Oral lesions Flashcards
What is cancer of the oral cavity associated with
ulcers or masses that do not heal
presentation of cancer on the tongue and lips
exophytic or ulcerative
Aphthousstomatitis
recurrent aphthous stomatitis, “canker sore”
Alternative name for simple aphthous
Mikulicz
Morphology of aphthous ulcers
minor ulcer <1cm
major ulcer >1cm
herpetiform 1 to 2 cm in clusters
Pathogenesis of aphthous lesions
-likely multifactorial
-immune dysregulation
-exaggerative proinflammatory process
-weak anti inflammatory response
-possible genetic predisposition
`
Risk factors of developing aphthous lesion
SMOKING CESSATION
- familial tendency
- trauma
- hormonal
- emotional stress
- food or drug hypersensitivity
- immunodeficiency
Clinical presentation of aphthous lesions
round clearly defined ulcers with erythematous rim and central yellowing
first line management of aphthous lesions
-oral hygiene
-pain control
viscous lidocaine
diphenhydramine
dyclonine losenges
treatment for refractory apthous lesions
topical steroids
dexamethason elixir
clobetasol gel
triamcinolone paste
Management for complex aphthous lesions
- intralesional or oral glucocorticoids
- colchicine
- dapsone
- pentoxifyline
- thalidomide in HIV pts
Where do leukoplakic lesion appear
trauma prone regions where the mucosa is thicker (cheek, dorsum of tongue)
Leukoplakia
whitish grey lesions that cannot be scraped off
early premalignant lesion
Treatment of leukoplakia
not usually needed
- surgical removal
- cryoprobe
- ? oral retinoids
What is hairy leukoplakia associated with
EBV, not premalignant
What population does hairy leukoplakia occur in
HIV infected
How is the majority of HSV-1 transmitted
individuals that do not know that they have the disease
Two types of HSV infection
primary infection- more severe systemic sx
recurrent infection- less severe local sx
Most common clinical manifestation of primary HSV-1 infection
herpetic gingivastomatitis
How do young children with primary HSV-1 disease present
- fever
- LAD
- drooling
- decreased oral intake
risk factors for HSV-1
- sulight exposure
- stress
- trauma
Diagnosis of HSV-1
- confirmed by Tzanck smear, immunofluorescence smear or viral cx
- serology for HSV by PCR
Management for HSV-1
- systemic antivirals (acyclovir, valacyclovir, famiciclovir)
- swish and spit miracle mouthwash
- supportive
Who gets oral candida
- young infants
- older adults who wear dentures
- cancer pts
- immunodef
What pathogens cause oral candida
- c albicans
- c glabrata
- c krusei
- c tropicalis
Pseudomembranous oral candida
-most common form
white plaques on buccal mucosa, palate, tongue and oropharynx
Atrophic oral candida (denture stomatitis)
found under upper dentures, erythema without plaques
Clinical presentation of oral candida
- dry mouth
- loss of taste
- pain
- beefy, red tongue
- angular chelitis
Diagnosis of oral candida
- removable white plaques
- fungal culture
- KOH prep
What should you test for in refractory thrush
HIV
Oral candida managment in pts w/o HIV
- local therapy
- nystatin swish and swallow
- clotrimazole
- miconazole tabs
- difulcan PO
