Chapter 9 Flashcards
What term describes clinical alterations involving variable fungiform papilla?
Transient lingual papillitis
What are the 3 forms of transient lingual papillitis?
Localized, generalized and diffuse, papulokeratotic variant
What is localized transient lingual papillitis?
When one to several fungiform papilla are involved
Where does localized transient lingual papillitis occur?
Usually anterior dorsal tongue
What is generalized transient lingual papillitis?
When a large percentage of fungiform papilla are involved
Where does generalized transient lingual papillitis commonly occur?
Tip and lateral dorsal tongue
What is generalized transient papillits associated with?
Fever and lymphadenopathy
What is diffuse transient lingual papillitis?
When a large number of affected papilla
What is different about diffuse transient lingual papillitis?
It is asymptomatic
What is the treatment for all 3 forms of transient lingual papillitis?
All 3 forms resolve without therapy, but for symptomatic forms (localized and generalized), topical steroids may reduce pain or duration
What is one of the most common oral mucosal pathoses?
Recurrent aphthous ulcerations
What is the cause of recurrent aphthous ulcerations?
No universal etiology, but it seems to be an allergy or immune dysfunction of some sort
Where do recurrent aphthous ulcers occur?
Occur exclusively on movable mucosa (EXCEPT in immunocompromised patients)
What are the 3 clinical variations of recurrent aphthous ulcerations?
Minor (85%)
Major (10%)
Herpetiform (5%)
In what age population does recurrent aphthous ulcerations occur?
Occur in younger patients
What is the most common form of recurrent aphthous ulcerations?
Minor RAU
At what age does minor recurrent aphthous ulceratiosn commonly occur?
Occurs in childhood
What is the duration of minor recurrent aphthous ulcerations?
7-10 days
What do lesions clinically present as in minor recurrent aphthous ulcerations?
Lesions present as erythematous macules followed by a central yellow-white, removable fibrinopurulent membrane
How big are minor recurrent aphthous ulcers?
Less than 1 cm
How many lesions per episode occur with minor recurrent aphthous ulcerations?
1-5 lesions per episode
What form of recurrent aphthous ulcerations occurs more in adolescents, are larger, and have a longer duration?
Major recurrent aphthous ulcerations
What is the duration of major recurrent aphthous ulcerations?
2-6 weeks
How big are major recurrent aphthous ulcers?
1-3 cm, so they may cause scarring
How many lesions per episode occur with major recurrent aphthous ulcerations?
1-10 lesions per episode
What tissues are commonly involved in major recurrent aphthous ulcerations?
Labial mucosa, soft palate, tonsillar fauces
What form of recurrent aphthous ulcerations has the highest number of recurrences and lesions?
Herpetiform recurrent aphthous ulcerations
In what age population does herpetiform recurrent apthous ulcerations occur?
Occurs more commonly in adults, and more commonly in females
How big are herpetiform recurrent aphthous ulcerations?
1-3 mm
How many lesions per episode occur with herpetiform recurrent aphthous ulcerations?
Up to 100 lesions per episode
What is the duration of lesions in herpetiform recurrent aphthous ulcerations?
7-10 days
Which form of recurrent aphthous ulcers are said to be most painful?
Herpetiform recurrent apthous ulcerations
What is the treatment of recurrent aphthous ulcerations?
Minor cases receive treatment, but if patient present with multiple recurrences, many lesions or intense pain, a topical corticosteroid can be prescribed (but can result in a yeast infection)
What term describes a chronic, recurrent immune mediated disease with oral aphthous like ulcerations, ocular inflammation, genital ulcers and skin lesions?
Behcet’s syndrome
What is an additional common complaint associated with Behcet’s syndrome
Joint pain (arthralgia, enlarged joints)
Where is Behcet’s syndrome common?
Turkey, Japan, East Mediterranean
What is the treatment for Behcet’s syndrome?
Systemic and topical steroids
What term describes a multisystem granulomatous disorder of unknown cause?
Sarcoidosis
What population is most commonly affected by Sarcoidosis?
African Americans (about 10x more prominent)
What organs are most commonly involved in sarcoidosis?
Lungs, lymph nodes, skin , eyes, salivary glands
What will 90% of chest X-rays show in sarcoidosis?
Granulomas - like TB
What term describes chronic, purple, indurated skin lesions assoicated with sarcoidosis?
Lupus pernio
What term describes the scattered, non specific, tender, red nodules on lower legs associated with sarcoidosis?
Erythema nodosum
What 2 syndromes are associated with Sarcoidosis?
Lofgren’s syndrome, Heerfordt’s syndrome
What are the 3 parts associated with Lofgren’s syndrome?
Erythema nodosum, bilateral hilar lymphadenopathy, arthralgia
What are the 4 parts associated with Heerfordt’s syndrome?
Parotid enlargement, inflammation of the eye, facial paralysis and fever
How is sarcoidosis diagnosed?
Elevated serum angiotensin-converting enzyme levels, and a chest x-ray. Kveim test is not longer used.
What is the treatment and prognosis of sarcoidosis?
60% resolve spontaneously in 2 years, corticosteroids if patients have progressive disease, 5-10% succumb to disease (organ failure)
What term describes non-tender, persistent swelling of the face?
Orofacial granulomatosis
What term describes when only the lips are involved in orofacial granulomatosis?
Cheilitis granulomatosa
What tissue is most commonly involved in orofaical granulomatosis?
Lips are most commonly involved
What syndrome is associated with orofacial granulomatosis?
Melkersson-Rosenthal syndrome
What are the 3 parts associated with Melkersson-Rosenthal syndrome?
Cheilitis granulomatosa, facial paralysis, fissured tongue
Is the granulomatous inflammation associated with orofaical granulomatosis caseating or non-caseating?
Non caseating
What term describes a condition withe necrotizing granulomatous leisons of the respiratory tract, necrotizing glomerulonephritis and systemic vasculitis or small arteries and veins?
Wegener’s granulomatosis (Classic form)
If untreated, Wegener’s granulomatosis can rapidly involve which organ system?
Renal involement, which is the most common cause of death
How is limited Wegener’s granulomatosis different from the classic form?
Upper respiratory tract is involved, with no renal lesions
How is superficial Wegener’s granulomatosis different from the classic form?
Lesions occur primarily on the skin and mucosa
What term describes the oral lesions associated with Wegener’s granulomatosis?
Strawberry gingivitis
Strawberry gingivitis is typically an ______ manifestation of Wegener’s granulomatosis.
An early manifestation of Wegener’s granulomatosis
How is Wegener’s granulomatosis diagnosed?
Indirect immunofluorescence detects presence of antineutrophil cytoplasm antibodies
What are the 2 types of antineutrophil cytoplasm antibodies and which one is more useful?
Perinuclear antineutrophil cytoplasm antibodies, and cytoplasmic antineutrophil cytoplasm antibodies (c-ANCA is more useful)
What is the treatment and prognosis for Wegener’s disease?
If untreated, 10% 2 year survivial, Tx = steroids but 30 % relapse… chance of curing is higher is caught early and treated
What term describes an allergic reaction to cinnamon causing sloughing, and ulcers?
Contact stomatitis from cinnamon
What products are most commonly associated with contact stomatitis?
Candy, chewing gum, toothpaste (usually sodium lauryl sulfate)
What ingredient is usually the cause of contact stomatitis from cinnamon and why does it cause a reaction?
Cinnamaldehyde, it is 100x more concentrated that the natural spice
How do clinical presentations vary based on the cause of contact stomatitis?
Toothpaste will cause a more diffuse form of contact stomatitis while gum/candy will cause a localized form of contact stomatitis
How is contact stomatitis treated?
No treatment, sings and symptoms disappear withing 1 weeks of discontinuation
What term describes diffuse, painless edematous swelling of the soft tissues?
Angioedema
What is another name for angioedema?
Quincke’s disease
What is the cause of angioedema?
It is a IgE-mediated hypersensitivity reaction (mast cell degranulation= histamine release)
Where does angioedema commonly occur?
On the extremities
What is the treatment for allergic angioedema?
Oral antihistamine therapy (IM or IV in severe cases)
Diffuse involvement of angioedema in the head and neck can be caused by ______ _____ _____.
Angiotensin-converting enzyme inhibitors (such as Lisinopril, which is medication for HTN/chronic heart failure)
In what population is angiotensin-converting enzyme inhibitor associated angioedema more common?
4x more common in African American than Caucasians
How is angiotensin-converting enzyme inhibitor assoicated angioedema treated?
Avoiding all medications in this class of drugs, monitor swelling. Does not respond will to antihistamines, but some respond to C1-INH concentrate
