Oral Disease Flashcards
What are fordyce granules?
Ectopic sebaceous glands not a/w hair follicles (as opposed to meibomian, Montgomery, Tyson)
Clinical appearance of Fordyce granules?
Multiple pinoint (1-2 mm) yellow-white papules on vermilion lips (upper > lower) and oral mucosa (mc buccal)
What is geographic tongue?
Well-delineated erythematous areas of atrophy missing filiform papillae (appear bald) partially surrounded by white serpiginous or scalloped
borders
What is the histology of geographic tongue?
Essentially psoriasis (regular acanthosis, neuts in horn, parakeratosis)
What things are a/w geographic tongue?
Usually incidental and normal (2-3% of people)
- can be associated with atopy and psoriasis (pustular variant most commonly)
What is fissured tongue?
Multiple deep furrows on the dorsal tongue especially in midline
What things are associated with fissured tongue?
Down syndrome, Cowden, Melkerson-Rosenthal
- Often normal finding
What is Melkerson-Rosenthal syndrome?
- Young adults
- Triad of fissured tongue, orofacial granulomatosis (lip edema from granulomas), and permanent facial nerve paralysis
- A/w sarcoidosis and Crohn’s
What is black hairy tongue?
Keratin retention –> hypertrophic papillae from decreased sloughing
- Hairlike projections confluent elongated papillae
- Yellowish to brown-black staining from food, tobacco, or chromogenic bacteria
- Chromogenic bacteria mc seen post-abx therapy
What things are associated with black hairy tongue?
Poor hygiene, smoking, hot drinks
What is the treatment of black hairy tongue?
Treat by scraping or brushing the tongue +/- dilute H2O2
What is median rhomboid glossitis?
Well-demarcated central erythematous atrophic area on dorsum of tongue in front of circumvallate papillae (largest papillae at the back)
What can median rhomboid glossitis be associated with?
Found in ~1% of adults and often a/w overgrowth of candida
- Can be a sign of HIV or DM2 if extensive
Treatment for median rhomboid glossitis?
Treatment is clotrimazole or oral fluconazole
(treat the cause - candida)
What is atrophic glossitis?
Atrophy of papillae
- Smooth appearance, can be tender, burning sensation
- Can looks beefy and red
What deficiencies are associated with atrophic glossitis?
B1 thiamine, B2 riboflavin, B3 niacin, B6 pyridoxine, B12 cobalamin, folate, iron
can also be seen in candidiasis and Sjogren’s syndrome
What conditions are associated with desquamative gingivitis?
Seen in mucous membrane pemphigoid, LP, drug reaction, GVHD, autoimmune bullous disorders, EM, fixed drug, chronic ulcerative stomatitis, contact derm, foreign body
What medications are associated with gingival hyperplasia?
Phenytoin, phenobarbital, lamotrigine, valproate, vigabatrin, ethosuximide, topiramate, primidone (antiseizure meds)
Calcium channel blockers: nifedipeine, amlodipine, diltiazem, felodipine, verapamil
Cyclosporin
What is the timing of drug-related gingival hyperplasia?
Seen within the first year of medication use, worse if oral hygiene is poor
What is a dental sinus?
Abnormal draining channel from a longstanding abscess a/w dead (devascularized) tooth (intraoral vs cutaneous)
- Intraoral: soft, non-tender, erythematous papule on alveolar process close to the affected tooth
- Cutaneous: erythematous papule, often with umbilicated or ulcerated center; found on chin or submandibular region (mandibular teeth > maxillary teeth)
What is necrotizing ulcerative gingivits?
Also known as trench mouth
Painful, hemorrhagic, necrotic gingivae w/ classic punched out interdental papillae
It is a mixed bacterial infection in susceptible people (immunosuppression, malnutrition, stress, smoking, poor oral hygiene
Treatment for necrotizing ulcerative gingivits?
Debridement followed by broad-spectrum abx
- low dose doxycycline for anti-inflammatory effects also recommended
What are the 3 classifications of recurrent aphthous stomatitis?
Minor: mc, <5 mm
Major: >1 cm, deeper, longer-lasting
Herpetiform: multiple small grouped ulcers ( but unlike HSV favors non-keratinized mucosa)
What can be associated with recurrent apthous stomatitis
Vitamin deficiencies, stress, hormones, and systemic dz (SLE, Behcets, IBD)
Treatment for recurrent aphthous stomatitis?
Topical CS +/- local anesthesia
If necessary, colchicine or dapsone
Thalidomide for major
Which one, leukoplakia or erythroplakia, is more common associated with malignancy?
Erythroplakia show more severe epithelial dysplasia than leukoplakia and are more likely to be malignant
What is leukoplakia and erythroplakia?
White vs red patch/plaque that cannot be characterized clinically or pathologically as any other disease; sharply demarcated borders
- Leukoplakia mc on the mouth floor, lateral/ventral tongue, and soft palate
What is the treatment for leukoplakia and erythroplakia?
Biopsy is needed
If interpretation is “hyperkeratosis of unknown significance,” the options depend on the age of the patient, medical status of the patient, and size of the lesion
- Narrow removal (surgery, cryo, or laser) and lifetime follow-up with wider excision of recurrences
- Follow-up of patient with re-biopsies as necessary and removal of lesion if there is noticeable progression in size or change in the nature of the lesion
What is proliferative verrucous leukoplakia?
Heterogenous white plaques with a rough verrucous surface +/- nodular and red areas
- often multifocal, present for 1-2 decades, and have had multiple biopsies
- F:M 4:1, seventh+ decade
- higher risk of maligngant transformation (70-100%) to SCC or verrucous carcinoma
Treatment of proliferative verrucous leukoplakia?
Biopsy q3-6 months on red and verrucous areas, multiple biopsies for extensive lesions
Should be managed by oral surgeons or oral specialists familiar with the condition
Tx: refractory to laser; involve ENT for excision
What is nicotine stomatitis?
- Caused by inflamed salivary ducts
- Clinically presents as a gray-white palatal mucosa with numerous umbilicated papules
- Tx: stop offending agent (pipe smokers) - will resolve in 1-2 weeks
Etiologies of angular chelitis?
Irritant, but also frequently infected with candida or staph
DDx: lip-licking dermatitis (more diffuse), syphilitic split papules, HSV (usually unilateral)
What is cheilitis glandularis?
Inflammatory hyperplasia of lower labial salivary glands –> pinpoint erythematous macules (site of salivary ducts), variable hypertrophy/eversion of the lower lip, and sticky mucoid film
- Feels nodular d/t enlarged glands
- seen in adult men with h/o chronic sun exposure and/or lip irritation
- Increased SCC risk
Treatment for cheilitis glandularis?
Cryosurgery, 5-FU, imiquimod, PDT, CO2 laser ablation, Mohs surgery
What HPV’s are associated with verrucous carcinoma (oral florid papillomatosis?
HPV-6/11
Should oral florid papillomatosis be irradiated?
Avoid radiation b/c of risk of anaplastic transformation
What are some key features of salivary gland tumors?
M/c location is the posterior hard palate - upper lip mucosa - buccal mucosa
Most are BENIGN - p/w painless, rubbery, firm swelling
Malignant types may become painful
What is the presentation of chemotherapy and radiotherapy-induced mucositis?
Multiple erosions +/- ulcerations that favor gingivae, lateral tongue, and buccal mucosa
What is the most common timeline for chemotherapy and radiotherapy-induced mucositis
4-7 days post-chemo administration and >2 weeks after starting radiation
What is the treatment for chemotherapy and radiotherapy-induced mucositis?
Self-limited – topical anesthetics, maintain good oral hygiene
What are some oral findings in leukemia?
- Associated intraoral findings include infections and gingival hemorrhage
- Gingival enlargement occurs mc w/monocytic and myelomonocytic leukemias
What are the most common cause of foreign body tattoos?
Foreign body tattoos are most common cause of acquired oral pigmentation and mostly due to implantation of dental amalgam
What should you be thinking if you see a question w/ macroglossia and carpal tunnel syndrome?
Systemic Amyloidosis (especially B2microglobulin/renal associated)
What oral findings can be seen w/ Crohn’s disease?
- Oral cobblestoning and ulcers (aphthous or linear)
- Angular cheilitis
- Orofacial granulomatosis
What is pyostomatitis vegetans?
Multiple pinpoint yellow pustules in a serpentine configuration with a red background
Evolves into snail-track ulcers
Labial, gingival, and buccal mucosa
Deep edematous folds of buccal mocosa
Pyostomatitis vegetans is most commonly associated with what disorders?
W/w IBD (UC >> Crohn’s), improves with IBD Tx
