Oral Path 3 (march on! march onward!) Flashcards
Which cutaneous ulcerative disease have a positive nikolsky’s sign? What does that mean?
- pemphigus vulgaris
- Mucous membrane/bullous pemphigoid
- EB
- Put pressure on surface of skin/mucosa an a bulla will form
Systemic connective tissue disease which may manifest with oral ulcerations?
- Lupus erythematous
- Reiter’s syndrome (an inflammatory arthritis of large joints)
- Mixed connective tissue disease
- Felty’s syndrome (infective arthritis w/swollen spleen and decreased WBC)
Herpetic gingivostomatitis: virus? presentation pain? tx?
HSV type 1 -oral ulcers, gingivitis, fever - Peak age 2-3 years - Transmission : direct contact, saliva -Site oropharyngeal anogenital cutaneous - Duration 5-14 days: inoculation 1 week Tx: palliative, systemic antiviral
Hand food mouth disease : virus? ages? symptoms
Cocksackie virus
- infants to 4 yo
- fever, malaise, lympadenopathy
- Vesciles and ulcerations intraorally and on hands, feet, legs
- Duration 7-10day
- tx: supprotive/palliative
Herpangina: virus? what happens? tx?
Cocksackie virus
- present with multiple vescular lesions involving the POSTERIOR mouth: uvula, tonsillar pillars, soft palate
- Vesicles rupture leaving ulcerations
- most common in summer
tx: supprotive
Acute Necrotizing Ulcerative Gingivitis
Fusiform bacteria, spirochetes
- rare in young children, but seen in adolescents and in developing countries
- site attached gingiva, interdental papilla, edema, ulceration
- necrosis, ulceration, punched out papilla
- tx: OHI, topical/systemic antibiotics (#1 is metronidazole; penicillin, amox)
Drugs assoc w/severe ulcerating of gingiva
Methotrexate, cytotoxics, 5-FU, NSAIDs
Triad of histiocytosis (langerhan’s cell histiocytosis):
- A disorder of what?
- What are the major types and the key characteristics of each?
- What do they present with clinically?
Mononuclear phagocyte disorder
Major types:
- Acute dessiminated form (worst prognosis) ,
- hand-scheuller christian chronic form classic triad of diabetes inspidus, exopthalamos and skull lesions.
- Acute localized form (eosinophilic granuloma) - lesions are limited to bone.
- Present w/soft tissue involvement, necrotic tissue, loss of attachment generally involving the POSTERIOR of the mouth
Carotenimia vs jaundice
Sclera is uninvolved in carotenemia
Addison’s Disease: what kind of problem? cause? clinically what occurs EOE/IOE? Other problems??
- Endocrinopathy
- Cause: destruction of adrenal cortex or decreased production of ACTH
- Bronzing of the skin, diffuse brown macules in the oral mucosa
- Hypotension, depression, weakness
Melasma: assoc with? what occurs?
Associated w/pregnancy, oral contraceptives, hormone replacement therapy
- Symmetrical pigmentation of face and neck (what vanessa had)
Acanthosis Nigrans: associated with? What occurs? where?
Assoc w/GI cancer, diabetes, hypothyroidism, addison’s disease, acromegaly, steroid, oral contraceptive use
- Velvety brown papules and plaques on the neck, axilla, flexural skin
- Fine papules on lips, tongue, and palate
Peutz- Jegher’s Syndrome: genetics (inheritance and involved gene)? what is it? what else is assoc’d w/it? Age? Site? Prognosis and Tx?
AD, STK11 gene mutation
- Periorofacial freckling around the lips, nose, oral mucosa, and hands. Anemia, rectal bleeding, small GI polyps
- First decade of life
Tx: none req’d for oral lesions, high risk for developing multiple cancers including colon cancer. Intestinal polyps may req sx
Melanoma: % of pediatric cancers? age? gender? lifetime risk? location? what is assoc w/poorer prognosis
1-3% of pediatric cancers
Age: in utero to age 21, 75% are teenagers
- Gender F>
- Lifetime risk 1/75
Location skin/mucous membranes
- Poorer prognosis: head, neck, face, eye, and oral
Melanotic Macule: cause? site? tx?
Cause: a focal increase in melanin
Site: lip, buccal mucosa, gingiva, palate
Tx: none
Nevus: what is it? age/gender? Site? looks like what ? and what are the most common types? Tx:
A benign proliferation of nevus cells
- 15% of oral nevi occur in children; may be congenital
- fm»m
- Sites: palate, buccal mucosa, gingiva, lip
- Pink, brown, black blue macule or nodule. 85% are pigmented; 70% elevated
- Tx/prognosis: excisional bx; rarely rarely becomes malignant
Kaposi’s Sarcoma: caused by? kids? Assoc w/?
Clinically what do you see?
Common site?
HHV-8
Rare in kids
Manifestation of AIDS
Red, blue, purple macules and nodules that do NOT blanch
Middle of the neck swelling/masses: what do you think of?
Lymph
- submental lymphadenopathy
- thyroglossal duct cyst
- ectopic thyroid
- plunging ranula
- ludwig’s angina
- dermoid cyst
Pierre Robin Sequence: what is the triad? what else occurs and its prevalence?
- Important consideration for pt tx?
Glossoptosis, micrognatia, and cleft palate (U)
- 15-25% also have a cardiac defect
- Mandible can display ‘catch up growth’
Cleidocranial Dysplasia: EOE? IOE? dental anomalies? On radiograph? Body defects?
- EOE: Brachycephaly, frontal and parietal bossing, depressed nasal bridge, delayed closure of suture and fontanels (wormian bones)
- IOE: supernumerary teeth, delayed/failure of exfoliation of primary teeth, delayed eruption of secondary teeth, high arches palate w/submucous or complete cleft
- Radiograph: roots lack layer of cellular cementum
- Clavicular defects
Treacher Collins Syndrome: what is the alternate name?
- Defect of what embryonic structure?
- EOE?
- IOE?
- Tx?
Mandibulofacial Dysostosis - Defect of the 1st branchial arch/pouch/groove - Microtia/malformed ears - Hypoplastic midface -downward sloping palpebral fissures - Coloboma -Hypoplastic mandible - 30% have cleft palate Tx: Distraction osteogenesis
Orofaciodigital syndrome: What is the most common form? Describe its inheritance?
- EOE? Body?
- IOE? Dentition/occlusion?
- Intelligence?
Type 1 is most common
- X-linked dominant trait; 75% are sporadic
- Digit anomalies- syndactyly, curved fingers (clinodactyly)
- hypoplastic alar cartilages (nose), brachycephaly
- Oral findings: multiple hyperplastic frenae, bifid/multilobed tongue, hypodontia (mandibular lateral incisors), supernumerary teeth (max canines), cleft palate, pseudo clef of midline of upper lip
- MR
Copper beaten skull and synostosis: name three syndromes with this issue
Apert’s, Crouzon’s and Pfeiffer’s syndromes
Craniosynostosis hallmark
Apert’s syndrome:
- Body/EOE
- IOE, dental and malocclusion
- intelligence?
Craniosynostosis
SYNDACTALY!
- shallow orbits, ocular hypertelorism, parrot nose
- 30% cleft palate, crowded, V shaped maxilla, and class III w/open bite
- Intellectual disability is variable
Crouzon’s :
- Body/EOE?
- IOE, dentition, occlusion?
- intelligence?
Craniosynostosis
- NO syndactaly (that would be apert’s)
- Brachycephalic, maxillary hypoplasia, ocular hypertelorism, exopthalamus, parrot nose
- Crowded, V shaped maxilla
- NORMAL intelligence
Pfieffer syndrome:
- Body/EOE?
- IOE? Dentition? occlusion?
- intelligence?
Craniosynostosis
- Broad thumbs, great toes, hand involvement
-
Carpenter Syndrome:
EOE/body?
IOE?
Intelligence?
Oxycephaly (premature closure of lamboid and coronal suture aka CONE HEAD CARPENTER)
- Soft tissue syndactyly, congenital heart disease, hypogenitalism, mild obesti
- Intellectual disability
Cleft lip and palate:
- What is the % of each CL/CP, CP, CL
- Environmental causes?
Both CL/CP: 45%
- CP only 30%; CL only 25%
- Environmental : maternal alcohol/cigarette, folic acid deficiency, corticosteroid use, anticonvulsant drugs
Inflammatory papillary hyperplasia: what is it?
- Infectious agent?
- Assoc w/?
- Looks like clinically?
- Tx?
- Reactive hyperplasia of hard palate
- secondary candida infection may be present
- Assoc w/dentures, palatal coverage ortho appliances, mouth breathing, high palatal vault
- Diffuse, red, or pink clusters or shteets of papules; nontender
- Tx: antifungal, decrease appliance, sx
Necrotizing sialometaplasia: what is it? Causes? Site? Clinically? Tx?
Reactive lesion of minor salivary glands due to ischemia and infarction
- Causes: trauma, dental injections, URI
- Site: posterior palatal mucosa, may be bilateral
- swelling may progress to cratered, irregular ulcer, nontender to painful
- Tx: bx, resolves in 6 weeks
Gardner’s Syndrome
- inheritance
- EOE?
- IOE?
- Body?
- Similar body involvement?
AD
Multiple facial osteomas
-Epidermoid/dermoid cysts
- Supernumerary teeth
- high polyps in large intestines with high malignancy potential
- Peutz Jeguer syndrome also has intestinal involvement
