L9 Oral Lesions

Question 1

Leukoplakia risk factors

Answer 1

Tobacco use (70-90%), alcohol use (increase 1.5 fold), HPV

Question 2

Risk factors for malignant transformation of leukoplakia

Answer 2

Female, long duration, nonsmoker (idiopathic), located on tongue/floor of mouth, >200 mm

Question 3

Clinical presentation of leukoplakia

Answer 3

Adherent white patched/plaques on oral mucosa or tongue, not painful

Question 4

Erythroplakia

Answer 4

Associated redness with white plaques of leukoplakia, higher risk of dysplasia/cancer

Question 5

DDx of leukoplakia

Answer 5

Oral hairy leukoplakia

Question 6

Oral hairy leukoplakia

Answer 6

Not premalignant, vertically corrugated white lesions on lateral tongue, usually soft so if indurated/hard then that’s not good

Question 7

Disease associated with oral hairy leukoplakia

Answer 7

HIV (Epstein-Barr virus), this can be the presenting symptom

Question 8

Risk factors of SCC

Answer 8

Tobacco and alcohol use, exposure to UV light, radiation exposure, HPV-16

Question 9

Clinical presentation of SCC

Answer 9

Ulcers or masses that do not heal (persistent papules, plaques, ulcers, erosions), poor fitting dentures, sore throat etc that does not resolve

Question 10

Treatment of SCC

Answer 10

Depends on stage/extent disease (surgical resection or radiation/chemo)

Question 11

Presentation of melanoma

Answer 11

Painless, bleeding mass, area or ulceration, regional of mucosal discoloration (if pigmented oral lesion, must consider this!) or ill-fitting dentures

Question 12

Amalgam tattoo

Answer 12

Blue-black macule seen in area adjacent to amalgam dental filling (gingival margin or buccal mucosa), irritates the tissue

Question 13

Melanosis

Answer 13

Pigmented lesion that is extremely common in individuals with dark skin, symmetric pattern

Question 14

Oral melanotic macules

Answer 14

Darkly pigmented benign macules on lips and oral mucosa, usually symmetric with sharp borders, stable and are present in adulthood

Question 15

What are mucoceles?

Answer 15

Fluid-filled cavities with mucous glands lining the epithelium, due to minor oral trauma

Question 16

Clinical presentation of mucoceles

Answer 16

Pinkish/blue soft papules or nodules filled with gelatinous fluid, variable in size and may rupture spontaneously

Question 17

Treatment of mucoceles

Answer 17

Remove with cryotherapy/excision if symptomatic, CO2 laser vaporization, aspiration (draw fluid out but usually returns)

Question 18

Herpetic gingivostomatitis

Answer 18

Most common clinical manifestation of primary HSV in childhood (before 5)

Question 19

Etiology of Herpes Simplex Virus

Answer 19

HSV type 1

Question 20

Clinical presentation of primary infection of Herpes Simplex Virus

Answer 20

Sudden onset of painful, intraoral grouped vesicles on an erythematous base, usually on buccal mucosa, when viral shedding is greatest

Question 21

Clinical presentation of recurrent infection of Herpes Simplex Virus

Answer 21

Prodrome of pain/burning/tingling 6-48 hours before lesion appears, fatigue and low-grade fever, “cold sores”

Question 22

Definitive diagnosis of Herpes Simplex Virus

Answer 22

Viral culture if there’s an active lesions

Question 23

When is Tzanck smear used?

Answer 23

Herpes simplex virus and varicella zoster virus

Question 24

Antiviral treatment of Herpes Simplex Virus

Answer 24

At onset of prodrome, acyclovir/valacyclovir/famiciclovir

Question 25

Miracle Mouthwash

Answer 25

Combo of Diphenhydramine (Benadryl) and aluminum hydroxide/magnesium carbonate (Maalox or Gaviscon-antacid)

Question 26

What is miracle mouthwash used for?

Answer 26

Herpes simplex virus, erythema multiforme major

Question 27

How can you tell herpes zoster virus from herpes simplex virus?

Answer 27

Herpes zoster is unilateral on the hard palate

Question 28

Etiology of oropharyngeal candidiasis (thrush)

Answer 28

Candida albicans (opportunistic infection)

Question 29

Predisposing factors for thrush

Answer 29

Infancy, dentures, immunocompromised, DM, chemo, antibiotics or corticosteroids

Question 30

Clinical presentation of oropharyngeal candidiasis

Answer 30

Mouth pain/sore throat, creamy white patches/plaques with underlying erythematous mucosa, "thrush will brush"

Question 31

How to diagnosis oropharyngeal candidiasis

Answer 31

Use KOH prep and see budding yeasts with or without pseudohyphae

Question 32

When should you think about an underlying disease associated with the thrush?

Answer 32

Esophageal candidiasis, recurrent candidiasis, associated pain somewhere else or lack of predisposing factors

Question 33

Treatment of oral candidiasis

Answer 33

Topical antifungal (nystatin oral suspension or clotrimazole oropharyngeal lozenges/troches)

Question 34

Genetic susceptibility for erythema multiforme major

Answer 34

HLA gene

Question 35

Etiology of erythema multiforme major

Answer 35

Commonly due to infection (HSV) but can be from medication

Question 36

Clinical presentation of erythema multiforme

Answer 36

Target-like lesions on skin, often with mucosal erythema, painful erosions or bullae

Question 37

Treatment of erythema multiforme major

Answer 37

Symptomatic relief that topical corticosteroid, oral anti-histamines, miracle mouthwash

Question 38

Clinical presentation of SJS

Answer 38

Mucosal involvement with erythema and edema of lips, intraoral bullae, ruptured bullae and must look for gentital and ocular involvement

Question 39

What are aphthous ulcers?

Answer 39

Canker sores

Question 40

Most common cause of mouth ulcers

Answer 40

Recurrent aphthous stomatitis

Question 41

Clinical presentation of aphthous ulcers

Answer 41

Single or multiple lesions that are shallow, round/oval, painful with grayish base on mucosa, usually do not bleed

Question 42

Treatment of aphthous ulcers

Answer 42

Typically heal but can use symptomatic steroid (triamcinolone orpharyngeal paste)

Question 43

What is behcet syndrome?

Answer 43

Neutrophilic inflammatory disorder

Question 44

Clinical presentation of behcet syndrome

Answer 44

Recurrent oral and genital ulcers that are painful, shallow or deep with central yellowish necrotic base with raised edges, NOT CONTAGIOUS

Question 45

Diagnos of behcet syndrome

Answer 45

Recurrent oral ulcers (>3x per year) AND 2 of the following (recurrent genital ulcers, ocular lesions, cutaneous lesions or positive pathergy test)

Question 46

Treatment of behcet syndrome

Answer 46

Refer to rheumatology

Question 47

Pathergy test

Answer 47

Do an intradermal injection with a 20 gauge needle under sterile conditions and positive test if an erythematous sterile papule develops within 48 hours

Question 48

Progression of oral lichen planus

Answer 48

Reticular, erythematous, erosive

Question 49

Clinical presentation of oral lichen planus

Answer 49

Reticular (lacy white plaques with Wickham's striae on buccal mucosa), erythematous (red patches of mucosal atrophy-pain), erosive (erosions/ulcers-pain)

Question 50

Treatment of oral lichen planus

Answer 50

Pain relief and topical corticosteroids (high potency like triamcinolone oropharyngeal Oralone or clobetasol topical ointment BID)

Question 51

What is black hairy tongue associated with?

Answer 51

Antibiotic use, candida albicans infection or poor oral hygiene

Question 52

Clinical presentation of black hair tongue

Answer 52

Elongated filiform papillae

Question 53

Clinical presentation of geographic tongue

Answer 53

Erythematous patches on dorsal tongue with circumferential white borders, can change location pattern and size

Question 54

What is atrophic glossitis?

Answer 54

Inflammatory disorder that leads to atrophy of the filiform papillae, must think about what else is going on with this patient!

Question 55

Etiology of atrophic glossitis

Answer 55

Nutritional deficiencies, dry mouth, Sjogren's syndrome, oral candida infection, celiac disease

Question 56

Clinical presentation of atrophic glossitis

Answer 56

Tongue appears smooth, glossy, erythematous, burning sensation and sensitivity with salty foods

Question 57

When should you prescribe gel application?

Answer 57

For a few localized lesions (gel form of topical steroids)

Question 58

When should you prescribe a rinse?

Answer 58

For widespread or generalized erythema