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Oral Pathology > Allergies and Immunologic Diseases > Flashcards

Allergies and Immunologic Diseases Flashcards

1
Q

also known as canker sores

A

recurrent aphthaous ulcerations

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2
Q

waht causes recurrent aphthaous ulcerations

A

-unknown pathogenesis, immune-mediated process

-

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3
Q

who is the most likely to get recurrent aphthalous ulcerations

A

-children and young adults

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4
Q

what are the possible triggers of recurrent aphthaous ulcerations

A

-stress, local trauma, menstrual cycle

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5
Q

what are the three clinical variations of recurrent aphthous ulcerations

A
  • minor
  • major
  • herpetiform
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6
Q

most commone form of recurrent aphthous ulcerations

A

minor aphthous ulcerations

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7
Q

what is the duration of minor aphthous ulcerations?

A

fewest recurrences and shortest duration of lesions

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8
Q

where do minor aphthous ulcerations occur/

A

EXCLUSIVELY on nonkeratinized mucosa

-buccal and labial mucosa, ventral tongue, floor of mouth and soft palate

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9
Q

what is the clinical signs of minor aphthous ulcerations?

A

1-5 PAINFUL ulcers, preceeded by erytheatous macule

-ERYTHEMATOUS HALO

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10
Q

What is the healing process like for minor aphthous ulcerations?

A

heal WITHOUT scarring 7-10 days

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11
Q

what is the rate of recurrence for minor aphthous ulcerations?

A

highly variable

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12
Q

larger than minor aphthous ulcers that are 1-3 cm in diameter that have 1-10 lesions per episode

A

major aphthous ulcerations

*NO RED HALO

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13
Q

what is the healing process like for major aphthous ulcerations?

A

longer duration per episode than minor, heal in 2-6 weeks often WITH scarring

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14
Q

what are the most common sites for major aphthous ulcerations?

A
  • labial mucosa
  • soft palate
  • tonsillar fauces
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15
Q

what is unique about herpetiform aphthous ulcerations?

A
  • greatest number of lesions and most frequent recurrences
  • rarely have time period where pt does not have ulcers
  • ANY oral mucosal surface
  • individual lesions small (1-3mm) with many present per episode
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16
Q

what does herpetiform aphthous ulcerations resemble?

A

superficial resemblence to primary HSV

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17
Q

what is the healing process for herpetiform aphthous ulcerations?

A

heal in 7-10 days but recurrences tend to be closely spaced

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18
Q

what is the major difference between primary herpes and herpetiform aphthae?

A

primary herpes = systemic symptoms

herpetiform aphthae = no systemic symptoms

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19
Q

what is the tx for recurrent aphthous ulcerations?

A

respond well to TOPICAL high - potency corticosteroids

*applied early in course of disease; thin film, multiple times per day

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20
Q

MULTISYSTEM disorder with oral aphthous-like ulcerations that has its highest prevalence in Middle East and Japan (much less frequency in US)

A

Bechet’s syndrome

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21
Q

what is the classic triad of Bechet’s syndrome

A
  • oral ulcerations
  • genital ulcerations
  • ocular disease
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22
Q

oral involvement of Bechet’s disease

A
  • first manifestation in 75% of cases
  • occurs in 99% of cases
  • commonly involves soft palate and oropharynx
  • variable size, ragged borders, large zone erythema
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23
Q

genital ulcerations of Bechet’s disease

A

similar in appearance to oral ulcerations

-occur in 75% of cases

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24
Q

ocular disease of Bechet’s disease

A
  • occur in 70-85% of cases

- posterior uveitis

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25
Q

how do you dx Bechet’s disease?

A

-clinical presentation and positive pathergy test

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26
Q

what is the tx for Bechet’s disease?

A

topical or systemic immunosuppressive or immunomodulatory therapy, early aggressive therapy for severe cases

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27
Q

what is the px for Bechet’s disease/

A

generally good

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28
Q

what causes orofacial granulomatosis?

A

unknown etiology, appears to represent an abnormal immune reaction

29
Q

who is affected by orofacial granulomatosis the most?

A

adults

30
Q

what is the clinical presentation of orofacial granulomatosis?

A

non-necrotizing granulomatous infammation, presenting as persistent non-tender swelling

31
Q

what is the location for orofacial granulomatosis?

A

lips most common site, may involve ANY oral mucosal or perioral location

32
Q

type of orofacial granulomatosis taht is involvement of the lips alone?

A

cheilitis granulomatosis

33
Q

type of orofacial granulomatosis that involves:

  • non-tender lip swelling
  • bell’s palsy
  • fissured tongue
A

meldersson-Rosenthal syndrome

34
Q

what is the tx for orofacial granulomatosis?

A
  • thorough medical eval
  • remove source of inflammation
  • INTRALESIONAL CORTICOSTEROIDS work best
  • multiple injections may be necessary
35
Q

what is the px for orofacial granulomatosis?

A

good

36
Q

granulomatosis that has polyangitis?

A

wegner’s granulomatosis

37
Q

is wegner’s granulomatosis common?

A

no but it is well-recognized

38
Q

where does wegner’s granulomatosis affect?

A
  • upper airway
  • lungs
  • kidneys
  • skin
  • mucosa
39
Q

how serious is wegner’s granulomatosis?

A

condition was uniformly fatal prior to development of current tx modalities

40
Q

type of wegner’s granulomatosis that involves the upper and lower respiratory tracts and kidneys

A

generalized wegner’s (classic wegner’s)

41
Q

type of wegner’s granulomatosis that affects the upper and lower respiratory tract only

A

limited wegner’s

42
Q

type of wegner’s granulomatosis that affects the lesions of primarily skin and mucosa

A

superficial wegner’s

43
Q

what is wegner’s granulomatosis characterized by?

A

“strawberry gingivitis”

44
Q

what are the two lab studies that can be used for wegner’s granulomatosis?

A

c-ANCA (cytoplasmic) = most useful

p-ANCA (perinuclear) = also seen in systemic vasculitidies

45
Q

what could happen to limited and superficial forms of wegner’s granulomatosis?

A

progress to classic wegner’s granulomatosis

46
Q

what is the clinical appearance of an allergic reaction to systemic drug/

A

oral mucosa ulceration and erosion with variable erythema and white stripes

47
Q

what re the most common sites for allergic reaction to systemic drugs

A
  • buccal mucosa
  • labial mucosa
  • ventro-lateral tongue
48
Q

inflammatory alterations that recur at the same site after the administration of a medication

A

fixed drug eruption

49
Q

medication induced mucosal alterations which mimic appearance of lichen planus

A

lichenoid drug reaction

50
Q

how do you dx an allergic rx to systemic drugs

A
  • biopsy (non-specific)
  • detailed medicinal and clinical history
  • serial elimination of the medications
  • mucoal alterations resolve after discontinue meds (recur on reintroduction)
51
Q

what is the tx for allergic reaction to systemic drugs

A

discontinue responsible meds in conjunction with pt physician +/- topical corticosteroids

52
Q

mild/barley visible erythema to extensive erythema, edema, erosions, ulcerations, and exfoliations

A

allergic contact stomatosis

*may be asymptomatic (burning, itching, stinging)

53
Q

how do you dx allergic contact stomatosis?

A
  • ID of temporal relationship between contact with agent and oral changes
  • patch testing (insert antigens under skin)
54
Q

what are the three aspects of allergic contact stomatosis?

A
  • dentrifice-realated sloughing
  • oral mucosal cinnamon reaction
  • lichenoid amalgam reaction
55
Q

what is dentrifice-related sloughing that is associated with allergic contact stomatosis?

A
  • toothpaste can cause widespread desquamation of the superficial layers of epithelium
  • minimal/mild erythema
  • associated with sodium lauryl sulfate
56
Q

what is the tx to dentrifice-related sloughing

A

no tx necessary, harmless process

-switching to a bland toothpaste will result in resolution

57
Q

what is oral mucosal cinnamon reaciton associated with allergic contact stomatosis?

A
  • contact reaction to artificial cinnamon flavoring
  • clinical distribution varies by medium of delivery
  • -toothpaste: diffuse, gingiva
  • -chewing gum/candy: localized
58
Q

what are the cliinical signs of oral mucosal cinnamon reaction

A
  • erythema with overlying shaggy hyperkeratosis

- pain and burning are common symptoms

59
Q

what is the tx of oral mucosal cinnamon rxs

A

resolution within one week following discontinuation of the cinnamon product

60
Q

what is a lichenoid amalgam reaction associated with allergic contact stomatosis?

A

associated with old amalga resotrations undergoing corrosion and release of metallic ions

61
Q

where does lichenoid amalgam reactions occur?

A

limited to mucosal surfaces directly in contact with the resotration

62
Q

what does the clinical presentation of lichenoid amalgam reactions look like?

A

may be white or erythematous, +/- peripheral striae

63
Q

what is the tx of lichenoid amalgam reations?

A
  • smooth, polish, recontour old amalgam

- replace amalgam with non-metallic resotration

64
Q

diffuse edematous swelling of soft tissue

A

angioedema

65
Q

what three things cause angioedema?

A
  • IgE mediated hypersensitivity reaciton (most common)
  • angiotension-converting enzyme (ACE) inhibitors
  • C1 esterase inhibitor deficiency
66
Q

what are the clinical features of angioedema?

A
  • relatively rapid onset of soft tissue swelling
  • non-painful, pruitus and erythema may be seen
  • solitary or multiple sites of involvement
  • commonly affects head and neck region
  • resolution in 24-72 hrs
67
Q

how do you dx angioedema?

A
  • clinical presentation (trigger)

- eval of C1-INH

68
Q

what is the tx of angioedema?

A
  • oral antihistamine, IV corticosteroids
  • prevention
  • ACE inhibitor related and C1-INH deficiency non-responsive to standard tx

Oral Pathology (9 decks)

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