Red lesions part 2

Question 1

For arteriovenous malformation (AVM), state:
• What it is 
• Places of occurrence
• Negative effects (6)
• Treatment

Answer 1

What it is:
• Abnormal connections between arteries and veins which permit blood to bypass the capillary network (loss of normal pressure down regulation)
• Causes: Congenital, secondary to trauma

Places of occurrence:
• Mandible

Negative effects:
• Pain
• Hypertrophy
• Bleeding
• Enlargement of bone
• Mobile teeth
• Can cause torrential haemorrhage 

Treatment:
• Refer for embolization, surgery
• DO NOT SCALE OR INJECT NEAR LESION

Question 2

Define petechiae and purpura

Answer 2

• Petechiae: red/purple dots that represent bleeding from leaking capillaries
• Purpura: Petechiae that have coalesced and become bigger

Question 3

List some reasons behind petechiae and purpura

Answer 3

• Thrombocytopenia (low platelet count]) may be detected initially in the oral mucosa
• Minor trauma to the oral mucosa during routine function (such as chewing or swallowing) may produce various types of haemorrhagic lesions, including petechiae, purpura, ecchymosis, haemorrhagic bullae, and hematoma formation.

Question 4

Define mucous membrane pemphigoid in terms of what it is and its characteristics

Answer 4

• Rare. Increases with age
• Autoimmune: IgG autoantibodies against hemidesmosomes (connect epithelial cells to the basal layer)
• Direct immunofluorescence shows linear deposition of IgG in the basement membrane
• Subepithelial blistering disease

Question 5

List the oral signs of mucous membrane pemphigoid and its treatment

Answer 5

• Desquamative gingivitis, pain, dysphagia
• Oral mucosa (85%), Ocular (65%) but can also present nasal, pharyngeal, esophageal and laryngeal mucosa.
• Tx: steroids, steroid sparing agents, biologics (rituximab)

Question 6

Define pemphigus vulgaris in terms of what it is and its characteristics

Answer 6

• Autoimmune: autoantibodies against desmosome proteins (holds epithelial cells together), resulting in loss of cell adhesion between keratinocytes
• Direct immunofluorescence shows binding of IgG on the epithelial cell surface which may be smooth or granular
• Most likely to have rupturing blisters

Question 7

For pemphigus vulgaris state its signs and symptoms treatment

Answer 7

• Desquamative gingivitis, pain, dysphagia

* Tx: steroids, steroid sparing agents, biologics (rituximab)

Question 8

For oral lichen planus state what it is and how it looks

Answer 8

What it is:
• Destruction of the basal keratinocytes by activated CD8 T lymphocytes

How it looks:
• Reticular (fine white striae cross each other in the lesion)
• Often appears bilaterally
• Areas can be painful, atrophic, erythematous erosions and ulcerations, which may be present for several months or longer

Question 9

For oral lichen plants, state the 5 types

Answer 9

5 types:
• Atrophic (areas of erythematous lesion surrounded by reticular components
• Papulartype
• Bullous type
• Plaque type
• Erosive or ulcerative type

Question 10

For erosive oral lichen planus state why it is concerning and how it is treated

Answer 10

• Biopsy to rule out malignancy (higher risk in erosive form, female, tongue*)
• Tx: Steroids, Steroid sparing agents

Question 11

List the 8 oral manifestations of megaloblastic B12 iron deficiency anaemia

Answer 11

• Mucosal pallor
• Atrophic glossitis
• Angular cheilitis
• Burning sensation of oral mucosa (oral dysaesthesia)
• Oral candidiasis
• Recurrent aphthous ulcers
• Dry mouth (xerostomia)
• Dysfunction of taste (dysgeusia)