True or False: When gingival lesions are of systemic origin, controlling plaque has no effect because it is not the cause of inflammation.
False: although it is NOT the cause, plaque makes the lesions worse
Gingival lesions of systemic origin include _______ disorders such as: lichen planus, pemphigoid, pemphigus vulgaris, erythema multiforme, lupus erythematosus.
_______ _______ is a mucocutaneous disorder of which oral involvement alone is common and for which there are characteristic Wickham Striae.
What are Wickham Striae?
lesions that are red with projecting web-like white lines
True or False: Lichen planus is rare in children.
What are the various clinical appearances of Lichen Planus?
True or False: Lichen Planus can occur on any area of the oral mucosa.
Atrophic and Ulcerative lesions are usually associated with _____.
____ is a large blister or skin vesicle filled with fluid.
What does "reticular" mean?
meshlike, in the form of a network
Sometimes if a biopsy is taken for the lichen planus, nothing will be seen. What is the test that should be done (labeling of specific proteins)?
What are "oral lichenoid lesions"?
a mucocutaneous disorder of uncertain background, that could be associated with dental restoration contact, medication reactions, or systemic disease (such as liver disease)
How is lichen planus differentiated from oral lichenoid lesions?
- heavy accumulation of CD4 and CD8 at the basement membrane for Lichen Planus
A group of disorders in which autoantibodies toward components of the basement membrane results in detachment of epithelium from the connective tissue. This definition describes?
True or False: Complement-mediated cell destructive processes may be involved in the pathogenesis of pemphigoid disorders.
For pemphigoid disorders, autoantibody reactions occur against _______ and _______ components.
What is the Nicholsky sign?
removal of epithelium that occurs after rubbing of the gingiva and creation of a bulla; associated with pemphigoid disorders (ie. disorders in which autoantibodies result in detachment of epithelium)
What are the three manifestations of pemphigoid disorders?
- benign mucous membrane
- cicatricial (scar formation)
Pemphigoid disorders are associated with deposits of C3, Ig___ and other _____.
When pemphigoid lesions are suspected, which other body part should you inspect?
the eyes, scars can cause blindness
What is pemphigus vulgaris?
formation of intraepithelial bullae in the skin and mucous membranes; like a "pimple at the basal membrane"
- strong genetic background (Jewish/mediterranean)
- Painful desquamative lesions
- Recurrent bullae, chronic course
- middle age and ederly most common
- acantholysis = clearing of CT
Clearing of connective tissue is also known as ________ and is associated with pemphigus vulgaris.
What is erythema multiforme?
vesiculobullous disease affecting both mucous membranes and skin
- red skin lesions
- swollen lips with crust formation
- bullae rupture and leave ulcers
- sometime recurrent
- Characteristic: iris appearance + bullae
- occurs at any age but mostly young
Extensive Necrosis (of eyes, skin, genitals, and mouth) associated with Erythema multiforme is known as _____ syndrome.
Erythema multiforme of palatal mucosa appears to be a cytotoxic immune reaction toaward keratinocytes precipitating from a variety of factors such as _____ and _____.
What is lupus erythematosus?
autoimmune connective tissue disorder in which autoantibodies form to various cellular constituents
- lesions can be ulcerated and cannot be differentiated from lichen planus or leukoplakia
- characteristic butterfly skin lesions (face/nose)
Atrophic gingival discoid lupus erythematosus is characterized by degeneration of ____ cells and increased ____ of the basement membrane due to deposits of various ______ and _____.
antibodies and fibrin
True or False: Systemic forms of lupus erythematosus reach the heart and nervous system.
True! can be fatal
What are three common drugs that cause mucocutaneous disorders?
- calcium channel blockers
- anti-epileptic drugs
True or False: Gingival enlargement is associated with drug-induced mucocutaneous disorders.
True or False: Oral ulceration, erythema multiforme, epithelial atrophy, and intense erythema are all conditions that are solely associated with genetics.
False: all of these are drug-induced
What are two systemic conditions that have gingival manifestations?
- Gastro-Intestinal Diseases (Crohn's)
- Hematological Disorders (leukemia)
How does Crohn's disease effect the mucosa?
defective neutrophil functions
How does leukemia present in the mouth?
swelling, ulceration, petecchia, and erythema
- 69% of patients have oral manifestation
- a child with spontaneous bleeding should be a tip-off!
True or False: Periodontal tumors and cysts may have the appearance of gingivitis or periodontitis.
Periodontal tumors can be ____, _____, or _____.
True or False: Periodontal tumors can affect the hard or soft tissues.
Reactive processes of periodontal ____ tissues include:
- Fibroma/Focal Fibrous Hyperplasia
- Calcified Fibroblast Granuloma
- Pyogenic Granuloma
- Peripheral Giant Cell Granuloma
"granuloma" or "fibroma" always think REACTIVE
A _____ is a focal fibrous hyperplasia caused by irritation. It is sessile, well-circumscribed, and smooth.
Granulomas are ______ of periodontal soft tissues and include:
- ________ =fibrous proliferation in which bone-like tissue forms
- _________ = highly vascular, ulcerated, reddish-bluish
- ______ = pedunculated, originates in PDL, focal location of multi-nucleated giant cells
- calcified fibroblastic
- peripheral giant cell
A periapical cemental dysplasia is a _____ ______ of periodontal hard tissues.
In a periapical cemental dysplasia, the periapical bone is replaced by ____ _______ tissue through a cementoblastic phase. These are usually symptomatic/asymptomatic?
NO symptoms (though tooth is usually vital)!
____ _______ of periodontal soft tissues include:
- verruca vulgaris
- peripheral odontogenic tumors
_________ will blanch when you apply pressure and appear as flat or raised soft lesions. They are asymptomic but will bleed uncontrollable if you attempt to biopsy...just keep an eye on it.
_______ is a benign neoplasm that is often confused with amalgam tattoos due to pigmentation of soft tissue. Most often seen in palate though.
Which benign neoplasm of the soft tissue will appear histologically as a "flower with four petals?"
- there are four-five different types
- commonly associated with HPV
Verruca Vulgaris is one type of benign soft tissue ______ that is associated with HPV type ___ and ____.
Which benign neoplasms of the soft tissue will often form around unerupted teeth and interfere with tooth eruption?
Peripheral Odontogenic tumors
Ameloblastomas, Squamous odontogenic tumors, and benign cementoblastomas are benign neoplasms of the _____ tissues.
True or False: Ameloblastomas are benign neoplasms of the hard tissue that appear radiographically as though there would be deep probe depths, however PD are normal.
Squamous odontogenic tumors are benign neoplasms of the hard tissue that are derived from ______ and are rarely seen.
epithelial rests of Malassez
Benign ________ are slow-growing neoplasms around the apex of a tooth that appear as radiopacity surrounded by a radiolucent margin.
Malignant neoplasms of the ____ tissues include:
- squamous cell carcinoma
- Kaposi's sarcoma
- Malignant lymphoma
________ carcinoma appears as nodular lesions, often with ulceration and surrounding leukoplakia. Lymph node metastasis is common and tissue samples should be sent straight to the lab.
(what grandma had!..."very rapid metastasis")
Most metastasis to the gingiva is _____, not sarcoma.
(which means they originate in the epithelial tissue not CT, bone, or fat)
_____ sarcoma is mostly detected in the palate and is associated with AIDS.
______ neoplasms of the periodontal ____ tissues include:
- Lymphoma (HIV-associated)
- Osteosarcoma (widening of PDL)
- Langerhan's Cell Disease (loosening of teeth +pain)
What are the effects of chemotherapy and radiotherapy on oral mucosa?
- unable to eat
Cysts of the periodontium mostly occur around the ______.
How should cysts be treated?
removal without poking it or allowing it to "open up" and spill its infective contents