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Oral Medicine & Disease > Immunologically mediated disease > Flashcards

Immunologically mediated disease Flashcards

1
Q

Immunological oral disease:

  • Local
  • Systemic disease: oral effects
A
  • Local - Apthous ulcers/lichen planus/OFG/Lupus erythematous
  • Systemic - Pemphigus vulgaris/Pemphigoid/erythema multiforme/Lupus erythematous/systemic sclerosis/sjogren’s syndrome
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2
Q

Types of recurrent apthous stomatitis

A

Minor
Major
Herpetiform
Behcet’s

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3
Q

Features of minor apthae

A 
<10mm
Shape - round/oval with red halo/yellow base
No. - 1-20
Affects - NON KERATINISING mucosa
Duration - 1-2 weeks 
Outcome - no scarring
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4
Q

Features of major apthae

A 
>10mm
Shape - irregular/oval
No. - <5
Affects - KERATINISING NON KERATINISING mucosa
Duration - 6-12wks
Outcome - scarring
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5
Q

Features of Herpetiform apthae

A 
<5mm
Shape - round/oval, coalesce
No. - 1-200
Affect - NON KERATINISING mucosa
Duration - 1-2wks
Outcome - no scarring
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6
Q

Features of Behcet’s sydrome

A 
Oral ulceration 
Genital ulceration
Neurological - motor/sensory disturbance
Eye disease - blindness
Arthritis
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7
Q

Aetiology of recurrent apthae

A
  • Autoimmune - CD4 cells attack epithelial cells
  • Trauma
  • Systemic disease- Coeliac/Crohns/UC/Pernicious anaemia
  • Stress - hormonal imbalance
  • Allergy - benzoates/cinamonaldehyde/sorbic acid
  • Genetic
  • Nutritional deficies - folate, iron, B12
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8
Q

Treatment of ulceration

Medication

A

Correct deficiency
Correct trauma source
Correct systemic disease
Remove allergens

Medication:
Salt mouthwash
Topical lidocaine oitment 5%
CHX 0.2% 10ml 2x daily

Topical corticosteroids
Betamethasone tablets - 2 tablets/2ml/2mins/2x daily
Beclometasone Inh 2 puffs 2x daily

Systemic steroids
Azathioprine

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9
Q

Lichen Planus features.

Types

A

Skin - itchy papules, mucosa - white patches
Types:
Reticular/Plaque/Papular/erosive/atrophic/bullous/
desquamative gingivitis

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10
Q

Lichen Planus - aetiology

A 
Autoimmune
Idiopathic
Drugs - B blockers
Amalgam
SLS
Poor OH
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11
Q

Pathogenesis of Lichen Planus

A 
Autoimmune - CD4/CD8 cells infiltrate
Loss of intercellular attachment (acantholysis)
Apoptosis
Atrophy
Keratinisation/Hyperplasia
Hugging band of lymphocytesLic
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12
Q

Lichenoid reaction causing drugs

A

NSAID/Antihypersensitives/Hypoglycaemics/Diuretics

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13
Q

Lichen Planus treatment - asymp and symp

A

Asymptomatic: OH
CHX 0.2% Mw

Symptomatic:
Topical corticosteroids - betamethasone/beclometasone
SLS allergy - avoidance
Immunodulation - azathioprine

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14
Q

Erythema multiforme - aetiology, sites

A

Aetiology:
Immune complex - HSV/hypersensitivity

Sites - lips/anterior of mouth - Crusting, brown area of lips, Skin - target (bullseye) lesions

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15
Q

Erythema multiforme - treatment

A

-Oral lesions - Systemic steroids Prednisolone 60mg
Systemic aciclovir

  • Encourage fluids
  • Encourage analgesia
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16
Q

Erythema Multiforme - Histological features

A

Intracellular oedema, necrosis - INTRAEPITHELIAL VESCICLES

Inflammation

17
Q

Vesiculobullous conditions

A

Pemphigus Vulgaris, Pemphigoid, Angina Bullosa Haemorrhagica, Epidermolysis Bullosa

18
Q

Immunofluorescence principles

A

Anti IgG + Fluorescent particles, attaches to IgG

19
Q

Pemphigoid features
Clinical
Histology
Immunofluorescence pattern

A

-SUBEPITHELIAL VESCICLE (Antibody attack)
Thick walled blisters
Blister seen intraorally - sometimes blood filled
Immunofluorescence - Fluorescent line (basal cell layer separate from epithelium)
HEMIDESMOSOMES

Oral/skin lesions - scarring
EYE lesion - blindness

20
Q

Pemphigoid Treatment

A

Systemic steroids/immunosuppressants - azathioprine/steroids

21
Q

Pemphigus Vulgaris
Features
Histology
Immunofluorescence pattern

A

Pemphigus Vulgaris - skin and mucosa
INTRAEPITHELIAL BULLAE, DESMOSOMES AFFECTED
Ashkenazi Jews
Blisters - not often seen as they burst easily, clear fluid
Deadly disease if not treated

Histology - intraepithelial bullae(suprabasal split) - Acantholytic cells (tzanck cells)
Immunofluorence pattern - Basket weave

22
Q

Angina bullosa haemorrghica
Features
Cause
Inv

A

Blood blisters in abscence of trauma
Steroid inhaler
Affect palate - advise patient to deroof
Inv - PLT count, coagulation screen, LFT, blood glucose

23
Q

Management of Desquamative gingivitis

A 
Change toothpaste - SLS allergy
Improve OH
Topical steroids - Betametasone/Beclomethasone
Topical Tacrolimus
Systemic immunosuppresion

Oral Medicine & Disease (9 decks)

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