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					    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?

				
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