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Oral Pathology (Management (Idiopathic/Stress/Defiencies (Lichen Planus…

- - - - Herpetiforme Recurrent Apthous Ulcertaion
        
        Multiple, small vesicles can be seen generalised on the anterior 2/3 of the tongue surface, with adjacent vesicles appearing to coalesce
        
        Tx: Determine the underlying cause, Aim of treatment is to decrease the symptoms, reduce ulcer number and size, and increase disease-free periods, CHX mouthwash. Topical corticosteroids (e.g. Orabase) – reduce inflammation. Pain relief
      - Primary Hepetic Gingivostomatitis
        
        (1) Inflammation at the gingival margin along the anteior dentition.
        (2) Erythematous, swollen gingival margins of the upper anteior teeth, with conconminant lesions on the mucosa of the upper lip, yellowish with eythematous border
        (3) lesions on the lower lip coalesce to form a greater region of ulceration
        (4) On the dorsal surface of the tongue (anterior 1/3) tehr are multiple small vesicles with erythematous borders that appear to coalesce
        
        Tx: Generally self-limiting and lasts for ~10 days
        Patient requires soft diet and plenty of fluids
        Good oral hygiene and gentle debridement of the mouth
        Consider prescription of acyclovir if the symptoms were severe
      - Hepes Labalis
        
        Multiple vesicles (which appear 1x1mm diameter) can be seen on the lower lip (to the left of the mid-line), and they appear to have a yellow-white colouration with an erythematous border.
        
        Tx: Acyclovir - cream (5%) or systemic PO (800mg x5daily 5-7 days)
      - HZV (Shingles) + Human Papilloma Virus (Sqamous pailloma) Tx: Acyclovir - cream (5%) or systemic PO (800mg x5daily 5-7 days) + Analgesics (PCT + NSAIDS)
  - - - well demarcated erythematous erosion with a white border. There appears to have been a loss of the filiform papillae in the erosive area (de-papillation)
        
        Tx: reassurance – no treatment unless causing discomfort Mouthwash with local anaesthetic or antiseptic agent Should consider the potential for nutritional deficiencies (e.g. B12, folate, iron)
    - - Growth/nodule on the lateral border of the tongue on the right hand side, which is approximately 1cm in size. It appears to pedunculated. The nodule appears to have similar colour to the adjacent tissue (e.g. tongue). These are generally the result of mild trauma or irritation
        removal of the irritant (e.g. sharp restoration) and excision of the growth
    - - Large, well-circumscribed, dome-shaped swelling on the inner mucosa of the lower lip (left to the midline). The swelling has a blue-ish translucent hue, and the base is erythematous.
        
        Tx: surgical excision
    - - Inflammatory, vascular lesion on the interdental papilla
        Ddx: giant cell epulis
        
        Tx: surgical excision with primary closure
    - - right has side of the lower lip there is an area of ulceration that is less than 1cm in diameter. The lesion is yellow-ish white in colour, with an erythematous border.
        
        Tx: Determine the underlying cause, Aim of treatment is to decrease the symptoms, reduce ulcer number and size, and increase disease-free periods, CHX mouthwash. Topical corticosteroids (e.g. Orabase) – reduce inflammation. Pain relief
    - - ommonly found symmetrically on the buccal mucosa, sometimes the tongue and gingiva.
        
        Reticular
        
        Plaque-like
        
        Erosive/Atrophic
        
        Bullous
      - Erosive/Atrophic
      - Tx:
        Check for skin lesions on the flexor surfaces of the arms and legs (these are often itchy) Identify and remove any potential agent that might have caused a lichenoid reaction (e.g. amalgam, medication) Biopsy for histological examination and immunofluorescence
        Good oral hygiene – avoid toothpaste with SLS Avoid smoking Topical corticosteroid
  - - - pus coming out of the parotid duct as a result of infection in the gland
    - - There is blunting of the interdental papilla, with these papillae appearing to be lost in some regions. There is a white pseudo-membrane of both the upper and lower gingiva below the above the gingival margins. There is some sloughing of the tissues, particularly in the lower arch.
        
        Tx: Debridement, Rx 1.5% H2O2 or 0.12% CHX, OHI, Metronidazole 400mg and Analgesics
  - - - Erythematous Candidosis
        
        broad-spectrum antibiotics, inhaled steroids, and in patients with HIV or xerostomiahe oral mucosa is red, shiny and atrophic, and there may be co-existing areas of thrush.
        
        eliminate the cause, topical fungal preparations, CHX mouthwash
        Topical antifungals include – miconazole gel, amphotericin B lozenges
      - Pseudomembranous Candidosis
        
        Appears as a creamy lightly adherent plaque on an erythematous oral mucosa, usually on the cheek, palate or oropharynx. The patient may have discomfort on eating, or have a bad taste in the mouth. These plaques can be gently wiped off, revealing a raw under-surface.
        
        Tx: eliminate the cause, topical fungal preparations, CHX mouthwash
        Topical antifungals include – miconazole gel, amphotericin B lozenges
      - Chronic Hyperplastic Candidosis
        
        white patch on the oral commissural buccal mucosa bilaterally, or dorsum of the tongue. There is an increased risk of malignant change.
        
        systemic antifungals such as fluconazole. This is often associated with iron/folate/B12 deficiencies, and smoking, which should be corrected.
      - Angular Chelitis
        
        a combined staphylococcal, streptococcus and candidal infection, and is a chronic form of candidosis which involves the tissues at the angle of the mouth
        Clinically, it presents as red, cracked, macerated skin at the angle of the mouth, often with a gold crust.
        
        Tx: miconazole cream
  - - - lcerative lesion present on the bilateral buccal mucosa. Irregular in shape and size, with pseudomembranous and erythematous surrounding. Some areas appear raw and erosive.
        
        Tx: topical corticosteriods --- systemic steriods if persists