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Oral pathology > acute and chronic ulcerative lesions 2 > Flashcards

acute and chronic ulcerative lesions 2 Flashcards

1
Q

aphthous stomatitis is aka

A

canker sores

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2
Q

aphthous stomatitis category

A

immune-mediated

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3
Q

aphthous stomatitis etiology

A
  • CD8+ T-cells produce TNF-a (inflammatory cytokine)
  • trigger is “different things in different people”
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4
Q

aphthous stomatitis demographics

A

more frequent in children and young adults

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5
Q

aphthous stomatitis clinical presentation

A
  • ulcer with yellow-white fibrinopurulent membrane, encircled by an erythematous halo
  • occur on nonkeratinized (moveable) mucosa
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6
Q

aphthous stomatitis diagnosis

A
  • clinical
  • histopathology of an aphthous ulcer is not diagnostic
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7
Q

aphthous stomatitis tx

A
  • heals without treatment
  • topical steroid or steroid rinse for recurrent cases
  • laser ablation shortens duration and decreases symptoms, but may not be practical in all cases
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8
Q

minor aphthous ulcers

A
  • most common (90%)
  • experience fewer recurrences
  • shortest duration
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9
Q

major aphthous ulcers

A
  • larger than minor aphthae
  • tend to be recurrent
  • take 2-6 weeks to heal
  • scarring can occur
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10
Q

herpetiform aphthous ulcers

A
  • tend to have multiple ulcers, but each ulcer is smaller than minor aphthae
  • tend to be recurrent
  • heal in 7-10 days
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11
Q

aphthous stomatitis reported causes

A
  • allergies
  • genetic predisposition
  • hematologic abnormalities
  • hormonal influences
  • immunologic factors
  • infectious agents
  • nutritional deficiencies
  • smoking cessation
  • stress (mental and physical)
  • trauma
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12
Q

recurrent aphthous stomatitis associated systemic disorders

A
  • behcet syndrome
  • celiac disease
  • cyclic neutropenia
  • crohn’s disease
  • ulcerative colitis
  • nutritional deficiences
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13
Q

allergic contact stomatitis category

A

immune-mediated

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14
Q

allergic contact stomatitis etiology

A

allergy to food additive, chewing gum, candy, dentifrice, mouthwash, or dental materials

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15
Q

allergic contact stomatitis demographics

A

more common in females

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16
Q

allergic contact stomatitis clinical presentation

A
  • burning sensation
  • erythema with out without edema
  • superficial ulcerations may be present
  • rarely, vesicles are seen
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17
Q

allergic contact stomatitis diagnosis

A
  • temporal relationship between use of the agent and eruption
  • patch testing may be useful in identifying allergen
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18
Q

allergic contact stomatitis tx

A

removal of allergen

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19
Q

erythema multiforme category

A

immune-mediated

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20
Q

erythema multiforme etiology

A
  • triggered by infection
    1. mycoplasm pneumoniae
    2. herpes simplex virus 1 (HSV-1)
  • triggered by medication
    1. NSAIDs
    2. Sulfonamides
    3. Antiseizure medications
    4. Antibiotics
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21
Q

erythema multiforme demographics

A

average age range is 20-40 years old

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22
Q

erythema multiforme clinical presentation

A
  • diffuse oral ulceration
  • hemorrhagic crusting of the lips
  • targetoid skin leasions
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23
Q

erythema multiforme diagnosis

A
  • clinical history and presentation
  • bloodwork for Mycoplasma penumoniae and HSV-1 IgM antibodies
  • identification of drug
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24
Q

erythema multiforme treatment

A

self limiting (2-6 weeks)

25
traumatic ulcer category
injury
26
traumatic ulcer etiology
some form of injury (biting, neighboring sharp tooth, puncture, etc.)
27
traumatic ulcer demographics
broad age range
28
traumatic ulcer clinical presentation
- area of erythema around a central yellow fibrinopurulent membrane - may develop a rolled white border of hyperkeratosis adjacent to ulceration - most common on tongue, lips, and buccal mucosa
29
traumatic ulcer diagnosis
if lesion persists beyond 2 weeks, biopsy to rule out squamous cell carcinoma
30
traumatic ulcer tx
- remove source of trauma - heals with time
31
syphilis category
infectious
32
syphilis etiology
- Treponema pallidum - spread by direct contact with mucosal surfaces ---> sexual contact ---> mother to fetus - three stages of disease (primary, secondary, tertiary) - patient are highly infectious during the first 2 stages
33
syphilis demographics
broad range
34
primary syphilis clinical presentation
- Chancre --> solitary, papular lesion with central ulceration --> 85% genital, 4% oral - regional lymphadenopathy - symptoms resolve in a few days, even without treatment
35
secondary syphilis (disseminated) clinical presentation
- occurs 4-10 weeks after initial infection - systemic symptoms - diffuse maculopapular cutaneous rash - split papule ---> papule in the crease of the oral commissure - mucous patch --> whitish, elevated plaque ---> frequently on tongue, lip, buccal mucosa and palate
36
secondary syphilis systemic symptoms
- painless lymphadenopathy - sore throat - malaise - headache - weight loss - fever
37
tertiary syphilis clinical presentation
- Gumma ---> indurated, nodular or ulcerated lesion ---> may cause extensive tissue destruction ---> usually affect palate or tongue - affects vascular system and CNS - can result in paralysis, psychosis, dementia and death
38
T/F oral manifestations of syphilis can mimic many other conditions
True
39
syphilis diagnosis
- biopsy - blood tests ---> Venereal disease research laboratory (VDRL) ---> rapid plasma reagin (RPR) ---> results can be negative for up to 6 weeks after initial infection
40
syphilis treatment
antibiotics (penicillin)
41
mucous membrane pemphigoid category
immune-mediated
42
mucous membrane pemphigoid etiology
autoantibodies against hemidesmosomes and components of basement membrane
43
mucous membrane pemphigoid demographics
older adults (50-60 yeras)
44
mucous membrane pemphigoid clinical presentation
- vesicles or bullae - large areas of ulcerated/denuded mucosa - can be limited to gingiva (desquamative gingivitis) - can involve skin and conjunctival, nasal, esophageal, laryngeal, and vaginal mucosa - positive Nikolsky sign
45
what is a positive nikolsky sign and when is it seen
- firm lateral pressure on intact mucosa causes epithelial separation - seen in mucous membrane pemphigoid and pemphigus vulgaris
46
what else can occur with mucous membrane pemphigoid
- symblepharon formation from conjunctival involvement can lead to blindness - must provide ophthalmology referral
47
mucous membrane pemphigoid diagnosis
- two perilesional biopsies --> one in formalin (- SUBepithelial clefting) ---> one in Michel's solution for direct immunofluorescence (DIF) (- LINEAR BAND of immunoreactants at basement membrane zone)
48
mucous membrane pemphigoid treatment
- should be managed by a clinician experienced with treating the condition - varying combinations of topical and systemic therapy, usually including steroids and immunosuppressive agents - referral to opthalmologist
49
pemphigus vulgaris category
immune mediated
50
pemphigus vulgaris etiology
autoantibodies against components of desmosomes
51
pemphigus vulgaris demographics
middle-aged adults
52
pemphigus vulgaris clinical presentation
- ulceration of any oral mucosal surface (predilection for palate) - may present with desquamative gingivitis - may have skin involvement - positive NIkolsky sign
53
pemphigus vulgaris diagnosis
two perilesional biopsies - one in formalin (INTRAepithelial cleft) - one in Michel's solution for direct immunofluorescence (DIF) ( - immunoreactants deposited in intracellular areas [CHICKEN WIRE PATTERN])
54
pemphigus vulgaris treatment
- should be managed by a clinician experienced with treating the condition - varying combinations of topical and systemic therapy, usually including steroids and immunosuppressive agents
55
desquamative gingivitis differential diagnosis
- Lichen planus (erosive or atrophic) - Pemphigus vulgaris - Mucous membrane pemphigoid - Allergy (dentifrice, preservatives, cinnamon, etc.)
56
which ulcerative lesions are only acute
- anesthetic necrosis - necrotizing sialometaplasia - primary herpetic gingivostomatitis - recurrent herpes labialis - recurrent intraoral herpes simplex - herpes zoster - hand-foot-and-mouth disease - necrotizing ulcerative gingivitis (NUG) - aphthous stomatitis - allergic contact stomatitis - erythema multiforme ---> pretty much everything not in the other categories
57
which ulcerative lesions can be acute or chronic
- traumatic ulcer - syphilis
58
which ulcerative lesions are only chronic
- mucous membrane pemphigoid - pemphigus vulgaris
59

Oral pathology (7 decks)

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