L9 Oral Lesions Flashcards
Leukoplakia risk factors
Tobacco use (70-90%), alcohol use (increase 1.5 fold), HPV
Risk factors for malignant transformation of leukoplakia
Female, long duration, nonsmoker (idiopathic), located on tongue/floor of mouth, >200 mm
Clinical presentation of leukoplakia
Adherent white patched/plaques on oral mucosa or tongue, not painful
Erythroplakia
Associated redness with white plaques of leukoplakia, higher risk of dysplasia/cancer
DDx of leukoplakia
Oral hairy leukoplakia
Oral hairy leukoplakia
Not premalignant, vertically corrugated white lesions on lateral tongue, usually soft so if indurated/hard then that’s not good
Disease associated with oral hairy leukoplakia
HIV (Epstein-Barr virus), this can be the presenting symptom
Risk factors of SCC
Tobacco and alcohol use, exposure to UV light, radiation exposure, HPV-16
Clinical presentation of SCC
Ulcers or masses that do not heal (persistent papules, plaques, ulcers, erosions), poor fitting dentures, sore throat etc that does not resolve
Treatment of SCC
Depends on stage/extent disease (surgical resection or radiation/chemo)
Presentation of melanoma
Painless, bleeding mass, area or ulceration, regional of mucosal discoloration (if pigmented oral lesion, must consider this!) or ill-fitting dentures
Amalgam tattoo
Blue-black macule seen in area adjacent to amalgam dental filling (gingival margin or buccal mucosa), irritates the tissue
Melanosis
Pigmented lesion that is extremely common in individuals with dark skin, symmetric pattern
Oral melanotic macules
Darkly pigmented benign macules on lips and oral mucosa, usually symmetric with sharp borders, stable and are present in adulthood
What are mucoceles?
Fluid-filled cavities with mucous glands lining the epithelium, due to minor oral trauma
Clinical presentation of mucoceles
Pinkish/blue soft papules or nodules filled with gelatinous fluid, variable in size and may rupture spontaneously
Treatment of mucoceles
Remove with cryotherapy/excision if symptomatic, CO2 laser vaporization, aspiration (draw fluid out but usually returns)
Herpetic gingivostomatitis
Most common clinical manifestation of primary HSV in childhood (before 5)
Etiology of Herpes Simplex Virus
HSV type 1
Clinical presentation of primary infection of Herpes Simplex Virus
Sudden onset of painful, intraoral grouped vesicles on an erythematous base, usually on buccal mucosa, when viral shedding is greatest
Clinical presentation of recurrent infection of Herpes Simplex Virus
Prodrome of pain/burning/tingling 6-48 hours before lesion appears, fatigue and low-grade fever, “cold sores”
Definitive diagnosis of Herpes Simplex Virus
Viral culture if there’s an active lesions
When is Tzanck smear used?
Herpes simplex virus and varicella zoster virus
Antiviral treatment of Herpes Simplex Virus
At onset of prodrome, acyclovir/valacyclovir/famiciclovir
Miracle Mouthwash
Combo of Diphenhydramine (Benadryl) and aluminum hydroxide/magnesium carbonate (Maalox or Gaviscon-antacid)
What is miracle mouthwash used for?
Herpes simplex virus, erythema multiforme major
How can you tell herpes zoster virus from herpes simplex virus?
Herpes zoster is unilateral on the hard palate
Etiology of oropharyngeal candidiasis (thrush)
Candida albicans (opportunistic infection)
Predisposing factors for thrush
Infancy, dentures, immunocompromised, DM, chemo, antibiotics or corticosteroids
Clinical presentation of oropharyngeal candidiasis
Mouth pain/sore throat, creamy white patches/plaques with underlying erythematous mucosa, “thrush will brush”
How to diagnosis oropharyngeal candidiasis
Use KOH prep and see budding yeasts with or without pseudohyphae
When should you think about an underlying disease associated with the thrush?
Esophageal candidiasis, recurrent candidiasis, associated pain somewhere else or lack of predisposing factors
Treatment of oral candidiasis
Topical antifungal (nystatin oral suspension or clotrimazole oropharyngeal lozenges/troches)
Genetic susceptibility for erythema multiforme major
HLA gene
Etiology of erythema multiforme major
Commonly due to infection (HSV) but can be from medication
Clinical presentation of erythema multiforme
Target-like lesions on skin, often with mucosal erythema, painful erosions or bullae
Treatment of erythema multiforme major
Symptomatic relief that topical corticosteroid, oral anti-histamines, miracle mouthwash
Clinical presentation of SJS
Mucosal involvement with erythema and edema of lips, intraoral bullae, ruptured bullae and must look for gentital and ocular involvement
What are aphthous ulcers?
Canker sores
Most common cause of mouth ulcers
Recurrent aphthous stomatitis
Clinical presentation of aphthous ulcers
Single or multiple lesions that are shallow, round/oval, painful with grayish base on mucosa, usually do not bleed
Treatment of aphthous ulcers
Typically heal but can use symptomatic steroid (triamcinolone orpharyngeal paste)
What is behcet syndrome?
Neutrophilic inflammatory disorder
Clinical presentation of behcet syndrome
Recurrent oral and genital ulcers that are painful, shallow or deep with central yellowish necrotic base with raised edges, NOT CONTAGIOUS
Diagnos of behcet syndrome
Recurrent oral ulcers (>3x per year) AND 2 of the following (recurrent genital ulcers, ocular lesions, cutaneous lesions or positive pathergy test)
Treatment of behcet syndrome
Refer to rheumatology
Pathergy test
Do an intradermal injection with a 20 gauge needle under sterile conditions and positive test if an erythematous sterile papule develops within 48 hours
Progression of oral lichen planus
Reticular, erythematous, erosive
Clinical presentation of oral lichen planus
Reticular (lacy white plaques with Wickham’s striae on buccal mucosa), erythematous (red patches of mucosal atrophy-pain), erosive (erosions/ulcers-pain)
Treatment of oral lichen planus
Pain relief and topical corticosteroids (high potency like triamcinolone oropharyngeal Oralone or clobetasol topical ointment BID)
What is black hairy tongue associated with?
Antibiotic use, candida albicans infection or poor oral hygiene
Clinical presentation of black hair tongue
Elongated filiform papillae
Clinical presentation of geographic tongue
Erythematous patches on dorsal tongue with circumferential white borders, can change location pattern and size
What is atrophic glossitis?
Inflammatory disorder that leads to atrophy of the filiform papillae, must think about what else is going on with this patient!
Etiology of atrophic glossitis
Nutritional deficiencies, dry mouth, Sjogren’s syndrome, oral candida infection, celiac disease
Clinical presentation of atrophic glossitis
Tongue appears smooth, glossy, erythematous, burning sensation and sensitivity with salty foods
When should you prescribe gel application?
For a few localized lesions (gel form of topical steroids)
When should you prescribe a rinse?
For widespread or generalized erythema
