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Oral Medicine > Colors of Oral Path > Flashcards

Colors of Oral Path Flashcards

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1
Q

What is normal dependent on?

A
  1. Race dependent
  2. Location dependent
  3. Pink!
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2
Q

what is the “normal” pink caused by?

A
  1. epithelium is semi-transparent/pale white

2. extensive capillary bed beneath show through = pink

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3
Q

What is the darker red vestibular mucosa/FOM mucosa caused by?

A

nearness of vascularity to the surface

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4
Q

What causes the lighter pink on hard palate and attached gingiva?

A

increased thickness of overlying epithelium

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5
Q

DX: an intraoral white plaque that does NOT rub off and can not be identified as any well known entity

A

Leukoplakia
TX: When in doubt cut it out. Remove obvious frictional causes, biopsy after two weeks

  • alveolar ridge = frictional keratosis from denture
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6
Q

5 white lesions that CAN be scraped, rubbed or pulled off

A
  1. Materia Alba
  2. white coated tongue
  3. burn (thermal, chemical, cotton roll)
  4. pseudomembranous candidiasis
  5. toothpaste or mouthwash overdose
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7
Q

White coated Tongue

A

Aysmptomatic

Tx: tongue scraping or brushing

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8
Q

Pseudomembranous Candidiasis

A

TX: antifungal prescription
Nystatin (Mycostatin)
Clotrimazole (Mycelex)
Nystatin/trianicinolone acetonide ointment (Mycolog II)

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9
Q

Bilateral on buccal mucosa at occlusal plane from friction, sucking

A

Linea Alba “white line”

Tx: no treatment

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10
Q

Bilaterally present in 70-90% of Blacks; diffuse grayish-white milky opalescent appearance

A

Leukoedema
Tx: no treatment is necessary
make sure that disappears when the cheek is stretched

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11
Q

Caused by reverse smoking. Heat causes salivary gland orifices to open = red dots

A

Nicotine Stomatitis

tx?

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12
Q

soft, fissured gray-white lesion of the mucosa located in the area of chronic snuff placement

Usually young males, gingival recession and root caries

A

Tobacco Pouch Keratosis (smokeless tobacco pouch, snuff pouch, spit tobacco keratosis)
Tx: cessation of “dipping” and then need to check again. try and plug around to different sites. If doesn’t go away then BIOPSY.

  • can progress from dysplasia to verrucous carcinoma
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13
Q

most common lesion Caused by EBV in AIDS pts
In patients with HIV and AIDS
Sign of sever immune depression and advanced disease
White mucosal plaque that doesn’t rub off
Lateral border of tongue

A

Oral Hairy Leukoplakia

tx: treat AIDS

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14
Q

Whickham Striae
2 forms erosive and reticular

Chronic muco-cutaneous disease

4 Ps: Purple, pruritic, polygonal, papules

saw tooth rete ridge, band like lymphocyte inflitration

A

Lichen Planus

Treatment: Steroids (Temovate, decadron, lidex .05% ointment or gel)
biopsy erosive anywhere, maybe reticular on gingiva/tongue

Nikolsky Test: air/water syringe positive = pemphigus vulgaris, mucous membrane pemphigoid

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15
Q

What are the 4 levels of Leukoplakia?

A
  1. Normal
  2. Hyperkeratosis
  3. Epithelial Dysplasia
  4. invasive squamous cell Carcinoma
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16
Q

localized bony protuberance arising from the cortical plate

A

Torus Palatinus/Mandibularis
Tx: None unless,
1. repeated trauma and ulceration usually removed at patient’s request
2. preprosthetic surgery before complete or partial denture construction

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17
Q

most common: lips, tongue, buccal mucosa

1-2 lesions, .5-1 cm in diameter

Etiology: different things in different ppl –> autoimmunes, hypersensitivity, stress (THEORY)

A

Recurrent Apthous Ulcerations (major, minor, herpetiform)

TX: avoid food if that is causing the hypersensitivity

Temovate
Decadron
Lidex
Kenalog

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18
Q

unique form of chronic traumatic ulceration with deep pseudoinvasive inflammatory process and slow to resolve

A

TUGSE: traumatic ulcerative granuloma with stromal eosinophilia

TX.: incisional biopsy

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19
Q

inflammatory process that arises withing the tissues, surrounding the crown of a partially erupted tooth

A

Pericornitis

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20
Q

accumulation of acute inflammatory cells at the apex of a nonvital tooth

A

periodontal abscess

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21
Q

Most common benign neoplasm of the oral cavity on buccal mucosa > labial mucosa > tongue> gingiva

Reactive hyperplasia of fibrous connective tissue in response to local irritation or trauma

A

Fibroma

tx: surgical excision

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22
Q

Ectopic sebacceous glands on buccal mucosa and then lips

A

Fordyce Granules

No treatment

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23
Q

benign proliferation of blood vessels

10-12% children

clinically blanches under pressure

10-12% children

Syndromes: SturgeWeber Angiomatosis

A

Hemangioma

Tx: surgery, laser, embolization,
clinical observation, removal, sclerotherapy

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24
Q

Benign proliferation of squamous epithelium (HPV 6 & 11) on tongue > soft palate

A

Papilloma

Tx: surgical excision

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25
variations of papilloma
Verruca vulgaris, Condyloma Acuminatum, Focal Epithelial Hyperplasia, Sinonasal papilloma
26
Focal inflammatory fibrous hyperplasia at the flange of an ill fitting denture Single or multiple folds of tissue in the vestibule
Epulis Fissuratum TX: surgical excision with relining or remaking of the denture
27
superficial dilated veins not associated with HTN or cardiopulmonary disease Most common sublingual
Varicosities (sulingual varix) Tx: NONE, unless solitary varicosities on the lips or buccal mucosa because of thrombus formation or esthetics
28
numerous grooves or fissure on the dorsal tongue, 2-6 mm deep with unknown cause (possibly hereditary)
Fissured Tongue Tx: brush the tongue
29
Inflammatory condition: asymptomatic with rare cases of sensitivity to hot or spicy foods
Geographic Tongue Tx: None unless symptomatic and then use magic mouthwash
30
denture papillomatosis: reactive tissue growth that develops under a denture in patients with ill fitting denture, poor denture hygiene and wearing denture 24 hrs a day
Papillary Hyperplasia tx: surgical excision (scapel, electro-cryo-laser surgery) then reline or remake of the denture possible antifungal tx...??
31
Initial exposure of HSV 1/2 between 6 mos- 5 years of age
Acute Herpetic Gingivostomatitis
32
Labialis, intraoral recurrent, whitlow, keratoconjuctivitis
Recurrent Herpetic Infections dx: serology, virus isolation, biopsy, cytology
33
Herpes Treatment
Acyclovir 5% ointment (zorivax), 15 gm tube apply 5x daily with finger at first symptom Acyclovir 200 mg capsules. dispense 50 and take 1 cap 5x daily Start during prodromal stages
34
rupture and spillage of saliva into the soft tissue related to trauma MC in lower lip
Mucocele (Ranula in FOM) TX; surgical excision along with the feeder gland
35
Post trauma and post surgical locations
Scar tissue Tx: NONE
36
"Perleche" fungal infection at corners of the mouth 20% candida albicans 20 % staphylococcus aureus alone 60% combination of both Causes reduced vertical dimension, salivary pooling, candidiasis
Angular Cheilitis TX: antifungals+ multivitamins Mycolog 2: nystatin and triaincinolone acetonide ointment Disp 15 gm apply sparingly to affected areas 4xday increase the vertical dimension
37
Lymphoid hyperplasia on the posterior lateral borders of the tongue, bilateral
Lingual Tonsil TX: None
38
Accumulation of blood within the tissues secondary to trauma Does not blanche
Hematoma Tx: none
39
Chronic Cheek biting | 2F: 1M
Morsicatio buccarum, labiorum, linguarum Tx: none or bite guard
40
Bony protuberances on the buccal of the mandible and/or maxilla
Buccal Exostoses Tx: Removal only with chronic repeated trauma or preprosthetic surgery
41
implantation of dental amalgam into oral soft or hard tissue
Amalgam Tattoo tx: none, however radiograph and then biopsy may be necessary to rule out melanoma
42
focal melanosis "oral freckle" Solitary well-demarcated tan to dark macule Melanin pigmentation is in the basal cell layer lower lip > buccal mucosa > gingiva
Oral Melanotic Macule tx: none, however biopsy may be indicated to rule out melanoma
43
central papillary atrophy of the tongue; asymptomatic erythematous zone in the midline posterior dorsal tongue. form of erythematous candidiasis
Median Rhomboid Glossitis tx: antifungals and brushing of the tongue
44
elongation and retention of the filiform papillae often due to increase keratin production and decrease in keratin desquamation. many pts are heavy smokers, bad hygiene, ABX, radiation therapy
Black Hairy Tongue tx: tongue brushing/scraping with OHI is adequate tx
45
from pernicious anemia, medication, avitaminosis
Smooth Red Tongue Tx: find the underlying cause and stop it
46
Skin cysts associated with inflammation of a hair follicle. Oral cysts occur in the midline of the FOM Slow growing, painless, rubbery mass
Epidermoid Cyst Tx: surgical removal
47
Benign tumor of fat more likely on buccal mucosa > tongue : FOM > lips
Lipoma tx: surgical excision, place in formalin and see if it floats
48
Thickened epithelial white lesions?
Hyperkeratosis, acanthosis, dysplasia, carcinoma
49
White lesions from decreased vascularity?
Anemia (palor)
50
white lesions from increased collagen
submucous fibrosis
51
What causes red lesions?
Thinner epithelium, increased vascularity, dissolution of the collagen content of the subepithelial tissue.
52
Wright's Lesion full name?
Localized juvenile spongiotic gingival hyperplasia
53
What causes blue lesions?
Venous blood collection as opposed to the red of arterial blood collection, tyndall effect, medications (antimalarial agents, lupus erythematosis, RA)
54
What causes black lesions?
Melanin (pigment produced by cells called melanocytes. acs as a sunscreen and protects skin from UV light), heavy metals (amalgam, iron, bismuth)
55
What causes brown lesions?
Melanin, hemosiderin (yellowish brown granular pigment formed by breakdown of hemoglobin, found in phagocytes)
56
What causes yellow lesions?
Adipose tissue, sebaceous material (skin oil) as noted in fordyce granules, pus as it is a collection of necrotic material, PMNs, and lymphocytes
57
Order of colors
White > Red> Black > Blue> Yellow
58
Snuff Dipper's Cancer low-grade variant of oral SCC can be caused by smokeless tobacco mandibular vestibule and gingiva
Verrucous Carcinoma tx. surgical excision without neck dissection
59
Differential for desquamative gingivitis?
Lichen planus, Mucous membrane pemphigoid, pemphigus vulgaris, hypersensitivity, systemic lupus erythematosus
60
What is the Rx for Temovate?
Clobetasol Proprionate Gel, .05% Disp: 15 or 30 gm tube Sig: dry the affected area and gently apply a thin amount bid-tid highest potency If only 1 ulcer heal within a weak-- no refills! Use: lichen planus, desquamative gingivits, RAU
61
What is the Rx for Decadron?
Dexamethasone elixir .5 mg/5 ml Disp: 12- 16 oz (2 100 ml bottles) Sig: rinse with 1 tsp for 3-4 min after meals and at bedtime and spit out Usually about 3 refills moderate potency steroid Rinse! WHEN ulcers all over the mouth, or back down to soft palate Use: lichen planus, RAU
62
What is the Rx for Lidex?
Fluocinonide .05 % gel disp: 15 or 30 gm tube Sig: dry the affected areas and gently apply a thin amount 3-4 times daily moderate potency Warn about the black box--> the amount using intraorally is okay Use: lichen Planus, RAU
63
acute or chronic trauma can cause surface ulcerations
traumatic ulceration Tx: Intralesional Injections w Kenalog when topicals don't work steroid + antibiotics Kenalog 10 (10 mg/ml), Kenalog 40 (40 mg/ml) 10 mg per cm of lesional tissue 1 ml of Kenalog 10 for 1 cm or .25 ml of kenalog 40 Triamcinolone Acetonide .5 %
64
what is the treatment for desquamative gingivitis?
Biopsy for confirmation, topical steroids
65
What is the Rx for Prednisone?
If GEL not working and it is systemic for pemphigoid, pemphigous, lichen planus 10 mg tabs Disp: 40 Sig: 2 tabs bid for 7 days, then 1 tab bid for 4 days, then 1 tab daily till gone
66
denture wearer and doesn't take out and clean at night and get candidiasis underneath. Types of Erythematous candidiasis
Denture Stomatitis
67
What are the various forms of candidiasis?
1. White pseudomembranous, Erythematous (central papillary atrophy of tongue/ median rhomboid glossitis, angular cheilitis, denture stomatitis)
68
What is the Rx for Nyastatin rinse Mycostatin?
Nystatin Oral suspension 100,000 units/ml disp: 180 ml Sig: rince with 1 tsp for 3-4 mine qid and expectorate or swallow if affecting soft pharynx
69
What is the Rx for Mycolog II ointment?
Triamcinolone .1% and Nystatin 100,000 units/gram ointment disp: 15 gm/tube sig: apply sparingly to affected areas qid If recurrs frequenlty then use a 30 gm tube
70
What is the Rx for Mycelex troche?
Clotrimazole troche 10 mg disp: 50 sig: dissolve 1 tab slowly in mouth 5x daily Use: when patient have fungal infection but has active caries or dry mouth .
71
Enlargement of lymphoid tissue typically due to infection
Lymphoid Hyperplasia tx: asymmetry is potentially serious sign. usually biopsy if necessary to establish dx. Once dx confirmed no tx required
72
Intraoral red patch that cannot be clinically diagnosed as any other condition. MC: FOM, tongue, soft palate
Erythroplakia
73
If there is pigmentation limited canine to canine on a white patient what is it?
Smoker's Melanosis
74
benign localized proliferation of cells from the neural crest
Intramucosal nevus
75
acquired pigmentation of the oral mucosa that appears to be reactive process due to trauma that results in melanoctes throughout epithelium MC: buccal mucosa in African Americans
Oral Melanoacanthoma Incisional biopsy is indicated to rule out melanoma No further tx necessary, lesions can regress
76
malignant neoplasm of melanocytic origin that arises from a benign melanocytic lesion or de novo from melanocytes within otherwise normal skin or mucosa Damage from UV radiation is a major causative factor (also fair complexion, light hair, sunburn easy, painful sunburns as child,
Melanoma Tx: Surgical excision is the treatment of choice with a 3-5 cm margin
77
epithelium lines cavity that arises from salivary gland tissue. most often in parotid gland, FOM, buccal mucoa, lips Bluish from the tyndall effect
Salivary Duct Cyst Tx: Surgical excision
78
Uncommon benign proliferation of dermal melanocytes | Appears blue due to tyndall effect
Blue Nevus tX: conservative surgical excision with minimal chance of recurrence
79
- most common malignant salivary neoplasm - most common malignant salivary gland tumor in children - affect parotid most often then minor glands - blue
Mucoepidermoid Carcinoma
80
Develops within oral lyphoid tissue on (FOM, ventral tongue, soft palate) and presents as a white or yello asymptomatic submucosal mass less than 1 cm in diameter
lymphoepithelial cysts Tx: Biopsy or clinical diagnosis
81
benign soft tissue neoplasm that show a predilection for the oral cavity. Most common site is the tongue (dorsal) Yellow, mucosal colored, in African Americans
Granular Cell Tumor
82
Dry mouth medications: antidepressants, antianxiety, beta blocker Sleep aids like ambient
Xerostomia Tx: Biotene Products, Mouth Kote 1. Sip water during day 2. suck on ice 3. discontinue alcohol, caffeine, soda 4. humidifier at night 5. lubricate lips 6. Fl supplementation
83
What is the Rx for Salagen?
Pilocarpine 5 mg tablets disp. 90 tablets Sig: 5 mg TID for first month and then titrating to max dose of 30 mg per day depending upon response and tolerance Use: DRY MOUTH from radiation/chemo, sjogren's syndrome Meds with anticholinergice effects counteract (benadryl, antidepressants)
84
What can be used for dry lips?
1. chapstick 2. aquaphor 3. blistex complete 4. lanolin
85
what is the Rx for abreva?
Docosanol 10% cream | non prescription product that comes in a 2 gram tube. a thin amount is applied to the affected are 5x a day
86
Burning Mouth Treatment
1. lubrication 2. candidiasis treatment 3. nutritional treatment (B12, Folate, Iron, Zinc) 4. diabetic control 5. eliminate triclosan/tarter control products 6. switch hypertensive medication if on ACE- inhibitor 7. clonazepan .5 mg tablet. Start with dissolving half a .5 mg tab bid and slowly increase to 1 mg bid *2 tabs) 8. alpha lipoic acid 9. capsaicin
87
What is the Rx for Magic mouthwash?
equal parts maylox, benadryl, lidocaine vious 2 % soothes and calms Disp 240 ml Sig: rinse with 1-2 tsp for 2 min and expectorate

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