random theme 5/6 Flashcards
what is hairy tongue?
clinical manifestation of elongation of filiform papillae - no etiologic cause
asymptomatic
4 things hairy tongue is often a response to?
infection
fever
xerostomia
substances - antibiotics, tobacco
keratinolytic drug used for hairy tongue
podophydllin 25% in tincture of benzoin
what is geographic tongue
depapillation of the filiform papillae on the dorsal of the tongue causing erythmatosus configurations
often white border
microscopical signs of geographic tongue
loss of filiform papillae
elongated rete ridges
neutrophil accumulation in the superficial epithelium
what is median rhomboid glossitis?
rhomboidal or elliptical reddish smooth or nodular surface located in midline of tongue
often associated with candida
what are fordyce granules? how can they be removed?
manifestation of heterotic sebaceous glands
co2 laser therapy
what causes white sponge naevus?
mutation in keratin 13 or 4 - hyperkeratosis
features of white spongy naves?
asymptomatic, diffuse, bilateral, white lesions, shaggy/spongy/wrinkled surface
how to diagnose leukodema?
stretch buccal mucosa - opaque change will dissipate
difference between erosion + ulcerations
erosion - epithelium only
ulceration - whole epithelium breached
3 types of white oral lichen planus
- papular
- reticular
- plaque - like
when is lichen Planus most common + uncommon?
most common - posterior buccal mucosa
spread to tongue, gingiae, labial mucosa, vermillion of lower lip
uncommon - palate, FOM, upper lip
3 types of red oral lichen planus
- atrophic - erythematous
- erosive - ulcerative
- bullous - blisters
what is planopilaris?
Lichen Planus involving scalp + hair follicles
most common place to find lichen Planus skin lesions
volar wrists + forearms
what is lichen planus
chronic inflammatory disorder of stratified squamous epithelium
4 histopathological characteristic of lichen Planus
- hyperkeratosis
- civatte bodies - basal cell liquefaction with apoptic cells
- bank-like inflammatory infiltrate mainly composed of T cells
- absence of epithelia dysplasia
how to determine difference between LP + OLCL (oral lichenoid contact lesion)
cannot distinguish histologically
patch testing
what reaction can amalgam cause orally?
oral lichenoid contact lesion
which virus may cause oral lichen Planus?
HCV
2 features of OLP that cause increased risk of malignant transformation
reticular plaque
atrophic-erosive
5 special investigation in oral med
- blood test
- skin patch testing
- exfoliate cytology
- biopsy
- direct/indirect immunofluorescence
difference between direct + indirect immunofluroence
direct = detect in situ deposition of Ig and/or complements
indirect = detect circulating autoantibodies
colour coding scheme for oral lesions
green = GDP monitor amber = GDP in conjunction with specialist unit red = specialist referral centre
description of smokers keratosis
lesion on palate with small red spots
what virus causes oral hairy leukoplakia
EBV
what is hydroxychloroquine sulphate used to treat?
oral lichen Planus
skin condition associated with geographic tongue?
psoriasis
characteristics of aphthous ulcers/stomatitis
superficial oral mucosa ulceratin recurrent no obvious cause usually self limiting individual healthy occur on non-keratinised oral ep usually
difference between major and minor recurrent aphthous stomatitis
minor = 1-5 ulcers, lasts 7-14 days, no scarring
major = 1-2 ulcers, lasts >14 days, scar (deeper)§
what is herpetiform RAS
small ulcers merge to form irregular shaped larger ulcers
> 10 per crop
lasts 7-21days
+/- scarring
9 causes of RAS
- genetics
- haematinic deficiency
- food allergy
- gluten sensitivity
- sex hormones
- drugs - NSAIDs, B blockers, nicorandil
- immunodeficiency
- infections
- trauma
ulcers in systemic conditions too but not technically ras- behcets, reiters, cyclic neutropenia
deficiencies causing RAS
iron, folic, zinc, B1, B2, B6, B12
what is behcets disease?
recurrent oral ulceration with 2 of the following: recurrent genital ulcers, eye lesions, skin lesions, positive pathergy test
1st line of treatment for oral ulcers
topical corticosteroids
pemphigus lesions are threatening to what?
life
pemphigoid lesions are threatening to what?
sight
what causes pemphigus ?
anti-epithelial auto-antibodies against surface of the keratinocytes
characteristics of pemphigus
- blisters + ulcerations
- acantholysis
- intra-epithelial
- autoantibodies
- intracellular deposits of IgG + c3 in immunofluorescence
2 types of oral pemphigus
pemphigus vulgaris
pemphigus paraneoplastic
most common oral pemphigoid
mucous membrane pemphigoid (MMP)
process of diagnosising bullis disease
- history
- clinical evaluation
- direct immunofluorescence
- indirect IF, immunoprecepitation, ELISA
- diagnosis
what cell type is predominant in chronic inflammation/ granulomatosis
activated macrophages
4 clinical manifestations of orofacial granulomatosis
- erythema
- ulceration
- oedema
- tissue enlargement
3 types of infection granulomatous disorders
- TB
- tertiary syphilis - gumma
- mycotic granulomatous infection
bowel condition causing orofaical granulomatosis
crohns disease
triad for diagnosis of melkersson-rosenthal syndrome?
persistent orofacial swelling
fissured tongue
facial paralysis
7 causes of non-infectious orofacial granulomatosis
- idiopathic OFG
- crohns
- melkerson-rosenthal syndrome
- cheilitis granulomatosis of miescher
- sarcoidosis
- wegeners granulomatosis
- foreign body reaction
what is chelitis granulomatosa
painless enlargement of 1/both lips - recurrent
triad to diagnose wegeners granulomatosis
- necrotising granulomatous lesions upper/lower respiratory tract
- systemic vasculitis
- necrotising glomulonephritis
what is sarcoidosis
multisystem granulomatous disorder of unknown cause
what is orofacial granulomatosis
persistent enlargement of face/oral cavity
caused by inflammation
orofacal manifestations of granulomatosis
soft tissue swellings
major salivary gland enlargement - mainly parotid
ulcerations
bacteria causing TB
mycobacterium tuberculosis/tb bacilli
staining test for TB
ziehl Neelson
colour of amalgam tattoo
grey-blue
histology of malanotic macule
increased melanin pigmentation in basal cell layer
no increase in melanin number
how to tell difference between freckle + melanotic macules
freckle = worse with sun melanotic = no change with sun
what is naevi
mole - proliferation of melanocytes
how would you treat oral naevi
excision - may be melanoma
what is melanoma
aggressive tumour of melanocytes
where are melanomas mostly found
hard palate, gingiva, tongue
clinical appearance of melanomas
pigmented plaques with asymmetrical irregular borders
dark brown/black (5-15% amelanotic/pink)
rapidly enlarging nodes causing - ulcers, bleeding, pain, tooth mobility
normally metastic not primary
2 types of oral melanomas
radial growth phase - in situ
vertical growth phase - invasive
clinical appearance of smokers melanosis
patchy brown macular pigmentations - buccal mucosa
histology of smokers melanosis
basilar melanosis without melanocyte proliferation
oral manifestation of peutz-jehgers syndrome
lips + buccal mucosa pigmentation
GI involvement too
most common drug induced pigmentation
minocycline induced pigmentation
6 options for peripheral diagnosis of soft tissue lump
cyst abscess granuloma hyperplasia neoplasia benign neoplasia malignant
6 examples of hyper plastic soft tissue lumps
fibroepithelial polylp pyogenic granuloma epulides denture granuloma squamous cell papilloma mucoceles
what is an epulis
any swelling on gingiva
development or reactive (calculus, partial)
When to treat OLP
if erosive or symptomatic
treatment options for OLP
- high potency topical steroids
- systemic steroids or ciclosporin if SS contradicated
SS +/- azathiopine
treatment order of minor RAS
- chlorhexidine mouthwash
- topical steroids
- systemic steroids
treatment of major RAS
- topical steroids
2. systemic steroids
treatment of herpetiform
systemic steroids
then topical
treatment for MMP or PV
topical or systemic steroids with adjunct agents
or other immunosuppressants if contraindicated
