Oral lesions Flashcards
where can candida albicans be cx’ed
mouth, vagina, feces
treatment of geographic tongue
reassurance
diagnosis for aphthous ulcers
clinical
non specific entities describe mucosal plaques as red or speckeled
erythroplakia, leukoplakia
____% of population are candida albicans carriers
20-30%
diagnosis of behcet syndrome
clinical (>3 x per year recurrence for oral ulcers) AND 2 other clinical findings (recurrent genital ulcers, ocular lesions, and or cutaneous lesions, pos pathergy test)
diagnosis of oropharyngeal candidasis
clinical confirmed by KOH prep: budding yeasts with or without pseudohyphae
coxsackie A16 virus
HFM
adherent white patches/ plaques on oral mucosa/ tongue, not painful, erythroplakia, leukoplakia
leukoplakia
treatment for severe EMM oral mucosal involvement
systemic glucocorticoids if can’t tolerate PO may need to be hospitalized
treatment for EMM mild/ moderate
1- self limited 2- symptomatic relief (top corticosteroids, oral antihistamines, miracle mouthwash)
oral lichen planus treatment
- pain relief - high potency topical corticosteroids (triamcinolone oropharyngeal (oralone) or clobestasol)
fever, malaise, sore throat prodrome
coxsackie
oral lichen planus diagnosis
biopsy/ ENT referral
denture wearers have painful red palate (atrophic form)
thrush
prodome of mucose membrane pemphigoid lasts
weeks to months
ways to evaluate melanoma
- endoscopic- paranasal disease - CT and/or MRI of primary site - Ct and/or PT lymph to assess metastasis
glossitis
inflammation of the tongue
- ulcers or masses that don’t heal - persistent papules, plaques, ulcers, erosions - dental changes or poorly fitting dentures - painful exophytic/ ulcerative lesions on tongue orlip - dysphagia, odynophagia, sore throat, hoarseness
SCC
fluid filled cavities with mucous glands lining the epithelium
mucoceles
- maybe asymptomatic - symptomatic- sudden onset, painful intraoral grouped vesicles on an erythematous base usually on buccal mucosa - high fever, lymphadenopathy, decreased oral intake
primary infxn of HSV
exanthem
skin eruption
<10% TBSA
SJS
amount of mucosal involvement with SJS
90%
___ of leukoplakia lesions will progress to carcinoma within 10 years
1-20%
what kind of infection is oropharyngeal candidiasis
opportunistic infection- when conditions are right for growth
mouth pain/ sore throat, beefy red tongue, difficulty eating, creamy white patches/ plaques with underlying erythematous mucosa on buccal mucosa, palate, tongue, or oropharynx (pseudomembranous form)
oropharyngeal candidasis
pale oval shaped puapules with a rim of erythema on the palmar/ plantar surfaces
coxsackie
most common clinical manifestation of primary HSV in childhood
herpetic gingivostomatitis
variable in size, pinkish/ blue soft papules or nodules filled with gelatinous fluid, may be seen in labia, may spontaneously rupture
mucoceles
mucoceles diagnosis
clinical
often on older pts 50-70
melanoma
SNE labs
ANA- double stranded DNA, anti-smith antibody
supportive care treatments of HSV
fluids, analgesics, “miracle mouthwash”, diphenhydramine (benadryl), aluminum hydroxide/ magnesium carbonate (Maalox or gaviscon)
neutrophilic inflammatory lesions
behcet syndrome
diagnosis for EMM
clinical and Bx
diagnosis of leukoplakia is by
biopsy
- lacy white plaques (wickham’s striae) on buccal mucosa sometimes with large, painful, hyperkeratotic plaques - painful red patches (muscular atrophy) - painful erosions/ ulcers
oral lichen planus
fever, fatigue, myalgia, unintentional weigh loss, painless oral &/ or nasal ulcers
SLE
benign migratory glossitis
geographic tongue
when is viral shedding the highest with HSV-1
the primary infection lessens with recurrences
tongue appears smoothy, glossy, erythematous with burning sensation and increased sensitivity to acidic/ salty foods
atrophic glossitis
acute immune mediated condition that has genetically susceptibility
EMM- Erythema Multiforme Major
autoimmune disease that w/ oral ulcers malar rash, photosensitivity, and discoid lupus that also affects many organs and has mild to severe remissions/ relapses
SLE- systemic lupus erythematosus
recurrent oral or genital ulcers (75% scrotum , vulva) that are painful, shallow, or deep with central yellowish necrotic base, extensive and often multiple
behcet syndrome
treatment for atrophic glossitis
address underlying condition
w/ coxsackie, throat lesions resolve in
5-6 days
>30% TBSA
TEN
HSV treatment
- antiviral at onset of prodrome - supportive care
when do aphthous ulcers occur and why
20’s, idopathic
painful lesions usually on cutaneous surface or keratinized areas (lip)
active phase of HSV-1 recurrent infxn “cold sores”
affects eptihelium of tongue
benign migratory glossitis
behcet syndrome treatment
refer to rheumatology
single/ multiple oral lesions: shallow, round/ oval, painful with grayish base, yellow- gray centers with red halos on buccal/ labial mucosa
aphthous ulcers
infancy, dentures, immunocompromised, DM, chemo/ radiation, abx (broad spectrum), corticosteroids (topical & systemic)
predisposing factors for oropharyngeal candidasis
there is a possibility of ____ with topical immunosuppressants
oral candidas
- elongated filiform plpillae - pseudohairy tongue (yellow/ white/ brown dorsal tongue surface)
lingua villosa nigra
treatment for oropharyngeal candidiasis
disinfect/ replace toothbrushes, pacifiers topical antifungal pt education
SCC diagnosis
biopsy
treatment for ocular involvement of EMM
refer to opthamologist
severe or many oral lesions can be treated by
systemic therapy
painful oral lesions- small aphthae that spare gingiva and lips
coxsackie
- ENT referral - surgical resection/ radiation/ chemoradiation- dependent on stage/ extent of disease
SCC treatment
inflammatory disorder that leads to atrophy of the filiform papillae
atrophic glossitis
mucoceles treatment
avoid cheek/ lip biting, if symptomatic remove (cryo/ excision), CO2 laser vaporization, aspiration
etiology of EMM
-infection (HSV most common) - <10% assoc with meds (NSADIS, sulfa, antiepiletics, abx)
usually asymptomatic, occasional oral discomfort, burning, or foreign body sensations with numerous exacerbations/ remissions over time
geographic tongue
coxsackie diagnosis
clinical
severe life threatening mucotaneous rxn
SJS
treatment for lingua villosa nigra
brush area of tongue BID-TID w/ toothbrush and toothpaste
treatment for pemphigus
systemic corticosteroids and immunosuppressants, viscous lidocaine (topical for oral lesions), triamcinolone acetonide (dental paste), abx (for secondary infxn), maybe hospitalization often chronic course of treatment
odynophagia
symptoms of gastroesophageal reflux
erythema and edema of lips, intraoral bullae, ruptured bullae, painful friable raw surfaces with hemorrhagic crusts
SJS
diagnosis of geographic tongue
clinical or bx
caused by nutritional deficiencies, malnutrition, dry mouth, sjogrens syndrome, oral candida infxn, celiac
atrophic glossitis
topical steroid for aphthous ulcers
triamcinolone oropharyngeal paste (oralone)
ulcerative stomatitis apthae, “canker sores”
apthous ulcers
nonspecific hyperreactivity of the skin after minor trauma intradermal injection into skin with 20 gauge needle, pos if erythematous papule develops w/in 48 hours
pathergy test
female, long duration of leukoplakia, nonsmoker, location on the tongue or floor of mouth, and being >200 mm are risk factors for
risk factors for precancerous leukolpakia SCC’s becoming malignant
tobacco, alcohol, UV exposure, radiation, HPV-16 risk factors for
risk factors SCC
chronic inflammatory disorder affecting skin and mucous membranes that may increase risk of oral cancer
oral lichen planus
etiology of mucoceles
mild/ minor oral trauma
acantholysis
skin sloughing
topical antifungal for thrush
nystatin clotrimazole lozenges (troches)
angular cheilitis or preleche
painful fissuring at the corners of the mouth, assoc with thrush
HSV antivirals
acyclovir, valacyclovir, famciclovir (treat primary infection longer)
lesions occur over 3-5 days and resolve in about 2 weeks
EMM
most common cause of mouth ulcers
recurrent aphthous stomatitis
HSV education
- active lesions –> avoid immunocompromised - oral transmission spreads - proper hand hygiene - avoid salty/ acidic/ sharp foods - sunscreen - virus will be there indefinitely with recurrence freq varying - high prevalence
treatment for aphthous ulcers
heal w/in 10-14 days, avoid irritating drinks/ foods, symptomatic relief (topical steroid)
tobacco (esp chewing), alcohol, and HPV are risk factors for
risk factors for leukoplakia
exophytic
lesion that grows out from epithelial surface
- avoid tobacco, alcohol, cheek biting, tongue chewing - regular dental care - refer to ENT for eval/ oral surgery - monitor closely for enlargement or induration
treatment for leukoplakia
candida albicans
oropharyngeal candidas aka thrush
pemphigus requires ____ evaluation
urgent dermatology
diagnosis of pemphigus
lesional and perilesional bx
treatment for melanoma
- excision with clear margins - radiation therapy
mucous membrane pemphigoid treatment
topical and/or corticosteroids + dermatology referral
odynophagia
pain with swallowing
treatment for SJS/TEN
stop meds, admit (maybe burn unit/ICU), supportive care
if oral lesion is pigmented you must
consider melanoma in the DDx
prodrome of recurrent HSV-1 infxn
- pain/ burning/ tingling 6-48 hours before lesions appear, - fatigue - low grade fever
precipitating factors of HSV-1
sunlight, fever, trauma, stress, menses
stomatitis
inflammation of the mucous membranes of the mouth
few localized oral lesions can be treated with
topical steroid gel- dry the area before applying and avoid eating/ drinking for 30 minutes after
diagnosis of HSV
- clinical - viral culture of active lesion - tzanck smear (look for multinucleated giant cells) - serology (look for HSV-1 antibodies)- not reliable
- often discovered during routine dental visits - painless bleeding mass - area of ulceration - region of mucosal discoloration - ill-fitting dentures
melanoma
target like lesions accompanied by diffuse areas of mucosal erythema, painful erosions, or bullae
EMM
leukoplakia associated with erythematous appearance
higher risk of dysplasia or cancer (90%)
frequent hand washing to prevent spread maintain hydration (popsicles) analgesics (acetaminophen/ ibuprofen)
treatment for coxsackie
painful erosion lesions with ruptured bullae
pemphigus
70% effects oral mucosa, as well as genitals and or ocular mucosa
EMM
enanthem
mucous membrane eruption
benign condition associated with abx use, candida albicans infxn, poor oral hygiene
black hairy tongue (lingua villosa nigra)
family hx, trauma, stress, hormones, infxn, immunocompromised, celiac/ IBD, vitamin/ mineral deficiencies
risk factors for aphthous ulcers
pt education for thrush
clean dentures carefully and frequently, rinse mouth after use of steroid inhalers
erythematous patches on dorsal tongue w. circumferential white borders that can change location, pattern, and size in minutes
geographic tongue
EMM gene
HLA
esophageal candidiasis, recurrent candidiasis, or lack of predisposing factors warrant
further investigation for underlying disease (HIV, DM)
