Reactive and Neoplastic Oral Diseases

Question 1

Traumatic Ulcers

Answer 1

Removable, yellow membrane with a rolled white border and surrounding erythema

Question 2

Cause of Traumatic Ulcers

Answer 2

Mechanical damage

Accidental biting, sharp teeth, sharp foods, etc

Question 3

Tx of Traumatic Ulcers:

Answer 3

Remove irritating source
Palliative
Salt-water rinses
Local anesthetic rinse (Dyclonine HCl )

Question 4

Morsicatio Buccarum

Answer 4

AKA chronic cheek chewing
Thickened, shredded, white areas found on anterior buccal mucosa at midline
Possible zones of erythema or ulceration

Question 5

Cause of Morsicatio Buccarum:

Answer 5

Chronic biting

Common in people under high stress

Question 6

Tx of Morsicatio Buccarum:

Answer 6

Cessation of habit
Reduce stress
No long-term difficulties

Question 7

Mucocele:

Answer 7

small dome-shaped swelling
Often tranlucent or bluish
Can wax & wane

Question 8

Cause of Mucocele:

Answer 8

Rupture of a salivary duct (usually by trauma) & spillage of mucin into tissue
Most often on lower lip

Question 9

Tx of Mucocele:

Answer 9

Removal of lesion and offending minor salivary gland

May recur

Question 10

Epulis Fissuratum:

Answer 10

Poorly fitting denture

Usually 2 folds of tissue where denture fits

Question 11

Tx of Epulis Fissuratum:

Answer 11

Surgical removal of tissue

Adjust or remake denture

Question 12

Pyogenic Granuloma

Answer 12

Reactive, tumor-like growth

Erythematous mass, usually ulcerated
Painless & bleeds easily
May grow rapidly

Question 13

Cause of Pyogenic Granuloma:

Answer 13

Local irritation or trauma

Female predilection, especially during pregnancy– “Pregnancy granuloma”

Question 14

Tx of Pyogenic Granuloma:

Answer 14

Excision

Defer tx during pregnancy, higher recurrence if removed during pregnancy

Question 15

Nicotine Stomatitis:

Answer 15

Hard palate is gray or white
Numerous elevated papules with red centers
Papules are inflamed minor salivary glands

Question 16

Cause of Nicotine Stomatitis:

Answer 16

Reaction to heat in cigarettes or cigars

Question 17

Tx of Nicotine Stomatitis:

Answer 17

Cessation of habit, completely reversible after 2 weeks of smoking cessation

Question 18

Fibroma:

Answer 18

Most common ‘tumor’ of oral cavity
Reactive hyperplasia of fibrous connective tissue

small painless, sessile, smooth pink nodule
Most are found on cheek along bite line

Question 19

Cause of Fibromas:

Answer 19

Local irritation or trauma

Question 20

Tx of Fibromas:

Answer 20

Surgical excision

Question 21

Papillomas:

Answer 21

Up to 5 mm (pencil eraser is 6 mm)
Painless, raised growth with numerous finger-like surface projections
White, slightly red, or normal in color
Grow rapidly to full size

Question 22

Cause of Papillomas:

Answer 22

(HPV), usually strains 6 and 11

Extremely low virulence & infectivity rate

Question 23

Tx of Papillomas:

Answer 23

Surgical excision, recurrence unlikely

Question 24

Common Benign Oral Neoplasms

Answer 24

Pleomorphic adenoma
Lipoma
Hemangioma

Question 25

Pleomorphic Adenoma:

Answer 25

Benign salivary tumor Most common salivary neoplasm Most common locations: palate & parotid gland Painless, slowly growing firm mass Often smooth surfaced, may be ulcerated from trauma

Question 26

Tx of Pleomorphic Adenoma:

Answer 26

Excision

Question 27

Lipoma:

Answer 27

Benign tumor of fat Appear to be more common in obese patients Soft, painless, yellow or pink nodular masses

Question 28

Tx of Lipomas:

Answer 28

Excision | Recurrence rare

Question 29

Hemangiomas:

Answer 29

Benign vascular tumor Most common tumor of infancy Head and neck is most common location Rapid growth during first few weeks of life Superficial skin lesions are raised with a bright-red color Feels firm & rubbery, blood does not move when pressure is applied Deeper tumors are slightly raised and blue

Question 30

Tx of Hemangiomas:

Answer 30

“Watchful neglect” | 90% spontaneously resolve before age 10

Question 31

Complications of Hemangiomas:

Answer 31

Ulceration, possible infection | Vision problems, airway obstruction

Question 32

Pre-malignant lesions

Answer 32

Leukoplakia | Erythroplakia

Question 33

Leukoplakia:

Answer 33

``` “White patch” Strictly a clinical diagnosis Most are due to thickened surface keratin Considered precancerous lesion Most common oral pre-cancer ```

Question 34

Risk Factors for Leukoplakia:

Answer 34

Tobacco 80% of pts are smokers Alcohol Ultraviolet radiation

Question 35

High risk sites for malignant transformation of Leukoplakia:

Answer 35

Tongue (ventral/lateral) Lip vermillion Floor of mouth 90% with dysplasia or carcinoma found in these locations

Question 36

Presentation of Leukoplakia:

Answer 36

Early lesions are grayish plaques Lesions then extend, become thicker, & white The mucosa feels leathery & may have fissures Next, increased surface irregularities & scattered red patches develop Erythroleukoplakia

Question 37

Tx of Leukoplakia:

Answer 37

Biopsy!

Question 38

Complications of Leukplakia:

Answer 38

Recurrence likely, especially for thick lesions

Question 39

Erythroplakia:

Answer 39

“Red patch” Strictly a clinical diagnosis Almost all are dysplasia or carcinoma

Question 40

Most common sites of Erythroplakia:

Answer 40

Floor of mouth Tongue (ventral/lateral) Soft palate

Question 41

Presentation of Erythroplakia:

Answer 41

Well-demarcated, asymptomatic, erythematous plaque with soft texture

Question 42

Tx of Erythroplakia:

Answer 42

Biopsy is mandatory and guides tx

Question 43

Complications of Erythroplakia:

Answer 43

Recurrence is common | Long-term follow-up is necessary

Question 44

Most Common Malignant Neoplasms:

Answer 44

Squamous cell carcinoma Non-Hodgkin’s lymphoma Mucoepidermoid carcinoma

Question 45

SCCA:

Answer 45

``` 95% of all oral malignancies Cause is multifactorial Tobacco smoke Alcohol Syphilis Sunlight (lip) Human papilloma virus (HPV 16, 18, 31, 33) Iron-deficiency anemia Immune suppression Radiation ```

Question 46

Causes of SCCA:

Answer 46

Heredity is NOT a cause Most are preceded by a precancerous lesion, There is minimal pain during early stages!! Delayed detection, delayed treatment

Question 47

Most common sites of SCCA:

Answer 47

Most common sites #1. Tongue (ventral/lateral) 2. Floor of mouth 3. Soft palate

Question 48

Tx of SCCA:

Answer 48

Wedge resection if on lower lip Wide excision Radiation Chemotherapy

Question 49

Non-Hodgkin’s Lymphoma:

Answer 49

2nd most common malignancy of head & neck after SCCA More common in older patients Painless, diffuse “boggy” swelling, may be red or purple

Question 50

Tx of Non-Hodgkin’s Lymphoma:

Answer 50

``` Depends on grade and type of lymphoma “Watch and wait” Rituximab Radiation Chemotherapy ........ Prognosis; If high-grade, 60% 5-year survival rate ```

Question 51

Complications of Non-Hodgkin’s Lymphoma:

Answer 51

Complications: | Infection, effects of treatment

Question 52

Mucoepidermoid Carcinoma:

Answer 52

Most common salivary gland malignancy Found parotid or palate in all ages Asymptomatic swelling In palate, may be fluctuant & have a bluish color

Question 53

Tx of Mucoepidermoid Carcinoma:

Answer 53

Surgical resection, sometimes radiation