OCP Final – Study guide for oral lesions and stuff. DEFINITIONS Stomatitis = inflammation of oral mucosa… generic term Neoplasm = abnormal growth of tissue, may be cancerous Sarcoma = cancer of the support tissues like bone, etc. (e.g., Karposi’s sarcoma = cancer of spindle cells) Carcinoma = cancer of the epithelial tissue Carcinoma in situ = cancer only involving the cells in which it started; carcinoma that hasn’t mestastisized Ulcer = localized loss of epithelium due to local or systemic factors Febrile = fever lymphadenopathy = abnormal swelling of lymphnodes exostoses = a bony growth on bone parulis = swelling on gingiva where pus escapes from an abcess osteomyelitis = infection of bone and bone marrow cellulitis = spreading inflammation of connective tissues ―—plakia‖ = plaque ―leuko-― = white ―erythro- ― = red THINGS TO KEEP IN MIND: When trying to distinguish between lesions, always think of location, shape/form, and recurrence. ULCERS General Facts re: Ulcers 1. Characterized by localized loss of epithelium 2. Can be induced by either trauma or disease (e.g., biting yourself or herpes, etc) 3. Common ulcers = apthous stomatitis (canker sores), Herpes infections of various types, pizza burns and other traumatic ulcers, cancers can manifest the mselves as red/redwhite ulce rs 4. When in doubt, BIOPSY A Word on Herpes: There are two kinds of herpes: herpes and The Herpes. Of the two, one is more preferable than the other. APTHOUS STOMATITIS VS. HERPETIC ULCERS Apthous stomatitis and Herpetic ulcers both affect mucosal surfaces. HOWEVER: 1. Apthous Stomatitis will never appear on hard palate or gingiva. 2. Secondary HSV Infection will occur on hard palate or gingiva. 3. Also although not manifested as ulcers, Nicotine stomatitis will occur on hard palate and gingiva When diagnosing ulcers: 1. Is it occurring with othe r symptoms (fever, painful gingival inflammation, cervical lymph nodes the size of cats)? a. Dx = Primary herpes Infection 2. Always check for source of trauma a. Dx traumatic ulcers 3. Always check for recurrence in same location AND whether there were vesicles/blisters immediately preceding a. Dx Herpes of some sort. 4. Unknown cause apthous stomatitis. Classify by lesion size. a. Non-herpetic ulcers < 5 mm = apthous minor b. Non-herpetic ulcers >5mm = apthous major Treating Ulcers: 1. Herpetic ulcers is caused by viral infection acyclovir 2. Primary herpetic infection just sucks palliative care, pats on the head 3. Nicotine stomatitis stop pipe smoking you idiot THINGS THAT CAN (MAYBE) BE MISTAKEN FOR ULCERS: Lichen Planus – isolated patches of LP can look like ulcers. Look for nearby spiderweb- type things. Especially erosive form – pretty bad LP is an inflammatory disease of the skin and mucous membranes Asymptomatic except for erosive form, which has ulce rated regions Tx = topical application of prednisone Geographic Tongue – It looks like a ring with diffuse border, and may be mistaken for an ulcer whose epithelial lining has rubbed off… it’s not it’s actually atrophying of filiform papilla LEUKOPLAKIAS AND OTHER PLAQUE-LIKE LESIONS When you see a white patch 1. Does it wipe off easily? a. YES, very … i. Candida b. YES, sorta but leaves raw/bloody patch underneath AND it was painful … i. That was a healing ulcer, you idiot. c. NO. Could be… i. Leukoplakia 1. May be premalignant, or cancerous – biopsy. 2. Could also be hyperkeratosis, harmless ii. HIV-assoc hairy leukoplakia iii. Could be Candidosis that’s been embedded in the tissue real good iv. Lichen Planus v. Lupus erythematosis (didn’t really cover, but fyi) vi. Leukoedema 1. Check to see if it disappears when stretched 2. This is b/c of hyperplastic keratinized layer, fluid. 3. common in African American men (~90%) vii. Snuff lesions 1. Very characteristic anyway, corrugated appearance. 2. Check to see if the patient uses snuff or chewing tobacco. Whether or not something wipes off indicates the level of attachment to the tissue and helps narrow down etiology. - Candida, for example, is easy to wipe off, it’s just fungal colonization. - Snuff lesions don’t wipe off, because the white patch is due to keratinization of epithelium - Cancer doesn’t wipe off because, well, you’re just boned. Candida - 3 forms; 2 white, 1 red. - white patches that are easily wiped off OR hyperplastic, keratinized white plaques OR white and red, embedded in the tissue (DENTUREs) - Common in immunosuppressed patients (AIDS, heavy antibiotic Tx, Diabetes) - Candida can also contribute to angular cheliosis aka angular chelitis o Droolers and vitamin deficiency - Standard Candida Tx = Nystatin, in almost all cases Snuff lesions will occur wherever you put chewing tobacco. - White hyperplastic plaques, corrugated appearance Leukoedema will look like a white/grey plaque and is also caused by tobacco use. However, you can stretch it out and it ―disappears‖… due to fluid buildup, etc. ERYTHROPLAKIAS and ORAL CANCERS: Be concerned if you see erythroplakias, esp in ppl over 40 y.o. Why? Key rule of thumb; the redder the plaque, the greater the chance of it becoming cancerous. Chance of cancer: Red/RedWhite >> White However, can be just simple infections, physical trauma, or chemical burns. SCCA can be red and white together. BUMPY THINGS on the GINGIVA Peripheral fibroma vs pyogenic granuloma vs peripheral giant cell granuloma SIMILARITIES: All occur on the gingiva TX = surgical excision. Biopsy needed for DDx. DIFFERENCES: P. Fibroma Pyogenic P. Giant Cell Granuloma Granuloma Color Normal or slight red Red Red Texture Normal texture Nodular overgrowth Soft red overgrowth overgrowth Growth starts Gingiva between On mucosa or skin Gingiva or alveolar whe re? teeth surface mucosa Distribution? Any gingiva Mostly gingiva, Any gingiva often interdental papillae of maxillary anteriors Avg Size n/a 3mm-4cm, avg 1cm > 1cm Painful? Sometimes, if Mild pain No pain inflamed Complications? Pressure resorption, Pus, mild pain, Pressure resorption tooth movement inflammation Recurrence? Sometimes Infrequent Sometimes BUMPY THINGS on the BUCCAL MUCOSA Mucoceles vs Varix vs He miangioma SIMILARITIES: Mucoceles, varices, and hemiangiomas can all manifest themselves as purple/grey purple lesions, but with different etiologies DIFFERENCES Etiology: - Mucocele = salivary gland that gets blocked off. o Can appear anywhere there are salivary glands (even underside of tongue, etc) o Not necessarily purple; can just be normal colored too. Or grey - Varix = varicose veins in the mouth, buccal mucosa, tongue o Use positive diascopy - you should see the blood getting pushed aside - Hemiangioma = abnormal mass of blood vessels, like a birthmark. Tx: - Mucocele Surgical excision - Varix nothing - Hemiangioma not covered in lecture Papilloma – look like raspberries growing on the mucosa. NOT premalignant LESIONS BY COMMON LOCATION Roof of the Mouth Denture sore mouth and papillary hyperplasia – you’re going to find them on the roof of the mouth, usually from poor denture hygiene. Lymphoid aggregates on the soft palate Karposi’s Sarcoma in HIV- infected Patients, although can appear anywhere in the oral cavity, since it is an invasive cancer of blood vessels. Secondary HSV Nicotine Stomatitis Pizza Burn Ulcers Candida thrush Things on the Tongue Foliate papillae that are huge Varices Mucoceles (submandibular duct, etc) Most SCCA cancers Karposi’s Sarcoma Hairy tongue, plaques of varying colors Candida thrush Things on the gingiva Granulomas, fibromas, marginal gingivitis, NUG, aids-related gingivitgis and periodontitis. General rules for diagnosing: Color? Shape? Form? Location? Recurrence? Vulnerable group?