exam 2- lecture 2 Flashcards
mucosa becomes erythematous/edematous accompanied by burning/itching
mucositis
syndrome that includes a wide spectrum of disease activity and signs and symptoms ranging from skin lesions (discoid lupus) to wide spread, debilitating, life threatening disease with multiple organ involvement
systemic lupus erythematous
these are canker sores or aphthous stomatitis, painful oral ulcers for which the cause of them remains unclear and they can occur frequently
aphthous ulcers
most common site is the gingiva (free and attached), desquamative gingivitis
cicatrical pemphigoid
what is the eye damage called occurring in sjorens syndrome
keratoconjunctivitis sicca
major and minor salivary glands involved in this, 50% have parotid enlargement..
Sjögren’s syndrome
this is a disorder affecting the fingers and toes involved with sjögren’s syndrome
raynaud’s phenomenon
20% of patients have this
changes that affect the oral flora so the organisms that are usually nonpathogenic are able to cause disease.
infectious diseases
how do you treat sjögren’s syndrome?
symptomatically
NSAIDS Corticosteroids saliva substitutes sugarless gum pilocarpine
lesions resulting from direct contact of ana allergen with the skin or mucosa, cell mediated immunity, type IV hypersensitivity
contact mucositis/dermatitis
both cellular and humoral immunity involved in this, 85% of individuals have skin lesions… classic butterfly rash occurs across the bridge of the nose
systemic lupus erythematous
lesions that appear in the same site each time a drug is introduced, subside when drug is removed, single or multiple slightly raised reddish patches or clusters of macules on smin
fixed drug eruptions
how do you diagnose cicatrical pemphigoid?
biopsy/histologic examination.
direct immunofluorescence shows a linear pattern at a basement membrane
these diseases cause tissue damage because the immune system treats the persons own cells and tissues as antigens
autoimmune disease affecting oral cavity
how do you treat bullous pemphigoid?
treat with NSAIDS- corticosteroids
with sjögren’s syndrome, 90% have a positive reaction to what?
rheumatoid factor-an antibody to IgG
what are the two types of sjögren’s syndrome?
primary- without another autoimmune disease
secondary- with another autoimmune disease
this is periosteal proliferation on heels, ankles, metatarsals, phalanges, knee and elbows.. aphthous like ulcers, erythematous lesions and geographic tongue like lesions in oral cavity
Reiters Syndrome
this is acute, self limited disease affecting the skin and mucous membrane, occurs in young adults and affects men more than women
erythema multiforme
what is it called if the epithelium separates from the connective tissue and erosion, bullae, or ulcers form?
erosive and or bullous lichen planus
this is abnormal visual intolerance to light of eye involvement with sjögren’s syndrome
photobia
this affects salivary and lacirmal glands causing xerostomia and xeropthalmia and the specific cause is unknown.. 50% have other autoimmune diseases(rheumatoid arthritis/systemic lupus)
Sjögren’s syndrome
what is the striae called in lichen planus?
Wickhams striae
these are hives that appear as multiple areas of well demarcated swellings associated with itching (pruitis)… caused by localized areas of vascular permeability in superficial connective tissue beneath epithelium
uticartia
what are the three types of pemphigus?
vegetans, foliaceus, erythematous
how long does reiters syndrome last and how do you treat it?
lasts from weeks to months.. treatment with ASA or NSAIDS
what are some possible causes of erythema multiforme
heroes simplex, TB, histoplasmosis, or drugs such as barbiturates and sulfonamides
treatment topical corticosteroids, systemic steroids
type of TB when kidneys and liver become involved
miliary TB
what is the most severe form of erythema multiforme
stevens johnson syndrome
this is suggested that patients with this are more at risk to develop squamous cell carcinoma.. it is a chronic disease treated symptomatically, treat with corticosteroids
lichen planus
diffuse swelling of tissue caused by permeability of deeper blood vessels but no itching and usually the lips are affected.
angieodema
what are the treatment types for TB?
isoniazid and rifampin and pyrazinamide
takes months to years
these are more common in females, trauma is the most common precipitating factor in developments and stress is associated
aphthous ulcers
lesions occur as a result of cleavage of epithelium from underlying connective tissue (acantholysis)
cicatrical pemphigoid
what is used to determine TB?
skin test (mantoux test)
antigens purified protein derivative (PPD) is injected into skin if previously exposed to a positive reaction occurs. type 4 hypersensitivity reaction
if positive then chest x-ray to detains if active disease present
this occurs in older children or adults, males, skull and mandible is involved.. a lesion resembles perio disease or PA inflammation or as well circumscribed (RL) with or without sclerotic borders. treatment with conservative surgical excision radiation
Eosinophilic granuloma
this is characterized by nikolskys sign (sloughing with finger pressure), diagnostic made by biopsy/microscopic examination and direct or indirect immunofluorescence
pemphigus vulgaris
primary infection of the lungs, oral lesions are rare but do occur as ulcers on tongue/soft palate, oral lesions are diagnostic for biopsy
tuberculosis (TB)
What do the an abnormalities include of sjögren’s syndrome?
mild anemia, decrease in WBC count, elevated erythrocyte sedimentation role, diffuse elevation of serum immunoglobulins
mucosal lesions more extensive and painful
genital mucosa/mucosa of eyes and lips generally encrusted/bloody
eye lesions can lead to blindness
stevens johnson syndrome
some lesions on the finger tips. the skin lesions tend to worsen when exposed to sunlight. arthritis/mytosis can occur
systemic lupus erythematous
infection caused by fimalentous bacterium actinomyces israelli
formation of abscesses that tend to drain by the formation of sinus tracts
the colonies or organisms appear in the pus as tiny bright yellow grains (sulfur granules)
often preceded by tooth extraction or abrasion of the mucosa
actinomycosis
what three changes of infectious disease include?
decreased salivary flow
ABC admin.
immune system alterations
this is an acute / chronic inflammatory autoimmune disease of unknown cause, affects women 8x more than men and 3x more frequently in black women
systemic lupus erythematous (SLE)
what type of gingivitis can be caused by lichen planus?
desquamative
what is the diagnostic process of bechets syndrome?
2 of the 3 need to be present (oral, genital, ocular)
pustule developing after needle puncture is highly suggestive of bechets
treat with topical or systemic corticosteroids
signs and symptoms of TB
fever chills fatigue malaise weight loss and persistent cough
3 types of histiocytosis
letterer -siwe disease
hand schuller- christian disease
eosinophilic granuloma
skin lesions 2-4 mm papules located on lumbar region, flexor surfaces of wrist, anterior surface of ankles.. diagnostic is made upon clinical appearance and histologic appearance of biopsy
lichen planus
bulls eye or target-concentric rings of erythema alternating with normal skin color… can affect oral cavity with or without skin
erythema multiforme
what is the antigenic marker in reiters syndrome?
HLA-B27 and is present suggestive of genetic influence
this is a triad of arthritis, urethritis, and conjunctivitis. It has an unknown cause and more prevalent in men than women.
Reiters syndrome
where do minor aphthous ulcers occur?
moveable mucosa, rogue and soft palate. more common in the anterior of the mouth
when does Reiters syndrome develop?
1-4 weeks after venereal or GI infection
this is the most common type, discrete round to oval ulcers that are up to 1 cm in diameter surfaced by a yellowish-white fibrin covering surrounded by a halo of erythema
minor aphthous ulcers
what three things can pemphigus vulgaris have at the same time?
lupus, rheumatoid arthritis and sjögren’s syndrome at the same time
erythematous, swelled and becomes encrusted with scaly, white epidermis.. most common cause is latex but can be caused by other things to/ local anesthetics, acrylic and metals… treatment topical or systemic steroids
dermatitis
this is involved with diabetes insipidus, oral manifestations such as sore mouth, halitosis, gingivitis, loose teeth, non healing extraction sites, appearance of advanced perio disease
hand schuller christian disease
chronic recurrent autoimmune disease consisting of primary of oral ulcers, genital ulcers, and olccular inflammations.. around 30 years old, the oral ulcers are very similar to aphthous ulcers. also painful
bechets syndrome
what is the diagnostic treatment with systemic lupus?
based on classic multiorgan involvement and presence of antinuclear antibodies in serum
these are ulcers on the lateral borders of the tongue and crusted and bleeding lips and explosive on set
erythema multiforme
what is TB caused by?
infectious chronic granulomatous disease by mycobacterium tuberculosis
how do you treat pemphigus vulgaris?
high dose corticosteroids, methotrexate.
treatment of actinomycosis
high dose of antibiotics for long term period
what are the routes of transfer of infectious disease?
via air by dust or H20 droplets
intimate or direct contact
hands/objects
blood or body fluids
involvement of submandivular and cervical lymphnodes
scrofula
breakdown of the cellular adhesion between epithelial cells known as
acantholysis
these appear on mucosa fixed to bone such as the plate and gingival, “bound down to mucosa”
herpetiform aphthous
how do you treat cicatrical pemphigoid and what are the side effects?
treat with topical or systemic corticosteroids, eye damage is possible and can lead to blindness
psychoses/depression are signs of CNS involvement-seizures can be present… precarditis, cardiac arrhythmia a and endocarditis may be seen late in the disease, kidney involvement..
systemic lupus erythematous
these are very tiny (1-2mm), resemble ulcers caused by the herpes simplex virus and can develop anywhere in the oral cavity and usually grouped
herpetiform aphthous
type 3 hypersensitivity, caused pain and itching. treatment is to discontinue the use of the drug after it has been identified
fixed drug eruption
what are some ways to distinguish herpetiform aphthous from primary herpes?
fever, malaise, fiery red gingiva.. primary herpes does not respond to topical application of liquid tetracycline
most common affecting tissues of the oral cavity: bacterial, fungal and viral infections
infectious diseases
when is diagnostic made of sjögren’s syndrome?
when 2 of the 3 are available: xerostomia, rheumatoid arthritis, or keratoconjunctivits sicca
what is the healing period of minor aphthous ulcers, and what kind of treatment?
7-10 days
treat symptomatically with Tylenol, topical anesthetics and some topic steroids (lidex)
what is the prodromal period of minor aphthous ulcers?
1-2 days of burning, itching and soreness
very similar to BMMP with incidence occurring in older patients (>60 years)
bullous pemphigoid
how do you treat systemic lupus erythematous?
ASA/NSAIDS for mild symptoms
hydroxychloroqhine (antimalarial)
corticosteroids with azathioprine and cyclophosphamide
excellent prognosis with mild symptoms but can be fatal
kidney failure is cause of death in SLE
SBE prophylaxis recommended (subacute bacterioendocarditis)
acute fulminating disorder affecting children younger than 3 years, resembles a lymphoma-rapid and fatal, sometimes responds to chemotherapy
letterer-siwe disease
how do you treat angioedema?
treatment includes use of antihistamines (benadryl and diphenhydramine)
this is benign, chronic disease affecting the skin and oral mucosa.. characteristic pattern of interconnecting lines (striae) resembling the pattern of the plant lichen as it grows on rocks and trees (lace appearance)
lichen planus
these are also called langheran cell granulomatosis..
Histiocytosis X
what are the three types of aphthous ulcers?
minor, major, and herpetiform
this is the most frequently seen type of phemogus, oral lesions appear as shallow ulcers to fragile vesicles or bullae
pemphigus vulgaris
benign mucous membrane pemphigoid (BMMP), chronic autoimmune disease affecting oral mucosa, conjunctiva, genital mucosa, and skin (requires referral to multiple specialists), heals with some scarring
cicatrical pemphigoid
this is on the buccal mucosa, usually bi lateral.. this is common in middle age with slight female predominance
lichen planus
this is the most common type of ulcer and about 20% of the population has had them
aphthous ulcers
this occurs in children less than 5 years, classic triad in 25% of patients, single or multiple “punched out” (RL) in skull, uni or bi lateral exophtalmous
hand-schuller- christian disease
skin lesions are popular and postulate and occur on the trunk and the limbs… genital ulcers are small and located on the scrotum or base of lenis.
bechets syndrome
these are larger than 1 cm in diameter and are deeper and last longer than minor, painful and occur in posterior part of the mouth, may require biopsy, takes several weeks to heal and can scar… may require some systemic steroids
major aphthous ulcers
three types of langheran granulomatous
letterer -siwe disease
hand schuller- christian disease
eosinophilic granuloma
what are some systemic diseases associated with aphthous ulcers?
bechets syndrome chrons disease ulcerative colitis cyclic neutropenia sprue (gluten intolerance) intestinal lymphoma
severe, progressive autoimmune disease affecting the skin and mucous membranes, characterized by intraepithelial blister formation that results from breakdown of the cellular adhesion between epithelial cells known as (acantholysis)
pemphigus vulgaris
