STOMATITIS

Question 1

6 types of Bacterial infections

Answer 1

1. Impetigo
2. Tonsillitis and pharyngitis
3. Syphilis
4. Tuberculosis
5. Actinomycosis- Bacterial infection
6. Necrotizing Ulcerative Gingivitis

Question 2

2 types of Fungal Infections

Answer 2

1. Candida albicans

2. Deep fungal infections

Question 3

6 types of Candida albicans

Answer 3

1. seudomembranous candidosis (candidiasis)
2. Erythematous “acute atrophic” candidosis
3. Chronic atrophic candidosis
4. Chronic hyperplastic candidosis
5. Angular cheilitis
6. Median rhomboid glossitis “chronic atrophic candidosis”

Question 4

types of Viral infection

Answer 4

1. Human papilloma viruses (HPVs): DNA viruses
2. Human herpes viruses (HHVs): DNA viruses
3. Coxsackie A viruses
4. Paramyxoviruses

Question 5

bacteria cause infection in impetigo

Answer 5

Streptococcus pyogenes and Staphylococcus aureus

Question 6

where does impetigo infect and who? what causes it?
it spread how?
can it be treated?

Answer 6

face and extermitiesFacial lesions usually develop around the nose and mouth
—
Poor hygiene, crowded living conditions, hot & humid climate Previous trauma: abrasions, insect bites, dematitis
—-
Spread by skin contact
Vesicles that rupture, leaving light brown (amber) colored crusts (“Cornflakes glued to the surface”)
—
Unlike HSV, lesions persist until treated

Question 7

antibiotic to treat impetigo

Answer 7

Mupirocin topical Cephalexin, dicloxacillin

Question 8

what organism causes Tonsillitis and pharyngitis?

age it affects?

other name?

Answer 8

Children aged 5 - 15 years
——–
“Strep throat”: sore throat, headache, fever, tonsillar

Question 9

sign and symptoms of Tonsillitis and pharyngitis?

how does it spread?

Answer 9

Culture and treat with antibiotics: penicillin, amoxicillin, cephalosporin

Question 10

Complications of Strep throat

Answer 10

Scarlet fever
Rheumatic fever
Glomerulonephpritis

Question 11

organism causes  Scarlet fever
----
age?
----
sign and symptoms 
----
how does it affect body?

Answer 11

Children aged 3-12 years
—-
Skin rash, fever, palatal petechiae, “strawberry tongue”
—-
Organisms elaborate an erythrogenic toxin that attacks blood vessels

Question 12

how does Rheumatic fever affect body?

Answer 12

Rheumatic fever

Question 13

organism causes syphilis 
---------
how does it spread
-----
what is the incident( in what population)

Answer 13

Direct contact with mucosal surfaces (e.g. sexual contact, mother to fetus)
————-
Increased incidence in African Americans, prostitutes, and drug abusers
50-100x higher prevalence in the United States compared with other industrialized countries

Question 14

what is chancre? syphilis

when does primary infection occur?

is it infectious

Answer 14

painless ulcer at site of inoculation External genitalia, anus, lip
-------
3-90 days after initial exposure
Regional lymphadenopathy
TPHA + FTA-ABS
-------
 Highly infectious

Question 15

when does secondary infection occur?

what type of ulcer occur? what are signs and symptoms?

is it infectious?

Answer 15

4-10 weeks after initial infection
-------
Mucous patches
“Snail track” ulcers
Condylomata lata (papillomas), maculopapular cutaneous rash
Lymphadenopathy, sore throat, fever
-------
Highly infectious

Question 16

when does latent syphilis show symptoms

Answer 16

1-30 years

Question 17

what percentage of infected population with syphilis will have 3 syphilis?

what type of necrosis occur?

what type of lesion will occur?where they occur? disease associated with it?

Answer 17

Gumma – unique type of necrosis
———
Indurated, nodular or ulcerated lesion Intraorally, usually affects palate (perforation) or
tongue
——
Glossitis, atrophy and loss of dorsal tongue papillae (Luetic glossitis)
Syphilitic leukoplakia
Cardiovascular system and CNS involvement

Question 18

signs and symptoms of congenital syphilis

Answer 18

Frontal bossing, underdeveloped Mx, high arched palate, saddle nose deformity

Question 19

Hutchinson’s triad

Answer 19

Interstitial keratitis of cornea
VIIIth nerve deafness
Dental abnormalities:
Screwdriver-shaped “Hutchinson’s incisors” “Mulberry molars” bumps on occlusal surface

Question 20

how to treat it?

Answer 20

Antibiotics: penicillin

Question 21

what are dental abnormalities associated with congenital syphilis

Answer 21

1. Screwdriver-shaped “Hutchinson’s incisors”

2. “Mulberry molars” bumps on occlusal surface

Question 22

organism associated with Tuberculosis?
where it occurs?
how does TB becomes an active disease

Answer 22

Primary infection of lungs
—–
Immunodeficiency (old age, poverty, HIV/AIDS) contributes to progression from infection to active dis

Question 23

clinical features of TB

Answer 23

Clinical Features: Fever, night sweats, fatigue, weight loss, productive cough, hemoptysis
Lymph node involvement (“scrofula”)
Skin: “Lupus vulgaris”
Oral: chronic painless ulceration usually involving tongue or palate, atypical periodontal disease

Question 24

Histology and biopsy of tissues culture

Answer 24

Biopsy shows granulomas with central areas of necrosis AFB- Acid fast bacillus stain shows typical red bacilli
PCR (polymerase chain reaction)
PPD skin test and chest radiograph
Isoniazid (INH) and rifampin

Question 25

what organism causes Actinomycosis- Bacterial infection --- how does Actinomycosis- Bacterial infection occur? ---- where does most of the cases occur by this infection orally?

Answer 25

↑Actinomyces israelii: normal saprophytic anaerobic inhabitant of oral cavity, ------ History of surgery or trauma ----- 55% of cases occur in cervicofacial areas Injury, periodontal pocket, nonvital tooth, extraction socket, infected tonsi

Question 26

what are the clinical features of Actinomycosis- Bacterial infection

Answer 26

Abscesses and draining sinus tracts | Colonies of organisms are yellow “sulphur granules”

Question 27

how to treat actinomycosis?

Answer 27

Long-term high doses of antibiotics Can range from 6 weeks to 12 months, depending on extent of infection. Localized acute infections (e.g. periapical or pericoronal actinomycosis) may be treated more conservatively Removal of infected tissue usually produces sufficient aeration that antibiotics aren’t needed (follow-up)

Question 28

``` other name for Necrotizing Ulcerative Gingivitis? ---- what organism causes it? --- what causes it? ----- what age? ```

Answer 28

NUG, ANUG, “trench mouth” ------ Bacillus fusiformis and Borrelia vincetii ----- Frequently occurs in situations of stress, immunodeficiency or malnourishment -------- Young and middle-aged adults

Question 29

dental association with NUG, ANUG

Answer 29

Interdental papillae are highly inflamed and hemorrhagic Papillae are blunted with areas of “punched-out” necrosis that are covered with a gray pseudomembrane

Question 30

Is NUG associated with odor?

Answer 30

Fetid odor and intense pain

Question 31

how to treat NUG

Answer 31

ebridement by scaling or curettage Chlorhexidine rinses Systemic antibiotics if fever or lymphadenopathy is present

Question 32

what is the most common oral infection

Answer 32

Candida albicans

Question 33

what organism causes Candida albicans

Answer 33

Dimorphism: yeast form and pathogenic hyphal form

Question 34

Organism of low virulence in healthy, need “opportunity” for growth Predisposing conditions like?

Answer 34

Antibiotic therapy Cancer chemotherapy Corticosteroid therapy Dentures Diabetes mellitus Pregnancy Iron deficiency Newborns Advanced malignancy Xerostomia Other immunocompromised states (HIV/AIDS)

Question 35

Overgrowth of Candida albicans, ------------ | can culture it in up to -----% of patients but with-------, probably present in all patients

Answer 35

``` part of the normal oral flora ---- 50% -------- PCR ```

Question 36

sign and symptoms associated with a. Pseudomembranous candidosis (candidiasis)

Answer 36

White material that can be wiped off: tangled hyphae, yeasts, dead epithelial cells, & debris Normal or erythematous mucosa underneath Symptomatic, burning sensation to pain Metallic taste

Question 37

what candida albican organism causes metallic taste

Answer 37

Pseudomembranous candidosis (candidiasis)

Question 38

symtpms and signs of b. Erythematous “acute atrophic” candidosis

Answer 38

``` ainful, burning sensation Often associated with antibiotics: “antibiotic sore mouth” Usually affects gingiva Loss of filiform papillae on tongu ```

Question 39

what organism is associated with antibiotic sore mouth

Answer 39

Erythematous “acute atrophic” candidosis

Question 40

this organism of candida causes Loss of filiform papillae on tongue

Answer 40

Erythematous “acute atrophic” candidosis

Question 41

what organism causes Denture stomatitis” “denture sore mouth

Answer 41

chronic atrophic candidosis

Question 42

sign and symptoms of Chronic atrophic candidosis

Answer 42

Denture stomatitis” “denture sore mouth” Erythematous change limited to mucosa covered by denture and confined to denture bearing tissues Only Mx and in patients who wear dentures 24 hrs/day Asymptomatic to symptom

Question 43

characteristics of Chronic hyperplastic candidosis

Answer 43

“Candidal leukoplakia” Indistinguishable from leukoplakia White lesion that does not wipe off Which came first - the candida or the leukoplakia? Biopsy if no resolution with anti fungal therapy

Question 44

what causes angular chelties?

Answer 44

Candida about 90%, rest caused by Strep or Staph-

Question 45

sign and symptoms of Angular cheilitis

Answer 45

Erythema or fissuring at labial commissures Unilat or bilat Predisposing factors: reduced vertical dimension and accentuated folds at the corners of the mouth

Question 46

sign and symptoms of f. Median rhomboid glossitis “chronic atrophic candidosis”

Answer 46

ho“Central papillary atrophy” | Well-defined, erythematous, rhomboid (diamond- shaped) area at midline of posterior dorsal tongue Often asymptomatic

Question 47

how does Median rhomboid glossitis “chronic atrophic candidosis diagnose

Answer 47

Diagnosis by clinical features, mucosal smear and tissue culture Exfoliative cytology: PAS stain

Question 48

how to treat Median rhomboid glossitis “chronic atrophic candidosis?

Answer 48

Oral or systemic antifungal therapy Nystatin (Mycostatin®) Oral suspension: 1 tsp. 5x daily for 2 wks. Clotrimazole (Mycelex®) Troches: 10 mg 5x daily for 7-10 days The “azoles”: ketoconazole and fluconazole are absorbed systemically Fluconazole (Diflucan®): 2 tabs. (200mg) Day 1 and then 1 tab. (100mg) daily for 2 wks.

Question 49

what deep fungal infection causes ---- what puts are susceptible to it?

Answer 49

Most cause primary lung involvement ---- ncreased susceptibility to infection and recurrence in immunocompromised (HIV+)

Question 50

how does deep fungal infection mimic squamous cell carcinoma? -- examples

Answer 50

Chronic, nonhealing intraoral ulcers which can mimic squamous cell carcinoma ----- Histoplasmosis Coccidiomycosis Blastomycosis Cryptococcosis Aspergillosis

Question 51

how to diagnose and treat deep fungal infection

Answer 51

Biopsy with tissue staining and culture Systemic antifungal medications

Question 52

organisms associated with Subcutaneous fungal &Opportunistic fungal infectionsinfections

Answer 52

ubcutaneous fungal infections Sporotrichosis Opportunistic fungal infections Zygomycosis (mucormycosis) Often in immunosuppressed/ diabetics

Question 53

types of Human papilloma viruses (HPVs): DNA viruses

Answer 53

1. Papilloma (usually HPV subtypes 6 and 11) 2. Verruca vulgaris (HPV subtypes 2, 4, 6, 40) 3. Condyloma acuminatum (HPV subtypes 2, 6, 11, 53, 54, 16, 18) 4. Focal epithelial hyperplasia (HPV subtypes 13 and 32) 5. HPV and cancer. Only some types, esp 16, 18, 6, 11, 30s, 50s

Question 54

Human herpes viruses (HHVs): DNA viruses

Answer 54

1. Herpes simplex viruses (HHV-1 and HHV-2 / HSV-1 and HSV-2) 2. Varicella-zoster virus (VZV / HHV-3) 3. Epstein-Barr virus (EBV / HHV-4) 4. Cytomegalovirus (HHV-5) 5. HHV-8

Question 55

how many types? most adults have at least? is it hard to distinguish between different kinds of HPV?

Answer 55

Over 100 types Most adults have buccal epithelial cells containing at least one type, tends to “clear” in health patients Yes, Can be difficult to distinguish between the various lesions of HPV

Question 56

``` Papilloma (usually HPV subtypes 6 and 11) what age? where does it occur? what are clinical presentation what cancer does this ```

Answer 56

Age 30 to 50 years Tongue, lips,↑ soft palate 17 White/red/normal color “cauliflower” shaped exophytic nodule, sessile or pedunculated Usuallysmall, but can be as large as 3 cm

Question 57

“common wart” is caused by what virus?

Answer 57

Verruca vulgaris (HPV subtypes 2, 4, 6, 40)

Question 58

``` Verruca vulgaris (HPV subtypes 2, 4, 6, 40) affects what age group? where does it occur? clinical presentation ? ```

Answer 58

Children Usually on skin of hands Oral mucosa: vermillion border, labial mucosa, anterior tongue Pink/white nodule with rough, pebbly surface Usually less than 5 mm

Question 59

histological feature of Verruca vulgaris (HPV subtypes 2, 4, 6, 40)

Answer 59

Koilocytes (enlarged cells with cytoplasmic clearing) Large keratohyaline granules Contagious, can spread to other parts of skin or mucosa by auto inoculation

Question 60

treatment of Verruca vulgaris (HPV subtypes 2, 4, 6, 40)

Answer 60

liquid nitrogen, cryotherapy/surgical excision/salicylic acid

Question 61

``` Condyloma acuminatum (HPV subtypes 2, 6, 11, 53, 54, 16, 18) affects what age group? where does it affect? where does it affect on oral mucosa ```

Answer 61

Teenagers and young adults Affects oral mucosa, larynx, genitalia Oral mucosa: labial mucosa, soft palate, lingual frenum

Question 62

how does Condyloma acuminatum (HPV subtypes 2, 6, 11, 53, 54, 16, 18) transmitt?

Answer 62

Transmitted through sexual transmission or self- inoculation | incubation of 1 to 3 months from time of sexual contact

Question 63

clinical feature of Condyloma acuminatum (HPV subtypes 2, 6, 11, 53, 54, 16, 18) ----- when does the risk of malignancy increases?

Answer 63

Pink to white exophytic mass with short, blunted surface projections 1 to 1.5 cm, can be as large as 3 cm Often occur in clusters and not quite as exophytic and papillary as papillomas or vurruca ------ Anogenital condylomata infected with HPV-16 and HPV- 18 have been associated with increased risk of malignant transformation

Question 64

what virus causes the “Heck’s Disease”

Answer 64

Focal epithelial hyperplasia (HPV subtypes 13 and 32)

Question 65

clinical feature of Focal epithelial hyperplasia (HPV subtypes 13 and 32) ------ what age group and what population is affected by this virus

Answer 65

Multiple soft, flattened papules clustered together --------- Most common in children often malnourished and In poor living conditions 1st described in Native Americans and Eskimos

Question 66

where does this virus occur in the mouth as what cells?

Answer 66

Labial, buccal, and lingual mucosa | Koilocytes and mitosoid cells

Question 67

Histology of Focal epithelial hyperplasia (HPV subtypes 13 and 32)

Answer 67

HPV identified by DNA in situ hybridization, immunohistochemical analysis, and PCR

Question 68

what types of HPV viruses cause cervical and oropharyngeal cancer

Answer 68

16, 18, 6, 11, 30s, 50s | 25 yrs ago, 20-25% of throat cancer was HPV, today 75%

Question 69

How does HHV virus survive in human body

Answer 69

Humans are natural reservoirs for the virus All HHVs can reside throughout the life of an infected host and are characterized by dormancy or latency where they reside within the host with the potential to be reactivated and produce recurrent patterns of disease

Question 70

what type of HSV cause oral infection

Answer 70

HSV-1 usually causes oral infections

Question 71

what type of HSV cause genital infection about 20% crossover

Answer 71

HSV-2 usually causes genital infections, about 20% crossover

Question 72

More than 90% of primary infections are ---------

Answer 72

asymptomatic

Question 73

what are symptoms of acute herpetic gingivostomatitis ----- what age group ? ------

Answer 73

Oral disease caused by initial infection of herpes simplex virus, very acute in onset Usually in children 6 months to 5 years old, but can occur in adults Fever, lymphadenopathy, nausea, irritability Painful, erythematous gingiva and tiny (1–3 mm) coalescing vesicles progress to widespread, multiple sharply marinated ulcers of oral mucosae and skin around mouth & lips In adults, may presents as pharyngotonsillitis Lesions heal spontaneously in 1 to 2 weeks

Question 74

what % of population have recurrent herpes simplex infection ? where does it stay dormant?

Answer 74

Occurs in 15-45% of the U.S. population --- irus is neurotrophic and persists in a latent state in the trigeminal ganglion

Question 75

what causes recurrent clinical lesions?

Answer 75

Old age, ultraviolet light, emotional stress, pregnancy, allergy, trauma, illness, dental therapy

Question 76

what is herpes labials(“cold sore” or “fever blister”)? --- Where does recurrent herpes simplex occur? ---- clinical presentation of herpes simplex?

Answer 76

Prodromal symptoms of pain, burning, or tingling- ---- At jct of vermillion and skin, not on mucosa (aphthae) Intraoral: limited to keratinized mucosa that is bound to bone → hard palate and gingiva ------ Tiny vesicles or ulcers that coalesce Heal within 7 to 10 days Herpetic whitlow (fingers) Histologic examination shows multinucleated, infected epithelial cells (viral cytopathic effect)

Question 77

how does herpes simplex diagnosed?

Answer 77

iagnosis usually based on clinical findings Cytologic smear and/or tissue biopsy Serologic tests for HSV antibodies are positive 4 - 8 days after initial exposure

Question 78

percentage of pt having HSV DNA virus in their saliva

Answer 78

At any time, 5-30% of your patients will asymptomatically excrete and will have HSV DNA in their saliva

Question 79

how to treat simplex herpes

Answer 79

opical and systemic antiviral medications Effective when administered early prodrome period in primary or recurrent infection 20 Acyclovir (Zovirax®): 800 mg tablet every 4 hours orally for 7 to 10 days 5% ointment applied to affected areas topically with a finger cot q4h Or pencicylovir topical Famciclovir (Famvir®): single 1500 mg dose or single-day (750 mg 2x for one day) dose Valacyclovir (Valtrex®): 2g (four 500mg tablets) q12h for one day

Question 80

at what age does Varicella-zoster virus (VZV / HHV-3) occur? is it contagious? what is the incubation period? what are the signs and symptoms? where does it occur orally? what is the recovery time and is there a vaccine?

Answer 80

``` Usually in children 5 - 9 years of age ---- Highly contagious ----- 10 – 21 day incubation ------ Headache, fever erythemavesiclepustulehardened crust on skin and mucous membranes Skin: extremities, face, trunk ---- Perioral and oral lesions: vermillion border of lips, palate and buccal mucosa ---------- Tx: symptomatic Recovery in 2 to 3 weeks ------- VZV vaccine ```

Question 81

``` what is Herpes zoster (“shingles”) --- adult or children? ---- what are some predisposing factor ```

Answer 81

reactivation of VZV VZV may lie dormant in sensory neural ganglia after initial chickenpox infection Herpes zoster occurs if the virus becomes reactivated ---- Immunosuppression, treatment with cytotoxic drugs, radiation, malignancy, old age, alcohol abuse, dental treatment

Question 82

what are the Prodromal symptoms of shingle

Answer 82

ntense pain, fever malaise, headache

Question 83

oral implication of shingles

Answer 83

oral lesions occur if trigeminal nerve is involved and lesions may be present on the movable or bound mucosa

Question 84

clinical presentation of shingle

Answer 84

``` Unilateral painful eruption of vesicles along the distribution of a sensory nerve classically stops at the midline Postherpetic Neuralgia (chronic infection) may take months to resolve ```

Question 85

what is Ramsay Hunt syndrome

Answer 85

Infection of external auditory canal with involvement of the ipsilateral facial and auditory nerves producing facial paralysis, hearing deficits and vertigo

Question 86

what virus causes the kissing disease?

Answer 86

Epstein-Barr virus (EBV / HHV-4)

Question 87

How does Epstein-Barr virus (EBV / HHV-4) transmit? ------------------------------ population affected by it? ---------------------------- what are the sign and symptoms of Infectious mononucleosis( kissing disease)? -------------------- How to diagnose kissing disease?

Answer 87

Transmitted through close contact or saliva Late ------------------------------- adolescents/ young adults in developed countries ------------------------------------ Sore throat, fever, lymphadenopathy, tonsillitis, fatigue, enlarged spleen Petechiae on hard/soft palate as prodrome -------------------------- Serum analysis shows presence of heterophil antibody and elevated white blood cell count Self-limiting in 4 to 6 weeks, treatment is symptomatic

Question 88

What are the sign and symtoms of hairy leukoplakia

Answer 88

Corrugated white lesion, usually on lateral border of tongue | Cannot be wiped off

Question 89

What infection is hairy leukoplakia associated with?

Answer 89

Often associated with candidal infection

Question 90

How can Hairy leukoplakia be diagnosed?

Answer 90

EBV can be identified by in situ hybridization, PCR, immunohistochemistry and is the cause

Question 91

Most commonly occurs in--------- patients, but can occur in other

Answer 91

Most commonly occurs in HIV+ patients, but can occur in | others

Question 92

cancers associated with hairy leukoplakia

Answer 92

Burkitt’s lymphoma other lymphomas (B cells have | receptors for EBV) Nasopharyngeal carcinoma

Question 93

``` What population is affected by Cytomegalovirus (HHV-5)? ----- Common in what population? ------ How does transmitt? ------ ```

Answer 93

Usually affects newborns and immunosuppressed adults ----------- Common in AIDS patients ----------- Transmitted through exchange of bodily fluids -----

Question 94

90% of infections are -------- but can produce a mono like illness ------- complications leading to ------,-------, and severe ------and -------- retardation

Answer 94

90% of infections are asymptomatic but can produce a mono like illness Canserious complications leading to organ failure, blindness, and severe mental and motor retardation

Question 95

oral lesions associated with Cytomegalovirus (HHV-5)

Answer 95

Chronic ulceration, affects endothelial cells and blood flow Can reside latently in salivary gland cells Infected cells show “owl eye” appearance

Question 96

"Owl eye" cell appliance associated with what virus ?

Answer 96

Cytomegalovirus (HHV-5)

Question 97

Treatment of Cytomegalovirus (HHV-5)

Answer 97

Systemic antiviral treatment is necessary in immunosuppressed individuals

Question 98

``` What causes Kapok's sarcoma? --- What do lesions look like? --- where does it affect in oral cavity? ```

Answer 98

``` HHV-8 ----- Reddish-purple flat or raised lesions ------ Orally, most commonly on palate, gingiva, and tongue ```

Question 99

what virus causes herpangia ?

Answer 99

Coxsackie A viruses

Question 100

what is herpangia?

Answer 100

Hand-foot-and-mouth disease

Question 101

what age group is affected by Coxsackie A viruses? --- How does it transmit?

Answer 101

Usually affect children under age 5, often in epidemics --------- Transmitted by fecal-oral route

Question 102

oral clinical features associated with Coxsackie A viruses ----- what other body parts are affected by Coxaackie A virus? ------ How can infection associated with this virus be treated?

Answer 102

ainful vesicles and ulcers intraorally Vesicles on soft palate with erythematous pharyngitis in herpangina Hyperplastic lymphoid tissue on soft palate and tonsils in acute lymphonodular pharyngitis ------- Papules occurring on skin of feet, toes, hands, and fingers in hand- foot-and-mouth disease ----- Infection usually resolves in 7 to 10 days

Question 103

Two diseases associated with Paramyxoviruses

Answer 103

Mumps | Measles (Rubeola)

Question 104

``` What age group is affected by measles? --- oral clinical features of measles ? ---- treatment? ```

Answer 104

Childhood, highly contagious( with skin rash) ----- “Koplik’s spots” may be an early intraoral manifestation Small, red patches with white, necrotic centers ---- MMR vaccine

Question 105

Mumps is associated with??

Answer 105

Salivary gland pathology

Question 106

What are "canker sore"

Answer 106

recurrent aphthous ulcerations

Question 107

Aphtha means?

Answer 107

“to inflame”

Question 108

What are the causes of Recurrent Aphthous Stomatitis (RAS)

Answer 108

trauma (e.g. dental procedures) or emotional stress Evidence of immunologic cause: T cell mediated Specific histocompatibility (HLA) antigens have been associated, indicating a possible genetic predisposition

Question 109

What are the three types of RAS?

Answer 109

``` Minor aphthae (80%) Major aphthae (10%) Herpetiform aphthae (10%) ```

Question 110

``` What age group affected by minor aphthae? ------- is male more affected than female ----- signs? ---- location ----- How does it heal? ```

Answer 110

Begin to develop in childhood or adolescence -------- No, Affect females more than males ------ Prodromal symptoms of burning, itching Less than 1.5 cm Painful tan ulcers with erythematous borders --------- Almost exclusively on moveable mucosa (not covering bone) Most often occur on buccal and labial mucosa ---- Heal spontaneously in 7 to 14 days without scarring Recurrence rate is variable

Question 111

``` Major Aphthae is what disease? ---- age group? ----- where does it affect orally? ---- Healing? ```

Answer 111

``` “Sutton’s disease” Onset in adolescence -------- 1.5 – 3+ cm, deeper than minor aphthae ----- Most commonly affect soft palate, tonsillar fauces or pharyngeal mucosa ---- Can take 2 – 6 weeks to heal, may cause scarring Recurrent episodes ```

Question 112

What is “Sutton’s disease” caused by?

Answer 112

Major aphthae

Question 113

``` clinical features of Herpetiform aphthae --- onset? --- female is more affected T or F? ---- what do the ulcers resemble? ```

Answer 113

``` 1 to 3 mm ulcers occurring in clusters ---- Onset in adulthood ---- Female predominance --- herpes simplex virus ulcers ```

Question 114

where do Herpetiform aphthae occur orally? ---- Healing?

Answer 114

Occur anywhere in the oral cavity (vs. herpes simplex ulcerations, which are usually on mucosa covering bone) No systemic signs or symptoms, as in primary herpetic gingivostomatitis ---- Heal in 7 to 10 days

Question 115

Treatment of RAS

Answer 115

Topical steroids: Dexamethasone elixir 0.01% (shouldn’t swallow) Fluocinonide (Lidex®) gel 0.05% Chlorhexidine Amlexanox 5% oral paste (Aphthasol®)

Question 116

what are the diseases associated with “Pseudo” aphthae?

Answer 116

1.Associated with systemic diseases 2.GI malabsorption diseases 3.(Crohn’s disease) 4. Vitamin deficiencies: iron, folate, B1, 2, 6, 12 5.Chronic, recurrent disease resulting from a systemic vasculitis 6. Immunogenetic basis: strong association with specific HLA types (B51) 7.Correlation with environmental antigens Oral (99%), ocular (70 – 85%), genital (75%), and systemic involvement

Question 117

syndrome associated with Pseudo” aphthae?

Answer 117

Behcet’s syndrome

Question 118

clinical features of “Pseudo” aphthae ulcers is similar to? ---- clinical features and location of “Pseudo” aphthae ------ what other body parts affected by it?

Answer 118

Oral lesions are similar to aphthous ulcers ---- 6 or more, commonly involving soft palate and oropharynx Ragged borders and variation in size Surrounded by diffuse erythema ---- Pustules on skin of trunk and limbs with genital and corneal ulceration 10 – 25% show CNS involvement, canparalysis and and dementia Vasculitis may affect cardiovascular, GI, hematologic, pulmonary, muscular, renal systems

Question 119

Treatment of “Pseudo” aphthae

Answer 119

Systemic and topical steroids | Other immunosuppressives like amlexanox Chlorhexidine

Question 120

Reason behind naming of Lichen Planus

Answer 120

Named for its similar appearance to the plant lichen (moss) Lichen = moss, planus = Latin for “flat ”

Question 121

``` what causes Lichen Planus ---- age group? ---- More female or male affected? ----- ```

Answer 121

``` Cause unknown but pathogenesis is immune mediated through T cells, slight association with hepatitis C --------- Most patients are middle-aged adults 26 Women represent about 2/3 of patients ```

Question 122

what is Koebner phenomenon

Answer 122

Lichen Planus Tends to affects tissues that are irritated or traumatized

Question 123

clinical presentation of Lichen Planus in skin and mouth?

Answer 123

Skin: purple, pruritic, polygonal papules Orally: reticular/erosive/bullous/plaque-like clinical appearance

Question 124

What is the most common type of Lichen Planus

Answer 124

Most common type is reticular characterized by Wickham’s striae

Question 125

Most common causes of desquamative gingivitis

Answer 125

LP, pemphigus vulgaris, pemphigoid, allergy)

Question 126

Histologic features of lichen planus

Answer 126

Saw-toothed rete ridges with destruction of the basal cell layer (liquefactive degeneration), with band like infiltrate of small lymphocytes (T cells) just under the epithelium

Question 127

what are lichenoid reactions?

Answer 127

Lesions that look like LP but aren’t: Assoc with Systemic drugs, hypersensitivity reactions, esp cinnamon and amalgam and epithelial dysplasia

Question 128

what is Vesiculo-bullous (blistering) diseases associated with?

Answer 128

Lichen planus

Question 129

How to treat Lichen planus?

Answer 129

Fluocinonide (Lidex®) gel 0.05% applied topically 3-4xs daily Clobetasol (Temovate®) gel 0.05% applied topically twice a day

Question 130

Meaning of Pemphigus ---- age group affected by it?

Answer 130

“Pemphigus” = Greek for blister ---- Most often in adults age 40’s and 50’s

Question 131

Foliaceus defintion

Answer 131

Severe progressive autoimmune disease that affects the | skin and mucous membranes: oral lesions are usually the first to appear

Question 132

clinical features of Pemphigus ?

Answer 132

Epithelial desquamation produces painful superficial erosions and ulcerations. Affects most mucosal surfaces but often affects gingiva producing chronic desquamative gingivitis. You can induce epithelial separation by manipulating tissue or producing lateral pressure (+ Nikolski sign). Rarely see blisters since they break early

Question 133

Histological features of Pemphigus?

Answer 133

The individual cells lose their cohesion and round up (acantholysis) producing a suprabasilar separation within the epithelium

Question 134

How to diagnose Pemphigus ?

Answer 134

Biopsy shows characteristic suprabasilar epithelial separation with acantholysis. Direct immunofluorescence demonstrates autoantibodies (usually IgG and C3) around the individual keratinocytes (chicken coop wire)

Question 135

How to treat Pamphigus

Answer 135

Systemic steroids ± steroid sparing drug

Question 136

What is Paraneoplastic pemphigus?

Answer 136

Affects patients who have a neoplasm, usually lymphoma or leukemia Very serious: high morbidity and mortality

Question 137

What is Benign mucous membrane pemphigoid (cicatricial pemphigoid)? ---- age? more male or female? ----- Is it more common than pemphigus vulgaris?

Answer 137

Chronic, autoimmune disease where patients produce antibodies against the structural proteins in their hemidesmosomes which anchor the basal keratinocytes to the underlying connective tissue, is a family of related disorders where antibodies are not directed against a single antigen, but many different antigens that comprise the hemidesmosomes ----- Average age 50 – 60, 3x more common in females ---- Considerably more common than pemphigus vulgaris

Question 138

where does Benign mucous membrane pemphigoid (cicatricial pemphigoid) affect in the body?

Answer 138

Affects oral, ocular, and genital mucosa ± larynx and esophagus and ± skin

Question 139

clinical features of Benign mucous membrane pemphigoid (cicatricial pemphigoid)

Answer 139

ery similar to pemphigus but not as severe. Tissue desquamation produces erosions and ulcers. + Nikolski sign. Most commonly affected site is gingiva where it produces desquamative gingivitis -Bullae form at separation of epithelium from connective tissue, producing a subepithelial split from the connective tissue Blisters rupture, leaving large areas of ulceration

Question 140

Ocular scarring in Benign mucous membrane pemphigoid (cicatricial pemphigoid) can progress to --------if untreated

Answer 140

blindness

Question 141

Diagnosis of Benign mucous membrane pemphigoid (cicatricial pemphigoid)

Answer 141

Biopsy shows characteristic subepithelial separation. Direct IF shows autoantibodies at junction of epithelium and connective tissue

Question 142

How to treat Benign mucous membrane pemphigoid (cicatricial pemphigoid)

Answer 142

Ophthalmologic consultation Topical or systemic steroids

Question 143

Desquamative Gingivitis can be a clinical manifestation of?

Answer 143

Lichen Planus Pemphigus vulgaris Mucous membrane pemphigoid Allergic reaction

Question 144

Allergic reaction causes Desquamative Gingivitis

Answer 144

Toothpaste – most commonly tartar control toothpastes Cinnamon-flavored products (containing a flavoring agent called cinnamic aldehyde) Preservatives (e.g. sodium benzoate)

Question 145

what is the flavored agent in toothpaste causes allergic reaction

Answer 145

cinnamic aldehyde

Question 146

What causes Erythema multiforme?

Answer 146

Most often following systemic medications or often as a post infectious process, esp post viral. Sometimes a cause cannot be

Question 147

clinical feartures of Erythema multiforme?

Answer 147

Acute onset, immune mediated blistering mucocutaneous condition

Question 148

Clinical features of Erythema multiforme?

Answer 148

It often follows a bacterial or viral (herpes simplex) infection or drug exposure (antibiotics, analgesics) Prodromal symptoms: fever, malaise, headache, cough, sore throat Skin - Skin lesions highly variable “multiforme” - Characteristic target or “bull’s eye” lesions - Can occur without oral lesions - Classically affects palms and soles Mucosa - Oral ulcers with erythema and irregular borders - Lips, labial mucosa, tongue, floor of mouth, soft palate - Crusting and bleeding at vermillion zone of lips Steven-Johnson syndrome - More severe form of erythema multiforme - Extensive mucosal ulceration - Also affects genital and ocular mucosa - Usually triggered by medications - Can affect internal organs and can be life threatening Toxic epidermal necrolysis - Most severe form of erythema multiforme - Triggered by drug exposure - Female predilection - Diffuse sloughing of skin and mucosal surfaces

Question 149

what population is affected by Erythema multiforme? ------- Male or female is more affected ?

Answer 149

Young adults 20s and 30s, men affected more

Question 150

What body parts affected by Erythema multiforme?

Answer 150

Affects skin and mucous membranes, rarely only the mouth

Question 151

Prodromal symptoms of Erythema multiforme

Answer 151

fever, malaise, headache, cough, sore throat

Question 152

What is the recurrence rate of Erythema multiforme

Answer 152

20% recurrence rate

Question 153

Multiforme and Bull's eyes features associated with what disease?

Answer 153

Erythema multiforme

Question 154

Steven-Johnson syndrome

Answer 154

More severe form of erythema multiforme - Extensive mucosal ulceration - Also affects genital and ocular mucosa - Usually triggered by medications - Can affect internal organs and can be life threatening

Question 155

what is the most severe for erythema multiforme

Answer 155

Steven-Johnson syndrome | Toxic epidermal necrolysis

Question 156

How to treat erythema multiforme

Answer 156

Topical and high dose systemic steroids

Question 157

``` what is geographic tongue? --- other names? --- is it a common disease and is is it more common in female or male? ---- ```

Answer 157

Inflammatory tongue condition of unknown etiology --- “Erythema migrans”, “benign migratory glossitis” ----- Relatively common (1 – 3% of population) 2x more common in females

Question 158

clinical features of Geographic tongue

Answer 158

Primarily affects dorsal and lateral borders of tongue Depapillated areas that are erythematous or normal colored with characteristic yellow-white borders that marginate the lesions. heal spontaneously and recur at different sites Usually asymptomatic but occasional burning Increased incidence in psoriatic patients

Question 159

Is treatment necessary for geographic tongue

Answer 159

No treatment necessary, topical steroids if symptomatic

Question 160

Is Reiters Syndrome associated with geographic tongue

Answer 160

it is very rare

Question 161

Disease associated with | geographic tongue

Answer 161

Urethritis, arthritis, conjunctivitis

Question 162

Lupus erythematosus is what kind of disease? ---- It is common in what age group?

Answer 162

Autoimmune disease --- 8x more common in women, average age is 31

Question 163

What disease is butterfly rash associated with?

Answer 163

Lupus erythematosus | 50 – 80% have skin lesions

Question 164

What is Discoid LE

Answer 164

lesions confined to skin Erythematous rash on sun-exposed skin 25% have oral lesions: erythematous plaques or erosions with white striations

Question 165

what is Systemic LE

Answer 165

chronic and progressive, can be life-threatening and affect multiple organs: CNS, heart, kidney Periods of remission and disease inactivity

Question 166

What are the lab tes used to diagnose LE

Answer 166

NA (antinuclear antibodies) & antibodies to the patient’s own DNA

Question 167

How to treat LE?

Answer 167

Corticosteroids, anti-malarial drugs (hydroxychloroquine), and other immunosuppressive medications are used in systemic LE Aspirin and NSAIDS are given for symptomatic treatment Antimalarial drugs for more severe conditions

Question 168

clinical features of Systemic Sclerosis “ Scleroderma” -------- Is it common in male or female more?

Answer 168

Rare immune mediated deposition of collagen in skin and other tissues ---- Usually adults, 3:1 women.

Question 169

What is Raynaud’s phenomenon associated with Systemic Sclerosis “ Scleroderma”

Answer 169

vasoconstrictive event in extremities triggered by stress, cold.

Question 170

Body parts affected by Systemic Sclerosis “ Scleroderma”

Answer 170

Skin: Diffuse, hard, taut “hide bound disease” Oral: Microstomia in 70%, dysphagia, ± xerostomia, diffuse widening of PDL, resorption of ramus or condyle or coronoid Affects other organs and can lead to organ failure

Question 171

How to diagnose Systemic Sclerosis “ Scleroderma”

Answer 171

Clinical features and Anti-Scl 70 antibodies | Topoisomerase 1

Question 172

How to treat Systemic Sclerosis “ Scleroderma”

Answer 172

D- penicillamine and Ca channel blockers

Question 173

prognosis of Systemic Sclerosis “ Scleroderma”

Answer 173

Dependent on organ involvement

Question 174

``` Graft vs Host Disease? --- Does it have oral implication --- treatment? ---- cancer associated with it ? ```

Answer 174

Immune reaction following allogenic bone marrow transplantation. Divided into acute (first 100 days) and chronic (over 100 days) ----- Most have oral lesions that can appear lichenoid and painful ---- Treated with immunosuppressive meds and corticosteroids ----- Pts at increased risk for dysplasia and oral cancer