Exam 3 - Acute/Chronic Ulceration Part 1 Flashcards
What is the etiology of anesthetic necrosis?
Necrosis secondary to administration of local anesthetic it is thought it may be a result of ischemia or faulty technique.
What is the most common site of anesthetic necrosis?
Hard palate most common
Name the lesion:
Well-circumscribed ulcer at site of previous injection
Anesthetic Necrosis
How to diagnose and tx anesthetic necrosis?
Diagnosis - Clinical diagnosis based on history of recent local anesthetic injection
Tx - Heals with time (usually 2 week) can put oral gel won’t help with healing but will help with pain
Name the pathology:
Ischemia of salivary tissue leads to local infarction
Necrotizing Sialometaplasia
What are the predisposing factors for necrotizing sialometaplasia? (5 things)
- Trauma
- Dental injections
- Ill-fitting dentures
- Eating disorder with binge purging
- Upper respiratory tract infection
What are the predisposing factors for necrotizing sialometaplasia? (5 things)
- Trauma
- Dental injections
- Ill-fitting dentures
- 5.
- Eating disorder with binge purging
- Upper respiratory tract infection
Common site to find necrotizing sialometaplasia?
The hard palate
Describe clinical presentation of necrotizing sialometaplasia?
Nonulcerated, painful swelling initially —> Within 2-3 wks, a crater like ulcer forms and pain is reduced
Name the lesion
Nonulcerated, painful swelling initially —> Within 2-3 wks, a crater like ulcer forms and pain is reduced
Necrotizing sialometaplasia
Necrotizing sialometaplasia
Initially _________ _________ ___________ —> Within ___wks , a crater like ulcer forms and _________
Initially nonulcerated, painful swelling—> Within 2-3 wks, a crater like ulcer forms and pain is reduced
How to diagnose necrotizing sialometaplasia?
Biopsy to exclude malignant process - only time not to biopsy is usually for a pt with eating disorder
How to tx necrotizing sialometaplasia?
Heals in 5-6 wks
Name the pathology:
Initial infection of herpes simplex virus type (HSV-1)
Primary herpetic gingivostomatitis
What are the injury acute ulcerative lesions we talked about?
- Anesthetic necrosis
- Necrotizing sialometaplasia
What are the infectious acute ulcerative lesions we talked about?
- Primary herpetic gingivostomatitis
- Recurrent herpes labialis
- Recurrent intraoral herpes simplex
- Herpes Zoster
- Hand-foot-and-mouth disease
- Necrotizing ulcerative gingivitis (NUG)
What are the immune mediated acute ulcerative lesions we talked about?
- Aphthous stomatitis
- Allergic rxn
- Erythema multiforme
What category does Primary herpetic gingivostomatitis fall under?
Infectious
(HSV-1)
Name the pathology.
Etiology: Initial infection of herpes simplex virus type (HSV-1).
Clinical Presentation:
Multiple small vesicles that often progress to ulceration. Along with painful, erythematous gingiva (Marginal gingivitis). May have fever and LAD.
Primary herpetic gingivostomatitis
Primary herpetic gingivostomatitis is acute onset because it is a bacterial condition.
FALSE It is of acute onset but it is not bacterial it is viral infection of HSV-1.
Primary herpetic gingivostomatitis affects what sites in the oral cavity.
Oral mucosa, lips and perioral skin
Movable and attached oral mucosa affected.
T/F Primary herpetic gingivostomatitis affects moveable and attached oral mcuosa.
True
How would you diagnose Primary herpetic gingivostomatitis ?
- Clinical Diagnosis - usually an easy one b/c very recognizable
- Viral culture (slow) or PCR (not usually done outside hospital setting)
- Cytologic smear (least invasive and most cost effective)
- Biopsy - not common for this
How to tx Primary herpetic gingivostomatitis?
For symptomatic relief you can use
- NSAIDS, Lidocaine for adults, and popsicle for children
Antiviral - for adults
If you do nothing should heal spontaneously in 2 weeks.
Primary herpetic gingivostomatitis: HSV-1 remains latent in the ____________ ____________.
Trigeminal ganglion
Describe the steps of a cytologic smear.
- Lightly moisten tongue depressor with water
- Gently remove cells (scrape) area
- Spread accumulated cells on microscope slide
- Spray slide lightly with fixative (sometime can use hairspray because fixative expires)
- Submit to pathologist
Name the pathology we talked about that has to do with the reactivation of HSV-1.
Recurrent Herpes Labialis
What are Recurrent Herpes Labialis and Recurrent intra-oral herpes simplex risk factors? (4 things)
- Advanced age
- UV light
- Physical and emotional stress
- Dental treatment
Can recur many times
T/F Recurrent Herpes Labialis can recur many times.
True!
T/F Recurrent intraoral herpes simplex can recur many times.
True!
T/F Both Recurrent Herpes Labialis and Recurrent intraoral herpes simplex can recur many times.
True!
What is the worldwide prevalence of HSV-1 in individuals under 50?
67%
Recurrent Herpes Labialis falls into what category?
Infectious
What is the site you are likely to find Recurrent Herpes Labialis?
Vermillion border and skin adjacent to lips
Pt with primary herpetic gingivostomatitis will experience prodrome 6-24 hours before lesions appear.
False this usually happens in pt with recurrent herpes labialis
What are symptoms of prodrome a individual may experience with recurrent herpes labialis? (6 things)
Pain, burning, itching, tingling, localized warmth, erythema in the area lesion will appear
different in different people
Name the lesion:
Multiple small erythematous papules form clusters of fluid-filled vesicles can burst and leave a scab like appearance
Recurrent Herpes Labialis
How is Recurrent Herpes Labialis diagnosed?
Clinical diagnosis - usually easy to diagnose this way
Viral culture (slow) or PCR
Cytologic smear
Biopsy
How to tx recurrent herpes labialis?
Antiviral
For pt with frequent recurrence, can provide rx to have on hand at home. Pt can start taking as soon as they feel prodrome
Heals in 7-10 days
What category does Recurrent intraoral herpes simplex fall under?
Infectious (viral) reactivation of HSV-1
What is the etiology of Recurrent intraoral herpes simplex?
Reactivation of HSV-1
What site is most common for Recurrent intraoral herpes simplex?
Attached (non-moveable) gingiva, hard palate
Name the lesion:
Affects keratinized mucosa bound to bone
Small vesicles that collapse to form cluster of erythematous macules
Reactivation of HSV-1
Recurrent intra oral herpes simplex
How is Recurrent Herpes Labialis diagnosed?
Clinical diagnosis
Viral culture (slow) or PCR
Cytologic smear
Biopsy
T/F Primary herpetic gingivostomatitis, Recurrent Herpes Labialis, Recurrent intraoral herpes simplex, Herpes Zoster ‘Shingles” are all diagnosed pretty much the same way.
True
Note: Cytologic smear or biopsy you will not be able to tell the difference between HSV-1 (herpes) or herpes zoster unless you do special test.
What is the treatment for Recurrent intra oral herpes simplex?
Same as the tx for Recurrent Herpes Labialis which is antiviral or it will heal in 7-10 days
Name the oral pathology:
Reactivation of varicella zoster virus (HHV-3) - chicken pox
Herpes Zoster ‘Shingles”
What is Herpes Zoster ‘Shingles” a reactivation of?
varicella zoster virus (HHV-3) - chicken pox
T/F Herpes Zoster usuallys recurs many times.
FALSE - usually recurs once
Acute infectious ulceration: think HHV-3
Incidence of ________ __________ increases with age. While ____________ increases susceptibility.
herpes zoster; Immunosuppression
T/F Immunosuppression increases susceptibility of herpes zoster.
True
T/F Incidence of herpes zoster increases with age.
True
T/F Herpes Zoster ‘Shingles” usually has a prodrome.
TRUE
but Not as helpful because usually only occurs once where as herpes have multiple recurrences usually
What are the prodromal symptoms usually for herpes zoster?
severe neuralgia (with or without fever, malaise, and headache)
Name the pathology:
Pain and lesions tend to occur along one dermatome.
Acute phase: clusters of vesicles with erythematous base, terminate at the midline (everyone goes through this phase)
Chronic: Postherpetic neuralgia (15% of pt Only a portion will undergo)
Herpes Zoster “shingles”
Describe the acute phase of Oral Herpes Zoster
Acute phase: clusters of vesicles with erythematous base, terminate at the midline (everyone goes through this phase)
Describe the chronic phase of Oral Herpes Zoster
Chronic: Postherpetic neuralgia (15% of pt Only a portion will undergo)
T/F: For a cytologic smear or biopsy you will not be able to tell the difference between HSV-1 and Herpes zoster unless you do special testing.
True
How to tx oral Herpes Zoster?
Antiviral regimen
Symptomatic relief
- NSAIDS, Diphenhydramine, Gabapentin, Steroids
What category does hand foot and mouth disease fall under?
Infectious
What is the etiology of hand foot and mouth disease?
Enterovirus infection
T/F Hand foot and mouth disease is most common in adults
FALSE
most common in children
How is the oral presentation of hand foot and mouth disease different from Recurrent intra oral herpes simplex?
Recurrent intra oral herpes simplex occurs on attached mucosa where as hand foot and mouth disease occurs on unattached tissue (and tongue)
T/F Cutaneous lesions for hand foot and mouth disease arise first.
FALSE - oral lesion arise first
Where can you find oral hand foot and mouth disease lesions?
Buccal mucosa, labial mucosa, and tongue most common.
NOTE: unattached gingiva
Describe oral hand foot and mouth disease lesions
Multiple aphthous like ulcerations
Describe cutaneous hand foot and mouth disease lesions
Erythematous macules becomes vesicles that primarily affect the hand and feet
How to diagnose hand foot and mouth disease?
Clinical diagnosis
PCR confirmation if necessary
How to tx hand foot and mouth disease?
NO tx necessary it is self limiting
What category does Necrotizing Ulcerative Gingivitis fall under?
Infectious
Etiology of Necrotizing Ulcerative Gingivitis
Fusobacterium nucleatum (other bacteria)
Who are you likely to find Fusobacterium nucleatum (other bacteria) in?
young adults and middle-aged adults
What are risk factor for necrtotizing ulcerative gingivitis?
(8 things)
Stress - biggest risk factor
Immunosuppression
Smoking
Local trauma
Poor nutritional status
Poor oral hygiene
Inadequate sleep
Recent illness
What is the clinical presentation of Necrotizing Ulcerative Gingivitis?
(5 things)
Interdental papilla blunted, inflamed, edamouts, and hemorrhagic
“Punched out” craterlike necrosis covered with gray pseudomembrane
Fetid odor
Severe pain - could help differentiate between periodontitis
May be accompanied by LAD, fever , malaise
How would you diagnose Necrotizing Ulcerative Gingivitis?
Clinical diagnosis should help you differentiate
Histopathology is not specific (biopsy does not establish diagnosis)
T/F Biopsy is important for diagnosing for NUG.
False clinical presentation is of utmost importance
How to tx Necrotizing Ulcerative Gingivitis?
Scaling, curettage, or ultrasonic instrumentation
Chlorohexidine rinse
Antibiotics if LAD or fever present
Evaluation for underlying cause of immunosuppression (HIV)
Name the pathology:
Interdental papilla blunted, inflamed, edamouts, and hemorrhagic
“Punched out” craterlike necrosis covered with gray pseudomembrane
Fetid odor
Sever pain - could help differentiate between periodontitis
May be accompanied by LAD, fever , malaise
Necrotizing Ulcerative Gingivitis
