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Oral Pathology & Associated Syndromes Flashcards

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1
Q

What are common infant ST lesions?

A
  • Natal oral cysts
  • Sucking pads and calluses
  • Pseudomembranous candidiasis
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2
Q

What are natal oral cysts?

A

White papules that slough off

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3
Q

Name palatal cysts of newborn

A
  • Epstein pearls
  • Bohn nodules

Single or multiple papules that rupture and heal

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4
Q

Epstein pearls

A
  • Occurs on palatal midline
  • Epithelial inclusion cyst
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5
Q

Bohn nodules

A
  • Occurs on junction of hard and soft palate
  • Remnants of minor salivary glands
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6
Q

Incidence of palatal cysts of newborn?

A
  • 55-85%
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7
Q

GIngival (alveolar) cyst of newborn

A
  • Dental lamina cyst – occurs on alveolar mucosa; remnants of dental lamina
  • Occurs in 50%
  • Single or multiple papules that rupture and heal
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8
Q

What do natal oral cysts mimic?

A
  • Superficial abscess
  • Thrush
  • Erupting tooth
  • Eruption cyst
  • Lymphoepithelial cyst (palate)
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9
Q

Sucking pads and calluses

A
  • Anatomical variant from sucking trauma
  • Most prominent in black infants
  • Site: Labial and vermillion border
  • Swollen, translucent to opaque white to pigmented scaly patches; may peel and recur; non-tender
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10
Q

Concurrent conditions with sucking pads and calluses

A
  • Leukoedema
  • Labial vesicles
  • Bullae
  • Erythema of nasiolabial folds and lips
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11
Q

Treatment for sucking pads and calluses

A
  • Resolves
  • Feeding position
  • Lip emollient, such as lanolin
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12
Q

What do sucking pads and calluses mimic?

A
  • Chapped lips
  • Breastfeeding keratosis
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13
Q

Pseudomembranous candidiasis

A
  • Common oral infection in neonates
  • Cause: Candida albicans usually
    • Usually does not cause infection unless host is immunocompromised
  • Contributing factors:
    • Maternal vaginal (untreated vulvovaginitis) or breast infection
    • Prematurity
    • Immunosuppression
    • Antibiotics
      • Increases susceptibility with long-term abx, corticosteroids, drugs that cause xerostomia debilitating disease, oral appliances
  • Site: Widespread oral involvement
  • White non-adherent papules and plaques with a curdled milk appearance
    • Multifocal white papules and plaques that wipe off and red patches that may burn
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14
Q

Concurrent conditions with pseudomembranous candidiasis

A
  • Diaper rash
  • Perioral rash
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15
Q

Pseudomembranous candidiasis: Treatment

A
  • Nystatin
  • Fluconazole
  • Clotrimazole
  • Itraconazole
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16
Q

What does pseudomembranous candidiasis mimic?

A
  • Coated tongue
  • Materia alba
  • Oral cysts of newborn
  • Mucosal sloughing
  • Breastfeeding keratosis
  • Plaque, mucosal sloughing
  • Koplik spots of measles
  • Mucous patches of syphilis
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17
Q

Uncommon infant ST lesions

A
  • Riga-Fede disease
  • Tongue trauma in infants
  • Vascular lesions
    • Vascular tumors
    • Vascular malformations
  • Vascular malformation
  • Hemangioma
  • Lymphatic malformation
  • Neonatal alveolar lymphangioma
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18
Q

Riga-Fede Disease

A
  • Cause: Chronic trauma from primary incisors
  • Represents a traumatic granuloma
  • Ulcerated lesion or mass on anterior ventral tongue
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19
Q

Riga-Fede Disease: Treatment

A
  • Identify cause
  • Modify feeding position and bottle used
  • Smooth incisal edges
  • Apply CHX rinse to ulcer for secondary infection
  • Evaluate for partial ankyloglossia
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20
Q

What does Riga-Fede Disease mimic?

A
  • Neuropathologic chewing
  • Factitial injury
  • Trauma from child abuse
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21
Q

Tongue trauma in infants

A
  • Neuropathologic chewing
  • Seizure disorder
  • Incorrect use of pacifier, bottle, teething rings
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22
Q

What are conditions with neuropathologic ulcers?

A
  • Familial dysautonomia
    • Lesch-Nyhan syndrome
    • Gaucher disease
    • Cerebral palsy
    • Tourette syndrome
    • Rhett syndrome
    • Autism
    • Cornelia de Lange syndrome
    • Traumatic brain injury
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23
Q

Classification of vascular lesions

A
  • Vascular tumors
    • Infantile hemangioma
    • Congenital hemangioma
    • Pyogenic granuloma (lobular capillary hemangioma)
  • Vascular malformations
    • Capillary malformation
    • Venous malformation
    • Lymphatic malformation
    • Arteriovenous malformation
    • Combined malformations
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24
Q

Vascular malformation

A
  • Present at birth and is persistent; occurs in 0.3% of newborns
  • Tends to grow with the child
  • Occurs in the head and neck region, including facial skin
  • May be associated with skeletal changes and be intrabony
  • Red, purple, blue macule, nodule or diffuse swelling
    • Low-flow – venous malformation
    • High-flow – arteriovenous malformation – bleeding, pain, warmth, palpable thrill or bruit
  • Sturge-Weber syndrome: vascular lesion of face and brain, port-wine nevus, risk for seizure disorder
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25
**Vascular malformation:** Treatment
* Surgery * Embolization * Laser treatment for port wine nevus
26
What do **vascular malformations** mimic?
* Hemangioma * Varix * Eruption cyst/hematoma * Blue nevus * Ecchymosis
27
Hemangioma
* Multiple types, including infantile and congenital * Neoplasm of vascular origin affecting **5%** of infants * **60%** occur in the head and neck region * May involve major salivary glands, usually parotid * **Lip and tongue are common oral sites** * Normal or reddish-blue skin coloration with swelling * Rubbery to palpation, may not blanch * Many regress with age
28
**Hemangioma:** Treatment
* Observe * Propanolol * Steroids
29
What do **hemangiomas** mimic?
* Vascular malformation * Pyogenic granuloma * Hematoma * Mucocele
30
**Lymphatic malformation (lymphangioma, cystic hygroma)**
* Hamartomatous growth of lymphatic vessels * Predilection for head and neck – **50-75%** * **90% develop by 2yo** * Superficial lesions have pink, red or purple with pebbly, vesicular surface * Cystic hygroma cause a diffuse swelling of cervical region of neck, parotid gland, tongue * Large lesions can compromise airway * Lesions rarely progress
31
**Lymphatic malformation (lymphangioma, cystic hygroma):** Treatment
May include surgery, sclerotherapy, drugs
32
What do **lymphatic malformations** mimic?
* Venous malformation * Squamous papilloma * Mucocele
33
Neonatal alveolar lymphangioma
* **Present at birth** * Usually occurs in **African American males** * Alveolar ridge; mandible \> maxilla * Translucent pink to blue, fluctuant swelling
34
**Neonatal alveolar lymphangioma:** Treatment
None; resolves spontaneously
35
What do **neonatal alveolar lymphangiomas** mimic?
* Gingival cyst of newborn * Eruption cyst
36
What are **rare** ST lesions?
* Congenital epulis * Congenital hamartoma/choristoma * Melanotic neuroectodermal tumor to infancy * Hemifacial hyperplasia * Hemifacial microsomia
37
Congenital epulis
* ST tumor of uncertain origin * **Occurs in females 90%** * Occurs in maxilla \> mandible * **Maxillary lateral and canine region – most common site** * Firm, pink to red mass arising from alveolar mucosa at birth
38
**Congenital epulis:** Treatment
* Excision * May regress
39
What does **congenital epulis** mimic?
* Eruption cyst * Gingival hamartoma * Pyogenic granuloma * Fibrous epulis
40
Congenital hamartoma/choristoma
* ST tumor-like enlargement * **Hamartoma:** Overgrowth of normal tissue that **belongs** at that site. * **Choristoma:** Overgrowth of normal tissue that **does not belong** at that site. * Tongue and alveolar mucosa are most common sites in infant. * Firm, pink nodules; single or multiple; nontender
41
**Congenital hamartoma/choristoma:** Treatment
* Excisional biopsy * Exclude syndromes such as orofacialdigital syndrome
42
What do congenital hamartomas/choristomas mimic?
* Irritation fibroma * Congenital epulis * Lipoma * Peripheral ossifying fibroma
43
Melanotic neuroectodermal tumor of infancy
* **_Tumor of neural crest origin_** * **Usually occurs in 1st year of life** * Most common site: **Anterior maxilla** * **_Rapidly expanding mass of alveolus_** * Frequently pigmented – blue or black * Displacement of teeth * Lab – **elevated urinary levels of vanillylmandelic acid** * Radiograph – **Poorly circumscribed RL with floating teeth**; may have **sun ray** pattern
44
**Melanotic neuroectodermal tumor of infancy:** Treatment
* Prognosis * Excision with margins * 20% recur
45
What do **melanotic neuroectodermal tumors of infancy** mimic?
* Congenital epulis * Intrabony vascular malformation * Malignancy
46
Hemifacial hyperplasia
* Unilateral oral and facial enlargement * **Usually evident at birth** * **Right side \> left side** * **Involves ST, bone, tongue, palate, teeth** * **Teeth may exfoliate and erupt prematurely** * Intellectual disability in **20%** * Increased incidence of abdominal tumors (Wilms tumor, hepatoblastoma, adrenal cortical carcinoma)
47
**Hemifacial hyperplasia:** Treatment
Evaluate for syndrome, cosmetic surgery, orthodontics
48
**Hemifacial hyperplasia:** Associated syndromes
* Neurofibromatosis * Beckwith-Wiedemann * McCune-Albright * Others…
49
**Hemifacial hyperplasia:** Mimics
Segmental odontomaxillary dysplasia
50
Hemifacial microsomia
* **Anomalies of 1st and 2nd branchial arch** * **Sporadic inheritance; rarely AD** * **Unilateral microtia, microstomia and failure of formation of mandibular ramus and condyle** * Unknown etiology * Frequent eye and skeletal involvement * **50% have cardiac pathology – VSD, PDA**
51
What condition(s) are **hemifacial microsomia** associated with?
Goldenhar syndrome
52
What does **hemifacial hyperplasia** mimic?
* Localized scleroderma * Unilateral TMJ ankylosis * Fracture
53
Wipeable white lesions
* Coated tongue * Pseudomembranous candidiasis (thrush) * Moriscatio (cheek or lip chewing) * Chemical burn * Toothpaste or mouthwash reaction
54
Non-wipeable white lesions
* Bilateral/Symmetrical * Lina alba * Leukoedema * Reticular lichen planus * White sponge nevus * Solitary or Multiple * Smokeless tobacco keratosis * Pachyonychia congenita * Dyskeratosis congenita * Hereditary benign intraepithelial dyskeratosis
55
What are **common** white lesions
* **Pseudomembranous candidiasis** * **Coated tongue** * **Leukoedema** * **Frictional keratosis/cheek- and tongue-biting (moriscatio) lesions** * **Mucosal burn** (thermal, chemical) * **Mucosal sloughing** (toothpaste, mouthwash reaction) * **Benign migratory glossitis** (erythema migrans, geographic tongue) – see red, purple, blue lesions * **Fordyce granules**
56
Coated tongue
* Collection of bacteria and sloughed epithelial cells on dorsal * Contributing factors include **xerostomia, mouth-breathing, sinusitis, poor OH, febrile conditions, dehydration** * Cream-colored or tan film that is non-adherent * May be **diffuse or localized to posterior tongue** * May contribute to **halitosis**
57
**Coated tongue:** Treatment
* Improve hydration * Gently debride dorsal tongue * Improve OH
58
What does **coated tongue** mimic?
* Pseudomembranous candidiasis * White hairy tongue
59
Leukoedema
* Variation of normal oral mucosa * Most commonly observed in **blacks**, occurring in **50% of children** * Most obvious on **buccal mucosa** * **Bilateral, diffuse, filmy white, adherent, wrinkled mucosa** * Stretching of mucosa causes lesions to be less prominent * Increase thickness of mucosa, intracellular edema of spinous layer
60
**Leukoedema:** Treatment
None
61
What does **leukoedema** mimic?
* Cheek-biting keratosis * White sponge nevus
62
Frictional keratosis/cheek- and tongue-biting (moriscatio) lesions
* Caused by low grade, chronic irritation that is usually obvious, especially chronic nibbling of mucosa * Usually on gingiva, buccal mucosa, lateral tongue * White, smooth to shaggy, adherent patches; non-tender * May observe a prominent linea alba on buccal mucosa
63
**Frictional keratosis/cheek- and tongue-biting (moriscatio) lesions:** Treatment
None; reversible lesion
64
What do **frictional keratosis/cheek- and tongue-biting (moriscatio) lesions** mimic?
* Cinnamon contact reaction * Smokeless tobacco keratosis * Leukoplakia * Chronic hyperplastic candidiasis
65
Mucosal burn (thermal, chemical)
* Thermal burn is common due to pizza, soup, hot beverages * Usually occurs on the palate and tongue * Chemical burn is caused by a number of agents: * Aspirin * Formocresol * Ferric sulfate * Phosphoric acid * Phenol * Usually occurs on gingiva, buccal, labial mucosa, perioral skin * Irregular white necrotic patch that wipes off or red erosion; tender
66
**Mucosal burn (thermal, chemical):** Treatment
Palliative tx only; most resolve in several days
67
What do **mucosal burns (thermal, chemical)** mimic?
* Pseudomembranous candidiasis * Toothpaste or mouthwash reaction * Cotton roll burn * Mucous patch of secondary syphilis
68
Benign migratory glossitis (erythema migrans, geographic tongue)
* Cause is unknown, but associated with **atopy** * Dorsal tongue usually * **Multiple oval to circular, red to pink patches of desquamated filiform papillae** * May be surrounded by **white border** * Does not wipe off * Pattern moves around * **May be tender especially with acidic or spicy foods** * May be seen with **transient lingual papillitis**
69
**Benign migratory glossitis (erythema migrans, geographic tongue):** Treatment
Palliative tx as needed Persistent condition
70
What does **benign migratory glossitis (erythema migrans, geographic tongue)** mimic?
* Median rhomboid glossitis * Lichen planus * Contact mucositis * Mucosal erosion
71
Fordyce granules
* **Ectopic sebaceous glands in oral mucosa** * Becomes more prominent during puberty * Common sites: Buccal mucosa, lips * Flat to slightly elevated, submucosal yellow-white papules or plaques
72
**Fordyce granules:** Treatment
None
73
What do **fordyce granules** mimic?
* Pustules * Frictional keratosis * Milia (lips)
74
What are **uncommon** white lesions?
* Smokeless tobacco keratosis * White hairy tongue
75
Smokeless tobacco keratosis
* Caused by chewing tobacco, snuff, snus * Occurs in vestibular mucosa * White, wrinkled, adherent plaque; gingival recession, stained, sensitive teeth, root caries, halitosis Malignant transformation is **_rare_**
76
**Smokeless tobacco keratosis:** Treatment
* D/c habit * Biopsy persistent lesions
77
What does **smokeless tobacco keratosis** mimic?
* Frictional keratosis * Cinnamon contact reaction * Chronic hyperplastic candidiasis
78
White hairy tongue
* Accumulation of keratin on filiform papillae * Occurs on dorsal tongue * **Cause is unknown; xerostomia, poor OH, tobacco smoking, in adolescents** * Multiple cream-colored to brown, slender surface projections * May have thick matted appearance * Adherent but the discoloration can be partially removed
79
**White hairy tongue:** Treatment
* Improve hydration * Brush tongue * D/c cigarette smoking
80
What does **white hairy tongue** mimic?
* Coated tongue * Pseudomembranous candidiasis
81
What are **rare** white lesions?
* Lichen planus * Chronic hyperplastic candidiasis * Hairy leukoplakia * White sponge nevus * Hereditary benign intraepithelial dyskeratosis (HBID) * Koplik spots
82
Lichen planus
* Chronic mucocutaneous disease – **_rare in children_** * Cause: * **T-cell mediated autoimmune disease** * **Some cases represent a contact allergy (lichenoid reaction)** * Affects both oral mucosa + skin (esp. extremities) * Oral sites: * Buccal mucosa * Gingiva * Tongue * **White lacy lines (_Wickham striae_)** w/ red background * Bilateral + symmetrical * Burns * Waxes and wanes * **May have a secondary candidal infection**
83
**Lichen planus:** Treatment
* Incisional biopsy * Topical steroids * Antifungal agents
84
What does **lichen planus** mimic?
* Cinnamon contact reaction * Cheek-biting keratosis * Benign migratory glossitis
85
Chronic hyperplastic candidiasis
* Chronic mucocutaneous disease * Some cases associated with **endocrine disease + autoimmune disorders** * Site: * Anterior buccal mucosa and tongue * **May have nail involvement** * White, wrinkled adherent plaques that are adherent * Distinctive raised border * **May be tender**
86
**Chronic hyperplastic candidiasis:** Treatment
* Incisional biopsy * Antifungal agents
87
What does **chronic hyperplastic candidiasis** mimic?
* Cinnamon reaction * Cheek- and tongue-biting keratosis * Lichen planus * Hairy leukoplakia
88
Hairy leukoplakia
* Cause: **Latent infection of _Epstein-Barr virus_** * Contributing factors: * Immunosuppression * HIV infection * Site: Ventrolateral tongue *
89
White sponge nevus
* **Autosomal dominant** mucocutaneous disease * Diffuse, white, thickened, adherent and wrinkled oral mucosa * May be present at birth, becomes more prominent in adolescence * The gingival margin and dorsal tongue are almost never affected. The soft palate and ventrolateral tongue are commonly involved.
90
**White sponge nevus:** Treatment
None. Persistent condition
91
What does **white sponge nevus** mimic?
* Leukoedema * Cinnamon reaction * Hereditary benign intraepithelial dyskeratosis
92
Hereditary benign intraepithelial dyskeratosis (HBID)
* **Autosomal dominant** mucocutaneous disease * **Affects individuals of mixed white, American Indian, and black ancestry living in North Carolina** * Appears similar to white sponge nevus, but **affects the eyes** * **May cause visual impairment**
93
Koplik spots
* Oral manifestation of **measles (rubeola)** * Observed in the **initial stage of viral infection** * Site: **Buccal mucosa and soft palate** * Multiple, tiny white macules that wipe off **(grains of sand appearance)**
94
**Koplik spots:** Treatment
Refer to pediatrician
95
What do **Koplik spots** mimic?
* Pseudomembranous candidiasis * Mucosal burn * Mucosal sloughing
96
Which red lesions are **diascopy positive**?
*Blanch* * Hemangioma/Vascular malformation * Sturge-Weber Syndrome * Hereditary hemorrhagic telangiectasia
97
Which red lesions are **diascopy negative**?
*Do _not_ blanch* * Submucosal hemorrhage * Petechial hemorrhage * Thrombocytopenia * Infectious mononucleosis
98
Which red lesions are **non-vascular**?
* Traumatic erythema * Thermal burns
99
Diascopy positive
Blanch w/ pressure
100
Diascopy negative
Do not blanch w/ pressure
101
What are **common** red lesions?
* Acute gingivitis * Submucosal hemorrhage * Traumatic erythema * Thermal burn
102
What are **uncommon** red lesions?
* Vascular malformation * Glossitis
103
What are **rare** red lesions?
* Hereditary hemorrhagic telangiectasia * Sturge-Weber angiomatosis * Acquired coagulation disturbance * Plasminogen deficiency * Thrombocytopenia * Hemophilia * Factor VIII * Factor IX * von Willebrand disease * Vitamin K deficiency * Hepatobiliary disease
104
Acute gingivitis
* Plaque-induced inflammatory lesion * Lesions may blanch with pressure due to **vascular dilation** * Nontender, red, swollen lesions that may bleed w/ brushing * Tx: Improved OH; reversible lesion
105
Submucosal hemorrhage
*Diascopy negative* * Entrapment or pooling of blood in tissues * Blue-gray color due to **hemosiderin** deposition * Does not blanch * Causes: * **Traumatic (common)** * **May be associated w/ child abuse** * **Suspect repeated trauma or chronic condition if multiple colors of bruising are present** * **Nontraumatic (uncommon)** * Blood dyscrasia * Viral infection (infectious mononucleosis, measles) * Anticoagulants * Terms: Petechiae, purpura, ecchymosis, hematoma * Site: **Lip and mucosa along occlusal plane** * Pinpoint to macular to diffuse red, purple or blue lesions * Usually nontender
106
**Submucosal hemorrhage:** Treatment
Resolves in 1-2 weeks. If recurrent, important to identify cause
107
Traumatic erythema
*Non-vascular* * Irritation resulting in erosion of mucosa * Do not blanch w/ pressure * Site: Any mucosal site * Red macule w/ irregular margins; usually tender * **May be associated w/ child abuse**
108
**Traumatic erythema:** Treatment
Palliative treatment, if tender Resolves \<1 week
109
Glossitis
* Redness due to **thinning of oral mucosa** * Generalized erythema and **depilation of dorsal tongue**; may appear normal * **Burning sensation** * Causes: * Anemia * Candidiasis * Vitamin B deficiency * Factitial injury * Xerostomia * Allergies * Diabetes * Hypothyroidism
110
**Glossitis:** Treatment
Treat underlying cause
111
Hereditary hemorrhagic telangiectasia
*Diascopy positive* * **Autosomal dominant** * Multiple dilated capillaries (telangiectasia) of skin and mucous membranes * Blanch w/ pressure * Arteriovenous fistulas of lung, liver, brain – **increased risk for abscess** * Prominent signs: **epistaxis, oral bleeding** * **Prophylactic abx may be indicated w/ AV fistulas** * Most common locations on skin: * Palms * Fingers * Nail beds * Face * Neck * Mucosal lesion locations: * Lung * Brain * GI tract * Liver
112
Hereditary hemorrhagic telangiectasia: Complications
* Liver cirrhosis * Pulmonary AV fistula → pulmonary HTN * Brain abscesses * Emboli
113
**Hereditary hemorrhagic telangiectasia:** Precautions
Precautions recommended with: * Use of inhalation analgesia * General anesthesia * **Oral surgical procedures** * Hepatotoxic and antihemostatic drugs
114
T/F: Antibiotic prophylaxis is recommended before invasive dental treatment in patients who have pulmonary arteriovenous malformations.
True - because of risk of **cerebral abscess**
115
Sturge-Weber angiomatosis
* AKA Encephalotrigeminal Syndrome* * Diascopy positive* * Congenital **port wine stain** of upper face, including forehead * **Leptomeningeal angiomas →** impaired blood flow to brain → atrophy + calficiations * **Ipsilateral facial angiomatosis usually** * **Ipsilateral gyriform calcifications of cerebral cortex** * Intellectual disability * **Seizures, strokes, ocular defects** (hemiplegia in some cases) * **Oral bleeding, pyogenic granulomas, gingival hyperplasia, alveolar bone loss, diffuse vascular lesions**
116
Approximately what percent of people with facial port wine stains have Sturge-Weber angiomatosis?
20%
117
**Sturge-Weber angiomatosis:** Treatment
Aspirin for stroke prevention
118
Name **red and white** lesions
* Geographic tongue * Dorsal/lateral tongue * Ectopic – other mucosal sites * Oral candidiasis * Cinnamon contact mucositis
119
What are **common** red and white lesions?
* Geographic tongue (benign migratory glossitis) * Candidiasis (also under ‘red lesions')
120
What are **uncommon** red and white lesions?
* Cinnamon contact mucositis
121
What are **rare** red and white lesions?
* Lichen planus * Systemic lupus erythematous (also under ‘oral ulcers’)
122
What percent of the population is affected by geographic tongue?
2%
123
Geographic tongue (benign migratory glossitis)
* Cause: Unknown * May be **associated w/ atopy, fissured tongue, transient lingual papillitis** * Affects **2%** of the population * Site: Primarily on the dorsal and ventrolateral tongue * Rarely on other mucosal sites * **Focal loss of filiform papillae on dorsal tongue** * Oval red patches w/ white borders that migrate * May be sensitive + persistent * Tx: None; palliative tx if tender
124
Cinnamon contact mucositis
* Cause: Flavoring agent in OH products, candy, gum * Site: Buccal mucosa + lateral tongue * White, shaggy, adherent patches with erythema; tender * Tx: Identify cause, d/c offending agent
125
What does **cinnamon contact mucositis** mimic?
* Cheek- and tongue-biting keratosis * Lichen planus * Chronic hyperplastic candidiasis
126
Lichen planus
* **Chronic mucocutaneous disease – rare in children** * Cause: **T-cell mediated autoimmune disease; some cases represent a contact allergy (lichenoid reaction)** * Sites: Affects both skin, especially extremities, and oral mucosa **(buccal mucosa, gingiva, and tongue)** * White lacy lines with red background, bilateral and symmetrical * Burns * Waxes and wanes * **May have secondary candidal infection**
127
**Lichen planus:** Treatment
* Incisional biopsy * Topical steroids * Antifungal agents
128
What does **lichen planus** mimic?
* Cinnamon contact reaction * Cheek-biting keratosis * Benign migratory glossitis * Lupus erythematous
129
**Diffuse** brown/black/gray lesions
* Physiologic pigmentation syndromes * Peutz-Jeghers * Addison's disease
130
**Localized** brown/black/gray lesions
* Melanotic macule * Amalgam tattoo * Non-amalgam tattoo * Intraoral nevus * Blue nevus * Melanoma
131
What are **common** localized pigmented lesions?
* Submucosal hemorrhage * Melanotic macule * Ephelis
132
What are **uncommon** localized pigmented lesions?
* Amalgam/graphite tattoo * Melanocytic nevus
133
What are **rare** localized pigmented lesions?
* Melanoma * Oral melanoacanthoma * Melanotic neuroectodermal tumor of infancy
134
Melanotic macule
* Common lesion due to focal increase in melanin * Site: Lip, buccal mucosa, gingiva, palate * Solitary, round to oval macule, brown, gray, black in color * Tx: None required; no malignant potential. * Excise if sudden onset and large * Periodic observation
135
What does **melanotic macule** mimic?
* Melanotic nevus * Amalgam/graphite tattoo * Smoker's melanosis * Late ecchymosis
136
Ephelis
* Freckle – occurs on skin * Similar to melanotic macule * Common lesion due to focal increase in melanin * Genetic predisposition for some * Occurs on sun-exposed skin; face commonly affected * Round to oval macule, tan, brown, gray in color * May be solitary, usually multiple * Tx: None required * Sunscreen to prevent increase of lesions or darkening of lesions
137
Amalgam/graphite tattoo
* Grey or blue macule on gingiva and palate * Entrapped foreign body; history supports lesion * Large particles may be seen on radiographs * Tx: None required
138
Melanocytic nevus
* Benign proliferation of nevus cells * Common on skin, but **uncommon in mouth; usually on palate** * May be **congenital** * Oral types: Blue and intramucosal are most common * Site: **Palate, buccal mucosa, gingiva, lip** * Brown, blue, black macule or nodule * **85% are pigmented** * **70% are elevated**
139
**Melanocytic nevus:** Treatment
* Excisional biopsy * **Rare malignant potential**
140
What does a **melanocytic nevus** mimic?
* Melanotic macule * Amalgam/graphite tattoo
141
Where does **melanoma** typically show up?
Palate and gingiva
142
Oral melanoacanthoma
Rapidly enlarging lesion that occurs in blacks
143
Melanotic neuroectodermal tumor of infancy
Expansile destructive tumor of anterior maxilla
144
What are **common** generalized pigmented lesions?
* Physiologic (racial) pigmentation * Brown hairy tongue * Post-inflammatory pigmentation * Acanthosis nigricans
145
Where is physiologic (racial) pigmentation most common?
Attached gingiva
146
Brown hairy tongue
Exogenous staining of elongated filiform papillae
147
What is **post-inflammatory pigmentation**?
Hyperpigmentation in response to chronic mucosal trauma
148
Acanthosis nigricans
* **Associated with obesity and diabetes in children** * Velvety brown to black papules and plaques on neck, axilla, flexural skin * Refer to pediatrician for evaluation of endocrine disease
149
What are **uncommon** generalized pigmented lesions?
* Smoker's melanosis * Melasma
150
Smoker's melanosis
* Brown patch on **anterior gingiva and labial mucosa** * Usually in **females** * **May be localized**
151
Melasma
Symmetrical pigmentation of face and neck associated with pregnancy, oral contraceptives
152
Rare generalized pigmentation lesions
* Addison disease * Peutz-Jeghers syndrome * Medications * Heavy metal toxicity * Hemochromatosis * Neurofibromatosis * McCune-Albright syndrome
153
Addison disease
* Adrenal insufficiency * Weakness, nausea, vomiting, **low BP**, oral + cutaneous pigmentation * **Oral: Diffuse grey patches**
154
Peutz-Jeghers syndrome
* AD * Melanin hyperpigmentation of lips * **Benign polyposis of small intestine; up to 9% become malignant** * Buccal lesions less likely to fade than lip lesions
155
What medications can cause generalized pigmentation?
* **Antimalarial drugs (chloroquine), antibiotics (minocycline), hormones (estrogen)** produce gray coloration of mucosa * Patient must take drugs for an extended period of time * **Pigmentation usually on hard palate + gingiva**
156
Heavy metal toxicity
* Bismuth * **Gingivostomatitis similar to necrotizing ulcerative gingivitis** * **Blue-black pigmentation of interdental papilla** * Lead * **Salivary gland swelling + dysphagia** * **Grey pigmentation of marginal gingiva** * Mercury * **Ropy, viscous saliva** * Faint grey alveolar gingival pigmentation * **Gingivostomatitis similar to necrotizing ulcerative gingivitis** * Silver * Skin is slate grey * Diffuse pigmentation * Copper * **Blue-green gingiva + teeth** * Zinc * Blue-gray line on gingiva * **Periodontal involvement**
157
Hemochromatosis
* Iron storage disease * **Bronzing of skin + gray pigmentation of palate**
158
Neurofibromatosis
Multiple cafe au lait macules + pigmented neurofibromas
159
McCune-Albright syndrome
Large cafe au lait macules, endocrine disease, **polyostotic fibrous dysplasia**
160
Common localized gingival enlargements
* Parulis/pericoronitis * Pyogenic granuloma * Localized juvenile spongiotic gingival hyperplasia * Irritation fibroma * Peripheral ossifying fibroma * Eruption cyst/hematoma * Squamous papilloma
161
Uncommon gingival enlargements
* Peripheral giant cell granuloma * Giant cell fibroma
162
Rare gingival enlargements
Neoplastic lesions * Benign neoplastic lesions * Langerhans cell histiocytosis * Aggressive fibromatosis * Malignant disease, including lymphoma * Metastatic disease
163
Parulis (soft tissue abscess)
* Odontogenic or gingival infection; entrapped foreign body * Red or pinkish white nodule w/ purulence; fluctuates in size * Soft + tender to palpation * Tx: Treat source of infection; curette lesion; abx may be indicated
164
Pyogenic granuloma
* Reactive lesion due to irritation * Occurs anywhere in mouth but gingiva common site * Sessile, red nodule that bleeds freely * **Surface ulceration is common** * Soft, friable and nontender to palpation * Tx: Surgical excision, removal of irritant * **Variants: Pulp polyp, pregnancy tumor, epulis granulomatosum**
165
Localized juvenile spongiotic gingival hyperplasia
* Distinct subtype of gingivitis * **Origin: Sulcular, junctional epithelium** * **Does not respond to local plaque control** * **Anterior facial gingiva, especially maxillary** * **May be multifocal** * **Papillary or velvety, red nodule that bleeds easily** * **Soft, friable and nontender to palpation** * Tx: Surgical excision; may resolve spontaneously * **Mimics as flat pyogenic granuloma**
166
Irritation fibroma
* **Reactive** hyperplasia due to chronic trauma * **Occurs on buccal + labial, gingiva, tongue** * Pink, smooth nodule; nontender * Tx: Surgical excision * **Variant: Frenal tag**
167
Peripheral ossifying fibroma
* **Reactive lesion** * Only occurs on the **gingiva** * Firm, pink or red nodule that **begins in interdental papilla; usually ulcerated** * **May displace or loosen teeth** * **Radiograph: May show foci of dystrophic calcification** * Tx: Surgical excision down to periosteum * **Recurrence rate - up to 16%**
168
Eruption cyst/hematoma
* **Soft tissue dentigerous cyst** * Associated w/ eruption of primary + permanent teeth * Red, purple swelling of alveolar mucosa * Radiograph: **May show an enlarged follicular space that extends to alveolar mucosa** * Tx: None, unless delayed eruption or symptomatic
169
Squamous papilloma
* Caused by **HPV 6 + 11** * **Most common mass of the soft palate** * Occurs on soft palate, tongue and labial mucosa; **uncommon of gingiva** * Solitary pink or white papillary, pedunculated nodule, multiple fingerlike projections * Tx: Excisional biopsy * **If multiple lesions, r/o verruca vulgaris + condyloma acuminatum**
170
Giant cell fibroma
* **Fibrous hyperplasia of unknown cause** * **Occurs on gingiva, tongue, hard palate** * Pink, smooth to stippled nodule; nontender * Tx: Surgical excision * **Developmental variant: retrocuspid papilla**
171
Peripheral giant cell granuloma
* **Reactive lesion caused by local irritation** * Occurs on **gingiva or alveolar mucosa only** * Red or purple nodule **that may bleed** * **May cause superficial bone resorption** * Tx: Surgical excision; remove local irritation * **10% recurrence rate** * **Rare cases represent central bony lesion w/ soft tissue extension**
172
What is used to treat oral mucositis?
Palifermin
173
What is the most common strain of HPV?
HPV 16
174
What strains of HPV cause squamous papilloma?
HPV 6 + 11
175
What strain of HPV is associated w/ verrucous vulgaris?
HPV2
176
What strains of HPV as associated w/ focal epithelial hyperplasia (Heck's)?
HPV 13 + 32
177
Neoplastic lesions
* Benign neoplastic lesions * Langerhans cell histiocytosis * Aggressive fibromatosis * Malignant disease, including lymphoma * Metastatic disease
178
Drug-induced gingival hyperplasia
* Phenytoin – 50% * Cyclosporine – 25% * Calcium channel blockers – 25%
179
Linear gingival erythema
* Appears to be associated w/ **candidal infection** * **HIV-related or immunosuppressed children** * Distinct linear band of fiery red + edematous attached gingiva that may extend beyond MGJ * **Key finding: Does not respond to normal plaque control measures** * Tx: * Local debridement * CHX rinse
180
Plasma cell gingivitis
* **Allergic rxn to multiple allergens including those found in toothpaste, candy, chewing gum + mouthwash** * Diffuse enlargement of attached gingiva of **sudden onset; often extends to palate** * Other sites may include concurrent tongue + lip involvement * Bright red + swollen tissues w/ lack of stippling that burn * Dx: * Incisional biopsy * Dietary hx * Allergy testing if persistent * Tx: * Identify + eliminate the allergen * Topical steroids
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Gingival fibromatosis
* May be familial (AD) or idiopathic * Diffuse, multinodular overgrowth of fibrous tissue of gingiva * May have a localized variant, esp. tuberosity-palatal area * May be associated w/ several syndromes * **May be associated w/ hypertrichosis** * Clinically similar to phenytoin-induced gingival overgrowth * May delay eruption of teeth + cause malocclusion * Tx: * Routine dental prophylaxis if mild * Surgical excision (gingival recontouring) if severe * **Recurrence is common**
182
Leukemia
* Gingivitis secondary to neutropenia * Gingival enlargement due to leukemic infiltrates, esp. in myelomonocytic types * Other signs: * Spontaneous gingival bleeding * Mucosal petechiae + ecchymosis * Ulcerations * Tumor-like growths * Tooth mobility * Radiograph: * Multifocal alveolar bone loss * Loss of lamina dura * Tx: * OH measures as tolerated by lab studies
183
Granulomatous gingivitis
* Foreign body gingivitis * Orofacial granulomatosis * Crohn's disease * Sarcoidosis * Granulomatosis w/ polyangitis (Wegener granulomatosis)
184
Mucocele
**Lower lip** * Due to severance of duct + spillage of mucin into tissues * Most frequent on lower lip, but may occur on palate or tongue, floor of mouth, buccal mucosa * Fluid-filled, translucent blue nodule; fluctuates in size, may be tender * Tx: * Excisional biopsy * May spontaneously resolve
185
Soft tissue abscess
* More common on the upper lip * Caused by extension of odontogenic infection or entrapped foreign body * Radiograph if trauma, foreign body, or dental source suspected * Tx: * Tx cause * May require I+D
186
Verruca vulgaris
* Common on skin but uncommon in mouth * Caused by **HPV 2 + others** * Occurs on skin, esp. hands, face * Oral sites * Vermilion border * Labial mucosa * Anterior tongue * Pink or stippled to papillary nodules – usually multiple * Tx: * Excisional biopsy in mouth * Refer skin lesions to prevent spread
187
Lipoma
* Well-circumscribed submucosal mass * Soft, freely movable * Yellow in color * Common on **buccal mucosa, tongue, floor mouth** * Tx: * Surgical excision
188
Traumatic neuroma
* Reactive lesions that may be tender * Focal reactive lesion due to local injury * Clinically resembles a fibroma * May be tender to palpation * Tx: * Excisional biopsy
189
Vascular lesions
* Hemangioma * Vascular malformation * Lymphatic malformation
190
Squamous papilloma location
Soft palate + tongue
191
Fibroma location
Buccal mucosa + lower lip + tongue
192
Ranula location
Floor of mouth
193
Lymphoepithelial cyst location
Floor of mouth
194
Multifocal epithelial hyperplasia (Heck disease)
* **Caused by HPV 13 + 31** * Risk factors * Genetics * Ethnicity * Poverty * Malnutrition * Poor OH * HIV infection * Numerous pink nodular lesions w/ a stippled, flat topped to papillary surface * Labial + buccal mucosa, tongue are common sites * Occurs usually in children * May be mistaken for condylomas * Tx: * Excise large lesions * May spontaneously resolve
195
Angioedema
* Allergic + hereditary forms * Multiple allergens + physical stimuli can trigger rxn * Acute onset of swelling + itching * Swelling of face, lips, tongue, pharynx * Extremities * Tx: * Allergic form – antihistamines, steroids, epinephrine * Hereditary form – androgens, esterase-inhibiting drugs * May be life-threatening w/ laryngeal involvement
196
Orofacial granulomatosis
* Granulomatous disease due to abnormal immune rxn * Food allergens are a trigger for children – may have GI problems * Site: * Lip, buccal mucosa, gingiva, tongue * Persistent swelling, erythema, ulcers, **cobblestone pattern + fissured tongue** * Tx: * Incisional biopsy * ID the allergen * Steroids * Rule out Crohn disease
197
Multiple endocrine neoplasia, type 2b
* AD * **Marfanoid body + narrow facies + full lips** * **Mucosal neuromas of lips, tongue, buccal mucosa + gingiva** * **Medullary carcinoma of thyroid** * **Pheochromocytoma** * Tx: * Biopsy to confirm dx * Early evaluation of thyroid is important
198
Benign mesenchymal neoplasms
* Neurilemma * Neurofibroma * Others
199
Benign + malignant salivary gland tumors
* Canalicular adenoma – upper lip * Malignant salivary gland tumors of the posterior buccal mucosa
200
Traumatic injury
* Usually involve tongue ulceration + submucosal hemorrhage * Localized + diffuse swelling * Bleeding is a problem due to vascularity * For severe trauma, healing takes **4-6 weeks**
201
Hyperplastic foliate papilla
* Benign lymphoid hyperplasia of lingual tonsil * Enlargement triggered by infection or trauma to area * Site: * Posterior lateral tongue * Often bilateral * Yellow-pink to red enlargement w/ irregular surface; may be tender * Important oral cancer site * Tx: None, except tx the source of irritation if present; may spontaneously resolve
202
Uncommon tongue swellings
* Irritation fibroma * Pyogenic granuloma * Mucocele of Blandin-Nuhn * Entrapped foreign body, tongue piercing * Giant cell fibroma
203
Rare tongue swellings
* Vascular malformation * Hemangioma * Lymphatic malformation * Granular cell tumor * Benign neoplasm of Schwann cells * Dorsal tongue most common oral site * Pale, smooth or slightly stippled nodule * Tx: Excisional biopsy * Micro: Pseudoepitheliomatous hyperplasia of surface epithelium + sheets of granular cells
204
Hamartoma + choristoma
* Tongue is the most common site * May be associated w/ syndromes such as oral-facial-digital syndrome * Tx: Surgical excision
205
Lingual thyroid
* Developmental lesion * Ectopic thyroid tissue in tongue * Located **midline base of tongue** * **Hypothyroidism (33%)** * Tx: * Thyroid replacement therapy * May require surgery
206
Cretinism
* Congenital hypothyroidism (myxedema in adults) * Intellectual disability, poor somatic growth, generalized edema * Shortening of cranial base – retraction of nose w/ flaring * Mandible underdeveloped, maxilla overdeveloped * **Tongue enlargement secondary to edema, delayed tooth eruption + exfoliation** * Progressive infiltration of skin + mucous membranes by glycoaminoglycans * Tx: * Thyroid replacement therapy
207
Macroglossia associated w/ common syndromes
* Down syndrome * Neurofibromatosis, type 1 * Mucopolysaccharoidosis (multiple types) * Beckwith-Weidemann syndrome * Duchenne muscular dystrophy (hypotonicity of tongue)
208
Ranula
* Mucous retention on oral floor * Dome shaped, painless, soft swelling of normal or blue color * Unilateral, fluctuates in size * Arises from the sublingual gland * Tx: * Excisional biopsy * Marsupialization of small lesions * Variant – plunging or cervical ranula
209
Sialolithiasis
* Salivary stone * **Calcium salts around focal debris in duct** * Usually involves **Wharton's duct** * **Episodic pain + swelling when eating** * Yellow-white mass may be seen close to ductal orifice * X-ray: May aid in detection * Tx: * Gentle massage * Salivary stimulation * Surgery
210
Oral lymphoepithelial cyst
* Entrapped epithelium w/in lymphoid tissue * Undergoes cystic degeneration * Occurs in oral floor, soft palate, tonsillar region, lateral tongue * Persistent yellow-white nodule * Tx: * Observe or excisional biopsy
211
Rare sublingual swellings
* Epidermoid/dermoid cyst – midline floor of mouth * Salivary gland tumor – most likely to be malignant * Ludwig's angina – life-threatening; usually of odontogenic origin
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Benign lymphoid hyperplasia
* Oral tonsil tissue * Yellow-pink to red nodules; may be tender * Tx: None required
213
Palatal abscess
* Odontogenic + gingival origin
214
Torus palatinus
* Bony exostosis that occurs in midline of hard palate * Nodular to lobular appearance * Tx: None required
215
What is the most common lesion of the soft palate
squamous papilloma
216
Nasopalatine duct cyst
* Arises from remnants of nasopalatine duct * Located in midline b/w roots of maxillary incisors * May cause root divergence * May cause fluctuant swelling of palate * Teeth are vital * X-ray: Oval to heart-shaped radiolucency * Tx: Surgical excision/curettage * Rare soft tissue counterpart is the cyst of incisive papilla * Mimics: periapical granuloma, periapical cyst, median palatal cyst
217
Inflammatory papillary hyperplasia
* Reactive lesion of the hard palatal mucosa * Associated w/ dentures, palatal coverage appliances, high palatal vault, mouthbreating * Red or pink sheets of papules; nontender * May be associated w/ candidal infection, along w/ trauma from appliance * Tx: * Antifungal agent * Disinfect appliance * May need to ⇓ wearing of appliance * Surgical excision
218
Oral lymphoepithelial cyst
Occurs on soft palate
219
Condyloma acuminatum
* **Caused by HPV 6, 11, 16, 18** * STD * May be infected at birth * Oral sites: palate, tongue, oral floor, labial mucosa * Multiple coalescing, pink nodules; **cauliflower surface** * Tx: Excisional biopsy
220
Where is the most common site for salivary gland tumors?
Posterior hard palate
221
Necrotizing sialometaplasia
* Reactive lesion of minor salivary glands due to ischemia + infarction * Cause: Trauma, dental injections, URI * May start as a swelling that progresses to cratered, irregular ulcer * Usually unilateral but may be bilateral * Ranges from nontender to painful * Tx: * Incisional biopsy to confirm dx * Resolves in **~6 weeks**
222
Acute single oral ulcers
* Aphthous ulcer * Traumatic ulcer * Riga Fede disease * Iatrogenic * Self-induced * Recurrent herpes labialis * Angular cheilitis * Behcet syndrome * Crohn disease
223
Acute multiple ulcers
* Primary herpetic gingivostomatitis * Coxsackie virus infections * Herpangina * Hand, food + mouth disease * Intraoral recurrent herpes simplex * Erythema multiforme * Necrotizing ulcerative gingivitis * Varicella
224
Chronic multiple ulcers
* Erosive/ulcerative lichen planus * Systemic lupus erythematosus * Chronic GVHD
225
Aphthous ulcers
* T-cell mediated immunologic rxn * Prevalence: 20-30% * Familial tendency * Site: **nonkeratinized mucosa** * Signs/symptoms: single or multiple, painful ulcers, recurrent lesions of sudden onset * Forms: minor, major, herpetiform * Tx: * Coating agents * Topical anesthetics * Steroids
226
Aphthous like ulcers associated w/ systemic disease
* Behcet disease * Celiac disease * Crohn disease * Periodic fevers, aphthous stomatitis, pharyngitis and adenitis (PFAPA) * Neutropenia * Immunodeficiency syndrome * Gastro-esophageal reflux disease
227
Angular cheilitis
* Cause: * Candida albicans * S. aureus * Nutritional deficiencies * Anemia * Crohn disease * Site: * Corners of the mouth * Erosions, scaly crusts, ulcerated fissures, papules; may bleed, tender * May recur * Tx: * Depends on cause * Antifungal ointment w/ or w/o short term low potency steroids
228
Recurrent herpes simplex infection
* Cause: reactivation of HSV-1 * Prevalence: 20-35% * Types: Herpes labialis, facialis, intraoral HSV * Risk factors: * UV light * Trauma * Fever * Dental tx * Site: Perioral skin, vermilion, gingiva, hard palate * Duration: 7-10 days * Recurrent, tender lesions, sudden onset, prodrome, clustered vesicles that ulcerate * Complications: Scars, erythema multiforme * Tx: * Topical anesthetics * Topical + systemic antiviral agents * Herpetic whitlow (herpetic paronychia) on finger
229
Acute herpetic gingivostomatitis (primary herpes)
* Infectious disease, primarily caused by herpes simplex virus type 1 (HSV 1) * Most common under age of 5 * Disease duration: **5-14 days** * Fever, lymphadenopathy, headache, malaise, intense gingival erythema, oral vesicles throughout mouth * Vesicles rupture, leaving painful ulcers * Widespread ulcers occur on any oral mucosal site + lip vermilion * Self-inoculation of fingers, eyes, genital area * Tx: * Systemic acyclovir * Valacyclovir may be warranted * Palliative + supportive care
230
In what age group is acute herpetic gingivostomatitis (primary herpes) the most common?
Most common under age of 5
231
Herpangina
* Cause: Enterovirus, usually **coxsackie virus** * **Most common in young children during summer months** * Multiple small vesicular lesions involving tonsillar pillars, uvula + soft palate * Vesicles rupture leaving ulcers w/ erythematous borders * Malaise, fever, sore throat, cough, rhinorrhea, diarrhea * Duration: **7-10 days** * Tx: Supportive + palliative care
232
Hand, foot + mouth disease
* Cause: **enterovirus, usually coxsackie virus** * **Common age is infant to age 4yo** * Fever, malaise, lymphadenopathy, **flu-like symptoms** * Vesicles + ulcers on buccal, labial, mucosa, tongue * Skin lesions on hands, arms, feet, and legs; **diaper rash** * Tx: Palliative + supportive resolves in **7-10 days** * Aggressive form associated w/ major neurologic complications
233
Impetigo
* **Most commonly caused by Staphylococcus aureus or in combination w/ Group A beta-hemolytic streptococcus** * Lesions are often on the face; bacteria is harbored in the nose * Usually seen in young children * **Scaly + thick amber crusts that are pruritic localized** * **_Localized_ disease tx'd w/ _topical_ abx** * **_Widespread_ disease tx'd w/ _systemic_ abx**
234
Necrotizing ulcerative gingivitis
* **Fusiform bacteria, spirochetes, HHVs** * Painful lesions, necrosis, ulceration, punched-out papilla; halitosis * Predisposing factors: * Vitamin deficiencies * Compromised immune function * Stress * Poor OH * Cigarette smoking * Viral infections (HIV, EBV, measles) * Rare in young children * Tx: * Debridement * OH * Antimicrobial rinse * +/- systemic abx
235
Erythema multiforme
* Immunologically-mediated disease * Triggers: * Drugs * HSV * Mycoplasma pneumonia * Tattooing * Other infections * **50% unknown** * Site: * Palmar + plantar surfaces * Neck * Face * Eyes * Lips * Oral mucosa * Acute onset, fever, sore throat: blood crusted lips, irregular ulcers, erythema * **_Target_** lesions on skin * **May have ocular + genital involvement (Steven-Johnson syndrome)** * Tx: ID cause; palliative care
236
Varicella
* Cause: **Varicella zoster virus** * Crops or pruritic vesicles on skin + mucous membrane * **Vesicles may precede fever** * Begins on **trunk** – spreads to limb + face * **Infectious 24hr before 6-7 days after vesicles appear** * Resolves in **7-10 days** * Tx: * Palliative + supportive * Systemic antiviral drugs in severe cases or immunocompromised children * Prevention: Vaccine – rare disease bc of vaccine
237
Chemotherapy
* Drug-induced mucositis * Widespread involvement * Pain, bleeding, sloughing, erythema, irregular ulcerations * Tx: Supportive + palliative care
238
Epidermolysis bullosa
* Hereditary vesiculobullous disease of skin + mucous membranes – multiple types * **_EB simplex_ – _most_ common; AD** * **_Junctional EB_ – _severe_ form; AR** * **Blistering of hands, feet, mouth in particular** * Scarring is common * **Oral problems: Enamel hypoplasia, microstomia, ankyloglossia, caries, gingivitis** * Tx: * No satisfactory tx * Caries prevention * Minimize trauma * Severe forms are life-threatening
239
Systemic lupus erythematosus
* Chronic multisystem progressive disorder * Autoimmune disorder * **Oral ulcerations, erosions + white striations; mimics lichen planus, secondary candidiasis** * Skin lesions, arthralgia, hematologic disorders are common * **Butterfly** rash on face * Tx: * Steroids, other immunosuppressive agents, antifungal agents
240
Graft vs. host disease
* Acute + chronic types * **Associated w/ hematopoietic stem cell transplant** * Multiorgan disease including oral mucosa + skin * **Oral manifestations:** * **Mucosal atrophy + ulcers** * **Xerostomia** * **Lichenoid rxn** * **Systemic sclerosis** * Rare development of oral cancer
241
Congenital indifference to pain
* AR * Frequent scarring of face w/ mutilation of lips, arms, legs as well as phalangeal amputation due to self-mutilation * Tongue + lips esp subject to injury * Extensive decay not associated w/ pain
242
Lesch-Nyhan syndrome
* X-linked condition * Intellectual disability * May have CP * Choreoathetosis * Bizarre, **self-mutilating** behavior — including lip destruction w/ teeth * **Absence of hypoxanthine – guanine** * **Phosphoribosyltransferase** (enzyme involved in purine metabolism)
243
Traumatic granuloma
* Traumatic ulcerative granuloma w/ stromal eosinophilia * Deep injury to the oral tissues, esp tongue * Solitary, painful, deep, persistent ulcer * Takes weeks to months to heal * Tx: * Eliminate cause * Topical or intralesional steroids * Incisional biopsy if persistent * Variant: Riga-Fede disease * **Mimics a deep mycotic infection or malignancy**
244
Causes of soft tissue neck swellings
* Reactive lymphadenopathy * Secondary to odontogenic infections * Secondary to viral infections * Other causes of lymphadenopathy * Infectious mononucleosis * Cat scratch disease * Hodgkin lymphoma * Leukemia * Kawasaki disease * Tuberculosis * Lipoma * Epidermoid cyst
245
Soft tissue neck swellings in the **midline**
* Thyroglossal duct cyst * Plunging ranula
246
**Lateral** soft tissue neck swellings
* Branchial cleft cyst * Cystic hygroma
247
Parotid gland swelling
* Mumps * Salivary gland tumor * HIV salivary gland disease
248
Infectious mononucleosis
* Caused by Epstein-Barr virus * Fever, palatal petechiae, NUG, pharyngitis, cervical lymphadenopathy
249
Cat-scratch fever
* Caused by **Bartonella henselae** * Usually due to scratch or bite from cats * Scratches on face result in **submandibular** lymphadenopathy or enlarged **parotid** lymph nodes * Tx: Usually resolves w/in 4mo; abx may be necessary
250
HIV-associated salivary gland disease
* Enlarged parotid gland * Often w/ concurrent cervical lymphadenopathy * Xerostomia * Associated w/ improved prognosis
251
Hodgkin's lymphoma
* Malignant lymphoproliferative disease * Usually unilateral, painless, enlarging mass * Unilateral presentation * **Most common nodes are cervical + supracervical nodes** * May be associated w/ fever, weight loss, night sweats, pruritis * Tx: * Radiation * Chemotherapy
252
Thyroglossal duct cyst
* Remnant of thyroglossal duct * Occurs midline anywhere along path of thyroglossal duct * Usually below hyoid * May move up and down w/ tongue movement
253
Mumps
* Usually involves parotid * Paramyxovirus (cytomegalic virus or staph in immunocompromised patient) * Incubation (2-3 weeks) * Pain, fever, malaise, headache, vomiting may precede swelling * Xerostomia * Tx: Symptomatic
254
Kawasaki disease
* Mucocutaneous lymph node syndrome * **Bilateral conjunctivitis** * **Fissured lips** * **Infected pharynx** * **Strawberry tongue** * Erythema of palms + soles * Rash * Cervical adenopathy
255
Tuberculosis
* Infectious disease that affects lungs * Caused by **Mycobacterium tuberculosis** * **Clinical findings: Weight loss, fever, night sweats, productive cough** * **Most common extrapulmonary sites in head + neck region are cervical lymph nodes** * Tx: Multiagent antibiotic therapy
256
Salivary gland tumor
* Pleomorphic adenoma most common benign lesion * Parotid most common site * Mucoepidermoid carcinoma most common malignant lesion
257
What is the most common benign salivary gland tumor?
Pleomorphic adenoma
258
Where are salivary gland tumors most common?
Parotid gland
259
What is the most common malignant salivary gland tumor?
Mucoepidermoid carcinoma
260
Branchial cleft cyst
* Area of anterior border of **sternocleidomastoid muscle** * Soft, movable, poorly delineated mass * Theories * **Origin from remnant of branchial clefts** * **Remnant of salivary gland**
261
Cystic hygroma
* Lymphatic malformation * May be present at birth * Slowly enlarges, may cause respiratory distress
262
Unilocular radiolucent lesions in the **pericoronal** area
* Dental follicle * Dentigerous cyst * Odontogenic keratocyst * Unicystic ameloblastoma * Ameloblastic fibroma * Adenomatoid odontogenic
263
Unilocular radiolucent lesions **periapical or other locations**
* Periapical granuloma or cyst * Nasopalatine duct cyst * Simple bone cyst (traumatic bone cyst) * Stafne bone cyst * Odontogenic keratocyst * Multiple nevoid basal cell carcinoma syndrome
264
Unilocular lesions in pericoronal location
* Dental follicle * Dentigerous cyst * Odontogenic keratocyst * Unicystic ameloblastoma * Adenomatoid odontogenic
265
Unilocular lesions in periapical or other locations
* Periapical granuloma or cyst * Nasopalatine duct cyst * Simple bone cyst (traumatic bone cyst) * Stafne bone cyst * OKC * Multiple nevoid basal cell carcinoma syndrome
266
RL lesions w/ ill-defined borders
* Periapical granuloma * Langerhans cell histiocytosis * Melanotic neuroectodermal tumor of infancy * Osteosarcoma * Ewing sarcoma * Soft tissue sarcomas of bone * Burkitt lymphoma * Leukemia * Metastatic tumors
267
Simple bone cyst
* Usually in mandible * Usually asymptomatic w/o expansion * Teeth are vital * May cross midline * Radiograph: Usually unilocular w/ scalloping b/w roots of vital teeth * Tx: Surgical exploration
268
Stafne defect (Stafne bone cyst, static bone cyst)
* Developmental cortical defect of the lingual mandible containing salivary gland tissue * Usually seen in adolescent males when it occurs in children * Represents submandibular fossa * Radiograph: Well-defined unilocular radiolucency of posterior mandible below mandibular canal; occasionally seen in anterior mandible * Tx: No tx

* (22 decks)

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