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Oral Pathology & Associated Syndromes Flashcards

1
Q

What are common infant ST lesions?

A
  • Natal oral cysts
  • Sucking pads and calluses
  • Pseudomembranous candidiasis
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2
Q

What are natal oral cysts?

A

White papules that slough off

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3
Q

Name palatal cysts of newborn

A
  • Epstein pearls
  • Bohn nodules

Single or multiple papules that rupture and heal

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4
Q

Epstein pearls

A
  • Occurs on palatal midline
  • Epithelial inclusion cyst
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5
Q

Bohn nodules

A
  • Occurs on junction of hard and soft palate
  • Remnants of minor salivary glands
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6
Q

Incidence of palatal cysts of newborn?

A
  • 55-85%
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7
Q

GIngival (alveolar) cyst of newborn

A
  • Dental lamina cyst – occurs on alveolar mucosa; remnants of dental lamina
  • Occurs in 50%
  • Single or multiple papules that rupture and heal
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8
Q

What do natal oral cysts mimic?

A
  • Superficial abscess
  • Thrush
  • Erupting tooth
  • Eruption cyst
  • Lymphoepithelial cyst (palate)
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9
Q

Sucking pads and calluses

A
  • Anatomical variant from sucking trauma
  • Most prominent in black infants
  • Site: Labial and vermillion border
  • Swollen, translucent to opaque white to pigmented scaly patches; may peel and recur; non-tender
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10
Q

Concurrent conditions with sucking pads and calluses

A
  • Leukoedema
  • Labial vesicles
  • Bullae
  • Erythema of nasiolabial folds and lips
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11
Q

Treatment for sucking pads and calluses

A
  • Resolves
  • Feeding position
  • Lip emollient, such as lanolin
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12
Q

What do sucking pads and calluses mimic?

A
  • Chapped lips
  • Breastfeeding keratosis
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13
Q

Pseudomembranous candidiasis

A
  • Common oral infection in neonates
  • Cause: Candida albicans usually
    • Usually does not cause infection unless host is immunocompromised
  • Contributing factors:
    • Maternal vaginal (untreated vulvovaginitis) or breast infection
    • Prematurity
    • Immunosuppression
    • Antibiotics
      • Increases susceptibility with long-term abx, corticosteroids, drugs that cause xerostomia debilitating disease, oral appliances
  • Site: Widespread oral involvement
  • White non-adherent papules and plaques with a curdled milk appearance
    • Multifocal white papules and plaques that wipe off and red patches that may burn
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14
Q

Concurrent conditions with pseudomembranous candidiasis

A
  • Diaper rash
  • Perioral rash
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15
Q

Pseudomembranous candidiasis: Treatment

A
  • Nystatin
  • Fluconazole
  • Clotrimazole
  • Itraconazole
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16
Q

What does pseudomembranous candidiasis mimic?

A
  • Coated tongue
  • Materia alba
  • Oral cysts of newborn
  • Mucosal sloughing
  • Breastfeeding keratosis
  • Plaque, mucosal sloughing
  • Koplik spots of measles
  • Mucous patches of syphilis
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17
Q

Uncommon infant ST lesions

A
  • Riga-Fede disease
  • Tongue trauma in infants
  • Vascular lesions
    • Vascular tumors
    • Vascular malformations
  • Vascular malformation
  • Hemangioma
  • Lymphatic malformation
  • Neonatal alveolar lymphangioma
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18
Q

Riga-Fede Disease

A
  • Cause: Chronic trauma from primary incisors
  • Represents a traumatic granuloma
  • Ulcerated lesion or mass on anterior ventral tongue
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19
Q

Riga-Fede Disease: Treatment

A
  • Identify cause
  • Modify feeding position and bottle used
  • Smooth incisal edges
  • Apply CHX rinse to ulcer for secondary infection
  • Evaluate for partial ankyloglossia
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20
Q

What does Riga-Fede Disease mimic?

A
  • Neuropathologic chewing
  • Factitial injury
  • Trauma from child abuse
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21
Q

Tongue trauma in infants

A
  • Neuropathologic chewing
  • Seizure disorder
  • Incorrect use of pacifier, bottle, teething rings
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22
Q

What are conditions with neuropathologic ulcers?

A
  • Familial dysautonomia
    • Lesch-Nyhan syndrome
    • Gaucher disease
    • Cerebral palsy
    • Tourette syndrome
    • Rhett syndrome
    • Autism
    • Cornelia de Lange syndrome
    • Traumatic brain injury
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23
Q

Classification of vascular lesions

A
  • Vascular tumors
    • Infantile hemangioma
    • Congenital hemangioma
    • Pyogenic granuloma (lobular capillary hemangioma)
  • Vascular malformations
    • Capillary malformation
    • Venous malformation
    • Lymphatic malformation
    • Arteriovenous malformation
    • Combined malformations
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24
Q

Vascular malformation

A
  • Present at birth and is persistent; occurs in 0.3% of newborns
  • Tends to grow with the child
  • Occurs in the head and neck region, including facial skin
  • May be associated with skeletal changes and be intrabony
  • Red, purple, blue macule, nodule or diffuse swelling
    • Low-flow – venous malformation
    • High-flow – arteriovenous malformation – bleeding, pain, warmth, palpable thrill or bruit
  • Sturge-Weber syndrome: vascular lesion of face and brain, port-wine nevus, risk for seizure disorder
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25
Q

Vascular malformation: Treatment

A
  • Surgery
  • Embolization
  • Laser treatment for port wine nevus
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26
Q

What do vascular malformations mimic?

A
  • Hemangioma
  • Varix
  • Eruption cyst/hematoma
  • Blue nevus
  • Ecchymosis
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27
Q

Hemangioma

A
  • Multiple types, including infantile and congenital
  • Neoplasm of vascular origin affecting 5% of infants
  • 60% occur in the head and neck region
  • May involve major salivary glands, usually parotid
  • Lip and tongue are common oral sites
  • Normal or reddish-blue skin coloration with swelling
  • Rubbery to palpation, may not blanch
  • Many regress with age
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28
Q

Hemangioma: Treatment

A
  • Observe
  • Propanolol
  • Steroids
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29
Q

What do hemangiomas mimic?

A
  • Vascular malformation
  • Pyogenic granuloma
  • Hematoma
  • Mucocele
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30
Q

Lymphatic malformation (lymphangioma, cystic hygroma)

A
  • Hamartomatous growth of lymphatic vessels
  • Predilection for head and neck – 50-75%
  • 90% develop by 2yo
  • Superficial lesions have pink, red or purple with pebbly, vesicular surface
  • Cystic hygroma cause a diffuse swelling of cervical region of neck, parotid gland, tongue
  • Large lesions can compromise airway
  • Lesions rarely progress
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31
Q

Lymphatic malformation (lymphangioma, cystic hygroma): Treatment

A

May include surgery, sclerotherapy, drugs

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32
Q

What do lymphatic malformations mimic?

A
  • Venous malformation
  • Squamous papilloma
  • Mucocele
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33
Q

Neonatal alveolar lymphangioma

A
  • Present at birth
  • Usually occurs in African American males
  • Alveolar ridge; mandible > maxilla
  • Translucent pink to blue, fluctuant swelling
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34
Q

Neonatal alveolar lymphangioma: Treatment

A

None; resolves spontaneously

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35
Q

What do neonatal alveolar lymphangiomas mimic?

A
  • Gingival cyst of newborn
  • Eruption cyst
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36
Q

What are rare ST lesions?

A
  • Congenital epulis
  • Congenital hamartoma/choristoma
  • Melanotic neuroectodermal tumor to infancy
  • Hemifacial hyperplasia
  • Hemifacial microsomia
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37
Q

Congenital epulis

A
  • ST tumor of uncertain origin
  • Occurs in females 90%
  • Occurs in maxilla > mandible
  • Maxillary lateral and canine region – most common site
  • Firm, pink to red mass arising from alveolar mucosa at birth
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38
Q

Congenital epulis: Treatment

A
  • Excision
  • May regress
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39
Q

What does congenital epulis mimic?

A
  • Eruption cyst
  • Gingival hamartoma
  • Pyogenic granuloma
  • Fibrous epulis
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40
Q

Congenital hamartoma/choristoma

A
  • ST tumor-like enlargement
  • Hamartoma: Overgrowth of normal tissue that belongs at that site.
  • Choristoma: Overgrowth of normal tissue that does not belong at that site.
  • Tongue and alveolar mucosa are most common sites in infant.
  • Firm, pink nodules; single or multiple; nontender
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41
Q

Congenital hamartoma/choristoma: Treatment

A
  • Excisional biopsy
  • Exclude syndromes such as orofacialdigital syndrome
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42
Q

What do congenital hamartomas/choristomas mimic?

A
  • Irritation fibroma
  • Congenital epulis
  • Lipoma
  • Peripheral ossifying fibroma
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43
Q

Melanotic neuroectodermal tumor of infancy

A
  • Tumor of neural crest origin
  • Usually occurs in 1st year of life
  • Most common site: Anterior maxilla
  • Rapidly expanding mass of alveolus
  • Frequently pigmented – blue or black
  • Displacement of teeth
  • Lab – elevated urinary levels of vanillylmandelic acid
  • Radiograph – Poorly circumscribed RL with floating teeth; may have sun ray pattern
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44
Q

Melanotic neuroectodermal tumor of infancy: Treatment

A
  • Prognosis
    • Excision with margins
    • 20% recur
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45
Q

What do melanotic neuroectodermal tumors of infancy mimic?

A
  • Congenital epulis
  • Intrabony vascular malformation
  • Malignancy
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46
Q

Hemifacial hyperplasia

A
  • Unilateral oral and facial enlargement
  • Usually evident at birth
  • Right side > left side
  • Involves ST, bone, tongue, palate, teeth
  • Teeth may exfoliate and erupt prematurely
  • Intellectual disability in 20%
  • Increased incidence of abdominal tumors (Wilms tumor, hepatoblastoma, adrenal cortical carcinoma)
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47
Q

Hemifacial hyperplasia: Treatment

A

Evaluate for syndrome, cosmetic surgery, orthodontics

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48
Q

Hemifacial hyperplasia: Associated syndromes

A
  • Neurofibromatosis
  • Beckwith-Wiedemann
  • McCune-Albright
  • Others…
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49
Q

Hemifacial hyperplasia: Mimics

A

Segmental odontomaxillary dysplasia

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50
Q

Hemifacial microsomia

A
  • Anomalies of 1st and 2nd branchial arch
  • Sporadic inheritance; rarely AD
  • Unilateral microtia, microstomia and failure of formation of mandibular ramus and condyle
  • Unknown etiology
  • Frequent eye and skeletal involvement
  • 50% have cardiac pathology – VSD, PDA
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51
Q

What condition(s) are hemifacial microsomia associated with?

A

Goldenhar syndrome

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52
Q

What does hemifacial hyperplasia mimic?

A
  • Localized scleroderma
  • Unilateral TMJ ankylosis
  • Fracture
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53
Q

Wipeable white lesions

A
  • Coated tongue
  • Pseudomembranous candidiasis (thrush)
  • Moriscatio (cheek or lip chewing)
  • Chemical burn
  • Toothpaste or mouthwash reaction
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54
Q

Non-wipeable white lesions

A
  • Bilateral/Symmetrical
    • Lina alba
    • Leukoedema
    • Reticular lichen planus
    • White sponge nevus
  • Solitary or Multiple
    • Smokeless tobacco keratosis
    • Pachyonychia congenita
    • Dyskeratosis congenita
    • Hereditary benign intraepithelial dyskeratosis
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55
Q

What are common white lesions

A
  • Pseudomembranous candidiasis
  • Coated tongue
  • Leukoedema
  • Frictional keratosis/cheek- and tongue-biting (moriscatio) lesions
  • Mucosal burn (thermal, chemical)
  • Mucosal sloughing (toothpaste, mouthwash reaction)
  • Benign migratory glossitis (erythema migrans, geographic tongue) – see red, purple, blue lesions
  • Fordyce granules
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56
Q

Coated tongue

A
  • Collection of bacteria and sloughed epithelial cells on dorsal
  • Contributing factors include xerostomia, mouth-breathing, sinusitis, poor OH, febrile conditions, dehydration
  • Cream-colored or tan film that is non-adherent
  • May be diffuse or localized to posterior tongue
  • May contribute to halitosis
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57
Q

Coated tongue: Treatment

A
  • Improve hydration
  • Gently debride dorsal tongue
  • Improve OH
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58
Q

What does coated tongue mimic?

A
  • Pseudomembranous candidiasis
  • White hairy tongue
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59
Q

Leukoedema

A
  • Variation of normal oral mucosa
  • Most commonly observed in blacks, occurring in 50% of children
  • Most obvious on buccal mucosa
  • Bilateral, diffuse, filmy white, adherent, wrinkled mucosa
  • Stretching of mucosa causes lesions to be less prominent
  • Increase thickness of mucosa, intracellular edema of spinous layer
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60
Q

Leukoedema: Treatment

A

None

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61
Q

What does leukoedema mimic?

A
  • Cheek-biting keratosis
  • White sponge nevus
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62
Q

Frictional keratosis/cheek- and tongue-biting (moriscatio) lesions

A
  • Caused by low grade, chronic irritation that is usually obvious, especially chronic nibbling of mucosa
  • Usually on gingiva, buccal mucosa, lateral tongue
  • White, smooth to shaggy, adherent patches; non-tender
  • May observe a prominent linea alba on buccal mucosa
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63
Q

Frictional keratosis/cheek- and tongue-biting (moriscatio) lesions: Treatment

A

None; reversible lesion

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64
Q

What do frictional keratosis/cheek- and tongue-biting (moriscatio) lesions mimic?

A
  • Cinnamon contact reaction
  • Smokeless tobacco keratosis
  • Leukoplakia
  • Chronic hyperplastic candidiasis
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65
Q

Mucosal burn (thermal, chemical)

A
  • Thermal burn is common due to pizza, soup, hot beverages
    • Usually occurs on the palate and tongue
  • Chemical burn is caused by a number of agents:
    • Aspirin
    • Formocresol
    • Ferric sulfate
    • Phosphoric acid
    • Phenol
    • Usually occurs on gingiva, buccal, labial mucosa, perioral skin
  • Irregular white necrotic patch that wipes off or red erosion; tender
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66
Q

Mucosal burn (thermal, chemical): Treatment

A

Palliative tx only; most resolve in several days

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67
Q

What do mucosal burns (thermal, chemical) mimic?

A
  • Pseudomembranous candidiasis
  • Toothpaste or mouthwash reaction
  • Cotton roll burn
  • Mucous patch of secondary syphilis
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68
Q

Benign migratory glossitis (erythema migrans, geographic tongue)

A
  • Cause is unknown, but associated with atopy
  • Dorsal tongue usually
  • Multiple oval to circular, red to pink patches of desquamated filiform papillae
    • May be surrounded by white border
    • Does not wipe off
    • Pattern moves around
  • May be tender especially with acidic or spicy foods
  • May be seen with transient lingual papillitis
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69
Q

Benign migratory glossitis (erythema migrans, geographic tongue): Treatment

A

Palliative tx as needed

Persistent condition

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70
Q

What does benign migratory glossitis (erythema migrans, geographic tongue) mimic?

A
  • Median rhomboid glossitis
  • Lichen planus
  • Contact mucositis
  • Mucosal erosion
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71
Q

Fordyce granules

A
  • Ectopic sebaceous glands in oral mucosa
  • Becomes more prominent during puberty
  • Common sites: Buccal mucosa, lips
  • Flat to slightly elevated, submucosal yellow-white papules or plaques
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72
Q

Fordyce granules: Treatment

A

None

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73
Q

What do fordyce granules mimic?

A
  • Pustules
  • Frictional keratosis
  • Milia (lips)
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74
Q

What are uncommon white lesions?

A
  • Smokeless tobacco keratosis
  • White hairy tongue
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75
Q

Smokeless tobacco keratosis

A
  • Caused by chewing tobacco, snuff, snus
  • Occurs in vestibular mucosa
  • White, wrinkled, adherent plaque; gingival recession, stained, sensitive teeth, root caries, halitosis

Malignant transformation is rare

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76
Q

Smokeless tobacco keratosis: Treatment

A
  • D/c habit
  • Biopsy persistent lesions
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77
Q

What does smokeless tobacco keratosis mimic?

A
  • Frictional keratosis
  • Cinnamon contact reaction
  • Chronic hyperplastic candidiasis
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78
Q

White hairy tongue

A
  • Accumulation of keratin on filiform papillae
  • Occurs on dorsal tongue
  • Cause is unknown; xerostomia, poor OH, tobacco smoking, in adolescents
  • Multiple cream-colored to brown, slender surface projections
    • May have thick matted appearance
  • Adherent but the discoloration can be partially removed
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79
Q

White hairy tongue: Treatment

A
  • Improve hydration
  • Brush tongue
  • D/c cigarette smoking
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80
Q

What does white hairy tongue mimic?

A
  • Coated tongue
  • Pseudomembranous candidiasis
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81
Q

What are rare white lesions?

A
  • Lichen planus
  • Chronic hyperplastic candidiasis
  • Hairy leukoplakia
  • White sponge nevus
  • Hereditary benign intraepithelial dyskeratosis (HBID)
  • Koplik spots
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82
Q

Lichen planus

A
  • Chronic mucocutaneous disease – rare in children
  • Cause:
    • T-cell mediated autoimmune disease
    • Some cases represent a contact allergy (lichenoid reaction)
  • Affects both oral mucosa + skin (esp. extremities)
  • Oral sites:
    • Buccal mucosa
    • Gingiva
    • Tongue
  • White lacy lines (Wickham striae) w/ red background
  • Bilateral + symmetrical
  • Burns
  • Waxes and wanes
  • May have a secondary candidal infection
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83
Q

Lichen planus: Treatment

A
  • Incisional biopsy
  • Topical steroids
  • Antifungal agents
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84
Q

What does lichen planus mimic?

A
  • Cinnamon contact reaction
  • Cheek-biting keratosis
  • Benign migratory glossitis
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85
Q

Chronic hyperplastic candidiasis

A
  • Chronic mucocutaneous disease
  • Some cases associated with endocrine disease + autoimmune disorders
  • Site:
    • Anterior buccal mucosa and tongue
    • May have nail involvement
  • White, wrinkled adherent plaques that are adherent
    • Distinctive raised border
  • May be tender
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86
Q

Chronic hyperplastic candidiasis: Treatment

A
  • Incisional biopsy
  • Antifungal agents
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87
Q

What does chronic hyperplastic candidiasis mimic?

A
  • Cinnamon reaction
  • Cheek- and tongue-biting keratosis
  • Lichen planus
  • Hairy leukoplakia
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88
Q

Hairy leukoplakia

A
  • Cause: Latent infection of Epstein-Barr virus
  • Contributing factors:
    • Immunosuppression
    • HIV infection
  • Site: Ventrolateral tongue
    *
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89
Q

White sponge nevus

A
  • Autosomal dominant mucocutaneous disease
  • Diffuse, white, thickened, adherent and wrinkled oral mucosa
  • May be present at birth, becomes more prominent in adolescence
  • The gingival margin and dorsal tongue are almost never affected. The soft palate and ventrolateral tongue are commonly involved.
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90
Q

White sponge nevus: Treatment

A

None. Persistent condition

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91
Q

What does white sponge nevus mimic?

A
  • Leukoedema
  • Cinnamon reaction
  • Hereditary benign intraepithelial dyskeratosis
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92
Q

Hereditary benign intraepithelial dyskeratosis (HBID)

A
  • Autosomal dominant mucocutaneous disease
  • Affects individuals of mixed white, American Indian, and black ancestry living in North Carolina
  • Appears similar to white sponge nevus, but affects the eyes
  • May cause visual impairment
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93
Q

Koplik spots

A
  • Oral manifestation of measles (rubeola)
  • Observed in the initial stage of viral infection
  • Site: Buccal mucosa and soft palate
  • Multiple, tiny white macules that wipe off (grains of sand appearance)
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94
Q

Koplik spots: Treatment

A

Refer to pediatrician

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95
Q

What do Koplik spots mimic?

A
  • Pseudomembranous candidiasis
  • Mucosal burn
  • Mucosal sloughing
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96
Q

Which red lesions are diascopy positive?

A

Blanch

  • Hemangioma/Vascular malformation
  • Sturge-Weber Syndrome
  • Hereditary hemorrhagic telangiectasia
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97
Q

Which red lesions are diascopy negative?

A

Do not blanch

  • Submucosal hemorrhage
  • Petechial hemorrhage
  • Thrombocytopenia
  • Infectious mononucleosis
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98
Q

Which red lesions are non-vascular?

A
  • Traumatic erythema
  • Thermal burns
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99
Q

Diascopy positive

A

Blanch w/ pressure

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100
Q

Diascopy negative

A

Do not blanch w/ pressure

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101
Q

What are common red lesions?

A
  • Acute gingivitis
  • Submucosal hemorrhage
  • Traumatic erythema
  • Thermal burn
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102
Q

What are uncommon red lesions?

A
  • Vascular malformation
  • Glossitis
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103
Q

What are rare red lesions?

A
  • Hereditary hemorrhagic telangiectasia
  • Sturge-Weber angiomatosis
  • Acquired coagulation disturbance
  • Plasminogen deficiency
  • Thrombocytopenia
  • Hemophilia
    • Factor VIII
    • Factor IX
    • von Willebrand disease
  • Vitamin K deficiency
  • Hepatobiliary disease
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104
Q

Acute gingivitis

A
  • Plaque-induced inflammatory lesion
  • Lesions may blanch with pressure due to vascular dilation
  • Nontender, red, swollen lesions that may bleed w/ brushing
  • Tx: Improved OH; reversible lesion
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105
Q

Submucosal hemorrhage

A

Diascopy negative

  • Entrapment or pooling of blood in tissues
  • Blue-gray color due to hemosiderin deposition
  • Does not blanch
  • Causes:
    • Traumatic (common)
      • May be associated w/ child abuse
      • Suspect repeated trauma or chronic condition if multiple colors of bruising are present
    • Nontraumatic (uncommon)
      • Blood dyscrasia
      • Viral infection (infectious mononucleosis, measles)
      • Anticoagulants
  • Terms: Petechiae, purpura, ecchymosis, hematoma
  • Site: Lip and mucosa along occlusal plane
  • Pinpoint to macular to diffuse red, purple or blue lesions
    • Usually nontender
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106
Q

Submucosal hemorrhage: Treatment

A

Resolves in 1-2 weeks. If recurrent, important to identify cause

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107
Q

Traumatic erythema

A

Non-vascular

  • Irritation resulting in erosion of mucosa
  • Do not blanch w/ pressure
  • Site: Any mucosal site
  • Red macule w/ irregular margins; usually tender
  • May be associated w/ child abuse
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108
Q

Traumatic erythema: Treatment

A

Palliative treatment, if tender

Resolves <1 week

109
Q

Glossitis

A
  • Redness due to thinning of oral mucosa
  • Generalized erythema and depilation of dorsal tongue; may appear normal
  • Burning sensation
  • Causes:
    • Anemia
    • Candidiasis
    • Vitamin B deficiency
    • Factitial injury
    • Xerostomia
    • Allergies
    • Diabetes
    • Hypothyroidism
110
Q

Glossitis: Treatment

A

Treat underlying cause

111
Q

Hereditary hemorrhagic telangiectasia

A

Diascopy positive

  • Autosomal dominant
  • Multiple dilated capillaries (telangiectasia) of skin and mucous membranes
  • Blanch w/ pressure
  • Arteriovenous fistulas of lung, liver, brain – increased risk for abscess
  • Prominent signs: epistaxis, oral bleeding
  • Prophylactic abx may be indicated w/ AV fistulas
  • Most common locations on skin:
    • Palms
    • Fingers
    • Nail beds
    • Face
    • Neck
  • Mucosal lesion locations:
    • Lung
    • Brain
    • GI tract
    • Liver
112
Q

Hereditary hemorrhagic telangiectasia: Complications

A
  • Liver cirrhosis
  • Pulmonary AV fistula → pulmonary HTN
  • Brain abscesses
  • Emboli
113
Q

Hereditary hemorrhagic telangiectasia: Precautions

A

Precautions recommended with:

  • Use of inhalation analgesia
  • General anesthesia
  • Oral surgical procedures
  • Hepatotoxic and antihemostatic drugs
114
Q

T/F: Antibiotic prophylaxis is recommended before invasive dental treatment in patients who have pulmonary arteriovenous malformations.

A

True - because of risk of cerebral abscess

115
Q

Sturge-Weber angiomatosis

A
  • AKA Encephalotrigeminal Syndrome*
  • Diascopy positive*
  • Congenital port wine stain of upper face, including forehead
  • Leptomeningeal angiomas → impaired blood flow to brain → atrophy + calficiations
  • Ipsilateral facial angiomatosis usually
  • Ipsilateral gyriform calcifications of cerebral cortex
  • Intellectual disability
  • Seizures, strokes, ocular defects (hemiplegia in some cases)
  • Oral bleeding, pyogenic granulomas, gingival hyperplasia, alveolar bone loss, diffuse vascular lesions
116
Q

Approximately what percent of people with facial port wine stains have Sturge-Weber angiomatosis?

117
Q

Sturge-Weber angiomatosis: Treatment

A

Aspirin for stroke prevention

118
Q

Name red and white lesions

A
  • Geographic tongue
    • Dorsal/lateral tongue
    • Ectopic – other mucosal sites
  • Oral candidiasis
  • Cinnamon contact mucositis
119
Q

What are common red and white lesions?

A
  • Geographic tongue (benign migratory glossitis)
  • Candidiasis (also under ‘red lesions’)
120
Q

What are uncommon red and white lesions?

A
  • Cinnamon contact mucositis
121
Q

What are rare red and white lesions?

A
  • Lichen planus
  • Systemic lupus erythematous (also under ‘oral ulcers’)
122
Q

What percent of the population is affected by geographic tongue?

123
Q

Geographic tongue (benign migratory glossitis)

A
  • Cause: Unknown
  • May be associated w/ atopy, fissured tongue, transient lingual papillitis
  • Affects 2% of the population
  • Site: Primarily on the dorsal and ventrolateral tongue
    • Rarely on other mucosal sites
  • Focal loss of filiform papillae on dorsal tongue
  • Oval red patches w/ white borders that migrate
  • May be sensitive + persistent
  • Tx: None; palliative tx if tender
124
Q

Cinnamon contact mucositis

A
  • Cause: Flavoring agent in OH products, candy, gum
  • Site: Buccal mucosa + lateral tongue
  • White, shaggy, adherent patches with erythema; tender
  • Tx: Identify cause, d/c offending agent
125
Q

What does cinnamon contact mucositis mimic?

A
  • Cheek- and tongue-biting keratosis
  • Lichen planus
  • Chronic hyperplastic candidiasis
126
Q

Lichen planus

A
  • Chronic mucocutaneous disease – rare in children
  • Cause: T-cell mediated autoimmune disease; some cases represent a contact allergy (lichenoid reaction)
  • Sites: Affects both skin, especially extremities, and oral mucosa (buccal mucosa, gingiva, and tongue)
  • White lacy lines with red background, bilateral and symmetrical
    • Burns
    • Waxes and wanes
  • May have secondary candidal infection
127
Q

Lichen planus: Treatment

A
  • Incisional biopsy
  • Topical steroids
  • Antifungal agents
128
Q

What does lichen planus mimic?

A
  • Cinnamon contact reaction
  • Cheek-biting keratosis
  • Benign migratory glossitis
  • Lupus erythematous
129
Q

Diffuse brown/black/gray lesions

A
  • Physiologic pigmentation syndromes
    • Peutz-Jeghers
    • Addison’s disease
130
Q

Localized brown/black/gray lesions

A
  • Melanotic macule
  • Amalgam tattoo
  • Non-amalgam tattoo
  • Intraoral nevus
  • Blue nevus
  • Melanoma
131
Q

What are common localized pigmented lesions?

A
  • Submucosal hemorrhage
  • Melanotic macule
  • Ephelis
132
Q

What are uncommon localized pigmented lesions?

A
  • Amalgam/graphite tattoo
  • Melanocytic nevus
133
Q

What are rare localized pigmented lesions?

A
  • Melanoma
  • Oral melanoacanthoma
  • Melanotic neuroectodermal tumor of infancy
134
Q

Melanotic macule

A
  • Common lesion due to focal increase in melanin
  • Site: Lip, buccal mucosa, gingiva, palate
  • Solitary, round to oval macule, brown, gray, black in color
  • Tx: None required; no malignant potential.
    • Excise if sudden onset and large
    • Periodic observation
135
Q

What does melanotic macule mimic?

A
  • Melanotic nevus
  • Amalgam/graphite tattoo
  • Smoker’s melanosis
  • Late ecchymosis
136
Q

Ephelis

A
  • Freckle – occurs on skin
  • Similar to melanotic macule
  • Common lesion due to focal increase in melanin
  • Genetic predisposition for some
  • Occurs on sun-exposed skin; face commonly affected
  • Round to oval macule, tan, brown, gray in color
  • May be solitary, usually multiple
  • Tx: None required
    • Sunscreen to prevent increase of lesions or darkening of lesions
137
Q

Amalgam/graphite tattoo

A
  • Grey or blue macule on gingiva and palate
  • Entrapped foreign body; history supports lesion
  • Large particles may be seen on radiographs
  • Tx: None required
138
Q

Melanocytic nevus

A
  • Benign proliferation of nevus cells
  • Common on skin, but uncommon in mouth; usually on palate
  • May be congenital
  • Oral types: Blue and intramucosal are most common
  • Site: Palate, buccal mucosa, gingiva, lip
  • Brown, blue, black macule or nodule
    • 85% are pigmented
    • 70% are elevated
139
Q

Melanocytic nevus: Treatment

A
  • Excisional biopsy
  • Rare malignant potential
140
Q

What does a melanocytic nevus mimic?

A
  • Melanotic macule
  • Amalgam/graphite tattoo
141
Q

Where does melanoma typically show up?

A

Palate and gingiva

142
Q

Oral melanoacanthoma

A

Rapidly enlarging lesion that occurs in blacks

143
Q

Melanotic neuroectodermal tumor of infancy

A

Expansile destructive tumor of anterior maxilla

144
Q

What are common generalized pigmented lesions?

A
  • Physiologic (racial) pigmentation
  • Brown hairy tongue
  • Post-inflammatory pigmentation
  • Acanthosis nigricans
145
Q

Where is physiologic (racial) pigmentation most common?

A

Attached gingiva

146
Q

Brown hairy tongue

A

Exogenous staining of elongated filiform papillae

147
Q

What is post-inflammatory pigmentation?

A

Hyperpigmentation in response to chronic mucosal trauma

148
Q

Acanthosis nigricans

A
  • Associated with obesity and diabetes in children
  • Velvety brown to black papules and plaques on neck, axilla, flexural skin
  • Refer to pediatrician for evaluation of endocrine disease
149
Q

What are uncommon generalized pigmented lesions?

A
  • Smoker’s melanosis
  • Melasma
150
Q

Smoker’s melanosis

A
  • Brown patch on anterior gingiva and labial mucosa
  • Usually in females
  • May be localized
151
Q

Melasma

A

Symmetrical pigmentation of face and neck associated with pregnancy, oral contraceptives

152
Q

Rare generalized pigmentation lesions

A
  • Addison disease
  • Peutz-Jeghers syndrome
  • Medications
  • Heavy metal toxicity
  • Hemochromatosis
  • Neurofibromatosis
  • McCune-Albright syndrome
153
Q

Addison disease

A
  • Adrenal insufficiency
  • Weakness, nausea, vomiting, low BP, oral + cutaneous pigmentation
  • Oral: Diffuse grey patches
154
Q

Peutz-Jeghers syndrome

A
  • AD
  • Melanin hyperpigmentation of lips
  • Benign polyposis of small intestine; up to 9% become malignant
  • Buccal lesions less likely to fade than lip lesions
155
Q

What medications can cause generalized pigmentation?

A
  • Antimalarial drugs (chloroquine), antibiotics (minocycline), hormones (estrogen) produce gray coloration of mucosa
  • Patient must take drugs for an extended period of time
  • Pigmentation usually on hard palate + gingiva
156
Q

Heavy metal toxicity

A
  • Bismuth
    • Gingivostomatitis similar to necrotizing ulcerative gingivitis
    • Blue-black pigmentation of interdental papilla
  • Lead
    • Salivary gland swelling + dysphagia
    • Grey pigmentation of marginal gingiva
  • Mercury
    • Ropy, viscous saliva
    • Faint grey alveolar gingival pigmentation
    • Gingivostomatitis similar to necrotizing ulcerative gingivitis
  • Silver
    • Skin is slate grey
    • Diffuse pigmentation
  • Copper
    • Blue-green gingiva + teeth
  • Zinc
    • Blue-gray line on gingiva
    • Periodontal involvement
157
Q

Hemochromatosis

A
  • Iron storage disease
  • Bronzing of skin + gray pigmentation of palate
158
Q

Neurofibromatosis

A

Multiple cafe au lait macules + pigmented neurofibromas

159
Q

McCune-Albright syndrome

A

Large cafe au lait macules, endocrine disease, polyostotic fibrous dysplasia

160
Q

Common localized gingival enlargements

A
  • Parulis/pericoronitis
  • Pyogenic granuloma
  • Localized juvenile spongiotic gingival hyperplasia
  • Irritation fibroma
  • Peripheral ossifying fibroma
  • Eruption cyst/hematoma
  • Squamous papilloma
161
Q

Uncommon gingival enlargements

A
  • Peripheral giant cell granuloma
  • Giant cell fibroma
162
Q

Rare gingival enlargements

A

Neoplastic lesions

  • Benign neoplastic lesions
  • Langerhans cell histiocytosis
  • Aggressive fibromatosis
  • Malignant disease, including lymphoma
  • Metastatic disease
163
Q

Parulis (soft tissue abscess)

A
  • Odontogenic or gingival infection; entrapped foreign body
  • Red or pinkish white nodule w/ purulence; fluctuates in size
  • Soft + tender to palpation
  • Tx: Treat source of infection; curette lesion; abx may be indicated
164
Q

Pyogenic granuloma

A
  • Reactive lesion due to irritation
  • Occurs anywhere in mouth but gingiva common site
  • Sessile, red nodule that bleeds freely
  • Surface ulceration is common
  • Soft, friable and nontender to palpation
  • Tx: Surgical excision, removal of irritant
  • Variants: Pulp polyp, pregnancy tumor, epulis granulomatosum
165
Q

Localized juvenile spongiotic gingival hyperplasia

A
  • Distinct subtype of gingivitis
  • Origin: Sulcular, junctional epithelium
  • Does not respond to local plaque control
  • Anterior facial gingiva, especially maxillary
    • May be multifocal
  • Papillary or velvety, red nodule that bleeds easily
  • Soft, friable and nontender to palpation
  • Tx: Surgical excision; may resolve spontaneously
  • Mimics as flat pyogenic granuloma
166
Q

Irritation fibroma

A
  • Reactive hyperplasia due to chronic trauma
  • Occurs on buccal + labial, gingiva, tongue
  • Pink, smooth nodule; nontender
  • Tx: Surgical excision
  • Variant: Frenal tag
167
Q

Peripheral ossifying fibroma

A
  • Reactive lesion
  • Only occurs on the gingiva
  • Firm, pink or red nodule that begins in interdental papilla; usually ulcerated
  • May displace or loosen teeth
  • Radiograph: May show foci of dystrophic calcification
  • Tx: Surgical excision down to periosteum
  • Recurrence rate - up to 16%
168
Q

Eruption cyst/hematoma

A
  • Soft tissue dentigerous cyst
  • Associated w/ eruption of primary + permanent teeth
  • Red, purple swelling of alveolar mucosa
  • Radiograph: May show an enlarged follicular space that extends to alveolar mucosa
  • Tx: None, unless delayed eruption or symptomatic
169
Q

Squamous papilloma

A
  • Caused by HPV 6 + 11
  • Most common mass of the soft palate
  • Occurs on soft palate, tongue and labial mucosa; uncommon of gingiva
  • Solitary pink or white papillary, pedunculated nodule, multiple fingerlike projections
  • Tx: Excisional biopsy
  • If multiple lesions, r/o verruca vulgaris + condyloma acuminatum
170
Q

Giant cell fibroma

A
  • Fibrous hyperplasia of unknown cause
  • Occurs on gingiva, tongue, hard palate
  • Pink, smooth to stippled nodule; nontender
  • Tx: Surgical excision
  • Developmental variant: retrocuspid papilla
171
Q

Peripheral giant cell granuloma

A
  • Reactive lesion caused by local irritation
  • Occurs on gingiva or alveolar mucosa only
  • Red or purple nodule that may bleed
  • May cause superficial bone resorption
  • Tx: Surgical excision; remove local irritation
  • 10% recurrence rate
  • Rare cases represent central bony lesion w/ soft tissue extension
172
Q

What is used to treat oral mucositis?

A

Palifermin

173
Q

What is the most common strain of HPV?

174
Q

What strains of HPV cause squamous papilloma?

A

HPV 6 + 11

175
Q

What strain of HPV is associated w/ verrucous vulgaris?

176
Q

What strains of HPV as associated w/ focal epithelial hyperplasia (Heck’s)?

A

HPV 13 + 32

177
Q

Neoplastic lesions

A
  • Benign neoplastic lesions
  • Langerhans cell histiocytosis
  • Aggressive fibromatosis
  • Malignant disease, including lymphoma
  • Metastatic disease
178
Q

Drug-induced gingival hyperplasia

A
  • Phenytoin – 50%
  • Cyclosporine – 25%
  • Calcium channel blockers – 25%
179
Q

Linear gingival erythema

A
  • Appears to be associated w/ candidal infection
  • HIV-related or immunosuppressed children
  • Distinct linear band of fiery red + edematous attached gingiva that may extend beyond MGJ
  • Key finding: Does not respond to normal plaque control measures
  • Tx:
    • Local debridement
    • CHX rinse
180
Q

Plasma cell gingivitis

A
  • Allergic rxn to multiple allergens including those found in toothpaste, candy, chewing gum + mouthwash
  • Diffuse enlargement of attached gingiva of sudden onset; often extends to palate
  • Other sites may include concurrent tongue + lip involvement
  • Bright red + swollen tissues w/ lack of stippling that burn
  • Dx:
    • Incisional biopsy
    • Dietary hx
    • Allergy testing if persistent
  • Tx:
    • Identify + eliminate the allergen
    • Topical steroids
181
Q

Gingival fibromatosis

A
  • May be familial (AD) or idiopathic
  • Diffuse, multinodular overgrowth of fibrous tissue of gingiva
  • May have a localized variant, esp. tuberosity-palatal area
  • May be associated w/ several syndromes
    • May be associated w/ hypertrichosis
  • Clinically similar to phenytoin-induced gingival overgrowth
  • May delay eruption of teeth + cause malocclusion
  • Tx:
    • Routine dental prophylaxis if mild
    • Surgical excision (gingival recontouring) if severe
  • Recurrence is common
182
Q

Leukemia

A
  • Gingivitis secondary to neutropenia
  • Gingival enlargement due to leukemic infiltrates, esp. in myelomonocytic types
  • Other signs:
    • Spontaneous gingival bleeding
    • Mucosal petechiae + ecchymosis
    • Ulcerations
    • Tumor-like growths
    • Tooth mobility
  • Radiograph:
    • Multifocal alveolar bone loss
    • Loss of lamina dura
  • Tx:
    • OH measures as tolerated by lab studies
183
Q

Granulomatous gingivitis

A
  • Foreign body gingivitis
  • Orofacial granulomatosis
  • Crohn’s disease
  • Sarcoidosis
  • Granulomatosis w/ polyangitis (Wegener granulomatosis)
184
Q

Mucocele

A

Lower lip

  • Due to severance of duct + spillage of mucin into tissues
  • Most frequent on lower lip, but may occur on palate or tongue, floor of mouth, buccal mucosa
  • Fluid-filled, translucent blue nodule; fluctuates in size, may be tender
  • Tx:
    • Excisional biopsy
    • May spontaneously resolve
185
Q

Soft tissue abscess

A
  • More common on the upper lip
  • Caused by extension of odontogenic infection or entrapped foreign body
  • Radiograph if trauma, foreign body, or dental source suspected
  • Tx:
    • Tx cause
    • May require I+D
186
Q

Verruca vulgaris

A
  • Common on skin but uncommon in mouth
  • Caused by HPV 2 + others
  • Occurs on skin, esp. hands, face
  • Oral sites
    • Vermilion border
    • Labial mucosa
    • Anterior tongue
  • Pink or stippled to papillary nodules – usually multiple
  • Tx:
    • Excisional biopsy in mouth
    • Refer skin lesions to prevent spread
187
Q

Lipoma

A
  • Well-circumscribed submucosal mass
  • Soft, freely movable
  • Yellow in color
  • Common on buccal mucosa, tongue, floor mouth
  • Tx:
    • Surgical excision
188
Q

Traumatic neuroma

A
  • Reactive lesions that may be tender
  • Focal reactive lesion due to local injury
  • Clinically resembles a fibroma
  • May be tender to palpation
  • Tx:
    • Excisional biopsy
189
Q

Vascular lesions

A
  • Hemangioma
  • Vascular malformation
  • Lymphatic malformation
190
Q

Squamous papilloma location

A

Soft palate + tongue

191
Q

Fibroma location

A

Buccal mucosa + lower lip + tongue

192
Q

Ranula location

A

Floor of mouth

193
Q

Lymphoepithelial cyst location

A

Floor of mouth

194
Q

Multifocal epithelial hyperplasia (Heck disease)

A
  • Caused by HPV 13 + 31
  • Risk factors
    • Genetics
    • Ethnicity
    • Poverty
    • Malnutrition
    • Poor OH
    • HIV infection
  • Numerous pink nodular lesions w/ a stippled, flat topped to papillary surface
  • Labial + buccal mucosa, tongue are common sites
  • Occurs usually in children
  • May be mistaken for condylomas
  • Tx:
    • Excise large lesions
    • May spontaneously resolve
195
Q

Angioedema

A
  • Allergic + hereditary forms
  • Multiple allergens + physical stimuli can trigger rxn
  • Acute onset of swelling + itching
  • Swelling of face, lips, tongue, pharynx
  • Extremities
  • Tx:
    • Allergic form – antihistamines, steroids, epinephrine
    • Hereditary form – androgens, esterase-inhibiting drugs
  • May be life-threatening w/ laryngeal involvement
196
Q

Orofacial granulomatosis

A
  • Granulomatous disease due to abnormal immune rxn
  • Food allergens are a trigger for children – may have GI problems
  • Site:
    • Lip, buccal mucosa, gingiva, tongue
  • Persistent swelling, erythema, ulcers, cobblestone pattern + fissured tongue
  • Tx:
    • Incisional biopsy
    • ID the allergen
    • Steroids
  • Rule out Crohn disease
197
Q

Multiple endocrine neoplasia, type 2b

A
  • AD
  • Marfanoid body + narrow facies + full lips
  • Mucosal neuromas of lips, tongue, buccal mucosa + gingiva
  • Medullary carcinoma of thyroid
  • Pheochromocytoma
  • Tx:
    • Biopsy to confirm dx
    • Early evaluation of thyroid is important
198
Q

Benign mesenchymal neoplasms

A
  • Neurilemma
  • Neurofibroma
  • Others
199
Q

Benign + malignant salivary gland tumors

A
  • Canalicular adenoma – upper lip
  • Malignant salivary gland tumors of the posterior buccal mucosa
200
Q

Traumatic injury

A
  • Usually involve tongue ulceration + submucosal hemorrhage
  • Localized + diffuse swelling
  • Bleeding is a problem due to vascularity
  • For severe trauma, healing takes 4-6 weeks
201
Q

Hyperplastic foliate papilla

A
  • Benign lymphoid hyperplasia of lingual tonsil
  • Enlargement triggered by infection or trauma to area
  • Site:
    • Posterior lateral tongue
    • Often bilateral
  • Yellow-pink to red enlargement w/ irregular surface; may be tender
  • Important oral cancer site
  • Tx: None, except tx the source of irritation if present; may spontaneously resolve
202
Q

Uncommon tongue swellings

A
  • Irritation fibroma
  • Pyogenic granuloma
  • Mucocele of Blandin-Nuhn
  • Entrapped foreign body, tongue piercing
  • Giant cell fibroma
203
Q

Rare tongue swellings

A
  • Vascular malformation
  • Hemangioma
  • Lymphatic malformation
  • Granular cell tumor
    • Benign neoplasm of Schwann cells
    • Dorsal tongue most common oral site
    • Pale, smooth or slightly stippled nodule
  • Tx: Excisional biopsy
  • Micro: Pseudoepitheliomatous hyperplasia of surface epithelium + sheets of granular cells
204
Q

Hamartoma + choristoma

A
  • Tongue is the most common site
  • May be associated w/ syndromes such as oral-facial-digital syndrome
  • Tx: Surgical excision
205
Q

Lingual thyroid

A
  • Developmental lesion
  • Ectopic thyroid tissue in tongue
  • Located midline base of tongue
  • Hypothyroidism (33%)
  • Tx:
    • Thyroid replacement therapy
    • May require surgery
206
Q

Cretinism

A
  • Congenital hypothyroidism (myxedema in adults)
  • Intellectual disability, poor somatic growth, generalized edema
  • Shortening of cranial base – retraction of nose w/ flaring
  • Mandible underdeveloped, maxilla overdeveloped
  • Tongue enlargement secondary to edema, delayed tooth eruption + exfoliation
  • Progressive infiltration of skin + mucous membranes by glycoaminoglycans
  • Tx:
    • Thyroid replacement therapy
207
Q

Macroglossia associated w/ common syndromes

A
  • Down syndrome
  • Neurofibromatosis, type 1
  • Mucopolysaccharoidosis (multiple types)
  • Beckwith-Weidemann syndrome
  • Duchenne muscular dystrophy (hypotonicity of tongue)
208
Q

Ranula

A
  • Mucous retention on oral floor
  • Dome shaped, painless, soft swelling of normal or blue color
  • Unilateral, fluctuates in size
  • Arises from the sublingual gland
  • Tx:
    • Excisional biopsy
    • Marsupialization of small lesions
  • Variant – plunging or cervical ranula
209
Q

Sialolithiasis

A
  • Salivary stone
  • Calcium salts around focal debris in duct
  • Usually involves Wharton’s duct
  • Episodic pain + swelling when eating
  • Yellow-white mass may be seen close to ductal orifice
  • X-ray: May aid in detection
  • Tx:
    • Gentle massage
    • Salivary stimulation
    • Surgery
210
Q

Oral lymphoepithelial cyst

A
  • Entrapped epithelium w/in lymphoid tissue
  • Undergoes cystic degeneration
  • Occurs in oral floor, soft palate, tonsillar region, lateral tongue
  • Persistent yellow-white nodule
  • Tx:
    • Observe or excisional biopsy
211
Q

Rare sublingual swellings

A
  • Epidermoid/dermoid cyst – midline floor of mouth
  • Salivary gland tumor – most likely to be malignant
  • Ludwig’s angina – life-threatening; usually of odontogenic origin
212
Q

Benign lymphoid hyperplasia

A
  • Oral tonsil tissue
  • Yellow-pink to red nodules; may be tender
  • Tx: None required
213
Q

Palatal abscess

A
  • Odontogenic + gingival origin
214
Q

Torus palatinus

A
  • Bony exostosis that occurs in midline of hard palate
  • Nodular to lobular appearance
  • Tx: None required
215
Q

What is the most common lesion of the soft palate

A

squamous papilloma

216
Q

Nasopalatine duct cyst

A
  • Arises from remnants of nasopalatine duct
  • Located in midline b/w roots of maxillary incisors
  • May cause root divergence
  • May cause fluctuant swelling of palate
  • Teeth are vital
  • X-ray: Oval to heart-shaped radiolucency
  • Tx: Surgical excision/curettage
  • Rare soft tissue counterpart is the cyst of incisive papilla
  • Mimics: periapical granuloma, periapical cyst, median palatal cyst
217
Q

Inflammatory papillary hyperplasia

A
  • Reactive lesion of the hard palatal mucosa
  • Associated w/ dentures, palatal coverage appliances, high palatal vault, mouthbreating
  • Red or pink sheets of papules; nontender
  • May be associated w/ candidal infection, along w/ trauma from appliance
  • Tx:
    • Antifungal agent
    • Disinfect appliance
    • May need to ⇓ wearing of appliance
    • Surgical excision
218
Q

Oral lymphoepithelial cyst

A

Occurs on soft palate

219
Q

Condyloma acuminatum

A
  • Caused by HPV 6, 11, 16, 18
  • STD
  • May be infected at birth
  • Oral sites: palate, tongue, oral floor, labial mucosa
  • Multiple coalescing, pink nodules; cauliflower surface
  • Tx: Excisional biopsy
220
Q

Where is the most common site for salivary gland tumors?

A

Posterior hard palate

221
Q

Necrotizing sialometaplasia

A
  • Reactive lesion of minor salivary glands due to ischemia + infarction
  • Cause: Trauma, dental injections, URI
  • May start as a swelling that progresses to cratered, irregular ulcer
  • Usually unilateral but may be bilateral
  • Ranges from nontender to painful
  • Tx:
    • Incisional biopsy to confirm dx
    • Resolves in ~6 weeks
222
Q

Acute single oral ulcers

A
  • Aphthous ulcer
  • Traumatic ulcer
    • Riga Fede disease
    • Iatrogenic
    • Self-induced
  • Recurrent herpes labialis
  • Angular cheilitis
  • Behcet syndrome
  • Crohn disease
223
Q

Acute multiple ulcers

A
  • Primary herpetic gingivostomatitis
  • Coxsackie virus infections
    • Herpangina
    • Hand, food + mouth disease
  • Intraoral recurrent herpes simplex
  • Erythema multiforme
  • Necrotizing ulcerative gingivitis
  • Varicella
224
Q

Chronic multiple ulcers

A
  • Erosive/ulcerative lichen planus
  • Systemic lupus erythematosus
  • Chronic GVHD
225
Q

Aphthous ulcers

A
  • T-cell mediated immunologic rxn
  • Prevalence: 20-30%
  • Familial tendency
  • Site: nonkeratinized mucosa
  • Signs/symptoms: single or multiple, painful ulcers, recurrent lesions of sudden onset
  • Forms: minor, major, herpetiform
  • Tx:
    • Coating agents
    • Topical anesthetics
    • Steroids
226
Q

Aphthous like ulcers associated w/ systemic disease

A
  • Behcet disease
  • Celiac disease
  • Crohn disease
  • Periodic fevers, aphthous stomatitis, pharyngitis and adenitis (PFAPA)
  • Neutropenia
  • Immunodeficiency syndrome
  • Gastro-esophageal reflux disease
227
Q

Angular cheilitis

A
  • Cause:
    • Candida albicans
    • S. aureus
    • Nutritional deficiencies
    • Anemia
    • Crohn disease
  • Site:
    • Corners of the mouth
  • Erosions, scaly crusts, ulcerated fissures, papules; may bleed, tender
  • May recur
  • Tx:
    • Depends on cause
    • Antifungal ointment w/ or w/o short term low potency steroids
228
Q

Recurrent herpes simplex infection

A
  • Cause: reactivation of HSV-1
  • Prevalence: 20-35%
  • Types: Herpes labialis, facialis, intraoral HSV
  • Risk factors:
    • UV light
    • Trauma
    • Fever
    • Dental tx
  • Site: Perioral skin, vermilion, gingiva, hard palate
  • Duration: 7-10 days
  • Recurrent, tender lesions, sudden onset, prodrome, clustered vesicles that ulcerate
  • Complications: Scars, erythema multiforme
  • Tx:
    • Topical anesthetics
    • Topical + systemic antiviral agents
    • Herpetic whitlow (herpetic paronychia) on finger
229
Q

Acute herpetic gingivostomatitis (primary herpes)

A
  • Infectious disease, primarily caused by herpes simplex virus type 1 (HSV 1)
  • Most common under age of 5
  • Disease duration: 5-14 days
  • Fever, lymphadenopathy, headache, malaise, intense gingival erythema, oral vesicles throughout mouth
  • Vesicles rupture, leaving painful ulcers
  • Widespread ulcers occur on any oral mucosal site + lip vermilion
  • Self-inoculation of fingers, eyes, genital area
  • Tx:
    • Systemic acyclovir
    • Valacyclovir may be warranted
    • Palliative + supportive care
230
Q

In what age group is acute herpetic gingivostomatitis (primary herpes) the most common?

A

Most common under age of 5

231
Q

Herpangina

A
  • Cause: Enterovirus, usually coxsackie virus
  • Most common in young children during summer months
  • Multiple small vesicular lesions involving tonsillar pillars, uvula + soft palate
  • Vesicles rupture leaving ulcers w/ erythematous borders
  • Malaise, fever, sore throat, cough, rhinorrhea, diarrhea
  • Duration: 7-10 days
  • Tx: Supportive + palliative care
232
Q

Hand, foot + mouth disease

A
  • Cause: enterovirus, usually coxsackie virus
  • Common age is infant to age 4yo
  • Fever, malaise, lymphadenopathy, flu-like symptoms
  • Vesicles + ulcers on buccal, labial, mucosa, tongue
  • Skin lesions on hands, arms, feet, and legs; diaper rash
  • Tx: Palliative + supportive resolves in 7-10 days
  • Aggressive form associated w/ major neurologic complications
233
Q

Impetigo

A
  • Most commonly caused by Staphylococcus aureus or in combination w/ Group A beta-hemolytic streptococcus
  • Lesions are often on the face; bacteria is harbored in the nose
  • Usually seen in young children
  • Scaly + thick amber crusts that are pruritic localized
  • Localized disease tx’d w/ topical abx
  • Widespread disease tx’d w/ systemic abx
234
Q

Necrotizing ulcerative gingivitis

A
  • Fusiform bacteria, spirochetes, HHVs
  • Painful lesions, necrosis, ulceration, punched-out papilla; halitosis
  • Predisposing factors:
    • Vitamin deficiencies
    • Compromised immune function
    • Stress
    • Poor OH
    • Cigarette smoking
    • Viral infections (HIV, EBV, measles)
  • Rare in young children
  • Tx:
    • Debridement
    • OH
    • Antimicrobial rinse
    • +/- systemic abx
235
Q

Erythema multiforme

A
  • Immunologically-mediated disease
  • Triggers:
    • Drugs
    • HSV
    • Mycoplasma pneumonia
    • Tattooing
    • Other infections
    • 50% unknown
  • Site:
    • Palmar + plantar surfaces
    • Neck
    • Face
    • Eyes
    • Lips
    • Oral mucosa
  • Acute onset, fever, sore throat: blood crusted lips, irregular ulcers, erythema
  • Target lesions on skin
  • May have ocular + genital involvement (Steven-Johnson syndrome)
  • Tx: ID cause; palliative care
236
Q

Varicella

A
  • Cause: Varicella zoster virus
  • Crops or pruritic vesicles on skin + mucous membrane
  • Vesicles may precede fever
  • Begins on trunk – spreads to limb + face
  • Infectious 24hr before 6-7 days after vesicles appear
  • Resolves in 7-10 days
  • Tx:
    • Palliative + supportive
    • Systemic antiviral drugs in severe cases or immunocompromised children
  • Prevention: Vaccine – rare disease bc of vaccine
237
Q

Chemotherapy

A
  • Drug-induced mucositis
  • Widespread involvement
  • Pain, bleeding, sloughing, erythema, irregular ulcerations
  • Tx: Supportive + palliative care
238
Q

Epidermolysis bullosa

A
  • Hereditary vesiculobullous disease of skin + mucous membranes – multiple types
  • EB simplex – most common; AD
  • Junctional EB – severe form; AR
  • Blistering of hands, feet, mouth in particular
  • Scarring is common
  • Oral problems: Enamel hypoplasia, microstomia, ankyloglossia, caries, gingivitis
  • Tx:
    • No satisfactory tx
    • Caries prevention
    • Minimize trauma
  • Severe forms are life-threatening
239
Q

Systemic lupus erythematosus

A
  • Chronic multisystem progressive disorder
  • Autoimmune disorder
  • Oral ulcerations, erosions + white striations; mimics lichen planus, secondary candidiasis
  • Skin lesions, arthralgia, hematologic disorders are common
  • Butterfly rash on face
  • Tx:
    • Steroids, other immunosuppressive agents, antifungal agents
240
Q

Graft vs. host disease

A
  • Acute + chronic types
  • Associated w/ hematopoietic stem cell transplant
  • Multiorgan disease including oral mucosa + skin
  • Oral manifestations:
    • Mucosal atrophy + ulcers
    • Xerostomia
    • Lichenoid rxn
    • Systemic sclerosis
  • Rare development of oral cancer
241
Q

Congenital indifference to pain

A
  • AR
  • Frequent scarring of face w/ mutilation of lips, arms, legs as well as phalangeal amputation due to self-mutilation
  • Tongue + lips esp subject to injury
  • Extensive decay not associated w/ pain
242
Q

Lesch-Nyhan syndrome

A
  • X-linked condition
  • Intellectual disability
  • May have CP
  • Choreoathetosis
  • Bizarre, self-mutilating behavior — including lip destruction w/ teeth
  • Absence of hypoxanthine – guanine
  • Phosphoribosyltransferase (enzyme involved in purine metabolism)
243
Q

Traumatic granuloma

A
  • Traumatic ulcerative granuloma w/ stromal eosinophilia
  • Deep injury to the oral tissues, esp tongue
  • Solitary, painful, deep, persistent ulcer
  • Takes weeks to months to heal
  • Tx:
    • Eliminate cause
    • Topical or intralesional steroids
    • Incisional biopsy if persistent
    • Variant: Riga-Fede disease
  • Mimics a deep mycotic infection or malignancy
244
Q

Causes of soft tissue neck swellings

A
  • Reactive lymphadenopathy
    • Secondary to odontogenic infections
    • Secondary to viral infections
  • Other causes of lymphadenopathy
    • Infectious mononucleosis
    • Cat scratch disease
    • Hodgkin lymphoma
    • Leukemia
    • Kawasaki disease
    • Tuberculosis
  • Lipoma
  • Epidermoid cyst
245
Q

Soft tissue neck swellings in the midline

A
  • Thyroglossal duct cyst
  • Plunging ranula
246
Q

Lateral soft tissue neck swellings

A
  • Branchial cleft cyst
  • Cystic hygroma
247
Q

Parotid gland swelling

A
  • Mumps
  • Salivary gland tumor
  • HIV salivary gland disease
248
Q

Infectious mononucleosis

A
  • Caused by Epstein-Barr virus
  • Fever, palatal petechiae, NUG, pharyngitis, cervical lymphadenopathy
249
Q

Cat-scratch fever

A
  • Caused by Bartonella henselae
  • Usually due to scratch or bite from cats
  • Scratches on face result in submandibular lymphadenopathy or enlarged parotid lymph nodes
  • Tx: Usually resolves w/in 4mo; abx may be necessary
250
Q

HIV-associated salivary gland disease

A
  • Enlarged parotid gland
  • Often w/ concurrent cervical lymphadenopathy
  • Xerostomia
  • Associated w/ improved prognosis
251
Q

Hodgkin’s lymphoma

A
  • Malignant lymphoproliferative disease
  • Usually unilateral, painless, enlarging mass
  • Unilateral presentation
  • Most common nodes are cervical + supracervical nodes
  • May be associated w/ fever, weight loss, night sweats, pruritis
  • Tx:
    • Radiation
    • Chemotherapy
252
Q

Thyroglossal duct cyst

A
  • Remnant of thyroglossal duct
  • Occurs midline anywhere along path of thyroglossal duct
  • Usually below hyoid
  • May move up and down w/ tongue movement
253
Q

Mumps

A
  • Usually involves parotid
  • Paramyxovirus (cytomegalic virus or staph in immunocompromised patient)
  • Incubation (2-3 weeks)
  • Pain, fever, malaise, headache, vomiting may precede swelling
  • Xerostomia
  • Tx: Symptomatic
254
Q

Kawasaki disease

A
  • Mucocutaneous lymph node syndrome
  • Bilateral conjunctivitis
  • Fissured lips
  • Infected pharynx
  • Strawberry tongue
  • Erythema of palms + soles
  • Rash
  • Cervical adenopathy
255
Q

Tuberculosis

A
  • Infectious disease that affects lungs
  • Caused by Mycobacterium tuberculosis
  • Clinical findings: Weight loss, fever, night sweats, productive cough
  • Most common extrapulmonary sites in head + neck region are cervical lymph nodes
  • Tx: Multiagent antibiotic therapy
256
Q

Salivary gland tumor

A
  • Pleomorphic adenoma most common benign lesion
  • Parotid most common site
  • Mucoepidermoid carcinoma most common malignant lesion
257
Q

What is the most common benign salivary gland tumor?

A

Pleomorphic adenoma

258
Q

Where are salivary gland tumors most common?

A

Parotid gland

259
Q

What is the most common malignant salivary gland tumor?

A

Mucoepidermoid carcinoma

260
Q

Branchial cleft cyst

A
  • Area of anterior border of sternocleidomastoid muscle
  • Soft, movable, poorly delineated mass
  • Theories
    • Origin from remnant of branchial clefts
    • Remnant of salivary gland
261
Q

Cystic hygroma

A
  • Lymphatic malformation
  • May be present at birth
  • Slowly enlarges, may cause respiratory distress
262
Q

Unilocular radiolucent lesions in the pericoronal area

A
  • Dental follicle
  • Dentigerous cyst
  • Odontogenic keratocyst
  • Unicystic ameloblastoma
  • Ameloblastic fibroma
  • Adenomatoid odontogenic
263
Q

Unilocular radiolucent lesions periapical or other locations

A
  • Periapical granuloma or cyst
  • Nasopalatine duct cyst
  • Simple bone cyst (traumatic bone cyst)
  • Stafne bone cyst
  • Odontogenic keratocyst
  • Multiple nevoid basal cell carcinoma syndrome
264
Q

Unilocular lesions in pericoronal location

A
  • Dental follicle
  • Dentigerous cyst
  • Odontogenic keratocyst
  • Unicystic ameloblastoma
  • Adenomatoid odontogenic
265
Q

Unilocular lesions in periapical or other locations

A
  • Periapical granuloma or cyst
  • Nasopalatine duct cyst
  • Simple bone cyst (traumatic bone cyst)
  • Stafne bone cyst
  • OKC
  • Multiple nevoid basal cell carcinoma syndrome
266
Q

RL lesions w/ ill-defined borders

A
  • Periapical granuloma
  • Langerhans cell histiocytosis
  • Melanotic neuroectodermal tumor of infancy
  • Osteosarcoma
  • Ewing sarcoma
  • Soft tissue sarcomas of bone
  • Burkitt lymphoma
  • Leukemia
  • Metastatic tumors
267
Q

Simple bone cyst

A
  • Usually in mandible
  • Usually asymptomatic w/o expansion
  • Teeth are vital
  • May cross midline
  • Radiograph: Usually unilocular w/ scalloping b/w roots of vital teeth
  • Tx: Surgical exploration
268
Q

Stafne defect (Stafne bone cyst, static bone cyst)

A
  • Developmental cortical defect of the lingual mandible containing salivary gland tissue
  • Usually seen in adolescent males when it occurs in children
  • Represents submandibular fossa
  • Radiograph: Well-defined unilocular radiolucency of posterior mandible below mandibular canal; occasionally seen in anterior mandible
  • Tx: No tx

* (22 decks)

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