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Oral Medicine > Colors of Oral Pathology I > Flashcards

Colors of Oral Pathology I Flashcards

1
Q

what is considered “normal” pink color?

A
  • epithelium is semi-transparent/pale white
  • extensive capillary bed beneath shows through = pink
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2
Q

where is a darker red color considered normal? why?

A
  • vestibular mucosa and floor of mouth
  • due to the nearness of the vascularity to the surface
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3
Q

what areas are lighter pink colors considered normal? why?

A
  • hard palate and attached gingiva
  • due to increased thickness of the overlying epithelium
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4
Q

what are white lesions caused by that result in a thickened epithelial covering?

A
  • hyperkeratosis
  • acanthosis
  • dysplasia
  • carcinoma
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5
Q

what causes white lesions in an anemic patient?

A

decreased vascularity

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6
Q

what results in a white lesion that consists of increased collagen?

A

submucous fibrosis

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7
Q

what causes lesions to be red?

A
  • thinner epithelium
  • increased vascularity
  • a dissolution of the collagen content of the subeptihelial tissue
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8
Q

what are causes of blue lesions?

A
  • venous blood collection as opposed to the red of arterial blood collection
  • tyndall effect
  • medications
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9
Q

what causes black lesions?

A
  • melanin: a pigment produced by cells called melanocytes; acts as a sunscreen and protects the skin from UV light
  • heavy metals: amalgam, iron, and bismuth
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10
Q

what causes brown lesions?

A
  • melanin
  • hemosiderin: a yellowish brown granular pigment formed by a breakdown of hemoglovin, found in phagocytes
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11
Q

what causes yellow lesions?

A
  • adipose tissue
  • sebaceous material (skin oil) as noted in fordyce granules
  • pus as it is a collection of mecrotic material, PMNs, and lymphocytes
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12
Q

what are the most common colors found ABNORMALLY in the oral cavity (in order from most to least)?

A
  1. whie
  2. red
  3. black
  4. blue
  5. yellow
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13
Q

pigment in the palate is usually caused by what?

A

medications

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14
Q

what is the first thing you should do with a white lesion?

A

try to rub it off - this will help narrow down your differential

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15
Q

what are 5 white lesions that can be scraped, rubbed, or pulled off?

A
  • materia alba
  • white coated tongue
  • burn (thermal, chemical, cotton roll, etc.)
  • toothpaste or mouthwash overdose
  • pseudomembranous candidiasis
  • fibrin membrane
  • exudate
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16
Q

what are some white lesions that cannot be rubbed off?

A
  • leukoplakia
  • linea alba
  • leukoedema
  • morsicatio buccarum (linguarum, laborium)
  • tobacco pouch keratosis
  • lichen planus
  • nicotine stomatitis
  • oral hairy leukoplakia
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17
Q

what is the definition of leukoplakia?

A

an intraoral white plaque that does not rub off and cannot be identified as any well known entity

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18
Q

histologically, what can leukoplakia show?

A
  • benign hyperkeratosis
  • eptihelial dysplasia (mild, moderate, severe)
  • carcinoma in situ
  • invasive squamous cell carcinoma
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19
Q

what should you do if you see a patient with leukoplakia?

A

remove any obvious frictional causes and biopsy if it persists after 2 weeks

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20
Q

what is the treatment for morsicatio buccarum (linguarum, laborium)?

A

none or bite guard

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21
Q

what are 3 other names for tobacco pouch keratosis?

A
  • smokeless tobacco pouch
  • snuff pouch
  • spit tobacco keratosis
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22
Q

what may be accompanied by tobacco pouch keratosis?

A

gingival recession and root caries

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23
Q

tobacco pouch keratosis is dose responsive and may lead to ___

A

verrucous carcinoma

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24
Q

is tobacco pouch keratosis reversible?

A

possibly, if dipping stops

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25
Q

what are the 4 p’s associated with lichen planus skin lesions?

A
  • purple
  • pruritic
  • polygonal
  • papules
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26
Q

what is the treatment for lichen planus?

A

topical steroid application

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27
Q

what should you consider when deciding which topical steroid to use to treat lichen planus?

A
  • size of lesions
  • frequency of recurrences
  • number of lesions
  • location of lesions
28
Q

if you see a patient with oral lichen planus, what should you ask them?

A

if they have related skin lesions

29
Q

which lichen planus topical steroid treatment has a very high potency?

A

clobetasol proprionate 0.05% gel

30
Q

what is the prescription for clobetasol proprionate 0.05% gel?

A
  • aka temovate
  • disp: 15 or 30 gram tube
  • sig: dry the affected area and gently apply a thin amount bid-tid
31
Q

other than clobetasol proprionate (temovate), what are 2 other lichen planus topical steroids?

A
  • dexamethasone elixir 0.5mg/5ml rinse (decadron)
  • fluocinonide 0.05% gel (lidex)
32
Q

what is the prescription for dexamethasone elixir 0.5mg/5ml?

A
  • aka decadron
  • disp: 12-16oz
  • sig: rinse with 1tsp for 2 minutes bid-qid and expectorate
33
Q

which lichen planus topical steroids have black box warnings?

A

clobetasol propionate 0.05% gel (temovate) and fluocinonide 0.05% gel (lidex)

it is supposed to be used for dermatologic purposes only, but intraoral lichen planus is an exception, so we ignore the black box warnings

34
Q

what is the prescription for fluocinonide 0.05% gel?

A
  • aka lidex
  • disp: 15 or 30 gram tube
  • sig: dry the affected area and gently apply a thin amount 3-4 times daily
35
Q

what topical steroid has moderate potency?

A

fluocinonide 0.05% gel (lidex)

36
Q

what is the treatment for oral hairy leukoplakia?

A

treat AIDS

37
Q

what are some red and white lesions?

A
  • ulcers - traumatic, aphthous, viral
  • geographic tongue
  • desquamative gingivitis
  • actinic keratosis
  • erythroleukoplakia
38
Q

what is the etiology of recurrent aphthous ulcers?

A
  • “different things in different people”
    • autoimmune, hypersensitivity, stress, etc.
39
Q

what are prescription options for recurrent aphthous ulcers?

A

aphthasol, dexamethasone, temovate (clobetasol proprionate), lidex, etc.

40
Q

what are the treatment options for traumatic ulcers?

A
  • surgical excision
  • nothing
  • steroids
41
Q

what are some options for intra-lesional steroid injections for traumatic ulcers?

A
  • kenalog 10 (10mg/ml) or kenalog 40 (40mg/ml)
  • 10 mg per cm of lesional tissue
  • so for a 1cm lesion, you can give:
    • 1ml of kenalog 10
    • 0.25ml of kenalog 40
42
Q

what are two other names for geographic tongue?

A
  • erythema areata migrans
  • benign migratory glossitis
43
Q

what is the treatment for geographic tongue?

A

no treatment

44
Q

what is the differential for desquamative gingivitis?

A
  • lichen planus
  • mucous membrane pemphigoid
  • pemphigus vulgaris
  • systemic lupus erythematosis
  • hypersensitivity
45
Q

what is the treatment for desquamative gingivitis?

A
  • biopsy for confirmation
  • topical steroids
46
Q

what is this possibly due to?

A

medications

47
Q

wipeable

A

pseudomembranous candidiasis

48
Q

does not wipe off

A

leukoplakia

49
Q

does not rub off

A

linea alba

50
Q

does not rub off, goes away with stretching

A

leukoedema

51
Q

does not rub off

picture is before and after treatment

A

morsicatio buccarum

52
Q

does not wipe off

A

tobacco pouch keratosis

53
Q

does not wipe off, history of tobacco pouch keratosis

A

verrucous carcinoma

54
Q

does not rub off

A

reticular lichen planus

55
Q

does not wipe off

A

erosive lichen planus

56
Q
A

lichen planus skin lesions

57
Q
A

recurrent aphthous ulcer

58
Q
A

intraoral herpes simplex

59
Q
A

traumatic ulcer

60
Q
A

geographic tongue

61
Q
A

geographic tongue

62
Q
A

erythema migrans

63
Q
A

desquamative gingivitis

64
Q
A

actinic cheilosis

if it is on the skin, it is actinic keratosis

65
Q
A

erythroleukoplakia

66
Q

if a traumatic ulcer does not go away with steroid treatment, what should you be thinking it might be?

A

TUGSE (traumatic ulcerative granuloma with stromal eosinophilia)

67
Q

what is the treatment for actinic cheilosis?

A

incisional biopsy then refer to oral surgeon for “lip shave”

Oral Medicine (10 decks)

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