Colors of Oral Path Flashcards
What is normal dependent on?
- Race dependent
- Location dependent
- Pink!
what is the “normal” pink caused by?
- epithelium is semi-transparent/pale white
2. extensive capillary bed beneath show through = pink
What is the darker red vestibular mucosa/FOM mucosa caused by?
nearness of vascularity to the surface
What causes the lighter pink on hard palate and attached gingiva?
increased thickness of overlying epithelium
DX: an intraoral white plaque that does NOT rub off and can not be identified as any well known entity
Leukoplakia
TX: When in doubt cut it out. Remove obvious frictional causes, biopsy after two weeks
- alveolar ridge = frictional keratosis from denture
5 white lesions that CAN be scraped, rubbed or pulled off
- Materia Alba
- white coated tongue
- burn (thermal, chemical, cotton roll)
- pseudomembranous candidiasis
- toothpaste or mouthwash overdose
White coated Tongue
Aysmptomatic
Tx: tongue scraping or brushing
Pseudomembranous Candidiasis
TX: antifungal prescription
Nystatin (Mycostatin)
Clotrimazole (Mycelex)
Nystatin/trianicinolone acetonide ointment (Mycolog II)
Bilateral on buccal mucosa at occlusal plane from friction, sucking
Linea Alba “white line”
Tx: no treatment
Bilaterally present in 70-90% of Blacks; diffuse grayish-white milky opalescent appearance
Leukoedema
Tx: no treatment is necessary
make sure that disappears when the cheek is stretched
Caused by reverse smoking. Heat causes salivary gland orifices to open = red dots
Nicotine Stomatitis
tx?
soft, fissured gray-white lesion of the mucosa located in the area of chronic snuff placement
Usually young males, gingival recession and root caries
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
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
Oral Hairy Leukoplakia
tx: treat AIDS
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
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
What are the 4 levels of Leukoplakia?
- Normal
- Hyperkeratosis
- Epithelial Dysplasia
- invasive squamous cell Carcinoma
localized bony protuberance arising from the cortical plate
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
most common: lips, tongue, buccal mucosa
1-2 lesions, .5-1 cm in diameter
Etiology: different things in different ppl –> autoimmunes, hypersensitivity, stress (THEORY)
Recurrent Apthous Ulcerations (major, minor, herpetiform)
TX: avoid food if that is causing the hypersensitivity
Temovate
Decadron
Lidex
Kenalog
unique form of chronic traumatic ulceration with deep pseudoinvasive inflammatory process and slow to resolve
TUGSE: traumatic ulcerative granuloma with stromal eosinophilia
TX.: incisional biopsy
inflammatory process that arises withing the tissues, surrounding the crown of a partially erupted tooth
Pericornitis
accumulation of acute inflammatory cells at the apex of a nonvital tooth
periodontal abscess
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
Fibroma
tx: surgical excision
Ectopic sebacceous glands on buccal mucosa and then lips
Fordyce Granules
No treatment
benign proliferation of blood vessels
10-12% children
clinically blanches under pressure
10-12% children
Syndromes: SturgeWeber Angiomatosis
Hemangioma
Tx: surgery, laser, embolization,
clinical observation, removal, sclerotherapy
Benign proliferation of squamous epithelium (HPV 6 & 11) on tongue > soft palate
Papilloma
Tx: surgical excision
variations of papilloma
Verruca vulgaris,
Condyloma Acuminatum,
Focal Epithelial Hyperplasia,
Sinonasal papilloma
Focal inflammatory fibrous hyperplasia at the flange of an ill fitting denture
Single or multiple folds of tissue in the vestibule
Epulis Fissuratum
TX: surgical excision with relining or remaking of the denture
superficial dilated veins not associated with HTN or cardiopulmonary disease
Most common sublingual
Varicosities (sulingual varix)
Tx: NONE, unless solitary varicosities on the lips or buccal mucosa because of thrombus formation or esthetics
numerous grooves or fissure on the dorsal tongue, 2-6 mm deep with unknown cause (possibly hereditary)
Fissured Tongue
Tx: brush the tongue
Inflammatory condition: asymptomatic with rare cases of sensitivity to hot or spicy foods
Geographic Tongue
Tx: None unless symptomatic and then use magic mouthwash
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
Papillary Hyperplasia
tx: surgical excision (scapel, electro-cryo-laser surgery) then reline or remake of the denture
possible antifungal tx…??
Initial exposure of HSV 1/2 between 6 mos- 5 years of age
Acute Herpetic Gingivostomatitis
Labialis, intraoral recurrent, whitlow, keratoconjuctivitis
Recurrent Herpetic Infections
dx: serology, virus isolation, biopsy, cytology
Herpes Treatment
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
rupture and spillage of saliva into the soft tissue related to trauma
MC in lower lip
Mucocele (Ranula in FOM)
TX; surgical excision along with the feeder gland
Post trauma and post surgical locations
Scar tissue
Tx: NONE
“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
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
Lymphoid hyperplasia on the posterior lateral borders of the tongue, bilateral
Lingual Tonsil
TX: None
Accumulation of blood within the tissues secondary to trauma
Does not blanche
Hematoma
Tx: none
Chronic Cheek biting
2F: 1M
Morsicatio buccarum, labiorum, linguarum
Tx: none or bite guard
Bony protuberances on the buccal of the mandible and/or maxilla
Buccal Exostoses
Tx: Removal only with chronic repeated trauma or preprosthetic surgery
implantation of dental amalgam into oral soft or hard tissue
Amalgam Tattoo
tx: none, however radiograph and then biopsy may be necessary to rule out melanoma
focal melanosis “oral freckle”
Solitary well-demarcated tan to dark macule
Melanin pigmentation is in the basal cell layer
lower lip > buccal mucosa > gingiva
Oral Melanotic Macule
tx: none, however biopsy may be indicated to rule out melanoma
central papillary atrophy of the tongue; asymptomatic erythematous zone in the midline posterior dorsal tongue.
form of erythematous candidiasis
Median Rhomboid Glossitis
tx: antifungals and brushing of the tongue
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
Black Hairy Tongue
tx: tongue brushing/scraping with OHI is adequate tx
from pernicious anemia, medication, avitaminosis
Smooth Red Tongue
Tx: find the underlying cause and stop it
Skin cysts associated with inflammation of a hair follicle.
Oral cysts occur in the midline of the FOM
Slow growing, painless, rubbery mass
Epidermoid Cyst
Tx: surgical removal
Benign tumor of fat more likely on buccal mucosa > tongue : FOM > lips
Lipoma
tx: surgical excision, place in formalin and see if it floats
Thickened epithelial white lesions?
Hyperkeratosis, acanthosis, dysplasia, carcinoma
White lesions from decreased vascularity?
Anemia (palor)
white lesions from increased collagen
submucous fibrosis
What causes red lesions?
Thinner epithelium, increased vascularity, dissolution of the collagen content of the subepithelial tissue.
Wright’s Lesion full name?
Localized juvenile spongiotic gingival hyperplasia
What causes blue lesions?
Venous blood collection as opposed to the red of arterial blood collection, tyndall effect, medications (antimalarial agents, lupus erythematosis, RA)
What causes black lesions?
Melanin (pigment produced by cells called melanocytes. acs as a sunscreen and protects skin from UV light), heavy metals (amalgam, iron, bismuth)
What causes brown lesions?
Melanin, hemosiderin (yellowish brown granular pigment formed by breakdown of hemoglobin, found in phagocytes)
What causes yellow lesions?
Adipose tissue, sebaceous material (skin oil) as noted in fordyce granules, pus as it is a collection of necrotic material, PMNs, and lymphocytes
Order of colors
White > Red> Black > Blue> Yellow
Snuff Dipper’s Cancer
low-grade variant of oral SCC
can be caused by smokeless tobacco
mandibular vestibule and gingiva
Verrucous Carcinoma
tx. surgical excision without neck dissection
Differential for desquamative gingivitis?
Lichen planus, Mucous membrane pemphigoid, pemphigus vulgaris, hypersensitivity, systemic lupus erythematosus
What is the Rx for Temovate?
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
What is the Rx for Decadron?
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
What is the Rx for Lidex?
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
acute or chronic trauma can cause surface ulcerations
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 %
what is the treatment for desquamative gingivitis?
Biopsy for confirmation, topical steroids
What is the Rx for Prednisone?
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
denture wearer and doesn’t take out and clean at night and get candidiasis underneath.
Types of Erythematous candidiasis
Denture Stomatitis
What are the various forms of candidiasis?
- White pseudomembranous, Erythematous (central papillary atrophy of tongue/ median rhomboid glossitis, angular cheilitis, denture stomatitis)
What is the Rx for Nyastatin rinse Mycostatin?
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
What is the Rx for Mycolog II ointment?
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
What is the Rx for Mycelex troche?
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 .
Enlargement of lymphoid tissue typically due to infection
Lymphoid Hyperplasia
tx: asymmetry is potentially serious sign. usually biopsy if necessary to establish dx. Once dx confirmed no tx required
Intraoral red patch that cannot be clinically diagnosed as any other condition.
MC: FOM, tongue, soft palate
Erythroplakia
If there is pigmentation limited canine to canine on a white patient what is it?
Smoker’s Melanosis
benign localized proliferation of cells from the neural crest
Intramucosal nevus
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
Oral Melanoacanthoma
Incisional biopsy is indicated to rule out melanoma
No further tx necessary, lesions can regress
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,
Melanoma
Tx: Surgical excision is the treatment of choice with a 3-5 cm margin
epithelium lines cavity that arises from salivary gland tissue. most often in parotid gland, FOM, buccal mucoa, lips
Bluish from the tyndall effect
Salivary Duct Cyst
Tx: Surgical excision
Uncommon benign proliferation of dermal melanocytes
Appears blue due to tyndall effect
Blue Nevus
tX: conservative surgical excision with minimal chance of recurrence
- most common malignant salivary neoplasm
- most common malignant salivary gland tumor in children
- affect parotid most often then minor glands
- blue
Mucoepidermoid Carcinoma
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
lymphoepithelial cysts
Tx: Biopsy or clinical diagnosis
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
Granular Cell Tumor
Dry mouth
medications: antidepressants, antianxiety, beta blocker
Sleep aids like ambient
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
What is the Rx for Salagen?
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)
What can be used for dry lips?
- chapstick
- aquaphor
- blistex complete
- lanolin
what is the Rx for abreva?
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
Burning Mouth Treatment
- lubrication
- candidiasis treatment
- nutritional treatment (B12, Folate, Iron, Zinc)
- diabetic control
- eliminate triclosan/tarter control products
- switch hypertensive medication if on ACE- inhibitor
- clonazepan .5 mg tablet. Start with dissolving half a .5 mg tab bid and slowly increase to 1 mg bid *2 tabs)
- alpha lipoic acid
- capsaicin
What is the Rx for Magic mouthwash?
equal parts maylox, benadryl, lidocaine vious 2 %
soothes and calms
Disp 240 ml
Sig: rinse with 1-2 tsp for 2 min and expectorate
