Oral Path OSCE Flashcards
Pseudomembranous Candidiasis
Aka Thrush
Cause:
* broad spectrum antibiotics
* immunocompromised
WhitePlaques
* on buccal mucose, palate & Dorsal tongue
* resemble cottage cheese
* removed w/tongue blade or dray gauze
Symptoms:
* burning sensation
* bad taste in mouth-salty or bitter
* Complain of blisters
Erythematous Candidiasis
AKA: Chronic Atrophic Candididiasis/Denture Stomatitis
Xerostomia (Dry Mouth) due to
* Pharmacologic
* Post-radiation therapy
* Sjogren Syndrome
Clinical Presentation:
* Varying degree of erythema
* sometimes petechiae
* denture bearing areas of maxilla
(wears denture continuously)
Symptoms:
* Mouth scalded by hot beverage sensation
Candidiasis Treatment
Rule out allergy to denture base
* avoid/reduce smoking
Tx any predisposing factors
* Xerostomia
Improve Oral Hygiene
AntiFungals
1. Nystatin
*Oral suspension-swish in mouth several mins and swallow
2. Clotrimazole
* oral troches 10 mg
* dissolve in mouth 5x per day for 14 days
Recurrent Aphthous Ulcers/Stomatitis
Aka Canker Sores
Defect in immune system
3 theories of pathogenesis:
* immunodisregulation
* decreased or impaired mucosal barrier
* elevated antigenic challenge
Systemic Disorders Associated w/RAUs (Recurrent Aphthous Ulcers)
Behcet syndrome
Celiac Disease
MAGIC syndrome
* Mouth & Genital ulcers w/Inflamed Cartilage syndrome
PFAPA syndrome
* Periodic Fever, Aphthous stomatitis, Pharyngitis, cervical Adenitis
RAU Variants
Minor
* (Mikulicz aphthae)
Major
* (Sutton Disease or Periadenitis Mucosa Necrotic Recurrens (PMNR))
Herpetiform Aphthous Ulcerations
Minor RAU
Mikulicz aphthae
* most common (80%)
* moveable Nonkeratinized mucosa
* 3-10 mm
* painful
* heal on their own w/in 7-10 days, no scar
* DO not biopsy, if biopsied dx=Non-specific ulcer
Major RAU
Sutton Disease or PMNR
10%
* Labial Mucosa, soft palate, tonsillar fauces
* 1-3 cm diameter
* heal w/in 2-6 weeks, might scar
* Develop after puberty
RAUs Management
Anti-inflammatory agents
* Non-steroidial Aphthasol-discontinued in 2014
Corticosteroids:
* Triamcinolone gel
* Fluconionide gel-external use only
* Dexamethasone elixir
Herptiform Aphthous Ulcerations
(Variant of RAU)
Unique Pattern
* Greatest # of lesions & most frequent recurrences
- 1-3 mm diameter
- 100+ lesions
- heal w/in 7-10 days w/close recurrences
*Female Predominance - Adult consent
Upon 1st exposure to Herpes Simplex Virus, what are the 3 possible outcomes
- Immune system completely eliminates the virus
* Antibodies protect throughout life - Inadequate immune response
* eliminates most of the virus
* resides in trigeminal ganglion throughout life (latent infection)
* experiences episodes when reactivated (Prodrome) - Completely inadequate immune response
* develops primary herpetic gingivostomatitis
Rucureent Oral HSV Infection
Secondary Herpes
KERATINIZED BOUND tissue ONLY
* Gingiva & Hard palate
Ulcers anywhere else in oral cavity are unlikely to be herpes unless immunocompromised
HSV Management Plan
Herpes Labialis:
* topical analgesic during prodrome, not helpful after vesicles form
* Pencyclovir ointment
* Topical Acyclovir
* Docanosol-prevents virus replication, reduces healing time by 0.7 day
Herpes Stomatitis:
* Topical Analgesic
* Acyclovir Gel-can be toxic if swallow
* after prodrome-no meds
Prophylaxis:
* Only for MOST SEVERE CASES
* Valcyclovir 500 mg 2x/day
Hairy Tongue
Overgrowth of Filliform papillae on dorsal tongue(back of tongue)
Predisposing Factors:
* Broad spectrum antibiotics
* Oxygenating mouth rinses
* Smoking
* Radiotherapy
* Stem cell transplant
Hairy Tongue: Management
Remove predisposing factors
Improve oral health
Tongue Scraper
Traumatic Fibroma
Hyperplastic Connective Tissue
* response to local irritation or masticatory trauma
Due to trauma, can be ulcerated
Management:
* eliminate source of trauma
* Conservative surgical excision
Pyogenic Granuloma
Reactive Process:response to local irritation or trauma
* smooth lobulated mass
* usually ulcerated
* might grow fast
* Color: Pink, red, or purple
Location:
Gingiva=Most common
* Lip, tongue, buccal mucosa
Most common in Children & Young Adults
Red Lesions in Gingiva
3 P’s (2 & 3-only in gingiva!)
1. Pyogenic Granuloma
2. Peripheral Giant Cell Granuloma
3. Peripheral Ossifying Fibroma
Peripheral Giant Cell Granuloma
Peripheral Ossifying Fibroma
Amalgam Tattoo
Flat bluish-black or gray
* Gingiva, Alveolar mucosa, buccal mucosa
* confirm w/radiograph
Pencil graphite-on hard palate
if it mimics mucosal melanoma, and no foreign body on radiograph–> BiOPSY
Reticular Lichen Planus
White Striations
usually Asymptomatic
* If symptoms: tx, if no improvement=biopsy
f/u once a year
Locations:
* Buccal mucosa
* ventral & dorsal surface of tongue
* labial mucosa
* gingiva
Lichen Planus Treatment
Steroids:
* Dexamethasone elixir 0.5mg/5mL x4 for up to 2 weeks
* Clobetasol gel
* Prednisone
Palliative Tx:
* Maalox
* Bendaryl
* Viscous Lidocaine
Anti-inflammatory agents:
* might be needed
Rehydration
Immunosuppresants:
* Calcineurin inhibitors
How can you manage acute ulcers?
No Biopsy
* Adjust denture base-> f/u 2 weeks
* repeat to remove injury
* If still present=Biopsy
What is an ulcer?
Loss of epithelial
* CT Exposed
Craters fill in w/granulation tissue
Why is there a red halo around oral ulcers?
Granulation tissue
Clinical Features of oral ulcers?
yellow necrotic center
w/red halo
Graphite Tattoo
Not visible on radiographs
* past hx of trauma
What are the variants of pyogenic granuloma?
Granuloma Gravidarum
* pregnant female
* Pyogenic granuloma of pregnancy
Epulis Granulomatosum
* found in the socket of recently extracted teeth
How do we treat pyogenic Granuloma?
Surgical Excision (down to periosteum)
Sometimes spontaneous regression occurs
Traumatic Ulcer
Acute onset
Location:
* Lateral border of tongue
* Labial Mucosa
Traumatic Ulcer: Management
Remove source of trauma
* Adjust or reline denture
Allow ulcer to heal on its own
* if painful=topical analgesic
2-3 weeks to heal then reassess
What are the prescription treatments for traumatic ulcers?
Topical anesthetic applied w/cotton tip to affected area
Lidocaine Hydrochloride Oral Topical Solution
What is the key to understanding traumatic ulcer?
Establish traumatic etiology
* never use anti-inflammatory on traumatic ulcer
REMEMBER: inflammatory response is needed to heal & repair the damage
Salivary Duct Cyst
True Developmental Cyst
* lined by epithelium
Develops Secondary to Ductal obstruction
* most common w/Parotid Gland (Major gland)
* Minor glands–> floor of mouth, buccal mucosa, lips
Clinical:
* Soft, fluctuant swelling w/bluish HUE
Ductal Ectasia:
* Cystic like dilation due to blockage & Increased intraluminal pressure
* not a true cyst
Peripheral Giant Cell Granuloma
Oral Hairy Leukoplakia
Epstein Barr virus while immunocompromised
LATERAL TONGUE
Etiology
* HIV Infection
* Hematologic neoplasms
* Immunocompromised
*Prolong corticosteroids
Tx:
* underlying cause of immunosuppression
Histoplasmosis
Most common systemic fungal infection in US
* Humid area w/soil-bird or bat feces
* Near Ohio & Mississippi River
Mild flu-like symptoms for 1-2 weeks
* Cause: Histoplasma Capsulatum
Mucosal Melanoma
Malignant Neoplasm
* Melanocytic origin
Etiology:
* UV Radiation
Risk Factors:
* Fair complexion
* family hx of melanoma
* Hx of blistering sunburn
3rd most common skin cancer
CDK2A & CDK4 Mutation
MC1R Mutation
Mucocele
Mucous Retention Phenomenon
Cause:
* salivary duct ruptures & Mucin fills soft tissue
Location:
* Lower lip-most common
Clinical Presentation
* Dome-shaped mucosal swelling
* Blue translucent hue
* 1 mm to several cm’s
* any age
Tx:
* Local excision
* remove minor salivary gland to prevent recurrence
Benign Alveolar Ridge Keratosis
AKA Frictional Keratosis
Hyperkaratotic plaque or patch
* edentulous alveolar ridge
* retromolar pad
Histology:
* Hyperkeratosis w/o dysplasia
Tx: Make a new denture
* Trauma from opposing teeth n soft tissue
* Biopsy if lesion does not resolve
Proliferative Veruccous Leukoplakia
Multifocal development of premalignant lesion in oral cavity
* relentless progression to malignancy
Most common locations for intraoral cancer in descending order
- Ventrolateral tongue
- Floor of Mouth
- Soft Palate
- Gingiva
- Hard Palate
- Buccal/Labial Mucosa
Erythroplakia
Clinical term to describe erythematous (red) area
* Cannot be anything else
Leukoplakia
Clinical Term ONLY
* not dx, biopsy will never say
White lesion
* Does not rub off
* Can not be anything else
out common risk lesion
* Malignant transformation rate: 0.7-2%
