Exam 2; Gingival Diseases 2 Flashcards by James Pacheco

What are the characteristics of lichen planus

characteristic skin lesions (wickham striae)
oral involvement alone is common
various clinical appearances
any area of the oral mucosa

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This is a small, inflammatory, congested spot on the skin, a pimple

papula

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this is a mesh; in the form of a network

reticular

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this is a patch on the skin or on a mucous surface

plaque

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This is wasting, a decrease in the size of tissue

atrophy

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This is affected with an ulcer, open sore or lesion of the skin or mucosa accompanied by the sloughing of inflamed necrotic tissue

ulcerative

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This is a large blister or skin vesicle filled with fluid

bulla

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Lichen plans can also look like this

oral lichenoid lesions

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What are three examples of oral lichenoid lesions

lesions in contact with dental restorations
lesions associated with various types of restorations
a group of systemic diseases

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What is the treatment for oral lichenoid lesions

biopsy
take sample for culture if questioning candida
traumatic plaque control
topical corticosteroids to control pain, discomfort

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This is a group of disorders in which autoantibodies towards components of the basement membrane result in detachment of the epithelium from the connective tissue

pemphigoid

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What is the histology behind pemphigoid

autoantibody reactions against hemidesmosomes and lama lucida components

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Pemphigoid results in deposits of what things

C3
IgG
other Ig’s

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What are the three types of pemphigoids

bullous
benign mucous membrane
cicatrical (scar formation)

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What is the nicholsky sign

rubbing of the gingiva creates bulla formation

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What is the treatment for pemphigoid

plaque removal with daily use of chlorahexidine and/or topical corticosteroid

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This results from the formation of intraepithelial bullae in the skin and mucous membranes; painful desquamative lesions, erosions, or ulcerations

pemphigus vulgaris

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Which group of people is more susceptible to pemphigus vulgaris

strong genetic background in Jewish and Mediterranean

typically in the middle aged or elderly

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What is the histology being pemphigus vulgaris

acantholysis (due to destruction of the desmosomes)
pericellular epithelial deposits of IgG and C3
circulating autoantibodies against intraepithelial adhesion molecules

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This is an acute, sometimes recurrent vesiculobullous disease affecting both mucous membranes and the skin; swollen lips often with extensive crust formation of the vermillion border; oral involvement in 25-60% of cases

erythema multiforme

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What are the characteristics of erythema multiforme

bullae that rupture and leave extensive ulcers
characteristic skin lesions (iris appearance + bulla)
extensive necrosis; Stevens-Johnson
may occur at any age buy mostly young individuals

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Erythema multiforme appears to be a cytotoxic immune response towards what

keratinocytes precipitating by a wide range of factors including herpex simplex and various drugs

What is the treatment of erythema multiforme

plaque control; local/systemic

This is an autoimmune connective tissue disorders in which autoantibodies form to various cellular constituents

lupus erythematous

What is the clinical manifestation of lupus erythematous

central atrophic area with small white dots surrounded by irradiating fine white striae with a periphery of telangiectasia; butterfly lesions lesions can be ulcerated and cannot be differentiated from leukoplakia or atrophic oral lichen planus

What is the histology of lupus erythematous

degeneration of basal cells and increased width of the basement membrane deposits of Ig's, C3, and fibrin along the basement membrane

What are some examples of drug induced mucocutaenous disorders

``` gingival hyperplasia erythema multiform oral ulceration epithelial atrophy, superficial sloughing intense erythema ```

What are some drugs that can cause mucocutaneous disorders

``` immunosuppressants calcium channel blockers anti-epipleptic anti-malarial anti-neoplastic methotrexate ```

This GI disease can cause chronic granulomatous infiltrates of the wall of gastrointestinal tract

Crohn's disease

This hematological disorder can cause swelling, petechia, and erythema of the gingiva, 69% of patients with this have oral signs

leukemia

This reactive process of the periodontal soft tissue is sessile, well-circumscribed smooth-surfaced modules

fibroma/focal fibrous hyperplasia

What is the histology behind a fibroma

cell-poor, hyper plastic collagenous tissue | may show hyperkeratinization

What could fibroma be differentially diagnosed as

giant cell fibroma

This reactive process of the periodontal soft tissue is often reddish, and ulcerated reactive lesion with highly cell-rich areas below uncharted sites; fibrous proliferation in which bone or cementum like hard tissue is formed

calcified fibroblastic granuloma

This reactive process of the periodontal soft tissue is ulcerated, at the gingival margins, reddish or bluish, sometimes lobulated, sessile or pedunculate; bleeding is common high vascular with chronic inflammatory cells

pyogenic granuloma

This reactive process of the periodontal soft tissue can be found anywhere on the gingival mucosa, pedunculate or sessile, red or purple, commonly ulcerated; a focal collection of multi-nucleated osteoclast-like giant cells with richly cellular and vascular stroma separated by collagenous septa; probably originated from PDL

peripheral giant cell granuloma

This reactive process of the periodontal hard tissue usually has no symptoms, vital tooth, fibrous-osseus cement lesions the perioapical bone is replaced by cellular fibroblastic tissue through cementoblastic phase

periapical cemental dysplasia

This benign neoplasm of the periodontal soft tissue is a rather frequent tumor of oral mucosa, flat or raised, sometime lobulated, soft lesions of blue - red color; asymptomatic by may bleed, blanch on pressure; capillary or cavernous types

hemangioma

This benign neoplasm of the periodontal soft tissue is a pigmented lesion containing melanocytes in the CT, mostly seen in the palate, flat, slightly raised lesions or tumors, brown or black; located along the basal layer of epithelium

nevus

This benign neoplasm of the periodontal soft tissue is exophytic, pedunculate, or sessile lesions, reddish/normal or whitish/grey in color granular/moruloid or filiform/digitated surface

papilloma; HPV is commonly found

This benign neoplasm of the periodontal soft tissue is less common in oral mucosa than the skin; lips and palate are main location; sessile, exophytic or raised lesion with a whitish surface papillomatous surface with hyperkeratinization and elongated rete pegs HPV 2 or 4

verruca vulgaris

This benign neoplasm of the periodontal soft tissue is non-ulcerated sessile or pedunculate gingival lesions generally detected in the soft tiara around unerupted teeth histopathology similar to intraossesus forms of tumors

peripheral odontogenic tumors

This benign neoplasm of the periodontal hard tissue is derived from odontogenic epithelium and has well-circumscribed radiolucency

ameoloblastoma

This benign neoplasm of the periodontal hard tissue is derived from the PDL, presumable from epithelial rests of Malassez often associated with lateral root surface rare

squamous odontogenic tumor

This benign neoplasm of the periodontal hard tissue is a slow growing neoplasm forming hard tissue around the apex of a tooth radiolucency typically surrounded by a radiolucent margin

benign cementoblastoma

This malignant neoplasm of the periodontal soft tissue is found on the mandible, posterior to premolars; nodular lesions often with ulceration and surrounding leukoplakia regional lymph-node metastasis is common

squamous cell carcinoma

These malignant neoplasms of the periodontal soft tissue are the majority of times intradoses; most are carcinoma and not sarcoma

metastasis of the gingiva

This malignant neoplasm of the periodontal soft tissue is a skin lesion followed by oral lesions, gingiva is the second most after palate, re-occurance with AIDS

kaposi's sarcoma

This malignant neoplasm of the periodontal soft tissue is rare in the oral cavity and occurs frequently among HIV-infected patients

malignant lymphoma

This malignant neoplasm of the periodontal hard tissue diagnosis required clinical and radiographic examinations, 7% occur in the jaw, widening of the PDL is common

osteosarcoma

This malignant neoplasm of the periodontal hard tissue is found 10-20% of the time in the jaws, associated with swelling, tenderness, pain, and loosening of teeth

langerhans cell disease (histiocytosis X)

What is the difference between an tumor and a cyst

``` tumor = growth of tissue, something bad cyst = empty sac, sometimes filled with fluid, need to remove all cell layers ```

What is the histology being lichen plants

Sub epithelial band-like accumulation of lymphocytes Type IV hypersensitivity Fibrin in basement membrane

What is deposited in lichen planus

IgM C3 C4 C5