Oral Pathology/Medicine revision Flashcards
Pseudo- membranous Candidiasis:
The best recognized form of candidal infection is pseudo- membranous candidiasis. Also known as thrush.
Pseudo- membranous Candidiasis:
Characteristics:
Is characterized by the presence of adherent white plaques that resemble cottage cheese** or **curdled milk on the oral mucosa
Pseudo- membranous Candidiasis:
White plaques:
The white plaques are composed of tangled masses of hyphae, yeasts, desquamated epithelial cells, and debris. Scraping them with a tongue blade or rubbing them with a dry gauze sponge can remove these plaques. The underlying mucosa may appear normal or erythematous.
Pseudo- membranous Candidiasis:
Initiated by:
- May be initiated by exposure of the patient to broad-spectrum antibiotics (thus eliminating competing bacteria) or by impairment of the patient’s immune system (leukemic patients or those infected with HIV).
- Infants may also be affected, ostensibly because of their underdeveloped immune systems
Pseudo- membranous Candidiasis:
Symptoms:
Symptoms, if present at all, are usually relatively mild, consisting of a burning sensation of the oral mucosa or an unpleasant taste in the mouth, variably described as salty or bitter
Acute atrophic candidiasis:
- Acute atrophic candidiasis, or “antibiotic sore mouth,” typically follows a course of broad- spectrum antibiotic therapy.
- Patients often complain that the mouth feels as if a hot beverage had scalded it. This burning sensation is usually accompanied by a diffuse loss of the filiform papillae of the dorsal tongue, resulting in a reddened, “bald” appearance of the tongue. Burning mouth syndrome frequently manifests with a scalded sensation of the tongue; however, the tongue appears normal in that condition.
- Patients who suffer from xerostomia for any reason (e.g., pharmacologic, postradiation therapy, or Sjögren syndrome) have an increased prevalence of erythematous candidiasis that is commonly symptomatic as well
Other forms of erythematous candidiasis:
Other forms of erythematous candidiasis are usually asymptomatic and chronic. Included in this category is the condition known as central papillary atrophy of the tongue, or median rhomboid glossitis. In the past, this was thought to be a developmental defect of the tongue, occurring in 0.01% to 1.00% of adults.
Central papillary atrophy:
- appears as a well- demarcated erythematous zone that affects the midline, posterior dorsal tongue and often is asymptomatic.
- The erythema is due to the loss of the filiform papillae in this area.
- The lesion is usually symmetrical, and its surface may range from smooth to lobulated.
- Often the mucosal alteration resolves with antifungal therapy, although occasionally only partial resolution can be achieved.
chronic multifocal candidiasis:
Some patients with central papillary atrophy may also exhibit signs of oral mucosal candidal infection at other sites. This presentation of erythematous candidiasis has been termed chronic multifocal candidiasis. In addition to the dorsal tongue, the sites that show involvement include the junction of the hard and soft palate and the angles of the mouth. The palatal lesion appears as an erythematous area that, when the tongue is at rest, contacts the dorsal tongue lesion, resulting in what is called a “kissing lesion” because of the intimate proximity of the involved areas.
chronic multifocal candidiasis
Denture Stomatitis:
Definition:
Is as a form of erythematous candidiasis (chronic atrophic candidiasis)
Denture Stomatitis:
Characteristics:
Is characterized by varying degrees of erythema, sometimes accompanied by petechial hemorrhage, localized to the denture- bearing areas of a maxillary removable dental prosthesis
Denture Stomatitis:
The process:
The process is rarely symptomatic. Usually the patient admits to wearing the denture continuously, removing it only periodically to clean it. Whether this represents actual infection by C. albicans or is simply a tissue response by the host to the various microorganisms living beneath the denture remains controversial
Denture Stomatitis:
Clinician’s approach:
The clinician should also rule out the possibility that this reaction could be caused by improper design of the denture (which could cause unusual pressure on the mucosa), allergy to the denture base, or inadequate curing of the denture acrylic
Denture Stomatitis
Denture stomatitis:
Medications:
- Nystatin
- fluconazole
- itraconazole
Histoplasmosis:
Type of infection:
- Histoplasmosis, the most common systemic fungal infection
- Humid areas with soil enriched by bird or bat excrement are especially suited to the growth of this organism.
- Most individuals who become exposed to the organism are relatively healthy
Acute histoplasmosis:
- is a self-limited pulmonary infection that probably develops in only about 1% of people who are exposed to a low number of spores. With a high concentration of spores, as many as 50% to 100% of individuals may experience acute symptoms.
- These symptoms (e.g., fever, headache, myalgia, nonproductive cough, and anorexia) result in a clinical picture similar to that of influenza
Chronic histoplasmosis:
- also primarily affects the lungs, although it is much less common than acute histoplasmosis.
- Affects older, emphysematous, white men or immunosuppressed patients.
Disseminated histoplasmosis:
- is even less common. Is characterized by the progressive spread of the infection to extra- pulmonary sites.
- It usually occurs in either older, debilitated, or immunosuppressed patients.
- Tissues that may be affected include the spleen, adrenal glands, liver, lymph nodes, gastrointestinal tract, central nervous system (CNS), kidneys, and oral mucosa
Disseminated histoplasmosis:
Affected sites:
Most oral lesions occur with the disseminated form of the disease. The most commonly affected sites are the tongue, palate, and buccal mucosa. The condition usually appears as a solitary, variably painful ulceration of several weeks’ duration; however, some lesions may appear erythematous or white with an irregular surface. The ulcerated lesions have firm, rolled margins, and they may be indistinguishable clinically from a malignancy
histoplasmosis:
Diagnosis:
The diagnosis of histoplasmosis can be made by histopathologic identification of the organism in tissue sections or by culture
histoplasmosis:
Histopathologic Features:
Microscopic examination of lesional tissue shows either a diffuse infiltrate of macrophages or, more commonly, collections of macrophages organized into granulomas. Multinucleated giant cells are usually seen in association with the granulomatous inflammation
Histoplasmosis:
Treatment:
- Disseminated histoplasmosis occurring in an immunesuppressed individual is a very serious condition that results in death in 80% to 90% of patients if they remain untreated
- Amphotericin B is indicated for such patients; once the life- threatening phase of the disease is under control, daily itraconazole is necessary for 6 to 18 months
Aspergillosis:
Forms:
Is characterized by noninvasive and invasive forms.
Noninvasive aspergillosis:
usually affects a normal host, appearing either allergic reaction or a cluster of fungal hyphae.
Localized invasive infection:
Localized invasive infection of damaged tissue may be seen in a normal host, but a more extensive invasive infection is often evident in the immunocompromised patient.
The clinical manifestations of aspergillosis vary, depending on the host immune status and the presence or absence of tissue damage
Aspergillosis:
Symptoms:
- It maybe encountered after tooth extraction or endodontic treatment, especially in the maxillary posterior segments.
- Tissue damage predisposes the sinus to infection, resulting in symptoms of localized pain and tenderness accompanied by nasal discharge.
- Immunocompromised patients are particularly susceptible to oral aspergillosis, and some investigators have suggested that the portal of entry may be the marginal gingiva and gingival sulcus.
*
Aspergillosis:
Treatment:
- Treatment depends on the clinical presentation
- For immunocompetent patients with a noninvasive aspergilloma, surgical débridement may be all that is necessary
- For localized invasive aspergillosis in the immunocompetent host, débridement followed by antifungal medication is indicated
Aspergillosis
Syphilis:
Causative agent:
Syphilis:
Hosts:
Humans are the only proven natural host for syphilis
Syphilis itself can cause a series of conditions affecting various systems of the body, some of which can be fatal. Moreover, it can increase individual’s susceptibility to HIV infection. Therefore, prevention and treatment of syphilis are still in urgent need
Syphilis:
Oral lesions:
Oral lesions are mostly seen at the stage of secondary syphilis, although they may be present in all stages
Primary syphilis:
Characteristics:
Is characterized by the chancre
Primary syphilis:
Chancre:
- begins as papular lesion that develop a central ulceration
- painless ulcer with smooth surface, raised borders, indurated margins
- develops at the site of inoculation
- becoming clinically evident 3 to 90 days after the initial exposure
- 85% arise in the genital areas, 10% are anal, 4% are oral, and the remaining 1% is discovered in other extragenital locations
Primary syphilis:
Chancre:
If untreated:
If untreated, then the initial lesion heals within 3 to 8 weeks
Primary syphilis:
Oral lesions:
Oral lesions are seen most commonly on the lip, but other sites include the buccal mucosa, tongue, palate, gingiva, and tonsils
Mouth-site of primary syphilis:
- The mouth, is rarely the site of primary syphilis, and because of its transient nature, the oral ulceration of primary syphilis often goes unnoticed by the patient or by any unsuspicious clinician.
- Moreover the lesions of primary disease may be confused with traumatic ulceration, squamous cell carcinoma, and non-Hodgkin’s lymphoma
Chancre
Secondary Syphilis:
Discovered:
Is discovered 4 to 10 weeks after the initial infection
Secondary Syphilis:
Causative agent-features:
The features of secondary syphilis reflect the hematogenous spread of T. pallidum
Secondary Syphilis:
Resolution:
- Multiple lesions are typical of secondary syphilis.
- Spontaneous resolution usually occurs within 3 to 12 weeks; however, relapses may occur during the next year
Secondary Syphilis:
Rash:
- painless, maculopapular cutaneous, which is widespread and can even affect the palmar and plantar areas.
- May result in areas of scarring and hyperpigmentation or hypopigmentation, it heals without scarring
- Secondary Syphilis
- Rash
Oral lesions associated with secondary syphilis:
- could be diverse and nonspecific, often clinically and histologically mimicking other oral diseases, such as multiple oral nodules, leukoplakia and pemphigus vulgaris
- The rash also may involve the oral cavity and appear as red, maculopapular areas
secondary syphilis:
mucous patches:
- In addition, roughly 30% of patients have focal areas of intense exocytosis and spongiosis of the oral mucosa, leading to zones of sensitive whitish mucosa known as mucous patches
- Mucous patches manifest as oval-to-crescenteric erosions or shallow ulcers of about 1 cm diameter, covered by a grey mucoid exudate and with an erythematous border. The patches usually arise bilaterally on the mobile surfaces of the mouth, although the pharynx, gingivae, tonsils, and very rarely the hard palate can be affected. At the commissures, the mucous patches may appear as split papules, while on the distal and lateral aspects of the tongue, they tend to ulcerate or manifest as irregular fissures. The mucous patches may coalesce to give rise to, or arise de novo as, serpiginous lesions, sometimes termed snail track ulcers
secondary syphilis:
mucous patches
condylomata lata:
Occasionally, papillary lesions that may resemble viral papillomas arise during this time and are known as condylomata lata
syphilis
“gumma”:
- The characteristic skin lesion of tertiary syphilis is the “gumma”
- Gumma appears as : an indurated, nodular, or ulcerated painless brownish-red lump of granulomatous inflammation which usually infiltrates the surrounding tissue and may produce extensive tissue destruction. Ulceration and necrosis may occur in the center of the gumma, leading to scar formation after healing
“gumma”-tertiary syphilis
Tertiary syphilis:
interstitial glossitis:
The tongue may be involved difusely with gummata and appear large, lobulated, and irregularly shaped. This lobulated pattern is termed interstitial glossitis and is thought to be the result of contracture of the lingual musculature after healing of gummas.
tertiary syphilis:
luetic glossitis:
Diffuse atrophy and loss of the dorsal tongue papillae produce a condition called luetic glossitis.
tertiary syphilis:
syphilitic leukoplakia:
- A less common oral manifestation of tertiary syphilis is syphilitic leukoplakia
- It usually affects the dorsal surface of the tongue and carries a high risk of malignant transformation
Neurosyphilis:
can cause unilateral or bilateral trigeminal neuropathy and facial nerve paralysis
Chancre:
Chancre is characterized by inflammatory infiltration of lymphocytes and macrophages, with large amount of T. pallidum.
Gumma:
Gumma is a granulomatous lesion, with necrosis in the center, accompanied by endovasculitis and perivasculitis. T. pallidum is rarely detected.
Tuberculosis:
Causatuve agent:
Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis
Tuberculosis:
Affected sites:
Lung is the most common involvement site but extrapulmonary involvement may occur at any organ
Extrapulmonary TB:
- is seen and represents an increasing proportion of the currently diagnosed cases. In patients with AIDS, more than 50% will have extrapulmonary lesions.
- Any organ system may be involved, including the lymphatic system, skin, skeletal system, CNS, kidneys, and gastrointestinal tract.
Extrapulmonary TB:
lupus vulgaris:
Involvement of the skin may develop and has been called lupus vulgaris
Tuberculosis:
most common extrapulmonary sites in the head and neck:
Head and neck involvement may occur. The most common extrapulmonary sites in the head and neck are the cervical lymph nodes followed by the larynx and middle ear. Much less common sites include the nasal cavity, nasopharynx, oral cavity, parotid gland, esophagus, and spine
Tuberculosis:
Oral clinical features:
Oral TB lesions may be either primary or secondary in occurrence
Tuberculosis:
Primary lesions:
are uncommon, seen in younger patients, and present as single painless ulcer with regional lymph node enlargement
Tuberculosis:
secondary lesions:
The secondary lesions are common, often associated with pulmonary disease, usually present as single, indurated, irregular, painful ulcer covered by inflammatory exudates in patients of any age group but relatively more common in middle-aged and elderly patients
Tuberculosis:
most common presentation for oral involvement:
The most common presentations for oral involvement are chronic ulcerations or swellings. Less frequent findings include non- healing extraction sockets, areas of mucosal granularity, or diffuse zones of inflammation
Tuberculosis:
Chronic tongue ulcerations:
Tuberculosis:
Most favorable site:
Dorsum of the tongue is most favourable site with these lesions appearing as a stellate ulcer. It can also present on the tongue as macroglossia
Actinomyces:
Causative agent:
- Although the term actinomycosis seems to imply a fungal infection, it is an infection of filamentous, branching, gram- positive anaerobic bacteria
- Actinomyces israelii is the causative organism in the majority of cases
- The organism penetrate mucosal barriers and enters tissue through an area of prior trauma
Actinomyces:
Type of infection:
- Actinomycetes are normal saprophytic components of the oral flora.
- Therefore is not an exogenous infection
Actinomyces:
Sites of colonization in healthy patients:
- Documented sites of colonization in healthy patients include the tonsillar crypts, dental plaque and calculus, carious dentin, bone sequestra, salivary calculi, gingival sulci, and periodontal pockets
- The colonies within the tonsillar crypts may form concretions and become large enough for the patient to feel the firm plugs within the crypts
Actinomyces
Actinomyces:
Progression:
Actinomycosis may be either an acute, rapidly progressing infection or a chronic, slowly spreading lesion that is associated with fibrosis
Actinomyces:
Affected sites:
- Approximately 55% of cases of actinomycosis are diagnosed in the cervicofacial region, with 25% occurring in the abdominal and pelvic region and 15% in the pulmonary system
Actinomyces:
Oral and cervicofacial disease- association:
Oral and cervicofacial disease are associated with dental procedures, trauma, oral surgery, soft tissue injury, periodontal pocket, nonvital tooth, extraction socket, or infected tonsil
Actinomyces:
“wooden” indurated area of fibrosis description::
The classic description is of a “wooden” indurated area of fibrosis, which ultimately forms a central, softer area of abscess. The infection may extend to the surface, forming a sinus tract. Pain often is minimal. The soft tissues of the submandibular, submental, and cheek areas are common areas of involvement, with the area overlying the angle of the mandible being the most frequently affected site
Actinomyces:
Affected oral sites:
- The tongue is the most frequently mentioned site, but any oral mucosal location is possible. Involvement of the tonsillar crypts may produce infectious symptoms; in most cases, however, the primary change is one of variable hyperplasia
Leishmaniasis:
Causative agent:
The term leishmaniasis comprises of a group of diseases caused by different species of a protozoan called Leishmania
Leishmaniasis
Dentigerous cyst:
Radiographic findings:
Radiographically, typically shows a unilocular radiolucent area that is associated with the crown of an unerupted tooth
A large dentigerous cyst may give the impression of a multilocular process because of the persistence of bone trabeculae within the radiolucency.
Eruption cyst
Eruption cyst:
Histopathologic Features:
- Surface oral epithelium on the superior aspect
- The underlying lamina propria shows a variable inflammatory cell infiltrate
- The deep portion of the specimen, which represents the roof of the cyst, shows a thin layer of nonkeratinizing squamous epithelium
OKCs
OKCs
OKCs
OKCs
Histopathologic features:
- The epithelial lining is composed of a uniform layer of stratified squamous epithelium - six to eight cells in thickness
- The luminal surface shows flattened parakeratotic epithelial cells, which exhibit a wavy or corrugated appearance
- On occasion, isolated foci of orthokeratin production may be found in addition to the parakeratin
- The basal epithelial layer is composed of a palisaded layer of cuboidal or columnar epithelial cells, which are often hyperchromatic
- The granular cell consist of compact layer of having keratohyaline granules in large amount
7% to 26%: small satellite cysts, cords, or islands of odontogenic epithelium may be seen within the
fibrous wall
Inflammatory changes, the typical
features of the OKC may be altered:
- The parakeratinized luminal surface
may disappear
- The epithelium may proliferate to
form rete ridges
- Loss of the characteristic palisaded basal layer
- The diagnosis of OKC cannot be confirmed unless other sections show the typical features described earlier
Gingival (alveolar) cyst of the newborn
Calcifying odontogenic cyst
Calcifying odontogenic cyst:
Histopathologic Features:
- fibrous capsule and a lining of odontogenic epithelium of four to ten cells in thickness.
basal cells may be cuboidal or columnar, similar to ameloblasts
- “ghost cells”: altered epithelial cells that are characterized by the loss of nuclei with preservation of the basic cell outline (most characteristic histopathologic feature)
calcification within the ghost cells is common / dentinoid
- several variants of the cystic type
- intraosseous and extraosseous solid dentinogenic ghost cell tumors
- ghost cells and juxtaepithelial dentinoid differentiate these lesions from ameloblastoma
Cleft lip:
- Normally, complete closure of the lip is accomplished by 35 days postconception as the lateral nasal, median nasal, and maxillary mesodermal processes merge**. **Failure of closure of any one of the three normal sites of fusion can produce unilateral (most common), bilateral (less common), or median (rare) lip clefting
- CL is considered incomplete when only the upper lip is affected and complete when the defect extends to the nose
Cleft palate:
- CP occurs when midline fusion of the palatal shelves fails to occur
- CP can occur with CL or alone; the latter is possible because palatal closure is not completed until 56 to 58 days postconception, well after closure of the lip, and because the etiology may differ
Micrognathia - Pierre Robin sequence:
a.k.a Pierre Robin syndrome
- Occurance: Hypoplasia of the mandible that occurs before the 9th week of development
- Etiology: The etiology of Pierre Robin sequence is uncertain. Possible mechanisms include genetic disorders, oligohydramnios (which may limit chin growth), myotonia, or connective tissue disease
- Type of abnormality: Pierre Robin sequence often is an isolated abnormality
- Associations: One-third of the patients with associated malformations had Stickler syndrome or velocardiofacial syndrome (VCFS).
Micrognathia - Pierre Robin sequence:
Clinical features:
- Micrognathia, glossoptosis, and cleft palate
- The tongue tends to prolapse backward, leading to airway obstruction that can be life threatening
- Respiratory compromise can lead to hypoxia, cardiopulmonary arrest, pulmonary hypertension, and failure to thrive. Feeding problems are common
Macrognathia – Acromegaly:
- Cause: Excessive secretion of growth hormone (GH)
- Annual incidence: 6-8/ 1000000
- Mean age of diagnosis: 40-45
- Most common cause:
- somatotroph (GH-secreting)
- adenoma of the anterior pituitary
- Onset: insidious onset, very slow progression
- Characteristic findings: enlarged jaw (macrognathia) and enlarged, swollen hands and feet
- Maxillofacial area: Macrognathia, Enlarged lips, Enlarged tongue, Supraorbital bulging, Enlarged nose
Progressive Hemifacial Atrophy (Parry-Romberg Syndrome):
Oral involvment:
Oral involvement affects the tongue, gingiva and soft palate
- Dental involvement includes delayed dental eruption, dental root exposure and resorption
Eagle Syndrome:
- Elongated stylohyoid process and/or calcification of stylohyoid ligament
- Symptoms: Recurrent episodes of dull and persistent throat pain, pharyngeal foreign body sensation, dysphagia, referred otalgia, and facial and neck pain
Condylar Hyperplasia:
Fordyce Granules
Paramedian Lip Pits:
- Rare congenital invaginations of the lower lip
- Arise from persistent lateral sulci on the embryonic mandibular arch
- Bilateral** and **symmetric fistulas on either side of the midline of the vermilion of the lower lip
- Depth of 1.5 cm and may express salivary secretion
Double Lip:
Clinical Features:
- Upper lip is affected much more often than the lower lip; occasionally, both lips are involved
- With the lips at rest, the condition is usually unnoticeable, but when the patient smiles or when the lips are tensed, the excess fold of tissue is visible
Macroglossia:
Tongue appearance:
The tongue usually has a multinodular appearance :
- Amyloidosis
- Neurofibromatosis
- Multiple Endocrine Neoplasia, type 2B
The tongue shows a diffuse, smooth, generalized enlargement:
- Hypothyroidism
- Beckwith-Wiedemann syndrome
- Neuromuscular disorders
Microglossia:
- Uncommon developmental condition of unknown cause that is characterized by an abnormally small tongue may be missing
- Associated with hypoplasia of the mandible, and the lower incisors
- Most cases have been associated with one of a group of overlapping conditions known as oromandibular-limb hypogenesis syndromes
- These syndromes feature associated limb anomalies, such as hypodactylia (i.e., absence of digits) and hypomelia (i.e., hypoplasia of part or all of a limb)
Melkersson–Rosenthal syndrome (MRS):
Clinical characteristics:
- MRS in children is a rare condition
Clinically characterised by a triad of synchronous or metachronous symptoms:
- recurrent peripheral facial palsy (can be on one side or both)
- relapsing orofacial oedema
- and a fissured tongue
Nevoid basal cell carcinoma syndrome or Gorlin - Goltz Syndrome:
Nevoid basal cell carcinoma syndrome or Gorlin - Goltz Syndrome:
The features of the syndrome include:
Peutz - Jegers Syndrome:
- Peutz-Jeghers syndrome is a relatively rare but well recognized condition
- 1 in 50,000 to 200,000 births
- Characterized by freckle - like lesions of the hands, perioral skin, and oral mucosa, in conjunction with intestinal polyposis and predisposition to develop cancer (GΙ tract, pancreas, lungs, breast, ovaries, testicles)
Peutz - Jegers Syndrome:
oral involvment:
- Pigmentation can also occur intraorally** (particularly on the buccal mucosa) and on the **skin** of the **extremities
- The oral lesions present as 1- to 4-mm brown to blue-gray macules primarily affect the vermilion zone, the labial and buccal mucosa, and the tongue; they are seen in more than 90% of these patients
- The oral and perioral pigmentation persists throughout life. Some degree of fading may be noted during adolescence. Does not require treatment however, laser therapy can be performed if the patient elects cosmetic intervention
Sturge Weber:
Characteristics:
It is characterized by a congenital hemangiomatous facial lesion (a port wine stain) in the distribution of the trigeminal nerve associated with similar lesion intracranially and neurological abnormalities
- Other symptoms associated with Sturge-Weber can include eye and internal organ irregularities
- Each case of Sturge-Weber Syndrome is unique and exhibits the characterizing findings to varying degrees
Sturge Weber:
Intraoral involvement:
- Intraoral involvement in Sturge-Weber syndrome is common, resulting in hypervascular changes to the ipsilateral mucosa
- The gingiva may exhibit slight vascular hyperplasia or a more massive hemangiomatous proliferation that can resemble a pyogenic granuloma
- Destruction of the underlying alveolar bone has been reported in rare instances
Papillon-Lefèvre Syndrome:
Characteristics:
- Is characterized by premature loss of the primary and permanent teeth and hyperkeratosis of the palms, soles, and sometimes of the knees and elbows
- The periodontal inflammation begins soon after eruption of the primary teeth
- The periodontal inflammation begins soon after eruption of the primary teeth
- Bone loss is rapid and severe; primary teeth are lost by 3 to 5 years of age and permanent teeth within a few years of eruption
Papillon-Lefèvre Syndrome:
Radiographic image:
FLOATING IN AIR TEETH”—DESTRUCTION OF ALVEOLAR BONE
Desquamative Gingivitis:
- Most > 40-year-old female
- Not a Diagnosis but Clincial Term for an underlying manifestation Clinical Features
- Smooth erythema, loss of stippling, desquamation, and erosion of the gingiva are common signs of DG, irrespective of the etiopathogenesis
- Generally involves the attached and free gingiva
- Chronic onset all over mouth
- Multifocal or generalized pattern
- Goes hand in hand with vesicle/bulla formation filled with clear fluid or blood
- Mostly asymptomatic, when symptomatic ranges from mild burning sensation to pain
- DG is considered as a clinical disorder that can be easily recognized by the examiner on the dental chair.
- DG has no association with loss of attachment and alveolar bone destruction
- Is a possible risk factor for long-standing periodontal health
Desquamative Gingivitis:
manifestation:
other diagnosis:
- DG has a wide range of manifestations, which may imitate other conditions
- The process almost always represents a manifestation of one of several different vesiculoerosive diseases, usually mucous membrane pemphigoid. Some clinicians broaden the definition to include patients with atrophic and erosive gingival lesions without true peeling of the epithelium.
- In such cases, lichen planus is diagnosed most frequently
- Other diagnoses that are made less frequently include linear IgA disease, pemphigus vulgaris, epidermolysis bullosa acquisita, systemic lupus erythematosus (SLE), chronic ulcerative stomatitis, and paraneoplastic pemphigus
- For definitive diagnosis biopsy immunofluorescence are necessary
Necrotizing Ulcerative Gingivitis (NUG):
Factors
- Has a distinctive pattern of gingival pathologic changes
Occurs in the presence of psychologic stress. Other factors have been related to an increased frequency of NUG: Immunosuppression
- Smoking
- Local trauma
- Poor nutritional status
- Poor oral hygiene
- Inadequate sleep
- Recent illness
- Immunocompromised status associated with acquired immunodeficiency syndrome (AIDS)
Necrotizing Ulcerative Gingivitis (NUG):
Clinical features:
- The interdental papillae are highly inflamed, edematous, and hemorrhagic
- Typically, the affected papillae are blunted and demonstrate areas of “punched-out,” craterlike necrosis that are covered with a gray pseudomembrane. Early cases may be missed easily because the ulceration initially involves only the tip of the interdental papilla
- A fetid odor, pain, spontaneous hemorrhage, and
- Lymphadenopathy, fever, and malaise accumulations of necrotic debris usually are noted
Acute herpetic gingivostomatitis (primary herpes):
initial symptoms are:
Primary infection in adults may cause pharyngotonsillitis. The initial symptoms are:
- sore throat
- fever
- malaise
- headache
- Numerous small vesicles develop on the tonsils and posterior pharynx. The vesicles rapidly rupture to form shallow ulcers, which often coalesce and develop an overlying diffuse, gray-yellow exudate.
- Involvement of the oral mucosa anterior to Waldeyer ring occurs in less than 10% of cases
Acute herpetic gingivostomatitis (primary herpes):
Therapy:
Hand-Foot-And-Mouth Disease:
Affected sites:
- The name fairly well describes the location of the lesions
- Oral and hand lesions almost always are present
- The oral lesions arise without prodromal symptoms and precede the development of the cutaneous lesions. Sore throat and mild fever usually are present also
- The cutaneous lesions range from a few to dozens and primarily affect the borders of the palms and soles and the ventral surfaces and sides of the fingers and toes. Rarely other sites, especially the buttocks, external genitals, and legs, may be involved. They begin as erythematous macules that develop central vesicles and heal without crusting. In some cases, nail loss or ridges (Beau lines) may ensue after several weeks
Hand-Foot-And-Mouth Disease:
oral lesions:
The oral lesions resemble those of herpangina but may be more numerous and more frequently involve anterior regions of the mouth. The number of lesions ranges from 1 to 30. The buccal mucosa, labial mucosa, and tongue are the most common sites, but any area of the oral mucosa may be involved. The individual lesions typically measure 2 to 7 mm in diameter but may be larger than 1cm. The lesions rapidly ulcerate and then typically heal within 1 week
Herpangina:
Therapy:
Therapy is directed toward symptomatic relief; non aspirin antipyretics and topical anesthetics, such as dyclonine hydrochloride, often are beneficial.
