Oral Path Exam 2 - Other White and Red Lesions Flashcards
Which lesion?
Common (~2% of population) benign condition of unknown cause primarily affecting the tongue (i.e. geographic tongue or benign migratory glossitis)
Erythema migrans
Which lesion?
Rarely affects soft palate, buccal mucosa, and FOM
Erythema migrans
Which lesion?
Yellowish/white
Serpentine or scalloped border
Central erythema
Loss of filiform papillae
Erythema migrans
Which lesion?
Immune-mediated
Erythema migrans
Which lesion?
Lesions move around the mouth in days to weeks
Erythema migrans
Which lesion?
1/3 of patients with a fissured tongue will have this
Erythema migrans
Which lesion?
Active lesions may cause sensitivity to spicy foods
Erythema migrans
Which lesion?
No tx needed
Erythema migrans
Which lesion?
Caused by a variety of caustic agents, many are OTC
Chemical injury
What are the most common causes of chemical injuries? (3)
Aspirin
Hydrogen peroxide
Phenol
Which lesion?
White surface change due to coagulation necrosis of epithelium
Chemical injury
Which lesion?
Heals within 1-2 weeks once offending agent is removed
Chemical injury
Which oral mucosal hemorrhage?
Round, pinpoint area of hemorrhage ≤ 0.2 cm
Petechiae
Which oral mucosal hemorrhage?
Non-elevated area of hemorrhage 0.3 - 1 cm
Purpura
Which oral mucosal hemorrhage?
Non-elevated area of hemorrhage > 1 cm
Ecchymosis (bruise)
Which oral mucosal hemorrhage?
Solid swelling of blood in tissues
Hematoma
Which lesion?
Caused by blunt trauma and increased BP
Oral mucosal hemorrhage
Which lesion?
If generalized, considered a clotting problem or viral infection (mono, measles, etc)
Oral mucosal hemorrhage
Which lesion?
Most often a viral cause (adenovirus, enterovirus, influenza, parainfluenza, EBV)
Tonsillitis
Pharyngitis
Which lesion?
Bacterial etiology = Group A, beta-hemolytic streptococci; can lead to scarlet fever with a rash (exanthem)
Tonsillitis
Pharyngitis
This bacteria causes ~30% of acute cases of tonsillits/pharyngitis in children and 5-15% in adults
Group A, beta-hemolytic strep
Which lesion?
Transmitted by respiratory droplets or oral secretions
Tonsillitis
Pharyngitis
Which lesion has the following signs and symptoms?
Sudden onset of sore throat
Fever 101-104
Dysphagia
Tonsillar hyperplasia
Redness of oropharynx and tonsils
Yellowish tonsillar exudate
Palatal petechiae
Cervical LAD
Tonsillitis
Pharyngitis
Which lesion has the following signs and symptoms in children:
HA
Malaise
Anorexia
Abdominal pain
Vomiting
Tonsillitis
Pharyngitis
Which lesion?
If the following are present, a viral etiology is suggested:
Conjunctivitis
Rhinorrhea
Cough
Hoarseness
Diarrhea
Viral exanthem
Absence of fever
Tonsillitis
Pharyngitis
Which lesion?
Do a rapid antigen detection (good sensitivity + specificity) if bacterial origin is suspected
Tonsillitis
Pharyngitis
Which lesion?
If rapid test is negative, do a throat culture
Tonsillitis
Pharyngitis
Which lesion?
Antibiotic like penicillin or amoxicillin should only be prescribed when bacterial infection is confirmed
Tonsillitis
Pharyngitis
Which lesion?
Tx rationale = to avoid complications of glomerulonephritis, rheumatic fever, or tonsillar abscess
Tonsillitis
Pharyngitis
Which lesion?
Typically self-limited (3-4 days)
Tonsillitis
Pharyngitis
Which lesion?
Chronic infection w/ candida albicans
Oral candidiasis
Which lesion?
Dimorphic (yeast and hyphal forms)
Oral candidiasis
Which lesion?
Most common oral fungal infection
Oral candidiasis
Which lesion?
~30-50% carrier state w/ subclinical infection
Oral candidiasis
Which lesion?
One or more clinical patterns may exist
Oral candidiasis
Which lesion?
Affects young/elderly, immunosuppressed, following broad-spectrum antibiotics, steroid therapy, cigarette smoking, denture wearers, and xerostomics
Oral candidiasis
What are the 3 clinical presentations of oral candidiasis?
Pseudomembranous
Erythematous
Chronic hyperplastic
Which clinical presentation of oral candidiasis?
Removable white
Pseudomembranous
Which clinical presentation of oral candidiasis?
Red, occasional white component
Erythematous
Which clinical presentation of oral candidiasis?
Acute atrophic (AB sore mouth)
Angular cheilitis
Central papillary atrophy (median rhomboid glossitis)
Central papillary atrophy +/- palatal erythema (kissing lesion)
Any combo of these = chronic multifocal candidiasis
Erythematous
Which clinical presentation of oral candidiasis?
Non-removable white
Chronic hyperplastic
Which clinical presentation of oral candidiasis?
AKA “thrush”
Pseudomembranous
Which clinical presentation of oral candidiasis?
Removable cheesy, white plaques on buccal mucosa, palate and tongue
Pseudomembranous
Which clinical presentation of oral candidiasis?
Scraping reveals a normal or erythematous (non-bleeding) surface
Pseudomembranous
Which clinical presentation of oral candidiasis?
Burning sensation or bad taste in the mouth
Pseudomembranous
Which clinical presentation of oral candidiasis?
Often acute onset with antibiotic exposure; slower onset with immunosuppression
Pseudomembranous
Which clinical presentation of oral erythematous candidiasis?
“Antibiotic sore mouth”- comes on after antibiotic use
Acute atrophic candidiasis
Which clinical presentation of oral erythematous candidiasis?
Scalded sensation to tongue
Acute atrophic candidiasis
Which clinical presentation of oral erythematous candidiasis?
Diffuse loss of filiform papillae
Acute atrophic candidiasis
Which clinical presentation of oral erythematous candidiasis?
Median rhomboid glossitis
Central papillary atrophy
Which clinical presentation of oral erythematous candidiasis?
Well-demarcated red zone, posterior dorsal tongue, midline, flat, smooth, symmetric
Central papillary atrophy
Which clinical presentation of oral erythematous candidiasis?
Often asymptomatic
Central papillary atrophy
Which clinical presentation of oral erythematous candidiasis?
Central papillary atrophy + an additional site (kissing lesion on palate and/or angular cheilitis)
Chronic multifocal candidiasis
Which clinical presentation of oral erythematous candidiasis?
Erythema, fissuring, and scaling of the angles of the mouth; waxes and wanes
Angular cheilitis
Which clinical presentation of oral erythematous candidiasis?
Can occur alone or with other forms of erythematous candidiasis
Angular cheilitis
Which clinical presentation of oral erythematous candidiasis?
Reduced VDO predisposes to this presentation
Angular cheilitis
Which clinical presentation of oral erythematous candidiasis?
20% candida alone
60% candida + staph aureus
20% staph aureus alone
Angular cheilitis
Which clinical presentation of oral erythematous candidiasis?
More extensive perioral involvement = cheilocandidiasis
Angular cheilitis
Which lesion?
Also called chronic atrophic candidiasis
Denture stomatitis
Which lesion?
Erythema of palatal denture bearing area, typically asymptomatic; may be related to continuous denture wear
Denture stomatitis
Which lesion?
Mostly a tissue response rather than true infection of mucosa as the denture is often contaminated with candidal organisms, but invasion of mucosa is seldom seen
Denture stomatitis
Which lesion has the following differential diagnosis?
Improper denture fit
Allergy to denture base
Inadequate cure of acrylic
Denture stomatitis
What can predispose to erythematous or pseudomembranous candidiasis of the hard/soft palate?
Steroid inhalers
What are the general signs of a neoplasm?
One lesion/location
Pain if malignant (or large benign)
Elevated
Which clinical presentation of oral candidiasis?
Non-removable white plaques
Chronic hyperplastic
Which clinical presentation of oral candidiasis?
Common sites are buccal mucosa and tongue
Chronic hyperplastic
Which clinical presentation of oral candidiasis?
If superimposed on a pre-neoplastic lesion, it will look speckled
Chronic hyperplastic
What are the 3 ways to diagnose oral candidiasis?
Culture
Cytology
Biopsy
Which type of diagnosis for oral candidiasis?
More sensitive
Culture
Which type of diagnosis for oral candidiasis?
Tales 2-3 days to grow yeast colonies (2-3mm creamy white)
Culture
Which type of diagnosis for oral candidiasis?
KOH prep
Cytology
Which type of diagnosis for oral candidiasis?
Periodic acid-Schiff (PAS) stained slide; next day results
Cytology
Which method of cytology to diagnose oral candidiasis?
Quick (several mins) and inexpensive
KOH prep
Which method of cytology to diagnose oral candidiasis?
Not as sensitive as culture or stained slide
KOH prep
Which method of cytology to diagnose oral candidiasis?
Not permanent
KOH prep
Which method of cytology to diagnose oral candidiasis?
Can’t assess maturation of epithelial cells
KOH prep
Which method of cytology to diagnose oral candidiasis?
Apply drop of 1% KOH -> coverslip and examine
KOH prep
Which type of diagnosis for oral candidiasis?
Fix cells to slide w/ alcohol -> send to lab for staining
Cytology
Which type of diagnosis for oral candidiasis?
Not necessary in most cases
Biopsy
What are the 5 main groups of anti-fungal medications?
Polyene agents
Imidazole agents
Triazoles
Echinocandins
Other
Which group of anti-fungal medication?
Nystatin
Polyene agent
Which group of anti-fungal medication?
Clotrimazole (Mycelex)
Imidazole agent
Which group of anti-fungal medication?
Miconazole
Imidazole agent
Which group of anti-fungal medication?
Fluconazole (Diflucan)
Triazole
Which group of anti-fungal medication?
Iodoquinol + hydrocortisone
Other
Which specific anti-fungal prescription?
Disp: 7 tabs
Sig: take 1 tab p.o. each day for 1 wk
Note: Interactions with oral hypoglycemics, coumadin, phenytoin, others
Absolute contraindication with warfarin!
Fluconazole (Diflucan)
(preferred Rx due to ease of use)
Which specific anti-fungal prescription?
Disp: 350 mL
Sig: swish with 2 tsp (10ml) for 3 min then spit (or swallow), 5x/day for a week
Note: can also soak partial dentures overnight in solution to treat dentures
Nystatin oral suspension
Which specific anti-fungal prescription?
Disp: 50
Sig: Dissolve 1 troche in mouth 5x/day for 1 week
Clotrimazole (Mycelex)
Which specific anti-fungal prescription?
Disp: 1 oz tube
Sig: apply to corners of mouth 3x/day (TID) for up to 2 weeks.
Note: used for angular cheilitis; add another antifungal if there are intraoral signs of candidiasis
Iodoquinol + hydrocortisone
Angular cheilitis and/or patchy or diffuse red patches and atrophy or even ulceration of the tongue (glossitis) that does not respond to antifungal therapy could be from what? Which pts are at risk?
Nutritional deficiency
Pts w/ malabsorption due to GI disease are at risk
Deficiency in which vitamins can cause angular cheilitis?
Iron
Vitamin B2, 3, 6, 12
What do nutritional deficiencies cause systemically?
Fatigue
Weakness
How are nutritional deficiencies identified by a PCP?
Serum levels (bloodwork)
Which lesion?
May occur only in mouth or with skin lesions (itchy purplish bumps)
Oral lichen planus
Which lesion?
Symmetrical lesions of the bilateral mucosa, tongue, and gingiva
Oral lichen planus
Which lesion?
Desquamative gingivitis is possible
Oral lichen planus
Which lesion?
Occurs in adults; tends to come and go in severity
Oral lichen planus
What are the 2 major forms of oral lichen planus?
Reticular
Erosive/ulcerative
Which form of oral lichen planus?
Most common type
Reticular
Which form of oral lichen planus?
Not painful
Reticular
Which form of oral lichen planus?
Interlacing white lesions/striations (“Wickham’s striae”) or papules
Reticular
Which form of oral lichen planus?
Dorsal tongue involvement shows patchy keratosis and atrophy
Reticular
Which form of oral lichen planus?
No tx needed
Reticular
Which form of oral lichen planus?
Painful
Erosive/ulcerative
Which form of oral lichen planus?
Shallow ulcers, peripheral erythema, and radiating white lines (striated border)
Erosive/ulcerative
Which form of oral lichen planus?
When involving gingiva, may create a bright red, eroded appearance called “desquamative gingivitis”
Erosive/ulcerative
Which form of oral lichen planus?
Treated with one of the stronger topical
corticosteroids (e.g. fluocinonide gel, clobetasol gel); systemic steroids usually not needed
Erosive/ulcerative
Which lesion?
Incurable but manageable; not contagious; pt education is important
Oral lichen planus
Which lesion?
Candida may be superimposed on this lesion, altering the appearance and making it more symptomatic; management first includes treatment of any associated candidiasis
Oral lichen planus
Which lesion?
Meticulous OH helps disease control
Oral lichen planus
Which lesion?
Prognosis is good; may last for many years
Oral lichen planus
What is the diagnosis for oral lichen planus a combination of?
Clinical + histological features
What is the histology of oral lichen planus?
Lichenoid mucositis
(rete ridges are efaced)
What does the following histology describe?
Direct immunofluorescence shows shaggy band of fibrinogen at BM zone; no antibody production
Lichenoid mucositis
What does the following histology describe?
Hydropic degeneration of basal layer keratinocytes
Bandlike lymphocytic infiltrate
Saw-tooth rete ridges
Hyperparakeratosis
Lichenoid condition
Which lesion?
Looks similar to oral lichen planus clinically and/or microscopically
Lichenoid lesions
(clinically looks similar when “Wickham striae” are present)
Which lichenoid lesion?
Caused by cinnamon or other fresh flavors (e.g. mint) gum/candy; white/striated; typically on buccal mucosa and lateral tongue
Contact stomatitis
Which lichenoid lesion?
Tissue usually touching old amalgam restorations (isolated lesion)
Lichenoid amalgam rxn
Which lichenoid lesion?
New medication or increased dose of medication within month of lesion onset; typically multiple sites including tongue and buccal mucosa
Lichenoid drug rxn
Which lichenoid lesion?
Flaring of skin lesions along with mouth lesions
Lupus erythematosus
Which lichenoid lesion?
Must correlate with patient history
Chronic graft vs host disease
Which lichenoid lesion?
Leukoplakia/erythroplakia can appear striated- expect an isolated lesion and more plaque-like appearance; PVL also occurs in a multifocal situation
Premalignant
T/F: There is controversy regarding the cancer risk of oral lichen planus
True
__________ __________ that are isolated or begin to show leukoplakia (thickening, verrucous changes) or erythroplakia may possess a higher risk to turn into cancer
Lichenoid lesions
What should you look for in regards to the cancer risk of oral lichen planus?
Developing leukoplakia/erythroplakia
