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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
Q

traumatic ulcer category

A

injury

26
Q

traumatic ulcer etiology

A

some form of injury (biting, neighboring sharp tooth, puncture, etc.)

27
Q

traumatic ulcer demographics

A

broad age range

28
Q

traumatic ulcer clinical presentation

A
  • 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
Q

traumatic ulcer diagnosis

A

if lesion persists beyond 2 weeks, biopsy to rule out squamous cell carcinoma

30
Q

traumatic ulcer tx

A
  • remove source of trauma
  • heals with time
31
Q

syphilis category

A

infectious

32
Q

syphilis etiology

A
  • 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
Q

syphilis demographics

A

broad range

34
Q

primary syphilis clinical presentation

A
  • Chancre
    –> solitary, papular lesion with central ulceration
    –> 85% genital, 4% oral
  • regional lymphadenopathy
  • symptoms resolve in a few days, even without treatment
35
Q

secondary syphilis (disseminated) clinical presentation

A
  • 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
Q

secondary syphilis systemic symptoms

A
  • painless lymphadenopathy
  • sore throat
  • malaise
  • headache
  • weight loss
  • fever
37
Q

tertiary syphilis clinical presentation

A
  • 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
Q

T/F oral manifestations of syphilis can mimic many other conditions

A

True

39
Q

syphilis diagnosis

A
  • 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
Q

syphilis treatment

A

antibiotics (penicillin)

41
Q

mucous membrane pemphigoid category

A

immune-mediated

42
Q

mucous membrane pemphigoid etiology

A

autoantibodies against hemidesmosomes and components of basement membrane

43
Q

mucous membrane pemphigoid demographics

A

older adults (50-60 yeras)

44
Q

mucous membrane pemphigoid clinical presentation

A
  • 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
Q

what is a positive nikolsky sign and when is it seen

A
  • firm lateral pressure on intact mucosa causes epithelial separation
  • seen in mucous membrane pemphigoid and pemphigus vulgaris
46
Q

what else can occur with mucous membrane pemphigoid

A
  • symblepharon formation from conjunctival involvement can lead to blindness
  • must provide ophthalmology referral
47
Q

mucous membrane pemphigoid diagnosis

A
  • 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
Q

mucous membrane pemphigoid treatment

A
  • 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
Q

pemphigus vulgaris category

A

immune mediated

50
Q

pemphigus vulgaris etiology

A

autoantibodies against components of desmosomes

51
Q

pemphigus vulgaris demographics

A

middle-aged adults

52
Q

pemphigus vulgaris clinical presentation

A
  • ulceration of any oral mucosal surface (predilection for palate)
  • may present with desquamative gingivitis
  • may have skin involvement
  • positive NIkolsky sign
53
Q

pemphigus vulgaris diagnosis

A

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
Q

pemphigus vulgaris treatment

A
  • 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
Q

desquamative gingivitis differential diagnosis

A
  • Lichen planus (erosive or atrophic)
  • Pemphigus vulgaris
  • Mucous membrane pemphigoid
  • Allergy (dentifrice, preservatives, cinnamon, etc.)
56
Q

which ulcerative lesions are only acute

A
  • 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
Q

which ulcerative lesions can be acute or chronic

A
  • traumatic ulcer
  • syphilis
58
Q

which ulcerative lesions are only chronic

A
  • mucous membrane pemphigoid
  • pemphigus vulgaris
59
Q
A

Oral pathology (7 decks)

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