Differential Diagnosis: Red Lesions Flashcards
What makes a red lesions red?
- Decreased thickness of epithelium
- Inflammatory dilation of blood vessels
- Increased numbers of small blood vessels
What is the most common oral form of Candida seen in the dental office?
Denture Stomatitis
What are things that can cause Angular Chelitis? (4)
- Overclosure
- Candidiasis
-
Vitamin B Complex Deficiency
- Except thiamine B1
- Iron Deficiency
What is the Differential Diagnosis for a red, atrophic, bald tongue? (4)
- Xerostomia
-
Acute Atrophic Candidiasis = Antibiotic Sore Mouth
- Scalded tongue sensation
- Loss of filliform papillae
- Vitamin B Complex Deficiency/Iron Deficiency
- Resolving Benign Migratory Glossitis
What is the Differential Diagnosis for Red, Atrophic, Desquamative Gingivitis = shiny erythema generalized to gingiva and alveolar mucosa, sloughing? (4)
Differentiate with histo
- Benign Mucous Membrane Pemphigoid
- Lichen Planus
- Pemphigus
- Allergy/Hormonal
What in the Differential Diagnosis for Red, Atrophic, Desquamatic Gingivitis, has a histo of SUBepithelial clefting?
BMMP
What in the Differential Diagnosis for Red, Atrophic, Desquamatic Gingivitis, has a histo of: hyperORTHOkeratosis, saw-tooth rete ridges, with a dense, linear subepithelial infiltrate of lymphocytes?
Erosive Lichen Planus
What in the Differential Diagnosis for Red, Atrophic, Desquamatic Gingivitis, has a histo of: SUPRAbasilar vesicles, acantholytic cells?
Pemphigus
What in the Differential Diagnosis for Red lesions of the Palate?
- Hemangioma
- Kaposi’s Sarcoma
When diagnosising a red palatal lesion, what questions should you ask?
- Has it been there pts entire life?
- Hemangioma - stops at the midline
- What is the pts HIV status?
- Kaposi’s Sarcoma
What is the Differential Diagnosis for Red and White Lesions? (5)
-
Amalgam Allergy
- Sulfur products
-
Aspirin Burn
- White when epithelium is present and red when it sloughs off
-
Candidiasis
- Palatal, related to steroids and dentures
-
Cinnamon Reaction
- Unilateral: buccal mucosa + tongue = kissing lesions
- Hurts, burns
- Lupus
What is the Differential Diagnosis for Asymptomatic Red Lesions on the Palate? (7)
- Non-specific irritation
- Candidiasis
- CIS/SCC
- Allergy
- Lichen Planus
-
Lupus
- Loves the palate and lips
-
Benign Migratory Stomatitis
- Kissing lesion
- Well demarcated erythmatous area surrounded by a white border
What is the Differential Diagnosis for Chronic, Burning Lesion on the Cheek? (5)
- Lichen Planus
- Cinnamon Stomatitis
- Candidiasis
- Dysplasia/CIS/SCC
-
Lupus
- Looks like LP in the mouth but the pt has the butterfly rash on their face
What are the many faces of Candidiasis? (5)
“MAP of DC”
- Median Rhomboid Glossitis
- Angular Chelitis
- Pseudomembranous Candidiasis
- Denture Sore Mouth
- Chronic Hyperplastic Candidiasis
In which type of Candidiasis does the white part scrape off, revealing an erythematous non-bleeding surface?
Pseudomembranous Candidiasis
What type of Candidiasis is most often found in smokers?
Median Rhomboid Glossitis
What type of Candidiasis is common in Diabetics?
Chronic Hyperplastic Candidiasis
- Bilateral corner of lips like in Angular Chelitis
- May be indurated
What are the Systemic Causes of Candidiasis? (5)
“AIDS X-ills”
- Antibiotic Therapy
-
Immunosuppressive Disease
- HIV
- Malignancy (Leukemia, Lymphoma, Myeloma)
- Diabetes
- Steroids
-
Xerostomia - from any cause
- Radiation/Chemo
- Sjogren Sx, Autoimmune Diseases
What are the Local Causes of Candidiasis? (4)
“Lucky to get my DMD”
-
Lichen Planus
- Candida loves to grow in LP
-
Dentures
- Angular Cheilitis from overclosed VDO
- DSM, Papillary Hyperplasia
- Median Rhomboid Glossitis
- Dysplasia
What are the Clinical Lichenoid Lesions? (7)
“GLAD lichenoid lesions are in the ACC”
- Graft vs. Host Disease
- Lupus
- Antihypertensives
- Dysplasia/CIS
- Amalgam Hypersensitivity
- Candida
- Cinnamon Reaction
How long can it take for a lichenoid lesion to appear due to Antihypertensives?
Can take up to 2 years of being on the medication for Lichen Planus to show up.
How long can it take for a lichenoid lesion caused by Antihypertensives to disappear?
Can take up to 1 year before the lichenoid lesion will go away, you can’t just take people off their HTN meds
What is the Diagnostic Histology of the Cinnamon Reaction?
Perivascular Infiltrate
What is the Histology of Dysplasia? (4)
- Keratin present = white lesion
- Dysmaturation - jumbled appearance of cells in the lower portion of the epithelium
- Tear Drop Rete Ridges
- Hyperkeratosis, mature surface cells, deeper cells show dysmaturation, dyskeratosis (squamous pearls), hyperchromatism, pleomorphism
What is the Histology of CIS?
- No Keratin = Red lesion
- Full thickness/top to bottom shows:
- Large, crowded, immature cells
- No maturation
