final Flashcards
what is due to defect in normal keratinization of oral mucosa?
white sponge nevus
white sponge nevus affects what and what are the signs and symptoms
WSN affects buccal mucosa mainly but can also affect nasal, esophageal, laryngeal, anogenital mucosa
asymptomatic thick white appearance
Biopsy of WSN shows what?
WSN: parakeratosis w acanthosis, perinuclear eosinophilic condensation which is pathognomic to WSN
WSN tx and prognosis
WSN tx is NOT necessary, harmless condition Good prognosis
what % of Peutz Jeghers syndrome pts are new mutations?
what gene is affected in Peutz Jeghers
35% new mutations!
SKT 11 gene affected which encodes for a serine threonine kinase
what is the frequency of Peutz Jeghers syndrome cases
1:100,00- 1:200,000 births
Peutz Jeghers syndrome dead giveaway sign?
Are the polyps from PJ pre-cancerous?
PJ= freckle like lesions which develop on hands, periorifical skin, and oral mucosa
Polyps in GI tract are NOT precancerous like in Gardners Syndrome
Peutz Jeghers syndrome pts have how many times INC risk for cancer?
what happens to their bowels?
PJ pts 18X more at risk for cancer!
Their bowel obstruct due to intussusception (telescoping of proximal segment)
What is the frequency of hereditary hemorrhagic telangiectasia?
lesions of HHT are most common where?
1: 10,000
lesions of HHT most common on vermillion zone of lips, tongue, and buccal mucosa
what is the initial clue to HHT?
where else may HHT be seen besides orally?
frequent spontaneous epistaxis
HHT may also be seen on hands and feet, GI mucosa, genitourinary mucosa, and conjunctival mucosa
what % of HHT pts have AV fistulas of lungs?
of liver?
of brain?
HHT AV fistula in lungs= 30%!
AV fistulas in liver = 30%
AV fistulas in brain 10-20%
3 out of what 4 things must be present for diagnosis of HHT
recurrent, spontaneous epistaxis
telangiectasias of mucosa and skin
AV malformation involving lung, liver, or brain
family history of HHT
What is the tx for mild HHT?
moderate HHT?
Severe HHT?
Mild HHT: no Tx
moderate HHT: selective cryotherapy or electrocautery of bothersome lesions
Severe: septal dermoplasty
HHT brain AV fistulas that get bacteremia from dental procedures occur in what % of pts? so what should be done for these pts?
HHT AV fistulas of brain bacteremia occurs 1% of pts : so these pts should get prophylactic ABs
What is the mortality rate for HHT pts?
what is the mortality rate for HHT pts with brain abscesses?
HHT mortality rate= 1-2% due to blood loss
HHT mortality rate w brain abscess= 10%
Pemphigus vulgaris autoantibodies destroy what? so a split occurs where in the tissue?
PV= autoAB destroy desmosomes
PV inhibits adherence so a split develops within the epithelium
PV occurs in who?
what percent of PV pts present w oral lesions? what are the oral lesions?
Rare no sex predilection but in older pts around 50.
More than 50% have oral lesions of superficial ragged erosions and ulcerations
where does PV occur?
PV is positive for what?
PV occurs on any oral mucosa, flacid bull on skin, intact oral blisters rare
+ Nikolsky sign!
in PV what is the 1st to show and last to go? common oral lesion?
ORAL LESIONS!
shallow ulcerations right along the marginal gingival area
DIF is used for what and what animal?
IFF is used for what and what animal?
DIF: detects autoABs bound to pts tissues DIF= goat IIF: detects autoAbs circulating in blood IIF: monkey
For each disease is DIF +/-? IIF +/-?
PV?
MM pemphigoid?
Bullous pemphigoid?
PV: + DIF and + IIF
MM pemphigoid: + DIF, - IIF
Bullous pemphigoid: + DIF and + IIF
PV shows what microscopically?
PV= INTRAepithelial clefting in basal layer and acantholysis- breakdown of spinous layer
Mortality rate of PV?
tx of PV?
PV= 5-10% mortality rate!
PV tx= systemic corticosteroids
what is 2x more common than PV and has a 2:1 female predilection? what is the average age?
Mucous membran pemphigoid: 2:1 females
average age 50-60 y/o
In MM pemphigoid what tissue is affected?
Is oral scarring common?
MM pemphigoid affects any mucosal surface and skin
cutaneous lesion and conjunctival scarring is common
ORAL Scarring is RARE!
What diseases present with desquamative gingivitis?
MM pemphigoid, oral lichen planus, pemphigus vulgaris
what is the most significant aspect of MM Pemphigoid
MM pemphigoid- ocular involvement! could lead to blindness
MM pemphigoid shows what under the microscope?
pemphigoid attacks what?
MM pemphigoid= SUBepithelial cleft cromation- separation of epithelium from CT at BMZ
MM pemphigoid attacks hemidesmosomes
what % of Bullous pemphigoid pt have oral lesions? what is the initial complaint of bullous pemphigoid?
8-39% of bullous pemphigoid pts have oral involvement
Pruritus is common initial complaint
what two diseases have SUBepithelial clefts?
bullous pemphigoid and MM (cicatrical) pemphigoid have SUBepithelial clefts
Tx of Bullous pemphigoid
most cases of BP resolve spontaneously in 1-2 years
what is a acute, self limiting ulcerative disorder that resolves in 2-6 weeks? what is the sexual predilection and average age?
Erythema multiform
EM: female predilection, adults in 20-30s
EM etiology
50% unknown
25% preceding infections
25%: medication related
clinical features of EM include what
target lesions of skin,
hemorrhagic crusting of lips, widespread oral ulcers w ragged margins, l and B mucosa, tongue
bright red conjunctiva- blood shot eye
Erythema multiform histo
keratinocyte destruction, sub epithelial edema, perivascular inflammation
What % of EM recur? when?
EM: 20% of cases recur in autumn and spring
EM mortality rate, EM major? TEN?
EM Major : 2-10% mortality
TEN: 34% mortality rate
What is similar to psoriasis?
Erythema Migrans is similar to psoriasis
Erythema migrans AKA geographic tongue, migratory glossitis
Cutaneous lichen Planus affects who?
what is a characteristic sign of cutaneous lichen planus? along with the oral cavity where can this occur?
CLP: female predilection 30-60 y.o
CLP: purple polygonal pruritic papules w Wickham striae
flexor surface of wrists, lumbar region and shins
SLE affects who more? average age?
SLE affect women 8-10 times more than men especially black women!
Average age 31 y/o
SLE clinical signs include
Malar butterfly rash which spares nasolabial folds, and skin lesions that flare w sun exposure
what percent of SLE pts have renal involvement?
what percent of SLE pts have sterile vegetations on heart valves?
40-50% of SLE pts have renal involvement
50% of SLE pts have vegetations on heart valves
what % of SLE pts have oral lesions? what tissues do they affect?
5-25% of SLE pts have oral lesions
SLE affects palata, buccal mucosa, or gingiva
What diseases are treated with anti-malarial drugs?
Mild SLE and severe Chronic cutaneous lupus
what is the 5 year survival of SLE?
15 year of SLE?
prognosis worst for who
SLE 5 year: 95%
SLE 15 year: 75%
prognosis for SLE is worse for men
what almost exclusively affects skin and mucosa that resembles erosive LP
Chronic cutaneous lupus: waxes and wanes
what % of Chronic cutaneous lupus pts transform to SLE?
what % resolve after a few years?
5%
CCL 50% resolve after several years
systemic scleroris show autoABs directed against what
Systemic sclerosis= Scl70 topoisomerase 1
Crest syndrome is associated with what
Crest syndrome= anticentromere ABs
Crest syndrome 6 year survival?
Crest syndrome 12 year survival?
Crest 6 year: 80%
12 year: 50%
what is the sensitivity of COE?
Specificity of COE?
are auxiliaries as accurate as dentists?
COE sensitivity = 85%
COE specificity= 97%
YES!
what is a test used to analyze abnormal finding or symptomatic pt in order to establish or suggest a diagnosis?
case finding test
what is a test used on people apparently free of disease in order to detect the disease in early stages
a screening test
what is the only diagnostic aid that is a case finding test aid?
what is it used for?
Brush test Oral Cdx: used to test the common, small, harmless appearing white or red tissue spots you see several times each
NO DIAGNOSIS IS GIVEN!!!
Brushtest gives a lot of what kind of results
Brushtest gives a lot of false negative results
Vizilite components?
Vizilite lit review results?
Vizilite components include acetic acid, light stick and Toluidine blue dye
Vizilite is unable to discriminate benign from pre-malignant lesions
No clear evidence better than COE
What does VELscope stand for?
Reviews of VELscope
VELScope= Visually enhanced lesion scope
VELscope normal tissue is pale green, abnormal tissue is dark
False negatives and False positives for VELscope
VELScope has what % of false positives?
VELScope is also used how?
VELScope= 90% false positives
VELscope also used as case finding tool in surgical margin delineation- extends margins beyond COE alone
Describe Identafi
Identafi: hand-held cordless multi spectral fluorescence and reflectance spectroscopy w 3 colors: white for COE, violet for tissue fluorescence, and amber light for suspected abnormalities
describe OralD which was introduced in 2013
uses a light, glasses and CytID for fluorescence and liquid base cytology but clinical application of device has NOT been proven
What percent of oral cancer is diagnosed in stage 3-4
63% of oral cancer is diagnosed in stage 3-4
what are the high risk sites for oral cancer/ dysplasia
ventro lateral tongue, floor of mouth and lateral soft palate/ anterior tonsillar pillars
what are the suspicious physical features
crisply defined red, white, or mixed red and white lesions, persistent ulceration and induration
