Exam 1 Flashcards
Bulla
A circumscribed, elevated lesion that is more than 5 mm in diameter
Usually contains serous fluid, and looks like a blister
Lobule
A segment or lobe that is part of a whole
These lobes sometimes appear fused together
Macule
An area that is usually distinguished by a color different from that of the surrounding tissue
It is flat and does not protrude above the surface of the normal tissue
A freckle is an example of a macule
Nodule
A palpable solid lesion up to 1 cm in diameter found in soft tissue
Can occur above, level with, or beneath the skin surface
papule
A small, circumscribed lesion usually less than 1 cm in diameter
It is elevated or protrudes above the surface of normal surrounding tissue
pedunculated
Attached by a stemlike or stalklike base similar to that of a mushroom
pustules
Variously sized circumscribed elevations containing pus
sessile
Describes the base of a lesion that is flat or broad instead of stemlike
Vesicle
A small, elevated lesion less than 1 cm in diameter that contains serous fluid
erythema
abnormal redness
erythroplakia
Appears as a smooth red patch or granular, red, velvety patch
Can NOT be rubbed off or diagnosed as a specific disease
pallor
paleness
leukoplakia
White patch or plaque-like lesion
Can NOT be rubbed off or diagnosed as a specific disease
corrugated
wrinkled
papillary
Small finger-like projections or elevations found in clusters
verrucose
Warty, often with a rough surface
coalescence
The process by which parts of a whole join together, or fuse, to make one
Diffuse
Describes a lesion with borders that are not well defined, making it impossible to detect the exact parameters of the lesion
well circumscribed
Used to describe a lesion with borders that are specifically defined and in which one can clearly see the exact margins and extent
multilocular
Describes a lesion that extends beyond the confines of one distinct area
Defined as many lobes or parts that are somewhat fused together
A multilocular radiolucency is sometimes described as resembling soap bubbles
uniocular
Having one compartment or unit that is well defined or outlined as in a simple radicular cyst
fordyce granules
Clusters of ectopic sebaceous glands
Appear as yellow lobules in clusters
Commonly observed on vermilion border of lips and buccal mucosa
No treatment
More than 80% of adults over 20 years old have
torus palatinus
An exophytic growth of normal compact bone
Observed clinically in midline of hard palate
Inherited, gradual formation
More common in women
May take on various shapes and sizes, may be lobulated, and is covered by normal soft tissue
Treatment
None, unless they interfere with speech, swallowing, or a prosthetic appliance
(an example of exostosis)
mandibular tori
Outgrowths of dense bone found on the lingual aspect of the mandible in the area of the premolars above the mylohyoid ridge
Usually bilateral
Often lobulated or nodular
Can appear fused together
Have no predilection for either sex
No treatment unless they interfere with fabrication and placement of a prosthodontic appliance
melanin pigmentation
The pigment that gives color to skin, eyes, hair, mucosa, and gingiva
Most commonly observed in dark-skinned individuals
lingual varicosities
Clinical appearance
Red-to-purple enlarged vessels or clusters
Usually observed on the ventral and lateral surfaces of the tongue
Most commonly observed in individuals older than 60 years
linea alba
A “white line” extends anteroposteriorly on the buccal mucosa along the occlusal plane
May be bilateral
May be more prominent in patients who have a clenching or bruxing habit
leukodema
A generalized opalescence on the buccal mucosa
Most commonly observed in black adults
If the mucosa is stretched, the opalescence becomes less prominent
No treatment
Up to 90% of cases are observed in black adults.
Median Rhomboid Glossitis (Central Papillary Atrophy)
Flat or slightly raised oval or rectangular erythematous area in center of tongue
May be associated with a chronic infection with Candida albicans
No treatment necessary, but antifungal treatment may be used
Erythema Migrans/Benign Migratory Glossitis(Geographic Tongue)
Erythematous patches surrounded by a white or yellow border
Diffuse areas devoid of filiform papillae
Distinct presence of fungiform papillae
Ectopic can occur on other muciosal tissues
No treatment needed
Fissured Tongue(Scrotal Tongue)
Clinical appearance
The dorsal surface of the tongue appears to have deep fissures or grooves
Cause: Unknown
Probably involves genetic factors
Seen in about 5% of the population
white hairy tongue
Clinical appearance
Elongated filiform papillae are white
Result of either an increase in keratin production or a decrease in normal desquamation
Home care
Direct the patient to brush the tongue gently with a toothbrush to remove debris
Black hairy tongue
Clinical appearance
Papillae are brown-to-black because of chromogenic bacteria
Contributing factors
Tobacco
Foods
Hydrogen peroxide
Alcohol
Chemical rinses
Home care
Direct the patient to brush the tongue gently with a toothbrush to remove debris
inflammation
Nonspecific response that allows the body to eliminate injurious agents, contain injuries, and heal defects
Extent and duration of injury → determine extent and duration of inflammatory response
local inflammation
one area
systemic inflammation
whole body
classic signs of inflammation localized
Redness
Heat
Swelling
Pain
Loss of normal tissue function
classic signs of inflammation systemic
Fever
Leukocytosis
Elevated C-reactive protein (CRP)
Lymphadenopathy
pyrogens
a fever over 98.6
Leukocytosis
Increase in #WBCs (10,000-30,000)
Normal= 4,000-10,000
Elevated C-reactive protein
Protein produced in liver
Lymphadenopathy
Enlarged lymph nodes
Results from hyperplasia & hypertrophy of lymphocytes
hyperplasia
enlargement of tissue from increased NUMBER of cells
Hypertrophy
enlargement of tissue from increased SIZE of its cells
inflammation sequence
-injury to tissue
-constriction of microcirculation
-dilatation of microcirculation
-increased permeability
-exudate leaves
-increased blood viscosity
-decreased blood flow
-margination and pavementing of WBC
-WBC’s enter tissue
-WBC’s ingest foreign material
hyperplasia
An increase in the number of cells, often in response to chronic irritation or abrasion
May return to normal if the insult subsides, or may persist after removal of the irritant
hypertrophy
An increase in the size of cells
May be seen in cardiac muscle as a response to hypertension
Atrophy
A decrease in size or function of a cell, tissue, organ, or entire body
Regeneration
The process by which injured tissue is replaced with tissue identical to that present before the injury
Repair
The restoration of damaged or diseased tissues
Healing by primary intention
Healing of an injury in which there is little loss of tissue
The margins are close together and very little granulation tissue forms
Oral mucosa is less prone to scar formation
Healing by secondary
The edges of the injury cannot be joined during healing
A large clot forms, resulting in increased granulation tissue
May result in excess scar tissue: A keloid
Healing by tertiary intention
Delaying surgical tissue repair until infection is resolved
An injured area may become infected, especially with puncture wounds
In some situations, an infected injury is left open until infection is controlled
attrition
tooth to tooth wear
Bruxism
Grinding and clenching teeth for nonfunctional purposes
abrasion
Pathologic wearing away of tooth structure that results from a repetitive mechanical habit
Most frequently seen as a notching on root surfaces with gingival recession
abfraction
Appearance: Typically appears as wedge-shaped lesions at the cervical areas of teeth
erosion
Loss of tooth structure as
a result of chemicals, without bacterial involvement
meth abuse
Rapid destruction of teeth as a result of:
Methamphetamine acid content
Decreased salivary flow
Cravings for high-sugar beverages
Lack of oral hygiene
Peripheral Giant Cell Granuloma
A lesion that contains many multinucleated giant cells, well-vascularized connective tissue, RBCs, and chronic inflammatory cells
Reactive lesion
Clinical appearance resembles that of pyogenic granuloma
Treatment: Surgical excision
external resorption
Nonreversible resorption of the tooth structure, beginning at the outside of the tooth
Causes
Inflammation
Pressure
Reimplantation
Idiopathic
internal resorption
tooth or root resorption: Resorption often associated with an inflammatory response in the pulp or an idiopathic reason
Appearance
Clinically: A pinkish area in the crown resulting from the vascular, inflamed connective tissue
Radiographically: Radiolucent
Immunity
the body has memory to fight infection
B-cell lymphocytes
Develops from stem cells in bone marrow
Matures in lymphoid tissue
lymph nodes & tonsillar tissue
B-cells travel to injury site when stimulated by antigen
Two main types:
Plasma cell - produce specific antibody needed to fight antigen
B-memory cell- retains memory of previous antigen
B-Cell Lymphocytes: Plasma Cells
Plasma cells produce antibodies (immunoglobins)
Carried in blood serum
IgA
Found in Saliva, breast milk, stomach secretions
IgE
Lung, Skin & cells of mucous membranes
IgG
Most circulating antibodies
what makes up the immune complex
antibodies + antigen
difference between inflammation and immunity
immunity has memory
type 1 hypersensitivity
Hay fever
Asthma
Anaphylaxis
type 2 hypersensitivity
cytotoxic type
Autoimmune hemolytic anemia
Type 3 hypersensitivity
immune complex type
Autoimmune diseases
Type 4 hypersensitivity
cell-mediated type
Granulomatous disease
Tuberculosis
Allergic/anaphylactic
(rapid onset) (IgA)
Cytotoxic type
(IgG/IgM)
Immune complex
(autoimmune disorders)
Delayed/cell-mediated type
(dermatitis, delayed reaction)
aphthous ulcers
Painful oral ulcers with an unclear cause
Reported incidence ranges from 5% to 56%
Trauma is the most common precipitating factor
May be caused by emotional stress or certain foods
May be associated with certain systemic diseases
3 types of aphthous ulcers
Minor
Major
Herpetiform
Minor Aphthous Ulcers
Most common
Discrete, round to oval, <1 cm, yellowish-white surface surrounded by erythema
Movable mucosa of oral cavity, gingiva
1-2 day prodromal period with burning or soreness
Single or multiple lesions
Heal in 7-10 days
Major Aphthous Ulcers
> 1cm, deeper, last longer
Painful, often in posterior portion of mouth
Diagnosis: biopsy…
May take several weeks
to heal and result in
scarring
(Sutton’s disease,
periadenitis mucosa
necrotica recurrens)
Urticaria
Hives
Swelling and itching of the skin
Localized areas of vascular permeability
Acute self-limited episodes, or chronic or recurrent forms
Erythema Multiforme
Acute self-limiting disease affecting the skin and mucous membranes
Target lesions on the skin that appear in concentric rings of erythema and normal skin color
Oral lesions are either ulcers or erythmatous areas
triggering factors of erythema multiforme
herpes simplex, tuberculosis, histoplasmosis, malignant tumors, and certain drugs
treatment of erythema multiforme
Topical or systemic corticosteroids, antiviral medication
Stevens-Johnson syndrome
Most severe form of erythema multiform
Lesions are more serious and painful
Encrusted and bloody lips, genital mucosa and mucosa of the eyes could be involved
Lichen Planus
Effects the skin and/or oral mucosa
Wickham striae
Small, papular, white nodule most commonly seen on buccal mucosa
Diagnosis: clinical and histological appearance
Treatment: topical corticosteroids, oral hygiene
Reiter Syndrome (Reactive Arthritis)
Triad of arthritis, urethritis, conjunctivitis
Aphthous like ulcers, erythematous lesions, and geographic tongue like lesions
Diagnosis- clinical signs and symptoms
Treatment- nonsteroidal antiinflammatory drugs such as aspirin
Sjogren Syndrome
Decrease in saliva and tears of salivary and lacrimal glands
Xerostomia
Cellular AND humoral immunity
Lips cracked and dry, loss of papillae on dorsal tongue surface, increased risk of caries, periodontal disease, and oral candidiasis
diagnosis and management of sjogren syndrome
Diagnosis is made when two of three components are present
Xerostomia
Measurement of salivary flow and biopsy can help
Keratoconjunctivitis sicca
Confirmed by eye examination
Rheumatoid arthritis
For most patients, the course of the disease is chronic and benign, but these patients are at risk for the development of other, more serious diseases
Treated symptomatically
Nonsteroidal antiinflammatory
agents for arthritis
May need corticosteroids and immunosuppressive drugs for severe cases
Treated symptomatically Saliva substitutes for xerostomia
Humidifier, sugarless gum, or lozenges
Pilocarpine
Treated symptomatically Glasses and/or artificial tears
to protect eyes
Good oral hygiene
Fluoride
Frequent re-care appointments
Systemic Lupus Erythematosus
Acute and chronic
“Butterfly” rash on the nose, white erosive lesions (Ibsen)
Arthritis and arthralgia
Dx: antinuclear antibodies in serum,
multiorgan involvement
Pemphigus Vulgaris
Severe progressive autoimmune disease
Mucosal ulcerations, fragile vesicles or bullae
Dx: biopsy and microscopic examinations
Tx: high doses of corticosteroids, immunosuppressive drugs
Nikolsky sign
of pemphigus vulgaris
Rubbing with a finger can produce a bulla
Bullous Pemphigoid
Mostly in elderly populations
Detectable autoantibodies
Oral lesions less common than in cicatrical pemphigoid
Tx: systemic corticosteroids, NSAIDS
Tuberculosis
Infectious chronic granulomatous disease
Caused by organism Mycobacterium Tuberculosis
Primary infection is in lungs:
inhaled droplets undergo Phagocytosis by macrophages but are resistant to destruction and
multiply in the macrophages
Travel by blood stream to kidney, liver, and lymph nodes.
Infectious Diseases
Oral cavity contains numerous microorganisms that make up the normal oral flora
400-500
types of infectious diseases
Bacterial, fungal and viral infections are most common
Protozoan and helminthic infections - rare
Opportunistic Infections
affect the oral flora so that organisms that are usually
nonpathogenic
are able to
cause disease
Syphilis
Treponema pallidum “Spirochete”
Acquired & congenital
Direct contact or infected blood
3 stages:
primary, secondary and tertiary
Primary “chancre” lesion= HIGHLY infectious!
syphilis secondary lesion
“mucous patch”-
multiple painless, grayish white plaques covering ulcerated mucosa
Most infectious stage occurs 6 weeks after primary lesion appear
Oral lesions
Treatment –penicillin G
Can undergo spontaneous remission
Can recur for months/years
syphilis tertiary
Tertiary syphilis occurs in infected persons…
Many years after nontreatment of secondary syphilis
Localized lesion termed “gumma” and is noninfectious
Lesion appears as a firm mass that eventually becomes an ulcer
Very destructive and can lead to palatal perforation
Congenital Syphilis
Transmitted to the offspring by an infected mother.
Developmental disorders in child
Characteristics of congenital syphilis:
high palatal areasaddle nosedeafnessMulberry molarsHutchinson’s incisors
“Acute” Necrotizing Ulcerative Gingivitis
Painful erythematous gingivitis
Tissue sloughing = pseudomembrane appearance
Accompanied by
Fever, cervical lymph node enlargement
lymphadenopathy
Necrosis of the interdental papillae
blunted appearance
Most likely caused by both a fusiform bacillus and spirochete
Associated with decreased resistance to infection.
very foul odor and metallic taste
Periocoronitis
Inflammation of the mucosa around the crown of a partially erupted, impacted tooth.
Most common site –mandibular 3rd molars
Bacteria is proliferating in pocket
Trauma, impaction of food, compromised host factors associated with increased risk of Periocoronitis
Herpes: oral & genital
Viral
Primary herpes (I)
Acute or primary herpetic gingivostomatitis
Painful, erythematous & swollen gingiva & multiple tiny vesicles on the perioral skin, vermilion border of the lips & oral mucosa
Vesicles progress to form ulcers
oral herpes VIRAL INFECTIONS
Vesicles progress to form ulcers
Systemic symptoms such as fever, malaise & cervical lymphadenopathy
Occurs most commonly in children between 6 months & 6 years.
Disease is self-limited & heals spontaneously in 1 to 2 weeks
Kissing is a common way of spreading
Secondary herpes or recurrent herpes simplex infection
Virus persist in a latent state, usually in the nerve tissue of trigeminal ganglion
~1/3 to ½ of the pop. has this
Cold sore, fever blister
Intraoral lesions found:
~Attached or bound down tissue
Herpetic Whitlow
A primary or recurrent infection
>eye infections also
shingles
Herpes zoster
Varicella-zoster virus
Chickenpox virus (age 10-14)
Vaccines available
Childhood & adults over 50
Occurs unilateral
(see Text: 4-30)
painful eruption of vesicles along the distribution of a sensory nerve
Decrease of CMI (cell- mediated immunity)
Coxsackie type A
Herpangina
Aphthous Pharyngitis
Lesions on soft palate along with fever, malaise, sore throat, and difficulty swallowing (dysphagia)
Resolves in less than a week without treatment.
Hand Foot & Mouth
Verruca vulgaris
Human wart virus
white, papillary, exophytic lesion
looks like a papilloma
Papillary oral lesion
Transmitted by direct contact
(skin to oral mucosa and lips)
Autoinoculation occurs through finger sucking or fingernail biting
Benign tumor of squamous epithelium
Epstein- Barr Virusherpes Virus 4
Epstein-Barr virus has been implicated in several diseases that occur in the oral region including:
Infectious mononucleosis
Nasopharyngeal carcinoma
Burkitt’s lymphoma
Hairy leukoplakia
Epstein-Barr VirusInfectious Mononucleosis
Sore throat
Fever
Generalized lymphadenopathy
Enlarged spleen
Malaise, and fatigue
Oral –palatal petechiae
Diagnosis: blood test
Usually benign, self-limited disease (4-6 weeks)
HIV INFECTION: Signs/symptoms/consequences
Wasting Syndrome
Neurological disease
Secondary infections or conditions
(opportunistic/fatal)
Pneumocystis carinii pneumonia
Tuberculosis
Non-Hodgkin’s lymphoma
Kaposi’s sarcoma
Viewed on next slide…
secondary infections of HIV
hairy leukoplakia (Epstein Barr virus)
herpes zoster
tuberculosis
oral candidiasis
List some Viruses or viral conditions more likely to be present in the oral cavity…
Human papillomavirus (warts)
Herpes simplex virus (herpetic stomatitis)
Varicella virus (Shingles)
Epstein Barr (Hairy leukoplakia)
Oral ulcerations
Salivary gland enlargement
Idiopathic thrombocytopenic purpura (spontaneous bleeding)
Types of candidiasis
Pseudomembranous
Acute atrophic
Chronic atrophic
(denture stomatitis)
Chronic hyperplastic
angular cheilitis
Treatment - antifungal medication, e.g.. Nystatin
