Ulcerated Lesions

Question 1

In conclusion…

Answer 1

oral ulcers can be caused by various reasons

trauma, infections, immunological issues

manifestation of systemic diseases

biopsy may be requied for diagnosis

Question 2

Answer 2

Acute ulcer:

painful, yellow base, red halo, history of trauma

Question 3

Answer 3

Chronic ulcer:

elevated margins, delayed healing, mimics oral cancer

Question 4

Answer 4

Riga-Fede disease:

ulcer on tongue of neonates due to trauma from erupting teeth

Question 5

T-cell mediated immunological reaction which affects 20% of the general population

1. Presence of highly antigenic reagent
2. Decrease in mucosal barrier
3. Abnormal response to common antigen

Answer 5

Aphthous Ulcers

Question 6

Answer 6

Minor Aphthous Ulcerations (Mikulicz aphthae)

80% of the cases

1-5 lesions

Between 3-10 mm

Heal in 7-14 days

Question 7

Answer 7

Major Apthous Ulcerations (Sutton’s disease)

10% of the lesions

1-10 lesions

Between 1-3 cm

Heal in upto 6 weeks

Question 8

Answer 8

Herpetiform Aphtous Ulcerations

10% of the cases

10-100 lesions

Between 1-3 mm

Heal in 7-10 day

Question 8

Answer 8

Erythema Multiforme

50% of cases associated w/ herpes and pneumonia

blistering, ulcerative mucocutaneous disorder

Question 8

Answer 8

Erythema Multiforme

Acute onset, with wide spectrum of severity (oral lesions only -> entire skin

Question 8

Answer 8

Erythema Multiforme

Large, shallow, irregular erosions and ulcerations which emerge quickly

Question 8

Answer 8

Erythema Multiforme

Hemorrhagic crusting of the vermillion zone of the lips

Question 8

Answer 8

Erythema Multiforme

Stevens-Johnson syndrome (EM major):

oral and skin + ocular/genital lesions

Question 8

Answer 8

Erythema Multiforme

Toxic epidermal necrolysis (Lyell’s disease):

diffuse sloughing of skin

Question 8

Answer 8

Contact Allergy

Acrylic resin

Question 8

Answer 8

Contact Allergy

Toothpaste

Question 8

Answer 8

Contact Allergy

Cinnamon

Question 8

Answer 8

Contact Allergy

Amalgam

Question 8

Answer 8

Drug Allergy

Methotrexate

Question 8

Answer 8

Drug Allergy

Nicorandil Ulcer

Question 8

Answer 8

Crohn’s Disease

inflammatory disease that may affect any part of the digestive tract

Teenagers, w/ second peak > 60y

GI issues (cramps, pain, diarrhea)

wieght loss and malnutrition

Wide range of oral lesions

Precede GI lesions in 30% of cases

Non-caseating, chronic granulomatous inflammation

Question 8

Answer 8

Wegener’s Granulomatosis (Granulomatosis with polyangiitis)

Strawberry gingivitis

Question 8

Answer 8

Wegener’s granulomatosis

Deep and irregular ulcerations

Question 8

Mycobacterium tuberculosis

2 million deaths/year

HIV increases risk

Poverty and crowding

Alcoholism, malnutrition, etc

Transmitted from person to person through saliva droplets in the air

Answer 8

Tuberculosis

Question 8

Answer 8

Chronic painless ulcer usually due to secondary infection

Question 8

caused by Mycobacterium leprae Initial infection often in nasal and oropharyngeal mucosa "Leonine Faces" Thick skin nodules

Answer 8

Hansen's Disease (Leprosy)

Question 8

Strong immune response Localized disease Hipopigmented macules Neural involvement

Answer 8

Tuberculoid (paucibacillary)

Question 8

Weak immune response Multiple lesions Macules, papules, nodules Neural involvement

Answer 8

Lepromatous (multibacillary)

Question 8

caused by Treponema pallidum sexual relations, blood transfusion, vertical transmission huge issue in the 40s until the discovery of penicillin by Alexander Fleming The great imitator

Answer 8

Syphilis

Question 8

Hutchinson's triad: hutchinson's teeth, ocular interstitial keratitis and eight nerve deafness

Answer 8

Congenital syphilis

Question 8

Answer 8

Gonorrhea caused by Neisseria gonorrhea second most common reportable bacteria infections in the U.S. slighly more common in females Most commonly seen in oropharynx. Asymptomatic or mildly bothersom rarely may show necrosis, purulence and hemorrhage of gingiva diagnosis: culture and antibiotic testing

Question 8

Answer 8

Histoplasmosis caused by Histoplasma capsulatum Dimorphic organism grows in humid areas with soil enriched by bird and bat excretion endemic in fertile river valleys, especially ohio and mississippi rivers

Question 9

Answer 9

Histoplasmosis Solitary, variably painful ulceration Resembles malignancy Usually in tongue, palate and cheek