Mouth Flashcards
(23 cards)
Mucosal Lesions
Oral Lichen planus Leukoplakia Erythroplakia Oral SCC Melanoma Fordyce's Spots
Stomatitis
Oral Candidiasis Pseudomembranous stomatitis Recurrent Aphthous Stomatitis Herpetic Gingivostomatitis Oral Erythema Multiforme Chancre
Oral Edema
Angioedema (Quincke’s edema)
Other Oral Findings
Palatal or Mandibular Torus Hemangioma Varicosities Papilloma Lipoma
Salivary Glands
Sialadenitis
Sjogren’s syndrome
Xerostomia
Oral Lichen planus
Etiology: unknown
Non-erosive lesion: painless, vary from lace-like white patches/papules/streaks on buccal mucosa to erosions on gingival margin
Erosive form: can erupt into violet papules with white lines/spots, on genitalia, lower back, ankles, pruritus
Chronic can increase risk of oral CA
Leukoplakia
Etiology: trauma, dentures, tobacco use, oral sepsis, syphilis, AIDS, vitamin deficiency, alcoholism, endocrine disturbances
Precancerous hyperplasia of squamous epithelium;
white patches or plaque on oral mucosa cannot be rubbed off
SSX: located on tongue, mandibular alveolar ridge, buccal mucosa
forms nonpalpable, faintly translucent white areas to thick, fissured, papillomatous indurated lesions
looks like “flaking white paint”
PE: lesion cannot be wiped away with gauze
check for cervical LA
DX: biopsy for definitive diagnosis
DDX: Candidiasis and aspirin burn (can be wiped away with gauze)
Erythroplakia
Red macule or plaque with well-demarcated edges with soft texture
Often on floor of mouth, tongue, or palate
Etiology: Unknown, type of epithelial dysplasia, pre-cancerous
DX: Biopsy
Risk factors: smoking, alcohol
Oral SCC
Risk factors: alcohol & smoking
Most on floor of mouth or lateral & ventral surfaces of tongue
SSX: appear as erythroplakia or leukoplakia
exophytic or ulcerated, both rea indurated with rolled border
metastatic mass (non tender) in neck may be first symptom
DX: Biopsy any persistent papules, plaques, erosions or ulcers
Melanoma
pigmented lesions with concerning signs: ABCD, lesions will not blanch
DDX: Melanosis - symmetric lesions in individuals with dark skin
oral melanotic macules - symmetric, stable, sharply delimited dark macules on lips or oral mucosa
Fordyce’s Spots
Benign neoplasms from sebaceous glands
Most common 20-30 yrs M=F
SSX: asymptomatic, multiple, white to yellow, 1-2mm papules, often occurring confluent cluster, granules do not wipe off
DDX: Candida albicans - wipes off
Stomatitis -
Inflammation of oral tissue
Etiology: strep, candida, syphilis, TB, measles, HIV, etc. deficiencies: vit. B & C, iron
mechanical trauma: poor fitting dentures
alcohol, tobacco mercury poisoning
Oral Candidiasis
“Thrush” Common oral fungal infection
Risk factors: denture-wearing, DM, antibiotics, chemo, HIV, infants
SSX: Lesion, slightly raised soft white plaques, easily wipe off, causing bleeding
DX: confirmed with KOH prep - recurrent warrants immune status eval
Recurrent Aphthous Stomatitis
aphthae = canker sore
Acute, painful, recurring, necrotizing ulcerations of oral mucosa
Etiology: Provocations (exact cause unknown)
trauma, food allergies, vit. deficiencies, stress
associated with celiac disease & IBS
SSX: Painful lesions, occasional prodromal burning/tingling,
ulcers are shallow, round with grayish base, red border
occur on non-keratinized, moveable mucosa
DDX: Secondary herpetic ulceration - h/o of vesicles preceding the ulcers, a location on periosteum-bound mucosa (gingival, hard palate) & crops of lesions
Trauma, pemphigus vulgaris & cicatricial pemphigoid
Systemic disorders: crohn’s disease, neutropenia & spue
Herpetic Gingivostomatitis
HSV-1 infection “Cold sores”
Painful eruptions of unmovable oral mucosa & vermilion border
SSX: prodrome of pain, burning, tingling, fever, malaise, LA -> eruption of multiple interoral vesicular lesions & erosions, erythematous base, crusting, self limiting 1-2wks
Lab: Tzank smear, direct immunofluorescence smear, or viral culture
DDX: aphthous stomatitis, erythema multiforme, drug eruptions, epmphigus
Oral Erythema Multiforme
Hypersensitivity reaction to HSV, other organisms, drugs, or idiopathic
SSX: painful stomatitis, sudden onset of diffuse hemorrhagic vesicles & bullae with erythematous base, on lips/mucosa
bullae rupture leaving raw, painful, friable surfaces, the form crusts
may be prodrome: sinusitis, rhinitis; may have fever & severe systemic symptoms
Other areas of body: maculopapular erythematous lesions (target lesions) form symmetrically on hands, arms, feet, legs, face….
DDX: aphthous stomatitis, llergiac stomatitis, pemphigus, herpes
Chancre
Lesion: Painless ulceration formed during primary stage of syphilis, ~21 days after initial exposure to Treponema pallidum
Ulcers form around lips, tongue, anus, penis, vagina
SSX: painless single ulcerated lesion, indurated border, no central necrotic tissue, tender cervical LA, lasts 2wk-3mo. w/out tx
PE: need to check for genital lesions
Lab: PCR serology
Angioedema (Quincke’s edema)
acute edema of skin, mucosa, submucosal tissues; rapid onset; urticarial (itchy raised bumps) if related to allergy
Etiology: Allergic (most common) not IgE mediated
SSX: Painless, non-pruritic (if non allergenic), nonpitting, well-circumscribed areas of edema from increased vascular permeability
May progress to complete airway obstruction & eadth caused by laryngeal edema
Palatal or Mandibular Torus
non-neoplastic, slowly growing nodular protuberance of bone
little clinical sig. except when interfering with dentures
Peak incidence occurs around age 30
Hemangioma
Proliferation of blood vessels, often congenital
SSX: lesions are flat or raised, deep red or blueish-red color, will blanch when compressed
DDX: arteriovenous fistula - more likely if h/o of trauma to area of lesion
Varicosities
Dilated, tortuous veins in oral cavity attributed to increased hydrostatic pressure & poor support of surrounding tissues
SSX: blue, blanch when compressed
Papilloma
Etiology: some associated with HPV subtypes
SSX: Asymptomatic, well-circumscribed, usually pedunculated benign growths with numerous, papillary or verrucal
Generally
Lipoma
Painless, benign, slow-growing mass of adipose tissue (check or tongue)
Yellow, non-tender, rubbery or soft, mobile
