Chapter 9 Flashcards
Transient Lingual Papilliits - Localized
1+ enlarged papilla - red/yellow
Painful
Anterior doral tongue
Transient Lingual Papillitis - Generalized
Large percent of fungiform papilla involved
Tip and lateral dorsal tongue
Painful and sensitive
Recurrent Apthous Ulcerations - Minor
Most common form
Occurs in childhood
3-10 mm lesions
1-5 lesions
7-14 days healing time
No Scarring
Fewest recurrences
Recurrent Aphthous Ulcerations - Major
“Sutton’s Disease”
Occurs in adolescents
1-3 cm lesions
1-10 lesions
Healing time 2-6 weeks
Scarring is possilbe
More recurrences than minor, less than herpetiform
Recurrent Aphthous Ulcerations - Herpetic Form
Occurs in adults
1-3 mm lesions
Up to 100 lesions
Healing time 2-4 weeks
Scarring
Most recurrences
Treatment of Recurrent Aphthous Ulcerations
Minor cases = no treatment
Major cases, multiple recurrences = clobetasol proprionate (.05% steroid for pain)
Transient Lingual Papillitis
Diffuse papulokeratotic variant
Large number of affected papilla –> transient papillitis
All papilla affected - all over the otngue
Apearance: elevated, white or yellow
Asymptomatic
Treatment for Transient Lingual Papillitis
Resolve w/o therapy
Topical steroids reduce pain
Magic mouthwash - malox, benadryl, lidocaine viscous
Recurrent Aphthous Ulcerations
AKA Recurrent aphthous stomatitiis
Very Common - 30%
Occur exclusively on MOVABLE MUCOSA
Clinical variations: minor, major, herpetiform
Younger patients
Behcet’s syndrome
Chronic, recurrent immune disease
Includes:
Oral aphthous-like ulcerations
Ocular inflammation
Genital ulcers
Skin lesions
Arthralgia
Sarcoidosis
Multisystem granulomatous disorder
Afican Americans >>>> Caucasions
90% Abnormal x-ray
25% skin lesions on head and neck and lower legs
Syndromes:
Lofgren’s syndrome
Heerfordt’s syndrome
Syndromes of Sarcoidosis
Lofgren’s Syndrome
Erythema nodosum
Bilateral hilar lymphadeopathy
Arthralgia
Heerfordt’s Syndrome
Parotid Enlargment
Inflammation of the eye
Facial paralysis
Fever
Organs involved in Sarcoidosis
Lungs
Lymph nodes
Skin
Eyes
Salivary glands
Lupus pernio
Chronic, purple, indurated lesion on head and neck
Erythema nodosum
Scattered, nonspecific, tender, red nodules on lower legs
Sarcoidosis - Histology
Non caseating granulomatous inflammation
Schaumann bodies (degenerated lysosomes)
Asteroid Bodies (entrapped collagen fragments)
Hamazaki-Weseberg bodies (large lysosomes)
Sarcoidosis - Diagnosis
Elevated serum angiotensin-converting enzyme levels
Chest x-ray
Kveim test - no longer used
Orofacial Granulomatosis
Variable presentation
Lips are most commonly involved
If only lips are invovled = cheilitis granulomatosa
Syndrome - Melkersson-Rosenthal syndrome
Histology - granulomatous inflammation
Melkersson-Rosenthal Syndrome
Cheilitis granulomatosa
Facial paralysis
Fissured tongue
clobetasol proprionate
Used for treatment of major or recurring apthough ulcers
Skin lesion of Sarcoidosis
Lupus Pernio
Erythema Nodosum
Wegener’s Granulomatosis
Necrotizing granulomatous lesions of Respiratory tract, glomerulonephritis, systemic vascluitis
If untreated –rapid renal involement –> DEATH
Oral lesions
STRAWBERRY GINGIVITIS
Oral lesions of Wegner’s Granulomatosis
Early manifestation
Appearance: Florid, erythematous, granular hyperplasia
Diagnosis of Wegner’s Granulomatosis
Indirect inmmunofluorescence detects presence of antineutrophil cytoplasm antibodies
Perinuclear (p-ANCA)
Cytoplasmic (c-ANCA) – most useful
Treatment of Wegner’s Granulamostosis
STERIODS – first line tx (75% survival)
Untreated – 10% two year survival (necrotixing glomerulonephritis)
Contact Stomatitis from Cinnamon
Reactions associated with pronlonged or frequent contact (candy, chewing gum, toothpaste)
Gingiva can appear large and red –> plasma cell gingivitis
Superficial slough of tissue (similar to sodiun laryl-sulfate containing toothpaste)
Localized lesions –> ulcerated, white, red
Signs –> disappear within 1 week discontinued use
Angioedema
Quincke’s Disease
DIffuse edematous swelling of the soft tissue
No pain
Itching and erythema
Quick onset
common cause –> mast cell degranulation leads to histamine release
** IgE mediated hypersensitivity **
Diffuse involvement of the head and neck –> caused by angiotensin-converting enzyme (ACE) inhibitors
Treatment for allergic angioedema
Oral antihistamine therapy
IM epinephrine and IV corticosteriods for SEVERE cases
What are some angiotensin-converting enzyme inhibitors?
-prils (lisinopril)
Medication used for HTN or chronic heart failure
Swelling associated with these drugs do not respond well to antihistamines
Treatmen tof ACE inhbitor associated angioedema
Avoid all ACE inhbitor medications
monitor until swelling subsides
C1-INH concentrate
Anigioedema vs Orofacial granulomatosis
Angioedema -> quick onset
Orofacial (chelitis) granulomatosis –> slow onset
Recurrent apthough ulcers vs HSV
Recurrent apthous ulcers –> MOVABLE mucosa
HSV –> MOVABLE and ATTACHED mucosa
Where do Major RAU generally occur?
Labial mucosa
Soft pallate
Tonsillar faucets
