Colors of Oral Pathology I Flashcards
what is considered “normal” pink color?
- epithelium is semi-transparent/pale white
- extensive capillary bed beneath shows through = pink
where is a darker red color considered normal? why?
- vestibular mucosa and floor of mouth
- due to the nearness of the vascularity to the surface
what areas are lighter pink colors considered normal? why?
- hard palate and attached gingiva
- due to increased thickness of the overlying epithelium
what are white lesions caused by that result in a thickened epithelial covering?
- hyperkeratosis
- acanthosis
- dysplasia
- carcinoma
what causes white lesions in an anemic patient?
decreased vascularity
what results in a white lesion that consists of increased collagen?
submucous fibrosis
what causes lesions to be red?
- thinner epithelium
- increased vascularity
- a dissolution of the collagen content of the subeptihelial tissue
what are causes of blue lesions?
- venous blood collection as opposed to the red of arterial blood collection
- tyndall effect
- medications
what causes black lesions?
- melanin: a pigment produced by cells called melanocytes; acts as a sunscreen and protects the skin from UV light
- heavy metals: amalgam, iron, and bismuth
what causes brown lesions?
- melanin
- hemosiderin: a yellowish brown granular pigment formed by a breakdown of hemoglovin, 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 mecrotic material, PMNs, and lymphocytes
what are the most common colors found ABNORMALLY in the oral cavity (in order from most to least)?
- whie
- red
- black
- blue
- yellow
pigment in the palate is usually caused by what?
medications
what is the first thing you should do with a white lesion?
try to rub it off - this will help narrow down your differential
what are 5 white lesions that can be scraped, rubbed, or pulled off?
- materia alba
- white coated tongue
- burn (thermal, chemical, cotton roll, etc.)
- toothpaste or mouthwash overdose
- pseudomembranous candidiasis
- fibrin membrane
- exudate
what are some white lesions that cannot be rubbed off?
- leukoplakia
- linea alba
- leukoedema
- morsicatio buccarum (linguarum, laborium)
- tobacco pouch keratosis
- lichen planus
- nicotine stomatitis
- oral hairy leukoplakia
what is the definition of leukoplakia?
an intraoral white plaque that does not rub off and cannot be identified as any well known entity
histologically, what can leukoplakia show?
- benign hyperkeratosis
- eptihelial dysplasia (mild, moderate, severe)
- carcinoma in situ
- invasive squamous cell carcinoma
what should you do if you see a patient with leukoplakia?
remove any obvious frictional causes and biopsy if it persists after 2 weeks
what is the treatment for morsicatio buccarum (linguarum, laborium)?
none or bite guard
what are 3 other names for tobacco pouch keratosis?
- smokeless tobacco pouch
- snuff pouch
- spit tobacco keratosis
what may be accompanied by tobacco pouch keratosis?
gingival recession and root caries
tobacco pouch keratosis is dose responsive and may lead to ___
verrucous carcinoma
is tobacco pouch keratosis reversible?
possibly, if dipping stops
what are the 4 p’s associated with lichen planus skin lesions?
- purple
- pruritic
- polygonal
- papules
what is the treatment for lichen planus?
topical steroid application
what should you consider when deciding which topical steroid to use to treat lichen planus?
- size of lesions
- frequency of recurrences
- number of lesions
- location of lesions
if you see a patient with oral lichen planus, what should you ask them?
if they have related skin lesions
which lichen planus topical steroid treatment has a very high potency?
clobetasol proprionate 0.05% gel
what is the prescription for clobetasol proprionate 0.05% gel?
- aka temovate
- disp: 15 or 30 gram tube
- sig: dry the affected area and gently apply a thin amount bid-tid
other than clobetasol proprionate (temovate), what are 2 other lichen planus topical steroids?
- dexamethasone elixir 0.5mg/5ml rinse (decadron)
- fluocinonide 0.05% gel (lidex)
what is the prescription for dexamethasone elixir 0.5mg/5ml?
- aka decadron
- disp: 12-16oz
- sig: rinse with 1tsp for 2 minutes bid-qid and expectorate
which lichen planus topical steroids have black box warnings?
clobetasol propionate 0.05% gel (temovate) and fluocinonide 0.05% gel (lidex)
it is supposed to be used for dermatologic purposes only, but intraoral lichen planus is an exception, so we ignore the black box warnings
what is the prescription for fluocinonide 0.05% gel?
- aka lidex
- disp: 15 or 30 gram tube
- sig: dry the affected area and gently apply a thin amount 3-4 times daily
what topical steroid has moderate potency?
fluocinonide 0.05% gel (lidex)
what is the treatment for oral hairy leukoplakia?
treat AIDS
what are some red and white lesions?
- ulcers - traumatic, aphthous, viral
- geographic tongue
- desquamative gingivitis
- actinic keratosis
- erythroleukoplakia
what is the etiology of recurrent aphthous ulcers?
- “different things in different people”
- autoimmune, hypersensitivity, stress, etc.
what are prescription options for recurrent aphthous ulcers?
aphthasol, dexamethasone, temovate (clobetasol proprionate), lidex, etc.
what are the treatment options for traumatic ulcers?
- surgical excision
- nothing
- steroids
what are some options for intra-lesional steroid injections for traumatic ulcers?
- kenalog 10 (10mg/ml) or kenalog 40 (40mg/ml)
- 10 mg per cm of lesional tissue
- so for a 1cm lesion, you can give:
- 1ml of kenalog 10
- 0.25ml of kenalog 40
what are two other names for geographic tongue?
- erythema areata migrans
- benign migratory glossitis
what is the treatment for geographic tongue?
no treatment
what is the differential for desquamative gingivitis?
- lichen planus
- mucous membrane pemphigoid
- pemphigus vulgaris
- systemic lupus erythematosis
- hypersensitivity
what is the treatment for desquamative gingivitis?
- biopsy for confirmation
- topical steroids
what is this possibly due to?
medications
wipeable
pseudomembranous candidiasis
does not wipe off
leukoplakia
does not rub off
linea alba
does not rub off, goes away with stretching
leukoedema
does not rub off
picture is before and after treatment
morsicatio buccarum
does not wipe off
tobacco pouch keratosis
does not wipe off, history of tobacco pouch keratosis
verrucous carcinoma
does not rub off
reticular lichen planus
does not wipe off
erosive lichen planus
lichen planus skin lesions
recurrent aphthous ulcer
intraoral herpes simplex
traumatic ulcer
geographic tongue
geographic tongue
erythema migrans
desquamative gingivitis
actinic cheilosis
if it is on the skin, it is actinic keratosis
erythroleukoplakia
if a traumatic ulcer does not go away with steroid treatment, what should you be thinking it might be?
TUGSE (traumatic ulcerative granuloma with stromal eosinophilia)
what is the treatment for actinic cheilosis?
incisional biopsy then refer to oral surgeon for “lip shave”
