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Clinical Medicine > Oral lesions - lecture 4 > Flashcards

Oral lesions - lecture 4 Flashcards

1
Q

cancer of oral cavity associated with what?

A

ulcers or masses that don’t heal

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2
Q

how do tongue and lip cancers present?

A

as exophytic (outward growth) or ulcerative lesions

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3
Q

what should be biopsied?

A

Persistent papules, plaques, erosions, or ulcers

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4
Q

what accounts for 80% of squamous cell carcinoma of head and neck? (HINT: 2)

A

use of tobacco and ETOH

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5
Q

aphthous stomatitis also called?

A

canker sore

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6
Q

what is aphthous stomatitis?

A
  • Painful oral lesions
  • Sometimes genital
  • Repeated development
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7
Q

where is aphthous stomatitis most common?

A

Middle East and south asia

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8
Q

what is the most common acute oral lesion?

A

aphthous stomatitis

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9
Q

when do you first develop aphthous stomatitis and when does it wane?

A

first develop during adolescence and wanes with increasing age

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10
Q

classification of aphthous stomatitis

A

simple (mikulicz) & complex

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11
Q

simple (mikulicz) aphthous stomatitis

A
  • Several episodes per year
  • One to several lesions
  • Lasting up to 14 days
  • Limited to oral mucosa
  • Most common form of disease
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12
Q

complex aphthous stomatitis

A
  • Oral and genital
  • More numerous lesions
  • Larger than 1 cm
  • Takes 4-6 weeks to resolve
  • So frequent that patients almost always have them
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13
Q

which canker sore is seen only on the oral mucosa?

A

simple (mikulicz) aphthous stomatitis

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14
Q

which canker sore is seen on oral mucosa and genital?

A

complex aphthous stomatitis

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15
Q

what has more lesions, simple or complex aphthous stomatitis?

A

complex - has numerous lesions vs simple has one to several

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16
Q

what takes longer to resolve, simple or complex aphthous stomatitis?

A

complex - 4-6 weeks

simple - lasts up to 14 days

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17
Q

what is most common form of aphthous stomatitis, complex or simple?

A

simple

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18
Q

morphology of aphthous stomatitis

A
  • Minor ulcers <1 cm
  • Major ulcers >1cm
  • Herpetiform are 1-2 cm typically in clusters
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19
Q

pathogenesis of aphthous stomatitis

A
  • immune dysregulation
  • exaggerated pro-inflammatory process
  • weak anti-inflammatory response
  • instigated by antimetabolites like methotrexate
  • vit B12, folic acid, iron deficiency
  • neutropenia of any cause
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20
Q

what can exacerbate aphthous stomatitis?

A

certain foods

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21
Q

what is aphthous stomatitis seen in, in terms of disease?

A 
bowel disease (celiac, IBD, chron's)
-conditions that decrease mucosal thickening
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22
Q

risk factors of aphthous stomatitis

A
  • Smoking cessation
  • Familial tendency
  • Trauma
  • Dental cleaning (from trauma)
  • Hormonal factors (Progestin level fall in luteal phase of menstrual cycle)
  • Emotional stress
  • Food or drug hypersensitivity
  • Immunodeficiency (HIV)
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23
Q

clinical presentation of aphthous stomatitis

A
  • one to five lesions
  • round to oval
  • clearly defined ulcers
  • yellowish center
  • small (1-3 cm)
  • erythematous rim
  • painful
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24
Q

dx of aphthous stomatitis

A
  • Patient history and PE
  • History of recurrent self-limited oral ulcers
  • Biopsy not needed
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25
Q

oral hygiene for management of aphthous stomatitis

A

non-alcohol mouthwash and soft toothbrush

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26
Q

pain control for management of aphthous stomatitis

A
  • Viscous lidocaine (swish & spit)
  • Diphenhydramine liquid (swish & spit)
  • Dyclonine lozenges
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27
Q

second-line/refractory txts for aphthous stomatitis

A

Topical steroids:

  • dexamethasone elixir (swish & spit)
  • clobetasol gel
  • traimcinolone paste
28
Q

Management for complex aphthous stomatitis

A
  • Intralesional or oral steroids for recalcitrant lesions or severe disease
  • Colchicine
  • Dapsone (aczone)
  • Pentoxifylline (bronchodilator and immunomodulator)
  • Thalidomide in HIV patients
29
Q

thalidomide med for complex aphthous stomatitis

A

for HIV patients with aphthous stomatitis

  • recurrent after cessation of therapy
  • cat X
  • can only be rx thru special program
30
Q

oral leukoplakia

A
  • benign reactive process (can develop oral cancer)
  • early step in transformation of premalignant lesions from hyperplasia -> dysplasia -> carcinoma in situ -> invasive malignant lesions
31
Q

what does oral leukoplakia’s clinical significants depend on?

A

degree and presence of dysplasia

32
Q

oral leukoplakia epidemiology

A
  • men>women
  • association w/HPV
  • similar to SCC
  • common in smokeless tobacco users (chew)
  • seen in pure inflammatory conditions not associated with malignancy
33
Q

oral leukoplakia clinical manifestations

A
  • leukoplakia lesions that show up in trauma prone regions where mucosa is thicker (cheek and dorm of tongue)
  • NOT painful (vs thrush is)
  • white/grey lesions
  • flat & no well defined
  • can’t scrape off (vs thrush can)
34
Q

thin areas of mucosa show more what in oral leukoplakia?

A

more dysplasia

-ventral tongue, retromolar triangle

35
Q

oral leukoplakia dx

A
  • hx & PE
  • whitish res that can’t scrape off
  • all indurated areas should be biopsied
36
Q

oral leukoplakia management

A
  • most don’t need txt (watch & see)
  • surgical removal
  • cryoprobe
  • chemoprevention
  • oral retinoids
37
Q

oral hairy leukoplakia

A
  • different than oral leukoplakia
  • NOT premalignant
  • EBV associated
  • occurs almost ENTIRELY in HIV infected pts
38
Q

Herpes (HSV-1) aka?

A

aka herpes labialis

39
Q

HSV-1 effects what sites?

A

multiple sites in the body especially perioral and oral cavity (80%) and 20% genital lesions

40
Q

what has HSV-1 been associated with?

A

increasing cases of genital herpes

41
Q

HSV-1 more common in?

A

women

42
Q

By who are a majority of infections transmitted?

A

people who don’t know they have it

43
Q

HSV-1 pathophysiology

A

enters -> latency -> survives in neural ganglia
-prevents elimination by immune response

  • recurrent infection is common
  • usually localized symptoms only
44
Q

types of HSV-1 infections

A

primary
-highly variable and usually severe & systemic

recurrent
-common & typically less severe and local

45
Q

clinical manifestations of HSV-1

A
  • systemic symptoms = primary
  • affects gingiva (primary = gums, recurrent = buccal mucosa & lips)
  • HERPETIC GINGIVASTOMATITIS
  • multiple oral vesicular lesions and erosions surrounded by erythematous base
  • painful
  • prodome (burning, tingly, pain)
46
Q

what is the most common clinical manifestation of HSV-1?

A

herpetic gingivastomatitis

47
Q

where does primary HSV-1 occur?

A

gums

48
Q

where does recurrent HSV-1 occur?

A

buccal mucosa and lips

49
Q

children <5 w/ HSV-1 may have?

A

-fever, LAD, drooling, decreased oral intake

50
Q

prodrome of HSV-1?

A

burning, tingling, pain

-25 hours prior to outbreak

51
Q

where are recurrent outbreaks of HSV-1 usually?

A

lip borders

52
Q

what may be first indication of infection in HSV-1?

A

recurrence

53
Q

HSV-1 risk factors

A

sunlight, stress, trauma

54
Q

HSV-1 diagnosis

A
  • Tzanck smear, immunofluorescence smear or viral cx
  • unroof vesicle
  • serology for HSV by PCR
55
Q

HSV-1 management

A

-systemic acyclovir, valacyclovir, famciclovir w/in 48-72 hours

  • swish and spit miracle mouthwash (internal lesions)
  • supportive
  • popsicles (ice pack)
56
Q

oral candida involves?

A

mucous membranes

  • oropharyngeal
  • esophageal
57
Q

oral candida epidemiology

A
  • Young infants
  • Older adults who wear dentures
  • Antibiotics
  • Radiation of head and neck
  • Immunodef
  • Inhaled corticosteroids
  • Xerostomia
58
Q

oral candida pathophysiology

A

-Candida albicans

also c. galbrata, c. krusei, c. tropicalis

59
Q

oral candida classification

A

pseudomembranous & atopic (denture stomatitis)

60
Q

pseudomembranous oral candida

A

most common form

-white plaques on buccal mucosa, palate, tongue, oropharynx

61
Q

atrophic (denture stomatitis) oral candidy

A
  • most common form in older adults
  • found under upper dentures
  • erythema w/out plaques
62
Q

asymptomatic manifestations of oral candida

A
  • dry mouth
  • loss of taste
  • pain with swallowing or eating (esophageal thrush)
  • also have angular chelitis
  • painful fissuring
63
Q

pseudomembranous oral candida clinical manifestations

A
  • White plaques on buccal mucosa, palate, or tongue

- PAINFUL

64
Q

atrophic (denture stomatitis) oral candida clinical manifestations

A
  • erythema w/out plaques
  • NOT painful
  • beeft, red tongue (worst case)
65
Q

oral candida dx

A
  • Usually based on risk factors
  • White plaques usually removable
  • Fungal culture
  • KOH prep
  • Refractory thrush should warrant HIV testing
66
Q

oral candida management for HIV negative patients

A
  • Local therapy
  • Nystatin suspension swish and swallow
  • Clotrimazole troches (suckers)
  • Miconazole buccal tabs
  • Diflucan PO (More extensive disease can warrant this)

Clinical Medicine (11 decks)

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