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Clinical Medicine > Oral lesions - lecture 4 > Flashcards

Oral lesions - lecture 4 Flashcards

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1
Q

cancer of oral cavity associated with what?

A

ulcers or masses that don’t heal

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2
Q

how do tongue and lip cancers present?

A

as exophytic (outward growth) or ulcerative lesions

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3
Q

what should be biopsied?

A

Persistent papules, plaques, erosions, or ulcers

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4
Q

what accounts for 80% of squamous cell carcinoma of head and neck? (HINT: 2)

A

use of tobacco and ETOH

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5
Q

aphthous stomatitis also called?

A

canker sore

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6
Q

what is aphthous stomatitis?

A
  • Painful oral lesions
  • Sometimes genital
  • Repeated development
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7
Q

where is aphthous stomatitis most common?

A

Middle East and south asia

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8
Q

what is the most common acute oral lesion?

A

aphthous stomatitis

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9
Q

when do you first develop aphthous stomatitis and when does it wane?

A

first develop during adolescence and wanes with increasing age

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10
Q

classification of aphthous stomatitis

A

simple (mikulicz) & complex

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11
Q

simple (mikulicz) aphthous stomatitis

A
  • Several episodes per year
  • One to several lesions
  • Lasting up to 14 days
  • Limited to oral mucosa
  • Most common form of disease
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12
Q

complex aphthous stomatitis

A
  • Oral and genital
  • More numerous lesions
  • Larger than 1 cm
  • Takes 4-6 weeks to resolve
  • So frequent that patients almost always have them
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13
Q

which canker sore is seen only on the oral mucosa?

A

simple (mikulicz) aphthous stomatitis

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14
Q

which canker sore is seen on oral mucosa and genital?

A

complex aphthous stomatitis

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15
Q

what has more lesions, simple or complex aphthous stomatitis?

A

complex - has numerous lesions vs simple has one to several

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16
Q

what takes longer to resolve, simple or complex aphthous stomatitis?

A

complex - 4-6 weeks

simple - lasts up to 14 days

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17
Q

what is most common form of aphthous stomatitis, complex or simple?

A

simple

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18
Q

morphology of aphthous stomatitis

A
  • Minor ulcers <1 cm
  • Major ulcers >1cm
  • Herpetiform are 1-2 cm typically in clusters
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19
Q

pathogenesis of aphthous stomatitis

A
  • immune dysregulation
  • exaggerated pro-inflammatory process
  • weak anti-inflammatory response
  • instigated by antimetabolites like methotrexate
  • vit B12, folic acid, iron deficiency
  • neutropenia of any cause
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20
Q

what can exacerbate aphthous stomatitis?

A

certain foods

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21
Q

what is aphthous stomatitis seen in, in terms of disease?

A 
bowel disease (celiac, IBD, chron's)
-conditions that decrease mucosal thickening
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22
Q

risk factors of aphthous stomatitis

A
  • Smoking cessation
  • Familial tendency
  • Trauma
  • Dental cleaning (from trauma)
  • Hormonal factors (Progestin level fall in luteal phase of menstrual cycle)
  • Emotional stress
  • Food or drug hypersensitivity
  • Immunodeficiency (HIV)
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23
Q

clinical presentation of aphthous stomatitis

A
  • one to five lesions
  • round to oval
  • clearly defined ulcers
  • yellowish center
  • small (1-3 cm)
  • erythematous rim
  • painful
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24
Q

dx of aphthous stomatitis

A
  • Patient history and PE
  • History of recurrent self-limited oral ulcers
  • Biopsy not needed
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25
oral hygiene for management of aphthous stomatitis
non-alcohol mouthwash and soft toothbrush
26
pain control for management of aphthous stomatitis
- Viscous lidocaine (swish & spit) - Diphenhydramine liquid (swish & spit) - Dyclonine lozenges
27
second-line/refractory txts for aphthous stomatitis
Topical steroids: - dexamethasone elixir (swish & spit) - clobetasol gel - traimcinolone paste
28
Management for complex aphthous stomatitis
- Intralesional or oral steroids for recalcitrant lesions or severe disease - Colchicine - Dapsone (aczone) - Pentoxifylline (bronchodilator and immunomodulator) - Thalidomide in HIV patients
29
thalidomide med for complex aphthous stomatitis
for HIV patients with aphthous stomatitis - recurrent after cessation of therapy - cat X - can only be rx thru special program
30
oral leukoplakia
- benign reactive process (can develop oral cancer) - early step in transformation of premalignant lesions from hyperplasia -> dysplasia -> carcinoma in situ -> invasive malignant lesions
31
what does oral leukoplakia's clinical significants depend on?
degree and presence of dysplasia
32
oral leukoplakia epidemiology
- men>women - association w/HPV - similar to SCC - common in smokeless tobacco users (chew) - seen in pure inflammatory conditions not associated with malignancy
33
oral leukoplakia clinical manifestations
- leukoplakia lesions that show up in trauma prone regions where mucosa is thicker (cheek and dorm of tongue) - NOT painful (vs thrush is) - white/grey lesions - flat & no well defined - can't scrape off (vs thrush can)
34
thin areas of mucosa show more what in oral leukoplakia?
more dysplasia | -ventral tongue, retromolar triangle
35
oral leukoplakia dx
- hx & PE - whitish res that can't scrape off - all indurated areas should be biopsied
36
oral leukoplakia management
- most don't need txt (watch & see) - surgical removal - cryoprobe - chemoprevention - oral retinoids
37
oral hairy leukoplakia
- different than oral leukoplakia - NOT premalignant - EBV associated - occurs almost ENTIRELY in HIV infected pts
38
Herpes (HSV-1) aka?
aka herpes labialis
39
HSV-1 effects what sites?
multiple sites in the body especially perioral and oral cavity (80%) and 20% genital lesions
40
what has HSV-1 been associated with?
increasing cases of genital herpes
41
HSV-1 more common in?
women
42
By who are a majority of infections transmitted?
people who don't know they have it
43
HSV-1 pathophysiology
enters -> latency -> survives in neural ganglia -prevents elimination by immune response - recurrent infection is common - usually localized symptoms only
44
types of HSV-1 infections
primary -highly variable and usually severe & systemic recurrent -common & typically less severe and local
45
clinical manifestations of HSV-1
- systemic symptoms = primary - affects gingiva (primary = gums, recurrent = buccal mucosa & lips) - HERPETIC GINGIVASTOMATITIS - multiple oral vesicular lesions and erosions surrounded by erythematous base - painful - prodome (burning, tingly, pain)
46
what is the most common clinical manifestation of HSV-1?
herpetic gingivastomatitis
47
where does primary HSV-1 occur?
gums
48
where does recurrent HSV-1 occur?
buccal mucosa and lips
49
children <5 w/ HSV-1 may have?
-fever, LAD, drooling, decreased oral intake
50
prodrome of HSV-1?
burning, tingling, pain | -25 hours prior to outbreak
51
where are recurrent outbreaks of HSV-1 usually?
lip borders
52
what may be first indication of infection in HSV-1?
recurrence
53
HSV-1 risk factors
sunlight, stress, trauma
54
HSV-1 diagnosis
- Tzanck smear, immunofluorescence smear or viral cx - unroof vesicle - serology for HSV by PCR
55
HSV-1 management
-systemic acyclovir, valacyclovir, famciclovir w/in 48-72 hours - swish and spit miracle mouthwash (internal lesions) - supportive - popsicles (ice pack)
56
oral candida involves?
mucous membranes - oropharyngeal - esophageal
57
oral candida epidemiology
- Young infants - Older adults who wear dentures - Antibiotics - Radiation of head and neck - Immunodef - Inhaled corticosteroids - Xerostomia
58
oral candida pathophysiology
-Candida albicans | also c. galbrata, c. krusei, c. tropicalis
59
oral candida classification
pseudomembranous & atopic (denture stomatitis)
60
pseudomembranous oral candida
most common form | -white plaques on buccal mucosa, palate, tongue, oropharynx
61
atrophic (denture stomatitis) oral candidy
- most common form in older adults - found under upper dentures - erythema w/out plaques
62
asymptomatic manifestations of oral candida
- dry mouth - loss of taste - pain with swallowing or eating (esophageal thrush) - also have angular chelitis - painful fissuring
63
pseudomembranous oral candida clinical manifestations
- White plaques on buccal mucosa, palate, or tongue | - PAINFUL
64
atrophic (denture stomatitis) oral candida clinical manifestations
- erythema w/out plaques - NOT painful - beeft, red tongue (worst case)
65
oral candida dx
- Usually based on risk factors - White plaques usually removable - Fungal culture - KOH prep - Refractory thrush should warrant HIV testing
66
oral candida management for HIV negative patients
- Local therapy - Nystatin suspension swish and swallow - Clotrimazole troches (suckers) - Miconazole buccal tabs - Diflucan PO (More extensive disease can warrant this)

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