Oral Lesions Flashcards
Know etiology, presentation, and treatment
etiology of thrush
Candida albicans
Thrush is also called “Oral Candidiasis” and is an oportunistic infection.
clinical presentation and diagnosis of thrush
Sore throat, oral erythema, white plaques that can be brushed off
Diagnosis can be confirmed with KOH prep showing budding yeast.
treatment of thrush
Nystatin, Clotrimazole (topical suspensions); Fluconazole (oral)
counsel patient regarding cleaning dentures/retainers and rinsing mouth after oral steroid use; check for HIV/Diabetes if infection is recurrent or involves esophagus
etiology of herpes
HSV type 1 (usually)
symptoms are brought on by precipitating factors:sunlight, trauma, stress
clinical presentation of herpes
Initial infection: grouped vesicles on an erythematous base, gingivostomatitis, lymphadenopathy, fever.
Recurrent: prodrome of pain, burning, or tingling 24 hours before lesions present
diagnosis of herpes
Diagnosis confirmed with Tzanck smear (only shows that it is a type of herpes); viral culture, serology showing HSV-1 antibodies
etiology of hand, foot & mouth disease
Coxsackie A16 virus
Usually a childhood disease
clinical presention of hand, foot & mouth disease
Prodrome: low grade fever, malaise, abdominal pain, URI symptoms,
Painful oral lesions - pale papules on an erythematous base that spares the gingiva and lips. Lesions also found on hands and feet.
treatment of hand, foot & mouth disease
supportive treatment: analgesics, popsicles, rest, hydration
resolves in 2-3 days
treatment of herpes
acyclovir (cream); acyclovir, valacyclovir, famciclovir (oral)
Abreva OTC
etiology of herpangina
Coxsackie A16 virus
usually in children 3-10 yo
clinical presentation of herpangina
sudden onset with symptoms similar to hand, foot & mouth; high fever (up to 105.8F), papules on soft palate become ulcers, oral lesions that spare lips and gingiva; sore throat, malaise, headache, myalgias, vomiting
treatment of herpangina
supportive treatment: analgesics, popsicles, rest, hydration
resolves in about a week
etiology of aphthae
etiology is not well defined - may be a cell mediated immunity brought on by predisposing factors (stress, immune irregularity, nutritional deficiencies, or specific foods)
Also called “oral ulcers” and “canker sores”
clinical presentation of aphthae
painful, small grey oral lesions on an erythematous base
treatment of aphthae
symptomatic - triamcinolone acetonide in orabase
etiology of Behcet’s
inflammatory disorder
clinical presentation of Behcet’s
recurrent aphthae lesions - may be oral or genital
diagnosis of Behcet’s
more than 3 oral lesions plus 2 other clinical findings (genital lesions or elsewhere) within a 1 year period
treatment of Behcet’s
refer to rheumatology
etiology of mononucleosis
Ebstein-Barr Virus
Spread by saliva exchange; saliva may be infectious for more than 6 months after onset of symptoms (even after all symptoms resolve).
clinical presentation of mononucleosis
strep-like symptoms; low grade fever, malaise, exudates in throat, cervical adenopathy, no cough; splenomegaly (always do an abdominal exam if mono is suspected)
diagnosis of mononucleosis
confirm with a monospot test, throat culture
rule out strep with rapid strep test, throat culture
treatment of mononucleosis
supportive; rest and fluids
spleen precautions (risk of splenic rupture if splenomegaly is present)
etiology of acute HIV
the initial period of HIV infection, patient is highly infective with a high viral load
clinical presentation of acute HIV
highly variable- viral syndrome with rash/oral lesions - difficult to distinguish from mono, flu, and strep
Fever, fatigue, malaise, rash, headache, pharyngitis, myalgias, lymphadenopathy, oral ulcers, night sweats, weight loss
etiology of leukoplakia
benign precancerious lesion
associated with HPV, inflammatory/autoimmune diseases, tobacco and alcohol use
treatment of acute HIV
immediate referral to an HIV specialist
make sure patient understands they are highly infective
clinical presention of leukoplakia
oral lesions that appear as white or grey plaques, painless, and does NOT brush
diagnosis of leukoplakia
biopsy
treatment of leukoplakia
refer to ENT, monitor, evaluation, and biopsy
etiology of lichen planus
chronic inflammatory/autoimmune disease
clinical presentation of lichen planus
lacy leukoplakia (may be a purple-ish white), may be erosive and painful
diagnosis of lichen planus
exfoliative cytology, biopsy
treatment of lichen planus
manage pain/discomfort with topical or systemic corticosteroids, refer to ENT
risk factors for oral squamous cell carcinoma
tobacco and alcohol use
clinical presentation of squamous cell carcinoma
papules, plaques, erosions, ulcers or masses that do not heal
diagnosis and treatment of squamous cell
refer to ENT for biopsy to assess stage and extent
etiology of syphilis
bacterium treponem pallidum
clinical presentation of syphalis
painless chancre
diagnosis of syphalis
RPR (rapid plasma reagin) blood test
good sexual history
treatment of syphalis
Benzathine PCN G 2.4 mu IM x1
check in with county health department
etiology of mucoceles
oral trauma
clinical presentation of mucoceles
fluid filled cavities with mucous glands lining the epithelium
treatment of mucoceles
may rupture spontaneously, can be removed with cryotherapy or excision of entire cyst, refer to ENT or dentist
etiology of lingua nigra
benign condition associated with antibiotic use, candida, and poor oral hygiene
clinical presentation of lingua nigra
black hairy tongue
treatment of lingua nigra
brush tongue using soft toothbrush and toothpaste 2-3 times daily
etiology of geographic tongue
unknown
a benign migratory glossitis
clinical presentation of geographic tongue
erythematous patches on dorsal tongue with white borders, patterns vary and may change, the condition may come and go; some complain of discomfort
diagnosis and treatment of geographic tongue
biopsy to rule out any more serious conditions
patient reassurance
etiology of Stevens Johnson Syndrome
hypersensitivity reaction usually to drugs - sulfa’s, antibotics, phenytoin etc.
clinical presentation of Stevens Johnson Syndrome
erythema/edema of the lips, painful ulcerations at >2 sites, skin lesions on trunk (may be widespread), involvement of mucosal layers; intraoral bullae and denudation are signs the syndrome is severe
diagnosis of Stevens Johnsons Syndrom
clinical and biopsy
treatment of Stevens Johnsons Syndrome
discontinue offending medications
admit patient, esp if there is blistering, mucosal involvement interferes with nutrition/hydration, or if there is excessive skin denudation (tx in burn unit)
etiology of pemphigus
Rare, chronic autoimmune blistering disease that usually occurs in middle age
cause unknown, may be drug induced
clinical presentation of phemphigus
acantholysis (separation of epidermal cells from each other), insidious onset, tender flacid bullae that are easy to rupture, lesions appear on oral mucous first, scalp also involved early, exhibits a positive Nikolsky’s sign.
diagnosis of phemphigus
Nikolsky’s sign: rubbing cotton swab or finger on surface fo uninvolved skin causes the superficial skin to slip free from deeper layers
biopsy, microscopy, derm consult
treatment of phemphigus
urgent referral to derm
systemic corticosteroids, immunosuppressive agents; antibiotics (high risk for secondary infections); hospitalization if severe.
etiology of bullous pemphigoid
autoimmune blistering benign disease that comes and goes, usually occurs after age 60 and more common in men
cause unknow, may be drug induced
clinical presentation of bullous pemphigoid
tense blisters in flexural areas, blisters may be preceded by uticarial lesions, oral lesions in 1/3 of patients
diagnosis of bullous pemphigoid
biopsy, light microscopy, derm referral
treatment of bullous pemphigoid
systemic corticosteroids, immunosuppressive agesnts
