Term
| Mucous Membrane Disorders Often present as ____ lesions or ulcers and erosions. Biopsy lesions and nonhealing ulcers/erosion to rule out ____ |
|
Definition
|
|
Term
| _____ = mucosal epithelium partly denuded |
|
Definition
|
|
Term
| _______= extend through the epidermis into the underlying tissue, the lamina propria |
|
Definition
|
|
Term
white lesions
______ of the oral mucosa
Thickened ____ appears white
Malignancy must be ruled out |
|
Definition
Hyperkeratosis
stratum corneum |
|
|
Term
_____ is superficial and will not leave a scar
_____ will leave a scar |
|
Definition
|
|
Term
| Most common cause of recurrent oral ulcers? |
|
Definition
|
|
Term
| Aphthous Stomatitis: Ulcers have a ____ base and peripheral ____. Multiple therapies indicate a lack of effective treatment |
|
Definition
|
|
Term
| _____: Common, recurrent, idiopathic disorder of mouth presenting as small punched out ulcers. |
|
Definition
|
|
Term
| Aphthous Stomatitis Incidence: |
|
Definition
| Common, 20-60% general population. Most common cause of oral ulceration. |
|
|
Term
| Aphthous Stomatitis History: precipitated by ____ (biting, misguided toothbrush), emotional stress, prodrome __ day prior of discomfort in area, ulcers ____, especially with eating |
|
Definition
|
|
Term
| Aphthous Stomatitis Physical Examination: 2-5 mm round, ________ ulcers with a yellowish necrotic surface and surrounding _____. Single or multiple, found on ____ and ____ mucosa. |
|
Definition
punched out
erythema
buccal
labial |
|
|
Term
Aphthous Stomatitis Differential Diagnosis:
(1)____ - which rarely recurs inside mouth.
(2)____ -has triad of oral ulcerations, genital ulcerations, and ocular inflammation (iridocyclitis).
(3)____ , e.g. Ulcerative colitis |
|
Definition
herpes simplex
Behcet’s syndrome
Inflammatory bowel disease |
|
|
Term
| Aphthous Stomatitis Laboratory and Biopsy: ____ not needed, will show ulceration and nonspecific ulceration. Get ____ - questionable association with ____ or ____ deficient anemia. |
|
Definition
|
|
Term
Aphthous Stomatitis
Therapy:
Treatment can be difficult.
Correct ____ if present
_______ swish and swallow
Topical steroids, e.g. ______in Orabase, intralesional injections for large ulcers
Oral steroids for severe incapacitating disease
Topical anesthetics, e.g. viscous ____ |
|
Definition
anemia
Tetracycline
triamcinolone
Xylocaine |
|
|
Term
Aphthous Stomatitis Course and Complications:
Minor cases spontaneously heal in 4-14 days
Major ulcers can take as long as 6 weeks
If lasts longer than ___ weeks, biopsy to rule out malignancy
____ are common- occasional to almost continuous
Usually eventually remits- may take 5 to 15 years or longer |
|
Definition
|
|
Term
| Aphthous Stomatitis Pathogenesis: (5) |
|
Definition
Emotional and physical stress
Hormones
Infection
Autoimmunity
Circulating T lymphocytes cytotoxic against oral mucosa |
|
|
Term
Thrush (Oral Candidiasis)
Common in _____ & _______ adults
Appears as ____ patches that easily scrape off
Treat with topical or oral ___ |
|
Definition
newborns & immunosuppressed
white
antifungals |
|
|
Term
| ______: Infection of the oral epithelium with Candida albicans- appears white and can be scraped off leaving an inflamed base. |
|
Definition
| Thrush (Oral Candidiasis) |
|
|
Term
Thrush (Oral Candidiasis)Incidence
most common in ___
____ wearers
____ patients |
|
Definition
newborns
Denture
Immunosuppressed |
|
|
Term
Thrush (Oral Candidiasis) History
Mothers of infected newborns usually have ____ candidiasis
Predisposing factors: (4) |
|
Definition
vaginal
Dentures
Steroids, e.g. aerosolized inhalers for asthma
Antibiotics
immunosuppression |
|
|
Term
| Thrush also occurs in patients with __________, a rare disorder in which chronic mucous membrane infection is accompanied by skin and nail involvement. |
|
Definition
| chronic mucocutaneous candidiasis |
|
|
Term
Thrush (Oral Candidiasis) Physical Examination
White curd like material on ____ & ____ mucosa- can be easily scraped off leaving a ____ base
Remove dentures if present to evaluate
Angles of mouth may be involved, called ______.
Confirm with _____ |
|
Definition
tongue and buccal
erythematous
angular cheilitis
KOH preparation |
|
|
Term
| Thrush Differential Diagnosis (1) |
|
Definition
| Lichen Planus- not easily scraped off like thrush |
|
|
Term
Thrush Laboratory and Biopsy
KOH preparation- slide will show ___ & ____
If no predisposing factors (dentures/antibiotics/steroid inhalers), rule out ____ infection |
|
Definition
hyphae and pseudohyphae
HIV |
|
|
Term
Thrush Therapy
Infants and Children
None
____ suspension swish and swallow
____ oral suspension
Adults
_____ swish and swallow
_____ (Sporanox) swish and swallow
Oral _____
Oral _____
Soak acrylic dentures in dilute ____ solution, use ____ for metal partial dentures |
|
Definition
Nystatin
Fluconazole
Nystatin
Itraconazole
Fluconazole
Ketoconazole
Peridex
Clorox |
|
|
Term
Thrush Course and Complications
Spontaneously clears in ___, use medication to speed healing
____therapy to treat recurrent and chronic infections in immunocompromised patients
Complications uncommon |
|
Definition
|
|
Term
| Thrush Pathogenesis: Pathogenesis of candidal infections is discussed in CH 12. |
|
Definition
|
|
Term
Lichen Planus: Characteristic ____ pattern on buccal mucosa
Diagnosis confirmed by ___
_____ to treatment |
|
Definition
|
|
Term
Lichen Planus Definition
Oral lesions occur alone or with ___ lesions
Oral lesions characterized by ___ and ____ - lesions most commonly in the form reticulated papules and lines that assume a ____ pattern
Erosive lichen planus is a less common variant
Origin unknown |
|
Definition
skin
inflammation & hyperkeratosis
lace like |
|
|
Term
Lichen Planus Incidence
most common cause of ____ lesions in the mouth.
0.5%-1% of patients at the dentist
Highest incidence in ____--____ year olds |
|
Definition
|
|
Term
Lichen Planus History
Drugs: (4)
Drugs can be causative
Usually no symptoms
Erosive type ____, especially with eating
Accompanying skin lesions usually ___ |
|
Definition
quinidine
quinicrine
sulfonylureas
tetracycline
painful
pruritic |
|
|
Term
Lichen Planus Physical Examination
Reticulated lace like pattern, especially ___ mucosa, is characteristic
____ lesions accompany oral lichen planus in up 40% of cases |
|
Definition
|
|
Term
Lichen Planus Differential Diagnosis
(1) _____ - scrapes off easily and hyphae & pseudohyphae found on KOH slide
(2) _____ - Rule out with biopsy
(3) _____ -Rule out with serologic test. Likely will have accompanying rash, fever, lymphadenopathy |
|
Definition
Candidiasis
Leukoplakia
Secondary syphilis |
|
|
Term
Lichen Planus Laboratory and Biopsy
Clinically diagnoses based on the characteristic ___ pattern
Biopsy is diagnostic
Biopsy shows ___ |
|
Definition
reticulated
hyperkeratosis |
|
|
Term
Lichen Planus Therapy:
More resistant to treatment than ___ lesions
Asymptomatic lesions requires no therapy
Topical therapy: steroids (e.g. ___ gel 0.05%), ____ gel 0.024%, ____ solution
Intralesional ____ (Kenalog) injections
Systemic therapy reserve for extremely severe disease (3) |
|
Definition
skin
fluocinonide
Tretinoin
Cyclosporine
triamcinolone
Prednisone
Acitretin
cyclosporine |
|
|
Term
| ______ White plaques that can signify cancer |
|
Definition
|
|
Term
| Leukoplakia: indurated ___ plaques that require biopsy. ____ is the most frequent cause |
|
Definition
|
|
Term
Leukoplakia Definition:
White patch or plaque with pathologic epithelial ____
White color due to macerated ____
Hyperkeratosis due to ____, e.g. dentures, ragged teeth, but most often cigarette smoking or chewing tobacco |
|
Definition
dysplasia
hyperkeratosis
irritation |
|
|
Term
|
Definition
| Uncommon, primarily middle aged and the elderly |
|
|
Term
Leukoplakia History
Onset is ____ and usually asymptomatic
May be irritated and thus seek medical attention
Most patients use ___ |
|
Definition
|
|
Term
Leukoplakia Physical Examination
White patch or plaque on mucous membrane
Surface ___ or ____
Pure white to gray
Located anywhere in the mouth, ____ most common
ALL WHITE PLAQUES SHOULD BE _____
_____ AREAS MUST BE EXAMINED BY BIOPSY TO RULE OUT CANCER |
|
Definition
flat or verrucous
tongue
PALPATED
INDURATED |
|
|
Term
Leukoplakia Differential Diagnosis - depends on biopsy
(1) ____- distinctive reticulated lacy pattern
(2) ____ - usually had rash and other constitutional symptoms
(3) ____ - a hereditary condition that begins in child hood, appears spongy
(4) ____ - a diagnosis of exclusion
(5) ____ - affects the sides of the tongue and occurs almost exclusively in AIDS patients and is cause by infection with Epstein-Barr virus. |
|
Definition
Lichen planus
Secondary syphilis
White sponge nevus
Leukokeratosis
Oral hairy leukoplakia |
|
|
Term
| Oral hairy leukoplakia is associated with ___ |
|
Definition
|
|
Term
Leukoplakia Laboratory and Biopsy
Histopathology includes hyperkeratosis, acanthosis, and inflammation
Epithelial changes similar to actinic keratosis
Cellular pleomorphism
Increased mitotic figures
Derangement of usual orderly architectural pattern of stratified epithelium
Carcinoma in situ when entire thickness of epithelium has dysplastic changes
Invasion into the lamina propria signifies squamous cell carcinoma |
|
Definition
|
|
Term
Leukoplakia Therapy:
Cessation of ___ use
Eliminate source of ___ trauma
_____ of superficial lesions
- Cryosurgery
- Carbon dioxide laser
- Shave excision
Topical _____
Systemic _____
Excision is cancer is suspected |
|
Definition
tobacco
physical
Ablation
bleomycin
retinoids |
|
|
Term
Leukoplakia Course and Complications
________ develops in 30% of patients with dysplastic leukoplakia
May spontaneously resolve when aggravating factor are withdrawn |
|
Definition
|
|
Term
Leukoplakia Pathogenesis
Induced by chronic, mild irritation from physical, chemical, or inflammatory processes
____ most common cause- heat may also contribute
____ implicated in some cases |
|
Definition
Smoking
Human papillomavirus |
|
|
Term
____ & ____ are autoimmune chronic blistering diseases with prominent or predominant mucosal involvement. ___ 90% have oral lesions, 50% of the time the lesions begin in the mouth.
Fragile blisters are easily broken so ____ are the usual finding.
______ are directed against mucosal epithelia
Diagnosis via _____ of biopsied mucosa |
|
Definition
Pemphigus vulgaris & mucous membrane pemphigoid (aka cicatricial pemphigoid)
Pemphigus vulgaris
erosions
Autoantibodies
direct immunofluorescence |
|
|
Term
Herpes: Accompanied by ___ and regional ___ and lasts for 2-3 weeks.
Herpetic gingivostomatitis
Often accompanied by lesions on the lips and perioral skin |
|
Definition
|
|
Term
Coxsackievirus
A-__ strain causes herpangia
Vesicular eruption in the back of the ___ lasting 7-10 days
A-__ strain causes hand, foot and mouth disease
Distinctive disorder characterized by small "____" shaped vesicles in the ___ and accompanied by similar lesions on the palms and soles |
|
Definition
|
|
Term
Syphilis
Primary lesion is a ____
Appears as a single, ___ , punched-out ulcer and characteristically feels ____.
Dark field examination of an oral chancre must be interpreted with caution as nontreponemal spirochetes normally colonize the mouth.
If doubt exists, get a VDRL or RPR. If result is negative retest in ___ month |
|
Definition
chancre
painless
indurated
one |
|
|
Term
Histoplasmosis
Oral ulcerations occur ____ in patients with disseminated systemic fungal infections
___ with special stains and cultures confirms the diagnosis |
|
Definition
|
|
Term
CANCER
Most common cause is ___ carcinoma
Intraoral squamous cell carcinoma more likely to metastasize than ____ squamous cell carcinoma
___ & ___ can also cause oral ulcers
Malignant tumors in the mouth can erode and result in ___
Lesions are characteristically indurated- _____!
Biopsy is diagnostic |
|
Definition
squamous cell
cutaneous
Lymphomas and leukemias
ulceration
palpate |
|
|
Term
Select the description most consistent with thrush (oral candidiasis).
Round, punched-out ulcer with a white-yellow necrotic surface.
White curd-like plaques that are easily scraped off.
Reticulate, lace-like pattern of lines and papules on buccal mucosa.
White and ulcerated nodule with a hard, indurated base.
Ulcerated lesions, often with vesicles and ulcers of the outer lip. |
|
Definition
| White curd-like plaques that are easily scraped off. |
|
|
Term
2. What is the most common origin of leukoplakia?
Smoking
Dentures
Ragged teeth
Cold beverages
Bacterial Overgrowth |
|
Definition
|
|
Term
3. What is the most common cause of oral ulceration?
Lichen planus
Leukoplakia
Thrush (oral candidiasis)
Aphthous stomatitis
Smoking |
|
Definition
|
|
Term
4. Select the description most consistent with aphthous stomatitis
Round, punched-out ulcer with a white-yellow necrotic surface.
White curd-like plaques that are easily scraped off.
Reticulate, lace-like pattern of lines and papules on buccal mucosa.
White and ulcerated nodule with a hard, indurated base.
Vesicles and erosions |
|
Definition
| Round, punched-out ulcer with a white-yellow necrotic surface. |
|
|
Term
|
Definition
|
|
Term
|
Definition
| chronic mucocutaneous candidiasis |
|
|
Term
|
Definition
| cosxackievirus A16 hand foot & mouth disease |
|
|
Term
|
Definition
| coxsackievirus A4 herpangia |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| pemphigus vulgaris & mucous membrane pemphigoid |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
