Chapter 76 Biology and Pathology of the Oral Cavity Flashcards
oral ulcer appears as a yellow–white papule or plaque of ____ (often referred to as a “pseudomembrane”), usually with a surrounding red rim
fibrin
Recurrent aphthous ulcer (RAU) is a ____-mediated disorder and _____ plays an important role in its occurrence
T-cell-
tumor necrosis factor (TNF)-α
____, ____, _____ predisposes to their occurrence in susceptible individuals
Stress, systemic illness, and local trauma
Aphtheiform ulcers are aphthous-like in their appearance and history but they may occur sometimes on the ______ if they are a result of ____ or _____
dorsum of the tongue
hematinic deficiency or IBD
RAU are seen in all patients with _____ disease and may precede other findings by years.
a vasculitic disorder, has a predilection for ____ and ____ populations and is associated with an increase in ____
Behçet disease
Turkish and Japanese
HLA-B51
Approximately 3% of patients with RAU have ______ and some show sensitivity to foods and _______
gluten-sensitive enteropathy
sodium lauryl sulfate
Idiopathic RAU occurs in 15–20% of the population beginning in the _____ of life and the disease generally becomes less severe over the age of ___
second decade
50
Minor ulcers ______; the most common form.
Major ulcers _______
Herpetiform ulcers_______
Severe aphthous ulcers where patients have minor ulcers but with _______
<1 cm, 1–10 at each episode lasting 1–2 weeks
> 1 cm lasting several weeks and healing with scarring
<1 cm, usually 0.1–0.5 cm each, >10 clustered ulcers at each episode, lasting 1–2 weeks
continuous ulcerations with minimum or no ulcer-free days for months
Idiopathic RAU are almost always con ned to the ______ mucosa
nonkeratinized
Differential Dx of RAU
Traumatic lesions
chemotherapy- and neutropenia-associated
Herpetic ulcers
Biopsy of RAU
nonspecific and shows only a fibrin membrane with acute and chronic inflammation and granulation tissue, but may exclude an infectious etiology
treatment for minor RAU is ____ or ____ if the ulcers are large and persistent, especially those of aphthous major or in patients with HIV disease
topical steroids or intralesional steroid injection
Systemic therapy with ____ for a few weeks and maintenance with _______ may reduce the number, duration and size of ulcers, and reduce the number of episodes
prednisone
pentoxifylline
most common bowel diseases associated with oral ulcers are ____, _____, _____ leading to hematinic deficiency, and celiac disease
Crohn disease, ulcerative colitis, malabsorption syndromes
Ulcers of Crohn disease typically present as ___ lesions along the ___________
reliable finding is a dusky-red firm area of the _____ skin that has a slight pitted, “orange peel” appearance
linear
maxillary and mandibular vestibule/sulcus
perivermilion
patients often also present with papulous folds of tissues, swelling of the lips (indistinguishable from cheilitis granulomatosa), and cobblestoning of the mucosa
______ (oral analog of pyoderma gangrenosum) associated with inflammatory bowel disease presents as ______ ulcers of the oral mucosa
Pyostomatitis vegetans
“snail-track”
Elevated _____ and the presence of ____ support the diagnosis of celiac disease
tissue transglutaminase
endomysial antibodies
biopsy of oral lesions of Crohn disease shows ______ or while pyostomatitis vegetans shows ______
granulomatous inflammation
acantholysis
Chemotherapy Agents often associated with chemo associated ulcerative mucositis include ____ and _____, especially when combined with ______
cytarabine and cisplatin
radiation
ulcers (chemo associated ulcerative mucositis) are generally located on the _____ sites and in particular the _____ and _____
nonkeratinized
buccal mucosa and ventral tongue
They begin within 3–5 days of the start of chemotherapy and generally resolve when absolute neutrophil counts recover, usually a course of 7–10 days.
Lesions are extremely painful and may measure several centimeters in size
Patients (chemo associated ulcerative mucositis) are often treated with ________ to reduce the period of neutropenia and this has reduced the frequency of such ulcers
granulocyte-colony-stimulating factor
Topical analgesia such as viscous _____ and systemic analgesia (especially _____) is the mainstay of pain control
lidocaine
narcotics
_______ seen usually in patients who have diabetes mellitus (usually ketoacidotic) or are immunocompromised, and are often life threatening
Mucor and Rhizopus infections
Organisms are inhaled and spread into the adjacent sinuses, eroding through the bone, sometimes presenting on the palate as a necrotic ulcer, a condition also referred to as _______
rhinocerebral zygomycosis
_______ are seen in neutropenic patients, especially those with leukemia and tend to present as necrotic soft tissue and bony lesions of the gingiva, while histoplasmosis, coccidioidomycosis, blastomycosis, and paracoccidioidomycosis are seen in areas where such infections are endemic such as in South America and in patients with _______
Aspergillus infections
HIV/AIDS
deep fungal infections usually present as ____ because they are _____ organisms that cause vascular _______
necrotic ulcers
angioinvasive
thrombosis and ischemia
most common location for rhinocerebral zygomycosis is the ______
palate
Treatment (zygomycosis) is with systemic antifungal agents such as ______ and triazole antifungal agents such as _____, _____, _____ often with surgical debridement
liposomal amphotericin
fluconazole, itraconazole, and posaconazole,
Oral ulcers in infectious mononucleosis in young adults; nasopharyngeal carcinoma in older adults, hairy leukoplakia in patients with HIV/AIDS
HHV-4 (Epstein Barr)
Oral ulcers; may be seen associated with HSV ulcers; usually in immunocompromised patients
HHV-5 (cytomegalovirus)
Kaposi sarcoma; usually seen in patients with HIV/AIDS
HHV-8
_______ tend to be well demarcated at least around part of the lesion, are frequently dysplastic at rst biopsy, and carry a significant potential for developing into SCC over time
True leukoplakias
________ is an extremely rare condition, inherited in an autosomal _______ fashion. It affects the ____ and ____ mucosa, usually in a symmetric and often multifocal pattern, due to mutation in keratin _____ that results in keratin instability and abnormal keratin aggregation
Biopsy or exfoliative cytology is always indicated and shows_______________ (representing abnormal keratin aggregation)
White sponge nevus dominant oral and genital K4 or K13 perinuclear eosinophilic condensations
poorly demarcated, diffuse, painless white plaques on the oral mucosa, usually the buccal mucosa and tongue, usually within the first two decades of life
Tx of white sponge nevus
tetracycline
postulated to affect the keratinization process and inhibits epithelial proliferation
______ occurs in 20%–70% with habits such as using tobacco, coca, or marijuana to >90% of dark- skinned individuals mainly because the whiteness of the lesion shows up more clearly on pigmented mucosa
Stretching the mucosa completely eliminates these fine lines since this is not a keratotic lesion, but rather caused by__________
Leukoedema
intracellular edema of damaged superficial keratinocytes
usually bilateral on the buccal mucosa or ventral tongue and consist of painless, fine grayish white, opalescent reticulations
no Tx
smoking cessation
________ common oral condition, where the injury to the tissue is slightly more severe than in leukoedema causing actual degeneration and detachment of the superficial keratinocytes
offending agents are mouthwashes and toothpastes that are caustic [in particular Listerine (Pfizer Pharmaceutical, NY) mouthwash that contains ___, ____, ____
Contact desquamation
27% alcohol, eucalyptol and menthol
often report that their mouth is “peeling.” Lesions present as painless sloughs of desquamated tissue that lie in thin ribbons on the mucosa and can be removed without pain or discomfort to the patient, with normal-appearing, pink underlying tissue
_______
white papules and plaques on either side of the linea alba on the buccal mucosa, lower labial mucosa, or the lateral tongue, usually caused by raking of the teeth over the mucosa
A biopsy shows varying degrees of ____ with _____ and benign epithelial hyperplasia.
Morsicatio Mucosae Oris
parakeratosis with impetiginization
more intense local factitial injury to the oral mucosa, caused by a chewing habit, leading to reactive keratosis and benign epithelial hyperplasia. It occurs in 3% of the population
_____ poorly demarcated, painless white papules and plaques, often with a rough surface, usually less than 1 cm in greatest dimension
The most common location is the _______ (at the site of previously extracted wisdom teeth) and other areas where teeth have been extracted
Benign Alveolar Ridge Keratosis
retromolar pad
occurs primarily on the keratinized mucosa of the gingiva and hard palate as a reaction to frictional trauma
_____
palate of adult patients is the site most often affected. It is diffusely white with red, punctuate areas representing the openings of salivary ducts
development of ______ areas should raise suspicion for malignant transformation
Nicotinic stomatitis
raised, indurated
not caused by nicotine as its name suggests but rather by heat, usually from pipe smoking
______ results from a combination of direct contact toxicity of the smokeless tobacco on the mucosa (early lesions), and from effects of carcinogens within the snuff, namely tobacco-associated ______ (late lesions that represent true leukoplakias)
Biopsy reveals thin parakeratosis, intracellular edema, and devitalization of _________
Smokeless tobacco keratosis
nitrosamines
superficial keratinocytes
lesions are located where the snuff is placed, usually the mandibular sulcus/vestibule, between the teeth and the buccal mucosa. The area looks grayish white, opalescent, and wrinkled, often with fissures
