oral lesions

Question 1

are oral lesions local or systemic

Answer 1

both

Question 2

why is diagnosing and treat oral lesions of the mouth + gums challenging?

Answer 2

wide variety of diseases that can present

Question 3

cancer of the oral cavity is associated with….

Answer 3

ulcers or masses that do not heal

Question 4

tongue + lip cancers are associated with…

Answer 4

exophytic (outward growth) or ulcerative lesions

Question 5

what accounts for 80% of squamous cell carcinoma of the head + neck

Answer 5

tobacco + ETOH use

Question 6

what is the common name for recurrent aphthous stomatitis (RAS)

Answer 6

canker sores

Question 7

what are the sx of recurrent aphthous stomatitis (RAS)

Answer 7

painful, shallow, round/oval, ulcers with grayish base
heal in 10-14 days - more severe can last 6wks
2-4 outbreaks a year

Question 8

etiology of recurrent aphthous stomatitis (RAS)

Answer 8

celiac dz
IBD
crohns dz
antimetabolite use (methotrexate for RA)
dec in mucosal thickening
vit b12, folic acid, iron deficiency
neutropenia of any cause

Question 9

tx of recurrent aphthous stomatitis (RAS)

Answer 9

symptomatic
topical corticosteroids (flucinonide, triamcinoline)
topical analgesics applied 2-4x/day
chemical cautery w silver nitrate or sulfuric acid
intralesional or oral glucocorticosteroids for recalcitrant lesions or severe dz
colchicine, dapson (aczone), pentoxifylline (bronchodilator + immunomodulator)
interferon alpha, levamisole
thalidomide in hIV pts - recurrent after cessation of therapy - category X, only rx through special distribution program

Question 10

risk factors for recurrent aphthous stomatitis

Answer 10

smoking cessation
familial tendency
trauma (dental cleaning)
hormonal factors (luteal phase of cycle- progesterone falls)
emotional stress
food or drug hypersensitivity
HIV

Question 11

is recurrent aphthous stomatitis infectious

Answer 11

no - not contagious or sexually transmitted

Question 12

when is recurrent aphthous stomatitis common

Answer 12

children + adolescence

Question 13

what is bechets disease

Answer 13

neutrophilic inflammatory disorder that causes small vessel vasculitis

Question 14

presentation of bechets disease

Answer 14

recurrent oral + genital ulcerations + uveitis (triad)

most cases initially start as oral

Question 15

tx of bechets disease

Answer 15

lesions heal spontaneously (1-3 weeks)
colchicine
topical anesthetics
topical/intralesional corticosteroids
systemic glucocorticoids
thalidomide
dapsone

Question 16

diagnosis of bechets disease

Answer 16

recurrent oral ulcers (3x+ in 12 mo) + 2 of the following:
recurrent genital lesions
eye lesions
skin lesions
positive pathergy test- minor trauma lead to development of ulcers

**don’t have to be at the same time

Question 17

what is complex aphthosis

Answer 17

recurrent large oral ulcers in conjunction w genital ulcers in absence of other bechet’s criteria

Question 18

what is oral leukoplakia

Answer 18

benign reactive process
precancerous lesions
white patches/plaques on oral mucosa- looks like thrush but does not scrape off
hyperplasia of squamous epithelium
can be progressive (20% of pts)
occur in trauma-prone regions (cheek, dorsum of tongue) where mucosa is normally thicker, show less dysplasia
thin areas of mucosa (ventral tongue, retromolar triangle) show more dysplasia

Question 19

how is leukoplakia diagnosed

Answer 19

biopsy - esp w hx of tobacco + other risk factors

Question 20

how is leukoplakia treated

Answer 20

chemoprevention (recent interest)

oral retinoids

Question 21

oral hairy leukoplakia

Answer 21

separate from oral leukoplakia
not premalignant
EBV associated
almost entirely in HIV pts

Question 22

young children w primary HSV 1 diagnosis may also present with…

Answer 22

fever
LAD
drooling
decreased oral intake

Question 23

oral candidiasis presentation

Answer 23

white plaques on buccal mucosa, palate or tongue
erythema w.o plaques in denture wearers
beefy, red tongue
angular chelitis

Question 24

diagnosis of oral candidiasis

Answer 24

clinical
white plaques usually scrape off
fungal cx
KOH prep 
refractory thrush should warrant HIV testing

Question 25

treatment of oral candidiasis

Answer 25

nystatin suspension
nystatin troches (lifesavers)
clotrimazole troches

Question 26

risk factors for oral candidiasis

Answer 26

inhaled or systemic steroids
diabetics
pts on antibiotics
chemo/radiation
HIV