common oral ds clinical photos exam 1 Flashcards
what is it? vesicle, bulla, pustule, lobule, papule, nodule, pednucleated, sessile, ulcer, plaque? and why
vesicle
- small circumscribed elevated lesion
- LESS THAN 1CM size impt when comparing against a bulla
- probably contains serous fluid
what is it? vesicle, bulla, pustule, lobule, papule, nodule, pednucleated, sessile, ulcer, plaque? and why
bulla
- circumscribed elevated lesion
- AROUND 1 CM IN SIZE size is impt when comparing against a vesicle
- contains serous fluid like vesicle.
what is it? vesicle, bulla, pustule, lobule, papule, nodule, pednucleated, sessile, ulcer, plaque? and why
pustulue
- varies in size so not as impt as in a bulla or vesicle
- a circumscribed lesion containing PUS
what is it? vesicle, bulla, pustule, lobule, papule, nodule, pednucleated, sessile, ulcer, plaque? and why
lobule
what is it? vesicle, bulla, pustule, lobule, papule, nodule, pednucleated, sessile, ulcer, plaque? and why
macule
- the color is different than the surroudning tissue
- it is FLAT
what is it? vesicle, bulla, pustule, lobule, papule, nodule, pednucleated, sessile, ulcer, plaque? and why
papule
- a small bump on the gums (big bump is nodule)
- LESS THAN 1 CM
- when palpate it is firm but not hard vs bulla/vescile can feel the liquid.
- -* it protrudes
what is it? vesicle, bulla, pustule, lobule, papule, nodule, pednucleated, sessile, ulcer, plaque? and why
nodule
- “a big bump on the gums”
- GREATER THAN 1CM
- it is elvated or protrudes above or belwo the surface of normal surrouding tissue.
- feels firm to touch not liquid like a bulla would be.
what is it? vesicle, bulla, pustule, lobule, papule, nodule, pednucleated, sessile, ulcer, plaque? and why
pednuculated
- attached by a stem-like or stalk base
what is it? vesicle, bulla, pustule, lobule, papule, nodule, pednucleated, sessile, ulcer, plaque? and why
sessile
- more flat like and cannot move around
what is it? vesicle, bulla, pustule, lobule, papule, nodule, pednucleated, sessile, ulcer, plaque? and why
ulcer
- we see a loss of continuity of the epithelium that penetrates to the underlying CT
what is it? vesicle, bulla, pustule, lobule, papule, nodule, pednucleated, sessile, ulcer, plaque? and why
plaque
- because it looks like a patch or differentiated area on a body surface
- erythroplakia - has a high % of being pre-malignant.*
what is it? vesicle, bulla, pustule, lobule, papule, nodule, pednucleated, sessile, ulcer, plaque? and why
plaque
- because it looks like a patch or differentiated area on the body surface
- leukoplakia.*
what is this?
palatal torus
More common than mandibular tori
Affects about 25% of the US population.
More F than M (2:1)
Asian and Inuits (Eskimo)
Tx: none. Depends on the size. Also if need to remove for full denture or RPD.
what is this?
palatal torus
notice that you are on the palate.
Easily can be ulcerated if eat crunchy stuff.
More common than mandibular tori
Affects about 25% of the US population.
More F than M (2:1)
Asian and Inuits (Eskimo)
Tx: none. Depends on the size. Also if need to remove for full denture or RPD.
what is this?
mandibular tori
- typically they are bilateral, as seen.
- less coommon than palatal tori
- slightly male gender predominance
- can be single or multiple nodules.
Affects 10% of population
Slight male gender predominance
Asiants and insuits
what is this?
mandibular tori
Less common than palatal tori
Affects 10% of population
Slight male gender predominance
Asiants and insuits
Tx: none. Again, depends on the size and if need to remove for a FD or RPD.
Most mand tori are bilateral. Can be single or multiple nodules.
what do we have here.
mandibular tori
Less common than palatal tori
Affects 10% of population
Slight male gender predominance
Asiants and insuits
Tx: none. Again, depends on the size and if need to remove for a FD or RPD.
Most mand tori are bilateral. Can be single or multiple nodules.
what is this?
-when palpated, rock hard.
buccal exostoses
since rock hard, this would rule out gingival overgrowth.
what is this?
buccal exostoses
what is this?
Fordyce Granules
i think they look like Fish scales so Fish=Fordyce
Ectopic sebaceous glands
Will appear yellow-ish. Can be seen bilaterally but maybe not the same amount on each side .
Development stimulated at puberty.
what is this?
Fordyce Granules
i think they look like Fish scales so Fish=Fordyce
Ectopic sebaceous glands
Will appear yellow-ish. Can be seen bilaterally but maybe not the same amount on each side .
Development stimulated at puberty.
what type of tongue is this?
fissured tongue.
can tell becaue that is the surface texture of the tongue.
this could be due to a syndrome too.
pts can complain of having bad breath bc bacteria can stay in the folds.
what is this?
this is at the post aspect of the tongue
foliate papillae and lingual tonsils.
look at both sides of tongue to see if it is present. If so, this could be biological.
what is this
oral lymphoepithelial cysts
which is a soft tissue cyst
clinical presentation:
- well circumscribed ulcer
- keratotic halo/border
- pt has some trauma
- not hard/enderated when palated
- on ventral area of the tongue
what is it?
traumatic ulcer
what is this? and why and what you should do.
traumatic ulcer.
- it is located on a mucosal site that is easily traumatized (ventral area of the tongue)
- montior if the ulcer has been there for more than 2 weeks, get a biopsy to see if it is cancerous. But biopsy can also help the area heal faster.
what is it
traumatic ulcer.
- it is located on a mucosal site that is easily traumatized (ventral/lateral area of the tongue)
- montior if the ulcer has been there for more than 2 weeks, get a biopsy to see if it is cancerous. But biopsy can also help the area heal faster.
what is this?
traumatic ulcer.
- it is located on a mucosal site that is easily traumatized (mandibular vestibule)
- montior if the ulcer has been there for more than 2 weeks, get a biopsy to see if it is cancerous. But biopsy can also help the area heal faster.
what is this?
-when palpatable, not hard.
traumatic ulcer.
- it is located on a mucosal site that is easily traumatized (ventral area of the tongue)
- montior if the ulcer has been there for more than 2 weeks, get a biopsy to see if it is cancerous. But biopsy can also help the area heal faster.
BUT SUSPICIOUS.
why? there are raised borders, central area of ulceration, you want to palpate and make sure it is not endurated/hard. It if IS, then this can be more of a cancerous lesion than a traumatic one.
what is this?
when palpatable, it is hard.
cancer.
why?
raised borders
Central area of ulceration
Want to palpate to make sure not enderated/hard or else could be cancer
what is this? and why.
mucocele.
- the most common lesion associated with the lower lip and salivary gland.
- Mucosal color or bluish nodule color
- Ares that are easily traumatized: Lower lip (THE MOST COMMON LOCATION) and Sublingual gland with ranula.
what is this? and why.
mucocele- ranula
- the most common lesion associated with the lower lip and salivary gland.
- Mucosal color or bluish nodule color
- Ares that are easily traumatized: Lower lip (THE MOST COMMON LOCATION) and Sublingual gland with ranula.
what is this? and why.
traumatic (irritation) fibroma
- its the most common “tumor” of the oral cavity
- Not a true neoplasm of fibroblasts - a reactive lesion rather than a true neoplasm. So it occurs when there is a constant source of trauma or irritation.
- Areas that are easily traumatized -Buccal mucosa, Easy to bite areas, Repeated biting
- it is a Mucosal color bump but Could have a white covering over the lesion due to thickened keratin layer from repeated episodes from biting
what is this and why
traumatic (irritation) fibroma
- its the most common “tumor” of the oral cavity
- Not a true neoplasm of fibroblasts - a reactive lesion rather than a true neoplasm. So it occurs when there is a constant source of trauma or irritation. here like right next to where the teeth occlude.
- Areas that are easily traumatized -Buccal mucosa, Easy to bite areas, Repeated biting
- it is a Mucosal color bump but Could have a white covering over the lesion due to thickened keratin layer from repeated episodes from biting
what is this
traumatic (irritation) fibroma
- its the most common “tumor” of the oral cavity
- Not a true neoplasm of fibroblasts - a reactive lesion rather than a true neoplasm. So it occurs when there is a constant source of trauma or irritation.
- Areas that are easily traumatized -Buccal mucosa, Easy to bite areas, Repeated biting
- it is a Mucosal color bump but Could have a white covering over the lesion due to thickened keratin layer from repeated episodes from biting
clincial presentation
- occurs when there is a constant source of trauma or irritation.
- in the following areas: Buccal mucosa, Easy to bite areas, Repeated biting
- it is a Mucosal color bump but has some white covering over the lesion
what is this?
traumatic (irritation) fibroma
- its the most common “tumor” of the oral cavity
- Not a true neoplasm of fibroblasts - a reactive lesion rather than a true neoplasm. So it occurs when there is a constant source of trauma or irritation.
- Areas that are easily traumatized -Buccal mucosa, Easy to bite areas, Repeated biting
- it is a Mucosal color bump but Could have a white covering over the lesion due to thickened keratin layer from repeated episodes from biting
what is this and why?
Fibroblasts are nucleated
giant cell fibroma
- Distinct from irritation fibroma - may not be associated with an identifiable source of chronic irritation and occurs at a younger age
- Sometimes you can see it on L aspect of mand around C area.
- Often exhibits a papillary surface and may be clinically mistaken for papilloma.
-Fibroblasts are nucleated; this is NOT THE SAME as a multinucleated giant cell.
what is this and why?
histo: fibroblasts are nucleated
giant cell fibroma
- Distinct from irritation fibroma - may not be associated with an identifiable source of chronic irritation and occurs at a younger age
- Sometimes you can see it on L aspect of mand around C area.
- Often exhibits a papillary surface and may be clinically mistaken for papilloma.
-Fibroblasts are nucleated; this is NOT THE SAME as a multinucleated giant cell.
what is this and why?
histo: fibroblasts are nucleated.
giant cell fibroma
- Distinct from irritation fibroma - may not be associated with an identifiable source of chronic irritation and occurs at a younger age
- Sometimes you can see it on L aspect of mand around C area.
- Often exhibits a papillary surface and may be clinically mistaken for papilloma.
-Fibroblasts are nucleated; this is NOT THE SAME as a multinucleated giant cell.
what is this and why?
histo: fibroblasts are nucleated
giant cell fibroma
- Distinct from irritation fibroma - may not be associated with an identifiable source of chronic irritation and occurs at a younger age
- Sometimes you can see it on L aspect of mand around C area.
- Often exhibits a papillary surface and may be clinically mistaken for papilloma.
-Fibroblasts are nucleated; this is NOT THE SAME as a multinucleated giant cell.
what is this and why?
Epulis fissuratum
- Aka inflammatory fibrous hyperplasia, denture injury tumor, ill fitting dentures, fibrous epulis, denture epulis
- Has redundant fibrous tissue
-Associated with denture flange can literally see where the denture would go
-Tx: surgically excise it.
what is this and why
Epulis fissuratum
Aka inflammatory fibrous hyperplasia, denture injury tumor, ill fitting dentures, fibrous epulis, denture epulis
Has redundant fibrous tissue
Associated with denture flange
Tx: surgically excise it.
what is this and why
Papillary hyperplasia/ inflammatory papillary hyperplasia
- Denture papillomatosis, Due to poor oral hygiene combined with ill-fitting prosthesis
- seen mostly on the palatal
- very red due to overlying infection, papillary apperance.
- Tx: Surgical excision and correct prosthesis
what is this and why
Papillary hyperplasia/ inflammatory papillary hyperplasia
- Denture papillomatosis, Due to poor oral hygiene combined with ill-fitting prosthesis
- seen mostly on the palatal
-very red due to overlying infection, papillary apperance.
-Tx: Surgical excision and correct prosthesis
what is this and why
Papillary hyperplasia/ inflammatory papillary hyperplasia
- Denture papillomatosis, Due to poor oral hygiene combined with ill-fitting prosthesis
- seen mostly on the palatal
-very red due to overlying infection, papillary apperance.
-Tx: Surgical excision and correct prosthesis
what is this and why
Papillary hyperplasia/ inflammatory papillary hyperplasia
- Denture papillomatosis, Due to poor oral hygiene combined with ill-fitting prosthesis
- seen mostly on the palatal
- very red due to overlying infection, papillary apperance. can see where the denture goes, posterior hard palate doesnt have any papillary hyperplasia.
- Tx: Surgical excision and correct prosthesis
what is this and why?
Medication associated gingival enlargement
Enlargement begins in the interdental papillae and forms pseudopockets
Non-specific clinical appearance
Multiple drugs are synergistic
Severity is related to patient susceptibility and local factors
Medications Associated with Gingival Enlargement
what kind of drugs could cause these gingival enlargements?
which is the most susceptible?
and how would you treat?
- anticonvulsants DILACTIN - 50%
- Ca2+ channel blocker PROCARDIA (nifedipine) -25%
- Immunosuppresant SANDIMMUNE (cyclosporin) - 25%
Treatment:
- Control local factors- anti-plaque agents (chlorhexidine)
- Drug substitution
- Drug therapy- folic acid, metronidazole, azithromycin
- Surgical excision– gingivectomy
what is this and why?
Pyogenic granuloma
= A reactive vascular lesion- essentially a capillary hemangioma
Definitie female predilection- vascular effects of hormones
May exhibit rapid growth. Can look concerning but it is normal because it is a reactive condition.
Gingiva most common site, but not limited to gingiva. It occurs throughout the body on any skin or mucosal surface
what is this and why?
Pyogenic granuloma
= A reactive vascular lesion- essentially a capillary hemangioma
Definitie female predilection- vascular effects of hormones
Name is a misnomer. It is unrelated to infection. It is not ‘pyogenic’ and is not a true granuloma it is actually endothelial hyperplasia
May exhibit rapid growth. Can look concerning but it is normal because it is a reactive condition.
Gingiva most common site, but not limited to gingiva. It occurs throughout the body on any skin or mucosal surface
what is this and why
Pyogenic granuloma
= A reactive vascular lesion- essentially a capillary hemangioma
Definitie female predilection- vascular effects of hormones
Name is a misnomer. It is unrelated to infection. It is not ‘pyogenic’ and is not a true granuloma it is actually endothelial hyperplasia
May exhibit rapid growth. Can look concerning but it is normal because it is a reactive condition.
Gingiva most common site, but not limited to gingiva. It occurs throughout the body on any skin or mucosal surface
what is this and why
Pyogenic granuloma
= A reactive vascular lesion- essentially a capillary hemangioma
Definitie female predilection- vascular effects of hormones
Name is a misnomer. It is unrelated to infection. It is not ‘pyogenic’ and is not a true granuloma it is actually endothelial hyperplasia
May exhibit rapid growth. Can look concerning but it is normal because it is a reactive condition.
Gingiva most common site, but not limited to gingiva. It occurs throughout the body on any skin or mucosal surface
what is this and why
Pyogenic granuloma
= A reactive vascular lesion- essentially a capillary hemangioma
Definitie female predilection- vascular effects of hormones
Name is a misnomer. It is unrelated to infection. It is not ‘pyogenic’ and is not a true granuloma it is actually endothelial hyperplasia
May exhibit rapid growth. Can look concerning but it is normal because it is a reactive condition.
Gingiva most common site, but not limited to gingiva. It occurs throughout the body on any skin or mucosal surface
what is this and why
Pyogenic granuloma
= A reactive vascular lesion- essentially a capillary hemangioma
Definitie female predilection- vascular effects of hormones
Name is a misnomer. It is unrelated to infection. It is not ‘pyogenic’ and is not a true granuloma it is actually endothelial hyperplasia
May exhibit rapid growth. Can look concerning but it is normal because it is a reactive condition. Here it is ulcerated.
Gingiva most common site, but not limited to gingiva. It occurs throughout the body on any skin or mucosal surface
what is this and why
Pyogenic granuloma
= A reactive vascular lesion- essentially a capillary hemangioma
Definitie female predilection- vascular effects of hormones
Name is a misnomer. It is unrelated to infection. It is not ‘pyogenic’ and is not a true granuloma it is actually endothelial hyperplasia
May exhibit rapid growth. Can look concerning but it is normal because it is a reactive condition.
Gingiva most common site, but not limited to gingiva. It occurs throughout the body on any skin or mucosal surface
what clinical variant of pyogenic granuloma is this?
Granuloma gravidarum Aka Pregnancy tumor
A clinical variant of pyogenic granuloma
May involute without treatment post partum and undergo fibrous maturation
Will go away once the mother delivers the baby.
Has that red - hematoma looking appearance to it, aside from it being a “bump on the gums”
what is this and why?
pt is 19 yo
Peripheral ossifying fibroma
Reactive lesion- not a neoplasm
Teenagers and young adults
Not related to central ossifying fibroma
OCCURS EXCLUSIVELY ON THE GINGIVA
Fibrous hyperplasia with osseous metaplasia– may appear radio-opaque
May recur
May move teeth
What is this and why?
pt is 16 yo
Peripheral ossifying fibroma
Reactive lesion- not a neoplasm
Teenagers and young adults
Not related to central ossifying fibroma
OCCURS EXCLUSIVELY ON THE GINGIVA
Fibrous hyperplasia with osseous metaplasia– may appear radio-opaque
May recur
May move teeth
what is this and why?
histo: fibrous tissue
Peripheral ossifying fibroma
Reactive lesion- not a neoplasm
Teenagers and young adults
Not related to central ossifying fibroma
OCCURS EXCLUSIVELY ON THE GINGIVA
Fibrous hyperplasia with osseous metaplasia– may appear radio-opaque
May recur
May move teeth
what is this and why?
histo: fibroblasts form bone, fibrous tissue
Peripheral ossifying fibroma
Reactive lesion- not a neoplasm
Teenagers and young adults
Not related to central ossifying fibroma
OCCURS EXCLUSIVELY ON THE GINGIVA
Fibrous hyperplasia with osseous metaplasia– may appear radio-opaque
May recur
May move teeth
what is this and why?
histo: fibrous tissue
Peripheral ossifying fibroma
Reactive lesion- not a neoplasm
Teenagers and young adults
Not related to central ossifying fibroma
OCCURS EXCLUSIVELY ON THE GINGIVA
Fibrous hyperplasia with osseous metaplasia– may appear radio-opaque
May recur
May move teeth
what is this and why?
pts is 65
Peripheral giant cell granuloma
Reactive lesion- not a neoplasm
Older adults
Occurs exclusively on gingiva and edentulous alveolar ridge
Contains hemosiderin– may be bluish-purple hemosiderin is a byproduct of RBC.
May recur
Absorption from the ulcer
Lots! Of Multi-nucleated giant cell (microscope above)
what is this and why?
pt is 72
Peripheral giant cell granuloma
Reactive lesion- not a neoplasm
Older adults
Occurs exclusively on gingiva and edentulous alveolar ridge
Contains hemosiderin– may be bluish-purple hemosiderin is a byproduct of RBC.
May recur
Absorption from the ulcer
Lots! Of Multi-nucleated giant cell
what is this and why?
histo: multinucleated giant cells
Peripheral giant cell granuloma
Reactive lesion- not a neoplasm
Older adults
Occurs exclusively on gingiva and edentulous alveolar ridge
Contains hemosiderin– may be bluish-purple hemosiderin is a byproduct of RBC.
May recur
Absorption from the ulcer it is ulcerated on the pic
Lots! Of Multi-nucleated giant cell
what is this and why?
Peripheral giant cell granuloma
Reactive lesion- not a neoplasm
Older adults
Occurs exclusively on gingiva and edentulous alveolar ridge
Contains hemosiderin– may be bluish-purple hemosiderin is a byproduct of RBC.
May recur
Absorption from the ulcer
Lots! Of Multi-nucleated giant cell (microscope above)
what could this be and why?
Human papilloma virus - Has three types: squamous papilloma, verruca vulgaris, and condyloma acuminatum
to tell them apart you need pt hx.
HPV because:
- fingerlike projections
- papillary
what is this and why?
pt hx: only has oral findings.
HPV - Squamous papilloma
Solitary lesion in adult
Pedunculated, exophytic papule
Numerous surface projections fingerlike projections
- whitish in color (has keratin)
can have one or several.
what is this and why?
pt hx: only oral findings
HPV - Squamous papilloma
Solitary lesion in adult
Pedunculated, exophytic papule
Numerous surface projections fingerlike projections
- whitish in color (has keratin)
can have one or several.
what is this and why?
pt hx: see some on hands of 6yo pt
HPV Verruca vulgaris aka “common warts”
Skin of hands in children
Multiple, clustered lesions common
White, verrucoid surface or papillary appearance
Autoinoculation of oral mucosa (hands → mouth)
HPV infection in immunocompromised hosts
what is this and why?
pt hx: 35 yo pt, seen in hands as well.
HPV- Verruca vulgaris aka “common warts”
Skin of hands in children
Multiple, clustered lesions common
White, verrucoid surface or papillary appearance
Autoinoculation of oral mucosa (hands → mouth)
HPV infection in immunocompromised hosts
what is this and why?
pt hx: findings on the hands and feet.
HPV Verruca vulgaris aka “common warts”
Skin of hands in children
Multiple, clustered lesions common
White, verrucoid surface or papillary appearance
Autoinoculation of oral mucosa (hands → mouth)
HPV infection in immunocompromised hosts
what is this and why?
pt hx: has STD.
HPV - Condyloma acuminatum
Venereal wart- sexually- transmitted diease how to distinguish from squamous papilloma and vulga vulgaris
multiple , clustered lesions common
Sessile, pink exophytic mass, larger than squamous papilloma
Low risk sub-types 6 and 11 frequently found (vaccine)< lip and broccoli appearance
High risk-sub types 16 and 18 may also be present (high risk refers to the ability to become malignant)
what is this and why?
pt hx: 6yo
primary herpetic gingivostomatitis
Initial exposure to virus in an individual without immunity
Generally occurs at young age after physical contact with infected individual
Mostly subclinical disease- 80% of US population has antibodies to HSV
Many times pt doesn’t know they have it but the 20% that is symptomatic do know.
Flu- like illness with fever, malaise, arthralgia, and headache
Cervical lymphadenopathy → causes asymmetry of facial profile.
Seen in different types of mucosal surfaces.
what is this and why?
Primary herpetic gingivostomatitis
Initial exposure to virus in an individual without immunity
Generally occurs at young age after physical contact with infected individual
Mostly subclinical disease- 80% of US population has antibodies to HSV
Many times pt doesn’t know they have it but the 20% that is symptomatic do know.
Flu- like illness with fever, malaise, arthralgia, and headache
Cervical lymphadenopathy → causes asymmetry of facial profile.
Seen in different types of mucosal surfaces.
what is this and why?
pt hx: pt is 6yo, flu-like iwth fever, malaise, arthralgia
Primary herpetic gingivostomatitis
Initial exposure to virus in an individual without immunity
Generally occurs at young age after physical contact with infected individual
Mostly subclinical disease- 80% of US population has antibodies to HSV
Many times pt doesn’t know they have it but the 20% that is symptomatic do know.
Flu- like illness with fever, malaise, arthralgia, and headache
Cervical lymphadenopathy → causes asymmetry of facial profile.
Seen in different types of mucosal surfaces.
what is this and why?
pt hx: 12 yp, see asymmetry of facial profile
Primary herpetic gingivostomatitis
Initial exposure to virus in an individual without immunity
Generally occurs at young age after physical contact with infected individual
Mostly subclinical disease- 80% of US population has antibodies to HSV
Many times pt doesn’t know they have it but the 20% that is symptomatic do know.
Flu- like illness with fever, malaise, arthralgia, and headache
Cervical lymphadenopathy → causes asymmetry of facial profile.
Seen in different types of mucosal surfaces.
what is this and why?
pt hx: has cervical lymphadenopathy
Primary herpetic gingivostomatitis
Initial exposure to virus in an individual without immunity
Generally occurs at young age after physical contact with infected individual
Mostly subclinical disease- 80% of US population has antibodies to HSV
Many times pt doesn’t know they have it but the 20% that is symptomatic do know.
Flu- like illness with fever, malaise, arthralgia, and headache
Cervical lymphadenopathy → causes asymmetry of facial profile.
Seen in different types of mucosal surfaces.
what is this and why?
Primary herpetic gingivostomatitis
Initial exposure to virus in an individual without immunity
Generally occurs at young age after physical contact with infected individual
Mostly subclinical disease- 80% of US population has antibodies to HSV
Many times pt doesn’t know they have it but the 20% that is symptomatic do know.
Flu- like illness with fever, malaise, arthralgia, and headache
Cervical lymphadenopathy → causes asymmetry of facial profile.
Seen in different types of mucosal surfaces.
what is this and why?
Primary herpetic gingivostomatitis
Initial exposure to virus in an individual without immunity
Generally occurs at young age after physical contact with infected individual
Mostly subclinical disease- 80% of US population has antibodies to HSV
Many times pt doesn’t know they have it but the 20% that is symptomatic do know.
Flu- like illness with fever, malaise, arthralgia, and headache
Cervical lymphadenopathy → causes asymmetry of facial profile.
Seen in different types of mucosal surfaces. seen in the buccal mucosa AND the tongue too.
what is this and why?
Secondary herpes simplex infection- recurrent herpes labialis.
Resides in the trigeminal ganglion dormant
When reactivated goes on the distribution of the trigeminal nerve.
Aka fever blisters
Can be intra or extra oral lesions
what is this is and why
Secondary herpes simplex infection- ulcerated
Resides in the trigeminal ganglion dormant
When reactivated goes on the distribution of the trigeminal nerve.
Aka fever blisters
Can be intra or extra oral lesions
what is this and why
Secondary herpes simplex infection
Resides in the trigeminal ganglion dormant
When reactivated goes on the distribution of the trigeminal nerve.
Aka fever blisters
Can be intra or extra oral lesions
what is this and why
hx: presented with tzanck cell
Secondary herpes simplex infection -here we see at top and bottom “kising lesion”
Resides in the trigeminal ganglion dormant
When reactivated goes on the distribution of the trigeminal nerve.
Aka fever blisters
Can be intra or extra oral lesions
what is this and why
Secondary herpes simplex infection- recurrent INTRoral lesion at palate
Resides in the trigeminal ganglion dormant
When reactivated goes on the distribution of the trigeminal nerve.
Aka fever blisters
Can be intra or extra oral lesions
what is this and why
Secondary herpes simplex infection
Resides in the trigeminal ganglion dormant
When reactivated goes on the distribution of the trigeminal nerve.
Aka fever blisters
Can be intra or extra oral lesions - notice the clustering of ulceration at the gingiva.
what is this and why
Secondary herpes simplex infection
Resides in the trigeminal ganglion dormant
When reactivated goes on the distribution of the trigeminal nerve.
Aka fever blisters
Can be intra or extra oral lesions notice the small ulcerations on the mucosa
what is this and why?
what is it NOT and why?
this is aphthous stomatits it is not herpatic lesion.
-lesions tend to be isolated with a yellow center and red membrane peripheral. herpatic lesions are seen more in clusters!!
where will we see:
recurrent aphthous stomatitis
primary herpatic lesion
recurrent herpes
recurrent aphthous stomatitis - unbound mucosa, movable and non keratinized.
primary herpatic lesion - both movable and unmovable, all over
recurrent herpes- bound down tissues, keratinized gingival palatal tissue
what is this and why?
pt hx: leison has only been there recently
aphthous stomatitis - minor
- at unbound mucosa, movable and non keratinized
- present for a couple of weeks
- no scar
- associated with systemic ds: Behcets, Reiter, Inflam bowel ds (ulcerative colitis and Crohns), Gluten sensitivity, cyclic neutropenia, HIV/AIDS
what is this and why?
pt hx: lesion has been there since last dental visit
aphthous stomatitis - major
- at unbound mucosa, movable and non keratinized
- present for a couple of months, ~6 months
- does scar
- associated with systemic ds: Behcets, Reiter, Inflam bowel ds (ulcerative colitis and Crohns), Gluten sensitivity, cyclic neutropenia, HIV/AIDS
what is this and why
aphthous stomatitis - herpeticform but not herpes!!
- at unbound mucosa, movable and non keratinized
- associated with systemic ds: Behcets, Reiter, Inflam bowel ds (ulcerative colitis and Crohns), Gluten sensitivity, cyclic neutropenia, HIV/AIDS
- i think you really have to look at the fact that they are still individually located there is just a lot of them vs herpes is more of a cluster.
what is the fungal etiology of this:
clincal findings: wipes off
Candidiasis “thrush”
Red background when wipe the white away
what is this and why?
clinical findings: it wipes off
fungal etiology - Candidiasis “thrush”
Red background when wipe the white away
what is this:
fungal infection - Angular cheilitis
@Corner of the mouth. Painful open sore. Treat by using a topical antifungal
Seen with patients that have a loss of VDO → denture patients
Pooling of saliva at lips. Saliva yeast bugs can cause a superficial infection.
what is this and why
fungal infection - Angular cheilitis
@Corner of the mouth. Painful open sore. Treat by using a topical antifungal
Seen with patients that have a loss of VDO → denture patients
Pooling of saliva at lips. Saliva yeast bugs can cause a superficial infection.
what is this and why
fungal etiology- Angular cheilitis
@Corner of the mouth. Painful open sore. Treat by using a topical antifungal
Seen with patients that have a loss of VDO → denture patients
Pooling of saliva at lips. Saliva yeast bugs can cause a superficial infection.
what is this and why?
clinical: does not wipe away
fungal etiology: Hyperplastic candidiasis
It is unique because the white DOES NOT wipe away
Histo: will tell you that it is superficial epithelium and has spores therefore an infection
what is this and why?
histo: spores spotted
fungal etiology - Hyperplastic candidiasis
It is unique because the white DOES NOT wipe away
Histo: will tell you that it is superficial epithelium and has spores therefore an infection.
what is this and why?
fungal etiology- Atrophic candidiasis erythematous candidiasis
Will be red where the complete denture rests on the mucosa
Palate is red. When a sample is taken and cultured→ yeast will grow
doesn’t have the papillay appearance therefore it is NOT papillary hyperplasia. But you can tx papillary hyperplasia with an antifungal as well.
what is this and why?
fungal etiology- Atrophic candidiasis erythematous candidiasis
Will be red where the complete denture rests on the mucosa
Palate is red. When a sample is taken and cultured→ yeast will grow
doesn’t have the papillay appearance therefore it is NOT papillary hyperplasia. But you can tx papillary hyperplasia with an antifungal as well.
what is this and why:
clinical findings: on the dorsal aspect of the tongue
fungal etiology- Central papillary atrophy median rhomboid glossitis
Midline of the dorsal portion of the tongue
Yeast infection
what is this and why?
necrotizing ulcerative gingivitis (NUG)
- looks like a punched out or really beaten up interdentall papilla
what type of gingivitis is presented:
Allergic gingivitis - gingival tissue if very red due to it being allergic to substance.
Plasma cell gingivitis
we will see: Patient chews mint gum and they are allergic too. Once the chewing was stopped then the inflammation stopped.
what is this and why?
perculum= soft tissue that covers the unerupted tooth
Inflammation of perculum⇒ pericoronitis
lesion located at the lateral border and tip of the tongue
has multiple erythematous zones surroudned by white borders that are elevated, yellow-white.
what is this?
- geographic tongue
what is this and why:
geographic tongue
- multiple erythematous zones with a white boarder surroudning it.
- most common at the lateral borders of the tongue and the tip of the tongue, but can also be seen on the floor of the mouth.
- histo: psoriasiform mucositis, exocytosis of neutrophils into the epithelium, muncro microabscesses.
what is this and why
geographic tongue
- multiple erythematous zones with a white boarder surroudning it.
- most common at the lateral borders of the tongue and the tip of the tongue, but can also be seen on the floor of the mouth.
- histo: psoriasiform mucositis, exocytosis of neutrophils into the epithelium, muncro microabscesses.
what is this and why
geographic tongue
- multiple erythematous zones with a white boarder surroudning it.
- most common at the lateral borders of the tongue and the tip of the tongue, but can also be seen on the floor of the mouth.
- histo: psoriasiform mucositis, exocytosis of neutrophils into the epithelium, muncro microabscesses.
what is this and why:
histo: shows exocytosis of neutrophils into the epithelium
geographic tongue
- multiple erythematous zones with a white boarder surroudning it.
- most common at the lateral borders of the tongue and the tip of the tongue, but can also be seen on the floor of the mouth.
-histo: psoriasiform mucositis, exocytosis of neutrophils into the epithelium, muncro microabscesses.
what is this and why:
a pigmented lesion
Usually physiologic to a person of darker skin tones if it is over the entire mouth. If it is only found in one area, ask the patient if they are a smoker.
what is this and why
oral melanotic macule - melanin is evenly pigmented.
Focal increase in melanin
Normal number of melanocytes
Lower lip vermillion most common
Can also be found on the inside of the cheek
Melanin found on the basement membrane and the lamina propria
what is this and why
oral melanotic macule
Focal increase in melanin
Normal number of melanocytes
Lower lip vermillion most common
Can also be found on the inside of the cheek
Melanin found on the basement membrane and the lamina propria
what is this and why
hairy tongue
Elongated filiform papillae
Exogenous pigmentation may impart a brown or black appearance
Various associated factors
Heavy smoking
Antibiotic therapy
what is this and why
Actinic cheilitis or actinic cheilosis —both potentially pre malignant
Sun damage, lip blends in with skin
what is this and why
actinic chelitis/actinic cheliosis
both potentially pre malignant here it is concerning because starting to get bump and irregular borders.
Sun damage, lip blends in with skin
what is this and why
Reticular lichen planus
notice this! White lace appearance
Bilateral asymptomatic white lesions of posterior buccal mucosa (wickman striae)
Also papules and plaques (Seen in skin areas that flex→ causes itchy rash)
what is this and why
Reticular lichen planus
notice this! White lace appearance
Bilateral asymptomatic white lesions of posterior buccal mucosa (wickman striae)
Also papules and plaques (Seen in skin areas that flex→ causes itchy rash)
what is this and why
Erosive lichen planus
Red with superimposed white
Erosive is typically more red.
what is this and why
Erosive lichen planus
Red with superimposed white
Erosive is typically more red.
what is this and why
Erosive lichen planus
Red with superimposed white
Erosive is typically more red.
