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Dermatology Board Prep > DERM (10) Hair, Nails, and Mucous Membranes > Oral Disease > Flashcards

Oral Disease Flashcards

1
Q

What are fordyce granules?

A

Ectopic sebaceous glands not a/w hair follicles (as opposed to meibomian, Montgomery, Tyson)

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2
Q

Clinical appearance of Fordyce granules?

A

Multiple pinoint (1-2 mm) yellow-white papules on vermilion lips (upper > lower) and oral mucosa (mc buccal)

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3
Q

What is geographic tongue?

A

Well-delineated erythematous areas of atrophy missing filiform papillae (appear bald) partially surrounded by white serpiginous or scalloped

borders

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4
Q

What is the histology of geographic tongue?

A

Essentially psoriasis (regular acanthosis, neuts in horn, parakeratosis)

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5
Q

What things are a/w geographic tongue?

A

Usually incidental and normal (2-3% of people)

  • can be associated with atopy and psoriasis (pustular variant most commonly)
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6
Q

What is fissured tongue?

A

Multiple deep furrows on the dorsal tongue especially in midline

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7
Q

What things are associated with fissured tongue?

A

Down syndrome, Cowden, Melkerson-Rosenthal

  • Often normal finding
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8
Q

What is Melkerson-Rosenthal syndrome?

A
  • Young adults
  • Triad of fissured tongue, orofacial granulomatosis (lip edema from granulomas), and permanent facial nerve paralysis
  • A/w sarcoidosis and Crohn’s
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9
Q

What is black hairy tongue?

A

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
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10
Q

What things are associated with black hairy tongue?

A

Poor hygiene, smoking, hot drinks

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11
Q

What is the treatment of black hairy tongue?

A

Treat by scraping or brushing the tongue +/- dilute H2O2

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12
Q

What is median rhomboid glossitis?

A

Well-demarcated central erythematous atrophic area on dorsum of tongue in front of circumvallate papillae (largest papillae at the back)

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13
Q

What can median rhomboid glossitis be associated with?

A

Found in ~1% of adults and often a/w overgrowth of candida

  • Can be a sign of HIV or DM2 if extensive
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14
Q

Treatment for median rhomboid glossitis?

A

Treatment is clotrimazole or oral fluconazole

(treat the cause - candida)

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15
Q

What is atrophic glossitis?

A

Atrophy of papillae

  • Smooth appearance, can be tender, burning sensation
  • Can looks beefy and red
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16
Q

What deficiencies are associated with atrophic glossitis?

A

B1 thiamine, B2 riboflavin, B3 niacin, B6 pyridoxine, B12 cobalamin, folate, iron

can also be seen in candidiasis and Sjogren’s syndrome

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17
Q

What conditions are associated with desquamative gingivitis?

A

Seen in mucous membrane pemphigoid, LP, drug reaction, GVHD, autoimmune bullous disorders, EM, fixed drug, chronic ulcerative stomatitis, contact derm, foreign body

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18
Q

What medications are associated with gingival hyperplasia?

A

Phenytoin, phenobarbital, lamotrigine, valproate, vigabatrin, ethosuximide, topiramate, primidone (antiseizure meds)

Calcium channel blockers: nifedipeine, amlodipine, diltiazem, felodipine, verapamil

Cyclosporin

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19
Q

What is the timing of drug-related gingival hyperplasia?

A

Seen within the first year of medication use, worse if oral hygiene is poor

20
Q

What is a dental sinus?

A

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)
21
Q

What is necrotizing ulcerative gingivits?

A

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

22
Q

Treatment for necrotizing ulcerative gingivits?

A

Debridement followed by broad-spectrum abx

  • low dose doxycycline for anti-inflammatory effects also recommended
23
Q

What are the 3 classifications of recurrent aphthous stomatitis?

A

Minor: mc, <5 mm

Major: >1 cm, deeper, longer-lasting

Herpetiform: multiple small grouped ulcers ( but unlike HSV favors non-keratinized mucosa)

24
Q

What can be associated with recurrent apthous stomatitis

A

Vitamin deficiencies, stress, hormones, and systemic dz (SLE, Behcets, IBD)

25
Q

Treatment for recurrent aphthous stomatitis?

A

Topical CS +/- local anesthesia

If necessary, colchicine or dapsone

Thalidomide for major

26
Q

Which one, leukoplakia or erythroplakia, is more common associated with malignancy?

A

Erythroplakia show more severe epithelial dysplasia than leukoplakia and are more likely to be malignant

27
Q

What is leukoplakia and erythroplakia?

A

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
28
Q

What is the treatment for leukoplakia and erythroplakia?

A

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
29
Q

What is proliferative verrucous leukoplakia?

A

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
30
Q

Treatment of proliferative verrucous leukoplakia?

A

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

31
Q

What is nicotine stomatitis?

A
  • 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
32
Q

Etiologies of angular chelitis?

A

Irritant, but also frequently infected with candida or staph

DDx: lip-licking dermatitis (more diffuse), syphilitic split papules, HSV (usually unilateral)

33
Q

What is cheilitis glandularis?

A

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
34
Q

Treatment for cheilitis glandularis?

A

Cryosurgery, 5-FU, imiquimod, PDT, CO2 laser ablation, Mohs surgery

35
Q

What HPV’s are associated with verrucous carcinoma (oral florid papillomatosis?

A

HPV-6/11

36
Q

Should oral florid papillomatosis be irradiated?

A

Avoid radiation b/c of risk of anaplastic transformation

37
Q

What are some key features of salivary gland tumors?

A

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

38
Q

What is the presentation of chemotherapy and radiotherapy-induced mucositis?

A

Multiple erosions +/- ulcerations that favor gingivae, lateral tongue, and buccal mucosa

39
Q

What is the most common timeline for chemotherapy and radiotherapy-induced mucositis

A

4-7 days post-chemo administration and >2 weeks after starting radiation

40
Q

What is the treatment for chemotherapy and radiotherapy-induced mucositis?

A

Self-limited – topical anesthetics, maintain good oral hygiene

41
Q

What are some oral findings in leukemia?

A
  • Associated intraoral findings include infections and gingival hemorrhage
  • Gingival enlargement occurs mc w/monocytic and myelomonocytic leukemias
42
Q

What are the most common cause of foreign body tattoos?

A

Foreign body tattoos are most common cause of acquired oral pigmentation and mostly due to implantation of dental amalgam

43
Q

What should you be thinking if you see a question w/ macroglossia and carpal tunnel syndrome?

A

Systemic Amyloidosis (especially B2microglobulin/renal associated)

44
Q

What oral findings can be seen w/ Crohn’s disease?

A
  • Oral cobblestoning and ulcers (aphthous or linear)
  • Angular cheilitis
  • Orofacial granulomatosis
45
Q

What is pyostomatitis vegetans?

A

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

46
Q

Pyostomatitis vegetans is most commonly associated with what disorders?

A

W/w IBD (UC >> Crohn’s), improves with IBD Tx

DERM (10) Hair, Nails, and Mucous Membranes (6 decks)

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