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Oral Medicine > Colors of Oral Path > Flashcards

Colors of Oral Path Flashcards

1
Q

What is normal dependent on?

A
  1. Race dependent
  2. Location dependent
  3. Pink!
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2
Q

what is the “normal” pink caused by?

A
  1. epithelium is semi-transparent/pale white

2. extensive capillary bed beneath show through = pink

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3
Q

What is the darker red vestibular mucosa/FOM mucosa caused by?

A

nearness of vascularity to the surface

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4
Q

What causes the lighter pink on hard palate and attached gingiva?

A

increased thickness of overlying epithelium

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5
Q

DX: an intraoral white plaque that does NOT rub off and can not be identified as any well known entity

A

Leukoplakia
TX: When in doubt cut it out. Remove obvious frictional causes, biopsy after two weeks

  • alveolar ridge = frictional keratosis from denture
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6
Q

5 white lesions that CAN be scraped, rubbed or pulled off

A
  1. Materia Alba
  2. white coated tongue
  3. burn (thermal, chemical, cotton roll)
  4. pseudomembranous candidiasis
  5. toothpaste or mouthwash overdose
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7
Q

White coated Tongue

A

Aysmptomatic

Tx: tongue scraping or brushing

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8
Q

Pseudomembranous Candidiasis

A

TX: antifungal prescription
Nystatin (Mycostatin)
Clotrimazole (Mycelex)
Nystatin/trianicinolone acetonide ointment (Mycolog II)

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9
Q

Bilateral on buccal mucosa at occlusal plane from friction, sucking

A

Linea Alba “white line”

Tx: no treatment

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10
Q

Bilaterally present in 70-90% of Blacks; diffuse grayish-white milky opalescent appearance

A

Leukoedema
Tx: no treatment is necessary
make sure that disappears when the cheek is stretched

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11
Q

Caused by reverse smoking. Heat causes salivary gland orifices to open = red dots

A

Nicotine Stomatitis

tx?

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12
Q

soft, fissured gray-white lesion of the mucosa located in the area of chronic snuff placement

Usually young males, gingival recession and root caries

A

Tobacco Pouch Keratosis (smokeless tobacco pouch, snuff pouch, spit tobacco keratosis)
Tx: cessation of “dipping” and then need to check again. try and plug around to different sites. If doesn’t go away then BIOPSY.

  • can progress from dysplasia to verrucous carcinoma
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13
Q

most common lesion Caused by EBV in AIDS pts
In patients with HIV and AIDS
Sign of sever immune depression and advanced disease
White mucosal plaque that doesn’t rub off
Lateral border of tongue

A

Oral Hairy Leukoplakia

tx: treat AIDS

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14
Q

Whickham Striae
2 forms erosive and reticular

Chronic muco-cutaneous disease

4 Ps: Purple, pruritic, polygonal, papules

saw tooth rete ridge, band like lymphocyte inflitration

A

Lichen Planus

Treatment: Steroids (Temovate, decadron, lidex .05% ointment or gel)
biopsy erosive anywhere, maybe reticular on gingiva/tongue

Nikolsky Test: air/water syringe positive = pemphigus vulgaris, mucous membrane pemphigoid

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15
Q

What are the 4 levels of Leukoplakia?

A
  1. Normal
  2. Hyperkeratosis
  3. Epithelial Dysplasia
  4. invasive squamous cell Carcinoma
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16
Q

localized bony protuberance arising from the cortical plate

A

Torus Palatinus/Mandibularis
Tx: None unless,
1. repeated trauma and ulceration usually removed at patient’s request
2. preprosthetic surgery before complete or partial denture construction

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17
Q

most common: lips, tongue, buccal mucosa

1-2 lesions, .5-1 cm in diameter

Etiology: different things in different ppl –> autoimmunes, hypersensitivity, stress (THEORY)

A

Recurrent Apthous Ulcerations (major, minor, herpetiform)

TX: avoid food if that is causing the hypersensitivity

Temovate
Decadron
Lidex
Kenalog

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18
Q

unique form of chronic traumatic ulceration with deep pseudoinvasive inflammatory process and slow to resolve

A

TUGSE: traumatic ulcerative granuloma with stromal eosinophilia

TX.: incisional biopsy

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19
Q

inflammatory process that arises withing the tissues, surrounding the crown of a partially erupted tooth

A

Pericornitis

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20
Q

accumulation of acute inflammatory cells at the apex of a nonvital tooth

A

periodontal abscess

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21
Q

Most common benign neoplasm of the oral cavity on buccal mucosa > labial mucosa > tongue> gingiva

Reactive hyperplasia of fibrous connective tissue in response to local irritation or trauma

A

Fibroma

tx: surgical excision

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22
Q

Ectopic sebacceous glands on buccal mucosa and then lips

A

Fordyce Granules

No treatment

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23
Q

benign proliferation of blood vessels

10-12% children

clinically blanches under pressure

10-12% children

Syndromes: SturgeWeber Angiomatosis

A

Hemangioma

Tx: surgery, laser, embolization,
clinical observation, removal, sclerotherapy

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24
Q

Benign proliferation of squamous epithelium (HPV 6 & 11) on tongue > soft palate

A

Papilloma

Tx: surgical excision

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25
Q

variations of papilloma

A

Verruca vulgaris,
Condyloma Acuminatum,
Focal Epithelial Hyperplasia,
Sinonasal papilloma

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26
Q

Focal inflammatory fibrous hyperplasia at the flange of an ill fitting denture

Single or multiple folds of tissue in the vestibule

A

Epulis Fissuratum

TX: surgical excision with relining or remaking of the denture

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27
Q

superficial dilated veins not associated with HTN or cardiopulmonary disease

Most common sublingual

A

Varicosities (sulingual varix)

Tx: NONE, unless solitary varicosities on the lips or buccal mucosa because of thrombus formation or esthetics

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28
Q

numerous grooves or fissure on the dorsal tongue, 2-6 mm deep with unknown cause (possibly hereditary)

A

Fissured Tongue

Tx: brush the tongue

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29
Q

Inflammatory condition: asymptomatic with rare cases of sensitivity to hot or spicy foods

A

Geographic Tongue

Tx: None unless symptomatic and then use magic mouthwash

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30
Q

denture papillomatosis: reactive tissue growth that develops under a denture

in patients with ill fitting denture, poor denture hygiene and wearing denture 24 hrs a day

A

Papillary Hyperplasia

tx: surgical excision (scapel, electro-cryo-laser surgery) then reline or remake of the denture

possible antifungal tx…??

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31
Q

Initial exposure of HSV 1/2 between 6 mos- 5 years of age

A

Acute Herpetic Gingivostomatitis

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32
Q

Labialis, intraoral recurrent, whitlow, keratoconjuctivitis

A

Recurrent Herpetic Infections

dx: serology, virus isolation, biopsy, cytology

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33
Q

Herpes Treatment

A

Acyclovir 5% ointment (zorivax), 15 gm tube apply 5x daily with finger at first symptom

Acyclovir 200 mg capsules. dispense 50 and take 1 cap 5x daily

Start during prodromal stages

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34
Q

rupture and spillage of saliva into the soft tissue related to trauma

MC in lower lip

A

Mucocele (Ranula in FOM)

TX; surgical excision along with the feeder gland

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35
Q

Post trauma and post surgical locations

A

Scar tissue

Tx: NONE

36
Q

“Perleche” fungal infection at corners of the mouth
20% candida albicans
20 % staphylococcus aureus alone
60% combination of both

Causes reduced vertical dimension, salivary pooling, candidiasis

A

Angular Cheilitis

TX: antifungals+ multivitamins
Mycolog 2: nystatin and triaincinolone acetonide ointment
Disp 15 gm apply sparingly to affected areas 4xday

increase the vertical dimension

37
Q

Lymphoid hyperplasia on the posterior lateral borders of the tongue, bilateral

A

Lingual Tonsil

TX: None

38
Q

Accumulation of blood within the tissues secondary to trauma

Does not blanche

A

Hematoma

Tx: none

39
Q

Chronic Cheek biting

2F: 1M

A

Morsicatio buccarum, labiorum, linguarum

Tx: none or bite guard

40
Q

Bony protuberances on the buccal of the mandible and/or maxilla

A

Buccal Exostoses

Tx: Removal only with chronic repeated trauma or preprosthetic surgery

41
Q

implantation of dental amalgam into oral soft or hard tissue

A

Amalgam Tattoo

tx: none, however radiograph and then biopsy may be necessary to rule out melanoma

42
Q

focal melanosis “oral freckle”
Solitary well-demarcated tan to dark macule
Melanin pigmentation is in the basal cell layer
lower lip > buccal mucosa > gingiva

A

Oral Melanotic Macule

tx: none, however biopsy may be indicated to rule out melanoma

43
Q

central papillary atrophy of the tongue; asymptomatic erythematous zone in the midline posterior dorsal tongue.

form of erythematous candidiasis

A

Median Rhomboid Glossitis

tx: antifungals and brushing of the tongue

44
Q

elongation and retention of the filiform papillae often due to increase keratin production and decrease in keratin desquamation. many pts are heavy smokers, bad hygiene, ABX, radiation therapy

A

Black Hairy Tongue

tx: tongue brushing/scraping with OHI is adequate tx

45
Q

from pernicious anemia, medication, avitaminosis

A

Smooth Red Tongue

Tx: find the underlying cause and stop it

46
Q

Skin cysts associated with inflammation of a hair follicle.
Oral cysts occur in the midline of the FOM
Slow growing, painless, rubbery mass

A

Epidermoid Cyst

Tx: surgical removal

47
Q

Benign tumor of fat more likely on buccal mucosa > tongue : FOM > lips

A

Lipoma

tx: surgical excision, place in formalin and see if it floats

48
Q

Thickened epithelial white lesions?

A

Hyperkeratosis, acanthosis, dysplasia, carcinoma

49
Q

White lesions from decreased vascularity?

A

Anemia (palor)

50
Q

white lesions from increased collagen

A

submucous fibrosis

51
Q

What causes red lesions?

A

Thinner epithelium, increased vascularity, dissolution of the collagen content of the subepithelial tissue.

52
Q

Wright’s Lesion full name?

A

Localized juvenile spongiotic gingival hyperplasia

53
Q

What causes blue lesions?

A

Venous blood collection as opposed to the red of arterial blood collection, tyndall effect, medications (antimalarial agents, lupus erythematosis, RA)

54
Q

What causes black lesions?

A

Melanin (pigment produced by cells called melanocytes. acs as a sunscreen and protects skin from UV light), heavy metals (amalgam, iron, bismuth)

55
Q

What causes brown lesions?

A

Melanin, hemosiderin (yellowish brown granular pigment formed by breakdown of hemoglobin, found in phagocytes)

56
Q

What causes yellow lesions?

A

Adipose tissue, sebaceous material (skin oil) as noted in fordyce granules, pus as it is a collection of necrotic material, PMNs, and lymphocytes

57
Q

Order of colors

A

White > Red> Black > Blue> Yellow

58
Q

Snuff Dipper’s Cancer
low-grade variant of oral SCC
can be caused by smokeless tobacco

mandibular vestibule and gingiva

A

Verrucous Carcinoma

tx. surgical excision without neck dissection

59
Q

Differential for desquamative gingivitis?

A

Lichen planus, Mucous membrane pemphigoid, pemphigus vulgaris, hypersensitivity, systemic lupus erythematosus

60
Q

What is the Rx for Temovate?

A

Clobetasol Proprionate Gel, .05%
Disp: 15 or 30 gm tube
Sig: dry the affected area and gently apply a thin amount bid-tid
highest potency
If only 1 ulcer heal within a weak– no refills!
Use: lichen planus, desquamative gingivits, RAU

61
Q

What is the Rx for Decadron?

A

Dexamethasone elixir .5 mg/5 ml
Disp: 12- 16 oz (2 100 ml bottles)
Sig: rinse with 1 tsp for 3-4 min after meals and at bedtime and spit out
Usually about 3 refills
moderate potency steroid
Rinse! WHEN ulcers all over the mouth, or back down to soft palate
Use: lichen planus, RAU

62
Q

What is the Rx for Lidex?

A

Fluocinonide .05 % gel
disp: 15 or 30 gm tube
Sig: dry the affected areas and gently apply a thin amount 3-4 times daily
moderate potency
Warn about the black box–> the amount using intraorally is okay

Use: lichen Planus, RAU

63
Q

acute or chronic trauma can cause surface ulcerations

A

traumatic ulceration

Tx: Intralesional Injections w Kenalog when topicals don’t work
steroid + antibiotics
Kenalog 10 (10 mg/ml), Kenalog 40 (40 mg/ml)
10 mg per cm of lesional tissue
1 ml of Kenalog 10 for 1 cm or .25 ml of kenalog 40

Triamcinolone Acetonide .5 %

64
Q

what is the treatment for desquamative gingivitis?

A

Biopsy for confirmation, topical steroids

65
Q

What is the Rx for Prednisone?

A

If GEL not working and it is systemic for pemphigoid, pemphigous, lichen planus

10 mg tabs
Disp: 40
Sig: 2 tabs bid for 7 days, then 1 tab bid for 4 days, then 1 tab daily till gone

66
Q

denture wearer and doesn’t take out and clean at night and get candidiasis underneath.
Types of Erythematous candidiasis

A

Denture Stomatitis

67
Q

What are the various forms of candidiasis?

A
  1. White pseudomembranous, Erythematous (central papillary atrophy of tongue/ median rhomboid glossitis, angular cheilitis, denture stomatitis)
68
Q

What is the Rx for Nyastatin rinse Mycostatin?

A

Nystatin Oral suspension 100,000 units/ml
disp: 180 ml
Sig: rince with 1 tsp for 3-4 mine qid and expectorate or swallow if affecting soft pharynx

69
Q

What is the Rx for Mycolog II ointment?

A

Triamcinolone .1% and Nystatin 100,000 units/gram ointment

disp: 15 gm/tube
sig: apply sparingly to affected areas qid

If recurrs frequenlty then use a 30 gm tube

70
Q

What is the Rx for Mycelex troche?

A

Clotrimazole troche 10 mg

disp: 50
sig: dissolve 1 tab slowly in mouth 5x daily

Use: when patient have fungal infection but has active caries or dry mouth .

71
Q

Enlargement of lymphoid tissue typically due to infection

A

Lymphoid Hyperplasia

tx: asymmetry is potentially serious sign. usually biopsy if necessary to establish dx. Once dx confirmed no tx required

72
Q

Intraoral red patch that cannot be clinically diagnosed as any other condition.

MC: FOM, tongue, soft palate

A

Erythroplakia

73
Q

If there is pigmentation limited canine to canine on a white patient what is it?

A

Smoker’s Melanosis

74
Q

benign localized proliferation of cells from the neural crest

A

Intramucosal nevus

75
Q

acquired pigmentation of the oral mucosa that appears to be reactive process due to trauma that results in melanoctes throughout epithelium

MC: buccal mucosa
in African Americans

A

Oral Melanoacanthoma

Incisional biopsy is indicated to rule out melanoma

No further tx necessary, lesions can regress

76
Q

malignant neoplasm of melanocytic origin that arises from a benign melanocytic lesion or de novo from melanocytes within otherwise normal skin or mucosa

Damage from UV radiation is a major causative factor (also fair complexion, light hair, sunburn easy, painful sunburns as child,

A

Melanoma

Tx: Surgical excision is the treatment of choice with a 3-5 cm margin

77
Q

epithelium lines cavity that arises from salivary gland tissue. most often in parotid gland, FOM, buccal mucoa, lips

Bluish from the tyndall effect

A

Salivary Duct Cyst

Tx: Surgical excision

78
Q

Uncommon benign proliferation of dermal melanocytes

Appears blue due to tyndall effect

A

Blue Nevus

tX: conservative surgical excision with minimal chance of recurrence

79
Q
  • most common malignant salivary neoplasm
  • most common malignant salivary gland tumor in children
  • affect parotid most often then minor glands
  • blue
A

Mucoepidermoid Carcinoma

80
Q

Develops within oral lyphoid tissue on (FOM, ventral tongue, soft palate) and presents as a white or yello asymptomatic submucosal mass less than 1 cm in diameter

A

lymphoepithelial cysts

Tx: Biopsy or clinical diagnosis

81
Q

benign soft tissue neoplasm that show a predilection for the oral cavity. Most common site is the tongue (dorsal)

Yellow, mucosal colored, in African Americans

A

Granular Cell Tumor

82
Q

Dry mouth
medications: antidepressants, antianxiety, beta blocker
Sleep aids like ambient

A

Xerostomia

Tx: Biotene Products, Mouth Kote
1. Sip water during day 2. suck on ice 3. discontinue alcohol, caffeine, soda 4. humidifier at night 5. lubricate lips 6. Fl supplementation

83
Q

What is the Rx for Salagen?

A

Pilocarpine 5 mg tablets
disp. 90 tablets
Sig: 5 mg TID for first month and then titrating to max dose of 30 mg per day depending upon response and tolerance

Use: DRY MOUTH from radiation/chemo, sjogren’s syndrome

Meds with anticholinergice effects counteract (benadryl, antidepressants)

84
Q

What can be used for dry lips?

A
  1. chapstick
  2. aquaphor
  3. blistex complete
  4. lanolin
85
Q

what is the Rx for abreva?

A

Docosanol 10% cream

non prescription product that comes in a 2 gram tube. a thin amount is applied to the affected are 5x a day

86
Q

Burning Mouth Treatment

A
  1. lubrication
  2. candidiasis treatment
  3. nutritional treatment (B12, Folate, Iron, Zinc)
  4. diabetic control
  5. eliminate triclosan/tarter control products
  6. switch hypertensive medication if on ACE- inhibitor
  7. clonazepan .5 mg tablet. Start with dissolving half a .5 mg tab bid and slowly increase to 1 mg bid *2 tabs)
  8. alpha lipoic acid
  9. capsaicin
87
Q

What is the Rx for Magic mouthwash?

A

equal parts maylox, benadryl, lidocaine vious 2 %
soothes and calms
Disp 240 ml
Sig: rinse with 1-2 tsp for 2 min and expectorate

Oral Medicine (1 decks)

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