Mucocutaneous Disorders Flashcards
Stages for Evaluation of oral lesions
Recognize tissue alteration Generate ddx Ddx procedures Recommend for tx Follow up
History of Present illness (HPI)
Onset Signs and symptoms Pain Trauma Meds
Classification of Pathology (4)
- developmental (congenital or acquired, parents, features)
- neoplastic (malignant vs benign)
- reaction (inflammatory, infectious, traumatic)
- autoimmune
Mucocutaneous lesions
lesions associated with immunocompromised ppl
Vesiculobullous diseases
Atypical of perio associated with HIV
Mucosal Manifestations: atypical forms
linear ging erythema, NUG, NUP
Linear ging erythema LGE
unusual pattern with persistent generalized band of erythema on margin
non painful, petechia like, bleeding, diffuse
extend from FGM apically
abnormal rxn to irritants, no response to plaque control
NUG
rapid onset or destruction
ulceration/necrosis of ging
severe pain, bleeding, malodor
IP ging necrosis, soft tissue craters
mand incisors and max molars
NUP
Disease involves bone/tissue
Most severe form, severe immunosuppression
Deep bone pain complaint
Rapid, exposes bone quickly
Cause: anaerobic bacteria, fusobacterium, spirocate
Clinical features of NUP/NUG
Severe ging pain Profuse bleeding IP papillae necrotic slough Punched out Malodor, metallic taste
Tx for LGE, NUP, NUG
Acute: pain control
Maintenance: decrease pathogens, debride, remove tissue, CHX 2x daily, OH home care, smoking cessation
Abx therapy: narrow spectrum 10-14 days
Necrotizing Stomatitis
localized, rapid bone destruction
highly erythematous, halitosis
invasive beyond periodontium (HIV destroyed immunity)
resembles Noma
soft tissue and bone involved
bone sequestration if not treated quick
Kaposi’s sarcoma
Solitary lesion first, no blanching
Elevated, painful, bleeding
Common on hard palate
Prev associated with >60, now associated with HIV/AIDS
Associated with HHV 8
malignancy of skin, spread to lungs/liver/GI
most common form of neoplasm in HIV ppl
mouth involved in 30% of cases
Tx for kaposi’s sarcoma
not curable
HAART to treat aids to shrink lesion
local lesions treated with Rad or cryosurgery
Non Hodgkin’s lymphoma
rapid growing painful ulcerated mass on gingiva or palate
seen in immunocompromised
plasmblastic lymphoma= rare form
Non Hodgkin’s therapy
rad or chemo
stabilize dental needs
Vesicular lesions: lichen planus
Etiology unknown (autoimmune, CD8+ T cells trigger apoptosis of epi cells)
infiltration of T cells in band into dermis “hugging” basal layer
similar to fungal infection
Cutaneous presentation
“saw tooth” appearance of rete pegs
Predisposing factors LP
meds, contact hypersens to dent materials, liver disease, genetics, infection, stress, DM, trauma
Lichenoid Rxn
similar appearance to LP
may be rxn to dent materials
Reticular LP
Wickham's Striaie Most common on B mucosa bilateral or symmetrical can't wipe off Found on floor of mouth, ventral tongue, gingiva
Atrophic LP
reticular form, tiny white papules with red background
on buccal
burning sensation
tx: glucocorticoid ointment
Plaque like LP
not common
dorsum of tongue
white patch with white papules together
tx: none if asymptomatic, associated with candida or burning
Erosive LP
peripheral ulceration
extensive
painful
result in scarring
tx: glucocorticosteroids, use rinse if extensive, prednisone pills
Mucous Membrane Pemphigoid MMP
Chronic blistering mucocutaneous autoimmune diseases
Oral cavity most commonly affected (skin, eyes)
Weakens CT attachment
Blisters form in subepi layer
Bulla short lived, leave ulcerated area
Scarring KEY feature
2:1 female to male, adults
oculars lesions 1/3 of cases
undetected circulating auto IgG
good prognosis; significant morbidity
Autoimmune attack
affects hemidesmosome
linear pattern
epi sloughs off, create bullae
