPLASIA
Txt of GENERALIZED GINGIVAL HYPERPLASIA
→ good oral hygiene necessary to minimize effects of inflammation on fibrous proliferation
→ gingivoplasty or gingivectomy, in combination with prophylaxis + oral hygiene instructions especially for dilantin hyperplasia
also known as epulis fissuratum
DENTURE-INDUCED FIBROUS HYPERPLASIA
→ a very common lesion
→ a form of chronic trauma produced by an ill-fitting denture
DENTURE-INDUCED FIBROUS HYPERPLASIA
CAUSE
bony ridges of mandible and maxilla resorb
with long-term denture use
↓
flanges extend farther into vestibule
↓
chronic irritation + trauma
↓
incite over exuberant fibrous connective tissue reparative response
↓
result into appearance of painless fold of fibrous tissues surrounding overextended dentures flanges
DENTURE-INDUCED FIBROUS HYPERPLASIA
CLINICAL FEATURES
→ usually occurs in the vestibular mucosa where the dentures flange contacts the tissues
DENTURE-INDUCED FIBROUS HYPERPLASIA
Txt of DENTURE-INDUCED FIBROUS HYPERPLASIA
TREATMENT
→ construction of a new denture
→ relining of the old denture
→ decreasing the flanges
→ surgical excision usually required
→ reduction in size of lesion may follow prolonged removal of
denture
also known as palatal papillomatosis
PAPILLARY HYPERPLASIA
CAUSE
→ exact cause appears exclusively on the hard palate and is often related with ill-fitting RPD, which somehow potentiates the growth of candida albicans organisms beneath interface of denture base material and mucosa
PAPILLARY HYPERPLASIA
CAUSE
→ related to the process of fungal organisms in a setting of a low-grade form of trauma
PAPILLARY HYPERPLASIA
CLINICAL FEATURES
→ involves most frequently the palatal vault and less affects the alveolar ridge
PAPILLARY HYPERPLASIA
multiple, erythematous papillary projections that are tightly aggregated, producing an overall verrucous granular or
“cobblestone appearance”
PAPILLARY HYPERPLASIA
HISTOLOGIC FEATURES
→ appears as numerous small papillary projections covered with intact parakeratotic stratified squamous epithelium
PAPILLARY HYPERPLASIA
HISTOLOGIC FEATURES
→ projections may be slender or almost villous
PAPILLARY HYPERPLASIA
Txt of PAPILLARY HYPERPLASIA
→ surgical removal
→ electrosurgery
→ laser ablation
→ curettage
→ cryosurgery
→ mucoabrasion
→ reconstruction of denture
→ antifungal therapy (can reduce but cannot cure alone)
→ in mild cases, utilize soft tissue conditioning agents and liners
with frequent changing of lining material
→ removal of appliance at bedtime
→ maintenance of good oral hygiene
also known as oral verruca vulgaris
ORAL SQUAMOUS PAPILLOMA
→ most common papillary lesion of oral mucosa
→ will include papillary and veruccal growths composed of benign
epithelium and connective tissues
ORAL SQUAMOUS PAPILLOMA
CAUSE
→ human papillomavirus
o a DNA virus with 1 molecule of a double-stranded DNA
ORAL SQUAMOUS PAPILLOMA
CLINICAL FEATURES
→ usually found in the vermillion border of the lips
→ predilection for hard and soft palate and uvula
ORAL SQUAMOUS PAPILLOMA
CLINICAL FEATURES
appear as exophytic granular to cauliflower-like surface
alteration
ORAL SQUAMOUS PAPILLOMA
CLINICAL FEATURES
many, long, thin, finger-like projections extending above the mucosal surface
ORAL SQUAMOUS PAPILLOMA
CLINICAL FEATURES
each projection is made up of a continuous layer of stratified squamous epithelium
ORAL SQUAMOUS PAPILLOMA
HISTOLOGIC FEATURES
→ represent an exaggerated growth of squamous epithelium
→ many cases demonstrate slight cellular atypia (rapid cellular
turnover)
ORAL SQUAMOUS PAPILLOMA
Txt of ORAL SQUAMOUS PAPILLOMA
surgical removal by routine excision or laser ablation
also referred to as ‘gumboil’
PARULIS
represents a focus of pus in gingival connective tissues
PARULIS
→ derived from an acute infection
o if the path of least resistance leads to gingival submucosa, soft tissue abscess/parulis is formed
→ usually associated with non-vital tooth
PARULIS
CLINICAL FEATURES
→ “yellow-white gingival tumescence” with variable amounts of erythema
→ induces pain
PARULIS
HISTOLOGIC FEATURES
→ central cavity filled with pus
PARULIS
TREATMENT of PARULIS
→ treat the acute infection to achieve resolution of gingival abscess
→ root canal treatment or extraction
→ periodontal surgery to reduce pocket depth
