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Exam 3 - Acute/Chronic Ulceration Part 1 Flashcards

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1
Q

What is the etiology of anesthetic necrosis?

A

Necrosis secondary to administration of local anesthetic it is thought it may be a result of ischemia or faulty technique.

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2
Q

What is the most common site of anesthetic necrosis?

A

Hard palate most common

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3
Q

Name the lesion:

Well-circumscribed ulcer at site of previous injection

A

Anesthetic Necrosis

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4
Q

How to diagnose and tx anesthetic necrosis?

A

Diagnosis - Clinical diagnosis based on history of recent local anesthetic injection
Tx - Heals with time (usually 2 week) can put oral gel won’t help with healing but will help with pain

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5
Q

Name the pathology:

Ischemia of salivary tissue leads to local infarction

A

Necrotizing Sialometaplasia

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6
Q

What are the predisposing factors for necrotizing sialometaplasia? (5 things)

A
  1. Trauma
  2. Dental injections
  3. Ill-fitting dentures
  4. Eating disorder with binge purging
  5. Upper respiratory tract infection
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7
Q

What are the predisposing factors for necrotizing sialometaplasia? (5 things)

  1. Trauma
  2. Dental injections
  3. Ill-fitting dentures
  4. 5.
A
  1. Eating disorder with binge purging
  2. Upper respiratory tract infection
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8
Q

Common site to find necrotizing sialometaplasia?

A

The hard palate

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9
Q

Describe clinical presentation of necrotizing sialometaplasia?

A

Nonulcerated, painful swelling initially —> Within 2-3 wks, a crater like ulcer forms and pain is reduced

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10
Q

Name the lesion

Nonulcerated, painful swelling initially —> Within 2-3 wks, a crater like ulcer forms and pain is reduced

A

Necrotizing sialometaplasia

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11
Q

Necrotizing sialometaplasia

Initially _________ _________ ___________ —> Within ___wks , a crater like ulcer forms and _________

A

Initially nonulcerated, painful swelling—> Within 2-3 wks, a crater like ulcer forms and pain is reduced

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12
Q

How to diagnose necrotizing sialometaplasia?

A

Biopsy to exclude malignant process - only time not to biopsy is usually for a pt with eating disorder

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13
Q

How to tx necrotizing sialometaplasia?

A

Heals in 5-6 wks

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14
Q

Name the pathology:

Initial infection of herpes simplex virus type (HSV-1)

A

Primary herpetic gingivostomatitis

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15
Q

What are the injury acute ulcerative lesions we talked about?

A
  1. Anesthetic necrosis
  2. Necrotizing sialometaplasia
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16
Q

What are the infectious acute ulcerative lesions we talked about?

A
  1. Primary herpetic gingivostomatitis
  2. Recurrent herpes labialis
  3. Recurrent intraoral herpes simplex
  4. Herpes Zoster
  5. Hand-foot-and-mouth disease
  6. Necrotizing ulcerative gingivitis (NUG)
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17
Q

What are the immune mediated acute ulcerative lesions we talked about?

A
  1. Aphthous stomatitis
  2. Allergic rxn
  3. Erythema multiforme
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18
Q

What category does Primary herpetic gingivostomatitis fall under?

A

Infectious

(HSV-1)

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19
Q

Name the pathology.

Etiology: Initial infection of herpes simplex virus type (HSV-1).

Clinical Presentation:
Multiple small vesicles that often progress to ulceration. Along with painful, erythematous gingiva (Marginal gingivitis). May have fever and LAD.

A

Primary herpetic gingivostomatitis

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20
Q

Primary herpetic gingivostomatitis is acute onset because it is a bacterial condition.

A

FALSE It is of acute onset but it is not bacterial it is viral infection of HSV-1.

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21
Q

Primary herpetic gingivostomatitis affects what sites in the oral cavity.

A

Oral mucosa, lips and perioral skin

Movable and attached oral mucosa affected.

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22
Q

T/F Primary herpetic gingivostomatitis affects moveable and attached oral mcuosa.

A

True

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23
Q

How would you diagnose Primary herpetic gingivostomatitis ?

A
  1. Clinical Diagnosis - usually an easy one b/c very recognizable
  2. Viral culture (slow) or PCR (not usually done outside hospital setting)
  3. Cytologic smear (least invasive and most cost effective)
  4. Biopsy - not common for this
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24
Q

How to tx Primary herpetic gingivostomatitis?

A

For symptomatic relief you can use
- NSAIDS, Lidocaine for adults, and popsicle for children

Antiviral - for adults

If you do nothing should heal spontaneously in 2 weeks.

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25
Primary herpetic gingivostomatitis: HSV-1 remains latent in the ____________ ____________.
Trigeminal ganglion
26
Describe the steps of a cytologic smear.
1. Lightly moisten tongue depressor with water 2. Gently remove cells (scrape) area 3. Spread accumulated cells on microscope slide 4. Spray slide lightly with fixative (sometime can use hairspray because fixative expires) 5. Submit to pathologist
27
Name the pathology we talked about that has to do with the reactivation of HSV-1.
Recurrent Herpes Labialis
28
What are Recurrent Herpes Labialis and Recurrent intra-oral herpes simplex risk factors? (4 things)
1. Advanced age 2. UV light 3. Physical and emotional stress 4. Dental treatment Can recur many times
29
T/F Recurrent Herpes Labialis can recur many times.
True!
30
T/F Recurrent intraoral herpes simplex can recur many times.
True!
31
T/F Both Recurrent Herpes Labialis and Recurrent intraoral herpes simplex can recur many times.
True!
32
What is the worldwide prevalence of HSV-1 in individuals under 50?
67%
33
Recurrent Herpes Labialis falls into what category?
Infectious
34
What is the site you are likely to find Recurrent Herpes Labialis?
Vermillion border and skin adjacent to lips
35
Pt with primary herpetic gingivostomatitis will experience prodrome 6-24 hours before lesions appear.
False this usually happens in pt with recurrent herpes labialis
36
What are symptoms of prodrome a individual may experience with recurrent herpes labialis? (6 things)
Pain, burning, itching, tingling, localized warmth, erythema in the area lesion will appear different in different people
37
Name the lesion: Multiple small erythematous papules form clusters of fluid-filled vesicles can burst and leave a scab like appearance
Recurrent Herpes Labialis
38
How is Recurrent Herpes Labialis diagnosed?
Clinical diagnosis - usually easy to diagnose this way Viral culture (slow) or PCR Cytologic smear Biopsy
39
How to tx recurrent herpes labialis?
Antiviral For pt with frequent recurrence, can provide rx to have on hand at home. Pt can start taking as soon as they feel prodrome Heals in 7-10 days
40
What category does Recurrent intraoral herpes simplex fall under?
Infectious (viral) reactivation of HSV-1
41
What is the etiology of Recurrent intraoral herpes simplex?
Reactivation of HSV-1
42
What site is most common for Recurrent intraoral herpes simplex?
Attached (non-moveable) gingiva, hard palate
43
Name the lesion: Affects keratinized mucosa bound to bone Small vesicles that collapse to form cluster of erythematous macules Reactivation of HSV-1
Recurrent intra oral herpes simplex
44
How is Recurrent Herpes Labialis diagnosed?
Clinical diagnosis Viral culture (slow) or PCR Cytologic smear Biopsy
45
T/F Primary herpetic gingivostomatitis, Recurrent Herpes Labialis, Recurrent intraoral herpes simplex, Herpes Zoster ‘Shingles” are all diagnosed pretty much the same way.
True Note: Cytologic smear or biopsy you will not be able to tell the difference between HSV-1 (herpes) or herpes zoster unless you do special test.
46
What is the treatment for Recurrent intra oral herpes simplex?
Same as the tx for Recurrent Herpes Labialis which is antiviral or it will heal in 7-10 days
47
Name the oral pathology: Reactivation of varicella zoster virus (HHV-3) - chicken pox
Herpes Zoster ‘Shingles”
48
What is Herpes Zoster ‘Shingles” a reactivation of?
varicella zoster virus (HHV-3) - chicken pox
49
T/F Herpes Zoster usuallys recurs many times.
FALSE - usually recurs once
50
Acute infectious ulceration: think HHV-3 Incidence of ________ __________ increases with age. While ____________ increases susceptibility.
herpes zoster; Immunosuppression
51
T/F Immunosuppression increases susceptibility of herpes zoster.
True
52
T/F Incidence of herpes zoster increases with age.
True
53
T/F Herpes Zoster ‘Shingles” usually has a prodrome.
TRUE but Not as helpful because usually only occurs once where as herpes have multiple recurrences usually
54
What are the prodromal symptoms usually for herpes zoster?
severe neuralgia (with or without fever, malaise, and headache)
55
Name the pathology: Pain and lesions tend to occur along one dermatome. Acute phase: clusters of vesicles with erythematous base, terminate at the midline (everyone goes through this phase) Chronic: Postherpetic neuralgia (15% of pt Only a portion will undergo)
Herpes Zoster "shingles"
56
Describe the acute phase of Oral Herpes Zoster
Acute phase: clusters of vesicles with erythematous base, terminate at the midline (everyone goes through this phase)
57
Describe the chronic phase of Oral Herpes Zoster
Chronic: Postherpetic neuralgia (15% of pt Only a portion will undergo)
58
T/F: For a cytologic smear or biopsy you will not be able to tell the difference between HSV-1 and Herpes zoster unless you do special testing.
True
59
How to tx oral Herpes Zoster?
Antiviral regimen Symptomatic relief - NSAIDS, Diphenhydramine, Gabapentin, Steroids
60
What category does hand foot and mouth disease fall under?
Infectious
61
What is the etiology of hand foot and mouth disease?
Enterovirus infection
62
T/F Hand foot and mouth disease is most common in adults
FALSE most common in children
63
How is the oral presentation of hand foot and mouth disease different from Recurrent intra oral herpes simplex?
Recurrent intra oral herpes simplex occurs on attached mucosa where as hand foot and mouth disease occurs on unattached tissue (and tongue)
64
T/F Cutaneous lesions for hand foot and mouth disease arise first.
FALSE - oral lesion arise first
65
Where can you find oral hand foot and mouth disease lesions?
Buccal mucosa, labial mucosa, and tongue most common. NOTE: unattached gingiva
66
Describe oral hand foot and mouth disease lesions
Multiple aphthous like ulcerations
67
Describe cutaneous hand foot and mouth disease lesions
Erythematous macules becomes vesicles that primarily affect the hand and feet
68
How to diagnose hand foot and mouth disease?
Clinical diagnosis PCR confirmation if necessary
69
How to tx hand foot and mouth disease?
NO tx necessary it is self limiting
70
What category does Necrotizing Ulcerative Gingivitis fall under?
Infectious
71
Etiology of Necrotizing Ulcerative Gingivitis
Fusobacterium nucleatum (other bacteria)
72
Who are you likely to find Fusobacterium nucleatum (other bacteria) in?
young adults and middle-aged adults
73
What are risk factor for necrtotizing ulcerative gingivitis? (8 things)
Stress - biggest risk factor Immunosuppression Smoking Local trauma Poor nutritional status Poor oral hygiene Inadequate sleep Recent illness
74
What is the clinical presentation of Necrotizing Ulcerative Gingivitis? (5 things)
Interdental papilla blunted, inflamed, edamouts, and hemorrhagic “Punched out” craterlike necrosis covered with gray pseudomembrane Fetid odor Severe pain - could help differentiate between periodontitis May be accompanied by LAD, fever , malaise
75
How would you diagnose Necrotizing Ulcerative Gingivitis?
Clinical diagnosis should help you differentiate Histopathology is not specific (biopsy does not establish diagnosis)
76
T/F Biopsy is important for diagnosing for NUG.
False clinical presentation is of utmost importance
77
How to tx Necrotizing Ulcerative Gingivitis?
Scaling, curettage, or ultrasonic instrumentation Chlorohexidine rinse Antibiotics if LAD or fever present Evaluation for underlying cause of immunosuppression (HIV)
78
Name the pathology: Interdental papilla blunted, inflamed, edamouts, and hemorrhagic “Punched out” craterlike necrosis covered with gray pseudomembrane Fetid odor Sever pain - could help differentiate between periodontitis May be accompanied by LAD, fever , malaise
Necrotizing Ulcerative Gingivitis

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