Common Oral Lesions-Dr. Hasan

Question 1

What are you most likely going to see in your practice?

Answer 1

• Aphthous Ulcer
• Traumatic Lesions
  
  • ulcerative
  • fibroma
• Lichen Planus/Lichenoid Reaction
• Denture related oral lesion
• Viral Lesions
• Geographic Tongue

Question 2

What will you occasionally see in your practice?

Answer 2

• MMP
• Pemphigus Vulgaris
• Erythema Multiforme

Question 3

What are the 2 major categories of oral lesions

Answer 3

• Infectious Etiology
• Non-infectious Etiology

Question 4

What oral lesions fall under infectious etiology?

Answer 4

• Oropharyngeal Candida
• Herpes Simplex
• Herpes Zoster

Question 5

What oral lesions fall under Non-Infectious Etiology

Answer 5

• Painful Traumatic Lesions
• Traumatic Fibroma
• Aphthous Stomatitis
• Geographic Tongue
• Lichen Planus/Lichenoid Reaction
• Mucous Membrane Pemphigoid
• Pemphigus
• Cancer

Question 6

Oropharyngeal Candida consists of:

Answer 6

• Pseudomembranous Candidiasis
• Erythematous (Atrophic) Candidiasis
• Chronic Hyperplastic Candidiasis

Question 7

Oropharyngeal Candida associated conditions

Answer 7

• Angular Cheilitis
• Central Papillary Atrophy
  
  • (median Rhomboid glossitis)

Question 8

Pseudomembranous Candidiasis

Answer 8

• aka Thrush
• Most common form of candidiasis
• opportunistic infection
• Common locations:
  
  • buccal mucosa
  • palate
  • tongue
• Cause fungal laryngitis

Question 9

Erythematous Candidiasis

Answer 9

• Red areas
• Presentation:
  
  • burning
  • stinging
  • itching
  • altered taste
• Locations
  
  • palate
  • dorsal of tongue
• Associated with:
  
  • dryness
  • compounded by use of dentures, antibiotics, or steroids

Question 10

DAS

Answer 10

• Denture Associated Stomatitis
• caused by contaminated dentures
• Most susceptible:
  
  • elderly
  • immunocompromised
• Diagnosed by:
  
  • swab & grow fungus on S. Agar medium

Question 11

Chronic Hyperplastic Candidiasis (CHC)

Answer 11

• old name- candidal leukoplakia
• oral candidiasis variant
• Caused by Candida albicans
• Asymptomatic

Question 12

Angular Cheilitis

Answer 12

• Aka:
  
  • Perleche
  • Angular Stomatitis
  • Cheilosis
• Diagnosed by presence of inflammation and fissuring of oral commisures
• Burning sensation or tender corners of mouth
• may limit range of motion of the mouth
• impaired eating

Question 13

Central Papillary Atrophy

Answer 13

• AKA Median Rhomboid Glossitis
• tongue missing filiform papilla
• Chronic Fungal (Candidiasis) infection
• Kissing lesions
  
  • sometimes
  • develops on the palate
• Common in immunosuppressed

Question 14

Herpes Simplex Virus

Answer 14

• aka herpes
• 2 types:
  
  • Herpes Simplex virus type 1 (HSV-1)
  • Herpes Simplex virus type 2 (HSV-2)
• Symptoms=most contagious
  
  • painful blisters or ulcers
  • tingling, itching, or burning before blisters appear
  • asymptomatic viral shedding=still contagious

Question 14

compare and contrast HSV-1 and HSV-2

Answer 14

• HSV-1
  
  • transmission: Oral to oral contact
  • cause:
    
    • oral herpes
      
      • symptoms-cold sores
    • genital herpes
• HSV-2:
  
  • sexually transmitted
  • causes:
    
    • genital herpes
  • increases the risk of acquiring and transmitting HIV infection
• Both:
  
  • lifelong infections

Question 15

How can children get infected by herpes simplex virus?

Answer 15

• infected adult
  
  • kiss
  • eating from same utensil
  • sharing a towel

Question 16

How long will it take for herpes to show up after contact with an infected person?

Answer 16

• 2-20 days

Question 17

What is Herpes Prodrome?

Answer 17

• Fever
• Malaise
• GI symptoms
• LAD
• headache

Question 18

Where do most blisters appear for Herpese Simplex virus?

Answer 18

• Lips
• around mouth
• Sometimes
  
  • face
  • tongue

Question 19

Herpes Simplex Virus: Differential Diagnosis

Answer 19

• Varicella Zoster Virus

Question 20

What causes Herpes Simplex virus to recurr?

Answer 20

• Cold
• Stress
• Sunlight
• Trauma
• Immunosuppresion
• RHL (recurrent Herpes Labialis)
  
  • cold sore
  • fever blister-most common form

Question 21

Varicella Zoster Virus (VZV)

Answer 21

• aka shingles, Herpes Zoster
• Primary infection=varicella (chickenpox)
  
  • Recurrent infection= herpes zoster (shingles)
• dormant/latent in Dorsal root ganglia
• Causes Herpes zoster
  
  • painful, maculo-papular rash
  • appears 1st on head
  • most concentrated on trunk

Question 22

Varicella Zoster Virus: Clinical Features

Answer 22

• More severe in HIV patients
• Intraoral lesions
  
  • more severe
  • involve bone=tooth loss
• Mild prodrome: 1-2 days

Question 23

How is VZV transmitted?

Answer 23

Respiratory transmission

Question 24

What is the incubation period for Varicella Zoster Virus?

Answer 24

* 14-16 days * range 10-21 days

Question 25

Traumatic Lesions

Answer 25

* More prevalent in patients with oral dryness * can be seen w/normal salivary flow

Question 26

Aphthous Stomatitis

Answer 26

* unclear etiology * factor=altered immune response * Any age * Herpetiform=not common * minor lesion: ≤ 0.5cm * Major lesion: ≤ 3.0cm

Question 27

Aphthous Stomatitis: Differential Diagnosis

Answer 27

* Bahcets disease * Crohns disease * Contact Dermatitis * Herpes simplex * Lichen planus

Question 28

What causes Geographic tongue?

Answer 28

* unknown * possible factors * emotional stress * psychological factors * habits * allergies * diabetes * hormona disturbances

Question 29

Geographic tongue

Answer 29

* oral form of psoriasis * any age * varies in color, shape, and size

Question 30

Lichen Planus

Answer 30

* autoimmune * occurs in 1-2% adults * usually middle aged females * Involves: * vagina * Skin (10-15%) * Biopsy solitary white plaque * leukoplaque & erythroleukoplakia misdiagnosed as LP

Question 31

What are the different types of LP

Answer 31

* Reticular * Erythematous/Erosive * ulcerative

Question 32

Reticular Lichen Planus

Answer 32

* White striations (webbed) * Located on: * buccal mucosa * labial mucosa * ventral & dorsal tongue * gingiva * Asymptomatic usually * Tx: if symptomatic * if no improvement=biopsy * see patient 1 time per year

Question 33

Erythematous/Erosive Lichen Planus

Answer 33

* Red areas * raw appearance * Located on * gingiva * painful * requires Tx

Question 34

Ulcerative Lichen Planus

Answer 34

* Any surface * tongue=causes atrophy of taste buds * painful * severe case=hx of weight loss

Question 35

Lichen Planus: Differential Diagnosis

Answer 35

* Epithelial Dysplasia * MMP * Chronic GVHD * Chronic Ulcerative Stomatitis

Question 36

Painful Traumatic Lesions

Answer 36

* More prevalent w/oral dryness * seen w/normal salivary flow

Question 37

Mucous Membrane Pemphigoid (MMP)

Answer 37

* autoimmune * Middle Aged females * Painful bleeding gums when brushing * Hx of oral and skin blisters * Desquamative gingivitis * bright red, tender gingiva * Limited to oral cavity mostly * ocular lesions-refer

Question 38

MMP Differential Diagnosis

Answer 38

* Lichen Planus * Aphthous ulcer * Pemphigus

Question 39

Pemphigus

Answer 39

* Middle aged and older patients * jewish decent * Located on: * palate * Painful ulcers * shallow erosion * involves esophagus * oral lesion might be only manifestation * Positive Nikolsky sign * associated w/desquamative gingivitis

Question 40

Pemphigus Differential Diagnosis

Answer 40

* Pemphigoid * Ulcerative LP * Erythema Multiforme