gingival diseases 2 Flashcards
inflammatory condition of the skin and mucous membranes; oral involvement alone is common and can affect any area of the oral mucosa
lichen planus
lichen planus has characteristic skin lesions called ____ and has various clinical appearances
wickham striae
forms of lichen planus that are generally asymptomatic
papular, reticular, and plaque-like forms
forms of lichen planus that are generally symptomatic
atrophic, ulcerative, bullous forms
lichen planus characterized by subepithelial, band-like accumulation of ____ and ____, characteristic of a ____ hypersensitivity reaction
lymphocytes and macrophages
type IV
lichen planus characterized by ____ in the basement membrane and deposits of _____
fibrin; IgM, C3, C4, and C5
group of disorders in which autoantibodies towards components of the basement membrane result in detachment of the epithelium from the connective tissue
pemphigoid
histology of pemphigoid shows autoantibody reactions against _____ and _____ components
hemidesmosome; lamina lucida
deposits of _____ in pemphigoid
C3, IgG and other Igs
three types of pemphigoid
- bullous
- benign mucous membrane
- cicatrical (scar formation)
in pemphigoid, rubbing of the gingiva creates bulla formation
Nicholsky sign
pemphigus vulgaris characterized by the formation of _____ in skin and mucous membranes
intraepithelial bullae
histology of pemphigus vulgaris shows _____ due to destruction of desmosomes and pericellular epithelial deposits of _____
acantholysis ; IgG and C3
histology of pemphigus vulgaris also shows circulating autoantibodies against _____
interepithelial adhesion molecules
acute, sometimes recurrent, vesiculobullous disease affecting both mucous membranes and skin; oral involvement in as much as 25-60% of cases
erythema multiforme
erythema multiforme characterized by ____, often with extensive crust formation of the _____
swollen lips; vermilion border
the extensive necrosis of erythema multiforme is called _____
stevens-johnson syndrome (oral, ocular, genital, skin)
erythema multiforme appears to be a cytotoxic immune reaction towards keratinocytes caused by a wide range of factors including _____ and _____
herpes simplex virus; various drugs
autoimmune connective tissue disorder in which autoantibodies form to various cellular constituents
lupus erythematosus
LE lesions characterized by central atrophic area with small white dots surrounded by irradiating fine ____ with a periphery of _____
white striae; telangiectasia
characteristic skin lesions of LE called _____
butterfly lesions
histology of LE shows degeneration of ____ and increased ____ of the BM
basal cells; width
mild chronic form of LE which affects skin and mucous membranes
discoid forms
drug-induced mucocutaneous disorders
gingival hyperplasia (enlargement) erythema multiforme oral ulceration epithelial atrophy, superficial sloughing intense erythema
drugs that can induce these mucocutaneous disorders
immunosuppressants, calcium channel blockers, anti-epilepsy drugs, anti-malarial drugs, anti-neoplastic drugs, methotrexate (for leukemia)
_____ diseases and _____ disorders can systemic problems that can cause gingival manifestations
GI diseases; hematological disorders (such as leukemia)
reactive processes of periodontal soft tissues
- fibroma/focal fibrous hyperplasia
- calcified fibroblastic granuloma
- pyogenic granuloma
- peripheral giant cell granuloma
reactive process of periodontal hard tissues
periapical cemental dysplasia
benign neoplasms of periodontal soft tissues
- hemangioma
- nevus
- papilloma
- verruca vulgaris (type of papilloma)
- peripheral odontogenic tumors
benign neoplasm derived from odontogenic epithelium; well-circumscribed radiolucency
ameloblastoma
benign neoplasm derived from PDL, presumably from epithelial rests of Malassez; often asssoc with lateral root surface; rarely seen
squamous odontogenic tumor
benign, slow-growing neoplasm forming hard tissue around the apex of a tooth; radiopacity typically surrounded by a radiolucent margin
benign cementoblastoma
malignancy often seen in the mandible; posterior to the premolars; nodular lesions, often with ulceration and surrounding leukoplakia
squamous cell carcinoma
skin lesion followed by oral lesions; gingiva second most detected site after palate; re-occurrence with AIDS
Kaposi’s sarcoma
rare in the oral cavity but occurs within HIV-infected patients frequently
malignant lymphoma
widening of the PDL is common in this malignancy
osteosarcoma
swelling, tenderness, pain, and loosening of the teeth are frequent symptoms of this malignancy
Langerhans cell disease (Histiocytosis X)
cysts of the periodontium
- gingival cyst
- lateral periodontal cyst
- inflammatory paradental cyst
- odontogenic keratocyst
- radicular cyst
has a strong genetic background (jewish and mediterranean); painful desquamative lesions, erosions, or ulcerations; chronic course with recurrent bulla formation; typically in the middle aged or elderly
pemphigus vulgaris
bullae that rupture and leave extensive ulcers; characteristic skin lesions (iris appearance + bullae); may occur at any age but mostly young individuals
erythema multiforme
lesions can be ulcerated and cannot be differentiated from leukoplakia or atrophic oral lichen planus
lupus erythematosus
sessile, well-circumscribed smooth surfaced nodules; cell poor, hyperplastic collagenous tissue ; may show hyperkeratinization
fibroma/focal fibrous hyperplasia
often reddish and ulcerated reactive lesion; fibrous proliferation in which bone or cementum-like hard tissue is formed; highly cell-rich areas below ulcerated sites
calcified fibroblastic granuloma
ulcerated (may resemble purulence); gingival margin; reddish or bluish, sometimes lobulated; sessile or pedunculated ; bleeding is common; highly vascular with chronic inflammatory cells
pyogenic granuloma
symptoms are painful severe gingivitis with redness; ulcerations with serofibrinous exudate; edema accompanied by stomatitis
primary HSV
incubation period for primary HSV is ____; formation of ____, which rupture, coalesce, and leave _____
one week; vesicles; fibrin-coated ulcers
there is healing of primary HSV within _____
10-14 days
common presentation of recurrent HSV is _____
herpes labialis
recurrent HSV usually occurs at the same location on the _____ and/or _____
vermilion border; skin adjacent to it
recurrent HSV characterized by intra-oral ulcers in ____ and _____; lesions mistaken for _____
attached gingiva; hard palate; aphthous ulcers
aphthous ulcers do not affect ____
keratinized mucosa
treatment for recurrent HSV
- limit bacterial superinfection (careful plaque control)
- anti virals (such as acyclovir) in immunocompromised patients
small ulcers usually on the tongue, palatal, and gingiva ; initial symptoms are pain and paresthesia; diagnosis usually obvious due to unilateral occurrence of lesions associated with severe pain
herpes zoster
most common type of oral candidiasis; acquired during birth; psuedomembranous/erosive lesions; caused by c. albicans
thrush
acute candidiasis (thrush) seen in 3 types of individuals:
- immunosuppressed individuals
- the infant
- adult who has been on antibiotic therapy for some time
predisposing conditions for thrush (acute pseudomembranous candidiasis)
antibiotics, immunosuppression, malnutrition, HIV, diabetes
most clinical characteristic of gingival candidal infections is _____, often associated with ____
redness of the attached gingiva; granular surface
____ candidosis shows whitish patches that can be whiped off
pseudomembranous
____ candidosis is intensely red, usually associated with pain
erythematous
treatment for oral candidiasis (thrush)
- correction of predisposing factors
- fluconazole, nystatin, amphotericin B (IV)
pain, ulceration, and necrosis of the interdental papillae; bleeding
necrotizing ulcerative gingivitis (NUG)
people commonly affected by NUG
adolescents or young adults, smokers, and individuals under stress
differential diagnosis of NUG
primary herpetic gingivostomatitis
predisposing factors to NUG
- systemic diseases like ulcerative colitis, blood dyscrasias, and nutritional deficiency states
- abnormalities of WBC function
- patients suffering from AIDS
treatment for NUG
- OHI
- mechanical debridement
- systemic antibiotic therapy
- surgical correction of gingival destruction
fibrous-osseous cemental lesions; tooth is usually vital; usually no symptoms; periapical bone is replaced by cellular fibroblastic tissue through a cementoblastic phase
periapical cemental dysplasis
diffuse gingival enlargement (may be confined to marginal gingiva, interdental papilla or include the attached gingiva); disease entity or a part of a syndrome; may interfere with or prevent tooth eruption
hereditary gingival fibromatosis
possible mechanism of hereditary gingival fibromatosis includes ____ favoring accumulation of ____; may be located on ____ in humans
TGF-b1; ECM
chromosome 2
