Common Oral Lesions-Dr. Hasan Flashcards
What are you most likely going to see in your practice?
- Aphthous Ulcer
- Traumatic Lesions
- ulcerative
- fibroma
- Lichen Planus/Lichenoid Reaction
- Denture related oral lesion
- Viral Lesions
- Geographic Tongue
What will you occasionally see in your practice?
- MMP
- Pemphigus Vulgaris
- Erythema Multiforme
What are the 2 major categories of oral lesions
- Infectious Etiology
- Non-infectious Etiology
What oral lesions fall under infectious etiology?
- Oropharyngeal Candida
- Herpes Simplex
- Herpes Zoster
What oral lesions fall under Non-Infectious Etiology
- Painful Traumatic Lesions
- Traumatic Fibroma
- Aphthous Stomatitis
- Geographic Tongue
- Lichen Planus/Lichenoid Reaction
- Mucous Membrane Pemphigoid
- Pemphigus
- Cancer
Oropharyngeal Candida consists of:
- Pseudomembranous Candidiasis
- Erythematous (Atrophic) Candidiasis
- Chronic Hyperplastic Candidiasis
Oropharyngeal Candida associated conditions
- Angular Cheilitis
- Central Papillary Atrophy
- (median Rhomboid glossitis)
Pseudomembranous Candidiasis
- aka Thrush
- Most common form of candidiasis
- opportunistic infection
- Common locations:
- buccal mucosa
- palate
- tongue
- Cause fungal laryngitis
Erythematous Candidiasis
- Red areas
- Presentation:
- burning
- stinging
- itching
- altered taste
- Locations
- palate
- dorsal of tongue
- Associated with:
- dryness
- compounded by use of dentures, antibiotics, or steroids
DAS
- Denture Associated Stomatitis
- caused by contaminated dentures
- Most susceptible:
- elderly
- immunocompromised
- Diagnosed by:
- swab & grow fungus on S. Agar medium
Chronic Hyperplastic Candidiasis (CHC)
- old name- candidal leukoplakia
- oral candidiasis variant
- Caused by Candida albicans
- Asymptomatic
Angular Cheilitis
- 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
Central Papillary Atrophy
- AKA Median Rhomboid Glossitis
- tongue missing filiform papilla
- Chronic Fungal (Candidiasis) infection
- Kissing lesions
- sometimes
- develops on the palate
- Common in immunosuppressed
Herpes Simplex Virus
- 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
compare and contrast HSV-1 and HSV-2
- HSV-1
- transmission: Oral to oral contact
- cause:
- oral herpes
- symptoms-cold sores
- genital herpes
- oral herpes
- HSV-2:
- sexually transmitted
- causes:
- genital herpes
- increases the risk of acquiring and transmitting HIV infection
- Both:
- lifelong infections
How can children get infected by herpes simplex virus?
- infected adult
- kiss
- eating from same utensil
- sharing a towel
How long will it take for herpes to show up after contact with an infected person?
- 2-20 days
What is Herpes Prodrome?
- Fever
- Malaise
- GI symptoms
- LAD
- headache
Where do most blisters appear for Herpese Simplex virus?
- Lips
- around mouth
- Sometimes
- face
- tongue
Herpes Simplex Virus: Differential Diagnosis
- Varicella Zoster Virus
What causes Herpes Simplex virus to recurr?
- Cold
- Stress
- Sunlight
- Trauma
- Immunosuppresion
- RHL (recurrent Herpes Labialis)
- cold sore
- fever blister-most common form
Varicella Zoster Virus (VZV)
- 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
Varicella Zoster Virus: Clinical Features
- More severe in HIV patients
- Intraoral lesions
- more severe
- involve bone=tooth loss
- Mild prodrome: 1-2 days
How is VZV transmitted?
Respiratory transmission
What is the incubation period for Varicella Zoster Virus?
- 14-16 days
- range 10-21 days
Traumatic Lesions
- More prevalent in patients with oral dryness
- can be seen w/normal salivary flow
Aphthous Stomatitis
- unclear etiology
- factor=altered immune response
- Any age
- Herpetiform=not common
- minor lesion: ≤ 0.5cm
- Major lesion: ≤ 3.0cm
Aphthous Stomatitis: Differential Diagnosis
- Bahcets disease
- Crohns disease
- Contact Dermatitis
- Herpes simplex
- Lichen planus
What causes Geographic tongue?
- unknown
- possible factors
- emotional stress
- psychological factors
- habits
- allergies
- diabetes
- hormona disturbances
- possible factors
Geographic tongue
- oral form of psoriasis
- any age
- varies in color, shape, and size
Lichen Planus
- autoimmune
- occurs in 1-2% adults
- usually middle aged females
- Involves:
- vagina
- Skin (10-15%)
- Biopsy solitary white plaque
- leukoplaque & erythroleukoplakia misdiagnosed as LP
What are the different types of LP
- Reticular
- Erythematous/Erosive
- ulcerative
Reticular Lichen Planus
- 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
Erythematous/Erosive Lichen Planus
- Red areas
- raw appearance
- Located on
- gingiva
- painful
- requires Tx
Ulcerative Lichen Planus
- Any surface
- tongue=causes atrophy of taste buds
- painful
- severe case=hx of weight loss
Lichen Planus: Differential Diagnosis
- Epithelial Dysplasia
- MMP
- Chronic GVHD
- Chronic Ulcerative Stomatitis
Painful Traumatic Lesions
- More prevalent w/oral dryness
- seen w/normal salivary flow
Mucous Membrane Pemphigoid (MMP)
- 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
MMP Differential Diagnosis
- Lichen Planus
- Aphthous ulcer
- Pemphigus
Pemphigus
- 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
Pemphigus Differential Diagnosis
- Pemphigoid
- Ulcerative LP
- Erythema Multiforme
