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Oral Pathology Exam 5 > Non-Infective Stomatitis > Flashcards

Non-Infective Stomatitis Flashcards

1
Q

Recurrent Aphthous Stomatitis is often precipitated by what? How do we know?

A

Trauma or emotional stress

Immunologic cause: T-cell mediated

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2
Q

Are Recurrent Aphthous Stomatitis (RAS) genetic?

A

Specific histocompatibility antigens have been associated, indicating a possible genetic predisposition

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3
Q

What percentage of aphthous ulcer are minor aphthae?

A

80%

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4
Q

In what patient’s do minor aphthae most commonly appear?

A

Affect females more than males

Begin to develop in childhood or adolescence

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5
Q

What location of the oral cavity are minor aphthae found?

A

Almost exclusively on moveable mucosa (not covering bone)

- Most often occur on buccal and labial mucosa

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6
Q

Symptoms and presentation of minor aphthae

A

Painful tan ulcers with erythematous borders
Prodromal symptoms of burning, itching
Less than 1.5 cm

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7
Q

Treatment of minor aphthae

A

Heal spontaneously in 7 to 14 days without scarring

Recurrence rate is variable

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8
Q

What percentage of aphthous ulcers are major aphthae?

A

10%

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9
Q

Another name for Major aphthae?

A

Sutton’s disease

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10
Q

What patient’s have major aphthae more commonly?

A

Onset in adolescence

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11
Q

Location and presentation of Major aphthae

A

Most commonly affect soft palate, tonsillar fauces or pharyngeal mucosa
- 1.5 to 3+ cm, deeper than minor aphthae

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12
Q

Treatment of major aphthae

A

Can take 2-6 weeks to heal, may cause scarring

Recurrent episodes

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13
Q

What percentage of aphthous ulcers are Herpetiform aphthae

A

10%

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14
Q

What patient’s have Herpetiform aphthae more commonly?

A

Onset in adulthood

Female prdeominance

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15
Q

Location and presentation of Herpetiform aphthae

A
  • Resemble ulcers caused by herpes simplex virus
  • 1 to 3 mm ulcers occurring in clusters
  • No systemic signs or symptoms, as in primary herpetic gingivostomatitis
  • Occur anywhere in the oral cavity (vs. herpes simplex ulcerations, which are usually on mucosa covering bone)
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16
Q

Treatment of Herpetiform aphthae

A

Heal in 7 to 10 days

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17
Q

Diagnosis of Aphthous ulcers is made how?

A

From clinical presentation and from exclusion of other diseases

Topical steroids

  • Dexamethasone elixir 0.01% (Shouldn’t swallow)
  • Fluocinonide (Lidex) gel 0.05%

Chlorhexidine
Amlexanox 5% oral paste (Aphthasol)

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18
Q

“pseudo” aphthae characteristics

A

Associated with systemic diseases
GI malabsorption diseases (Crohn’s disease)
Vitamin deficiencies: iron, folate, B1, 2,6,12

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19
Q

What is Behcet’s syndrome

A

Chronic, recurrent disease resulting from a systemic vasculitis

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20
Q

Explain the oral presentation of Behcet’s syndrome

A

Similar to aphthous ulcers

  • 6 or more, commonly involving soft palate and oropharynx
  • Ragged borders and variation in size
  • Surrounded by diffuse erythema
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21
Q

Pathogenesis of Lichen planus

A

immune mediated through T Cells, slight association with hepatitis C.
Cause unknown

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22
Q

What patients does Lichen planus affect more commonly

A

Middle-aged adults

Women represent about 2/3 of patients

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23
Q

Location of Lichen Planus

A

Affects both skin and oral mucosa

Tends to affect tissue that are irritated or traumatized: Koebner phenomenon

24
Q

Symptoms and presentation of Lichen Planus

A

Skin: purple, Pruritic, polygonal papules (PPP)
Orally: Reticular/erosive/bullous/plaque-like clinical appearance

25
Q

Most common type of lichen planus

A

is reticular characterized by Wickham’s striae

Erosive is characterized by redness and/or ulceration and symptoms

26
Q

T or F, Lichen planus is most common cause of desquamative gingivitis

A

True

27
Q

Explain the difference between Lichen Planus and Lichenoid reactions

A

Lichenoid reactions are lesions that look like LP but aren’t: Assoc with systemic drugs, hypersensitivity reactions, esp cinnamon and amalgam and epithelial dysplasia

28
Q

Treatment for Lichen Planus

A

Topical steroids

  • Fluocinonide gel 0.05% applied topically 3-4x daily
  • Clobetasol gel 0.05% applied topically twice a day
29
Q

Name the 4 Pemphigus conditions

A

Blisters (autoimmune)

  1. Vulgaris (Most common)
  2. Vegetans
  3. Erythematosus
  4. Foliaceus
30
Q

What group of people does Pemphigus most commonly affect

A

Often in adults age 40’s and 50’s

31
Q

What is Pemphigus

A

Severe progressive autoimmune disease that affects the skin and mucous membranes: oral lesions are usually the first to appear
- Circulating autoantibodies to components of epithelial cell attachments: desmosomes (desmoglein 3)

32
Q

Clinical features of Pemphigus

A
  • Epithelial desquamation produces painful superficial erosions and ulcerations
  • Affects most mucosal surfaces but often affects gingiva producing chronic desquamative gingivitis
  • You can induce epithelial separation by manipulation tissue or producing lateral pressure (+ Nikolski sign)
  • Rarely see blisters since they break early
33
Q

Diagnosis of Pemphigus

A

Biopsy shows characteristic suprabasilar epithelial separation with acantholysis. Direct immunofluorescence demonstrates autoantibodies (usually IgG and C3) around the individual keratinocytes (Chicekn coop wire)

34
Q

Treatment of Pemphigus

A

Systemic steroids +- steroid sparing drugs

35
Q

What are paraneoplastic pemphigus

A

Affects patients who have a neoplasm, usually lymphoma or leukemia
Very serious, high morbidity and mortality

36
Q

What is Benign mucous membrane pemphigoid

A

Chronic, autoimmune disease where patients produce antibodies against the structural proteins in their hemidesmosomes which anchor the basal keratinocytes to the underlying connective tissue, is a family of realted disorders where antibodies are not directed against a single antigen, but many different antigens that comprise the hemidesmosomes.

37
Q

Patients most commonly found with Benign mucous membrane pemphigoid

A

Average age 50-60,
3x more common in females

More common than pemphigus vulgaris

38
Q

What location is Benign mucous membrane pemphigoid found

A

Affects oral, ocular, and genital mucous +- larynx and esophagus and +- skin
*Most commonly affected site is gingiva where it produces desquamative gingivitis

Ocular scarring can progress to blindness if untreated.

39
Q

Clinical features of Benign mucous membrane pemphigoid

A

Similar to pemphigus but not as severe

- Tissue desquamation produces erosions and ulcers (+ Nikolski sign)

40
Q

Diagnosis of Benign mucous membrane pemphigoid

A

Biopsy shows characteristic subepithelial separation

Direct IF shows autoantibodies at junction of epithelium and connective tissue

41
Q

Treatment of Benign mucous membrane pemphigoid

A

Ophthalmologic consultation

Topical or systemic steroids

42
Q

Desquamative Gingivitis can be a clinical manifestation of what?

A

Lichen Planus
Pemphigus Vulgaris
Mucous membrane pemphigoid
Allergic reaction (toothpaste, ie. tartar control, cinnamon, prservatives)

43
Q

What is Erythema multiforme

A

Acute onset
Immune mediated blistering mucocutaneous condition
Most often following systemic medications or often as a post infectious process, esp post viral
- Sometimes a cause cannot be identified.

44
Q

What locations does Erythema multiforme

A

Affects skin and mucous membranes

Rarely only the mouth

45
Q

Clinical features of Erythema multiforme

A

Young adults 20s and 30s
Men affected more
Often follows a bacterial or viral infection or drug exposure.

46
Q

Symptoms of Erythema multiforme

A

Prodromal symptoms: Fever, malaise, headache, cough, sore throat

47
Q

Treatment of Erythema multiforme

A

Self-limiting 2 to 6 weeks

- 20% recurrence rate

48
Q

Erythema Multiforme: Skin

A
  • Skin lesions highly variable “multiforme”
  • Characteristic target or “bull’s eye” lesions
  • Can occur without oral lesions
  • Classically affects palms and soles
49
Q

Erythema Multiforme: Mucosa

A
  • Oral ulcers with erythema and irregular borders
  • Lips, labial mucosa, tongue, floor of mouth, soft palate
  • Crusting and bleeding at vermillion zone of lips
50
Q

Erythema Multiforme: Steven-Johnson syndrome

A
  • More severe form of erythema multiforme
  • Extensive mucosal ulceration
  • Also effects genital and ocular mucosa
  • Usually triggered by medications
  • Can affect internal organs and can be life threatening
51
Q

Erythema Multiforme: Toxic epidermal necrolysis

A
  • Most severe form of erythema multiforme
  • Triggered by drug exposure
  • Female predilection
  • Diffuse sloughing of skin and mucosal surfaces
52
Q

How is Erythema Multiforme diagnosed

A

Can be diagnosed clinically
Initiating factor should be identified
Topical and high dose systemic steroids

53
Q

Geographic tongue affects what portions of the tongue

A

Primarily affects dorsal and lateral borders of tongue

54
Q

Characteristics of geographic tongue

A

Depapillated areas that are erythematous or normal colored with characteristic yellow-white borders that marginate the lesions

55
Q

What oral symptoms do patients with Systemic Sclerosis “scleroderma” experience

A

Oral: Micrstomia in 70%, dysphagia, +- xerostomia, DIFFUSE WIDENING OF PDL, resorption of ramus or condyle or coronoide

56
Q

Oral symptoms experienced by patients with Graft vs Host disease

A

Most have oral lesions that can appear lichenoid and painful

Oral Pathology Exam 5 (5 decks)

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