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Ulcers and Inflammatory Lesions - Coggle Diagram

- - - - Intraoral/perioral: Site of the lesion is usually ulcerative and may have exudate associated with the ulcer. In the case of extraction sites. The infection would be at the point of the extraction. Burkhart, Delong. pp 284
      - Distinguishing: Exudate produced is a yellow pus-like substance containing what is known as sulfur granules.
        Burkhart, Delong. pp 284
      - Extraoral: May become an indurated, ulcerative lesion developing into a fistula leading out through the skin of the neck or mandible. Exudates build up developing a tract leading outside the body. Burkhart, Delong. pp 284
      - Significant Microscopic Feats: The sulfur granules and branching filamentous bacteria/organism are identified through clinical examination, evaluated microscopically, and diagnosed with cultures.
        Burkhart, Delong. pp 284
  - - - Intraoral/perioral: Presents with sudden painful swelling of the free gingiva and necrosis with cratered interdental papilla. A fiery red, bleeding gingiva is common. Foul odor is present. Metallic taste may be reported. Inflammation may extend to the palate and oral pharynx.
        Burkhart, Delong. pp 285
      - Distinguishing: The foul odor. A gray pseudomembrane forms over the necrotic gingiva in NUG and spontaneous bleeding occurs with any tissue manipulation.
        Burkhart, Delong. pp 285
      - Extraoral: May involve the general physical health of the person as well as characteristics of fever, pain, and swollen lymph nodes.
        Burkhart, Delong. pp 285
      - Significant Microscopic Feats: A mixed flora of spirochetes, fusobacterium, Prevotella intermedia, Veillonella spp., and streptococci has been implicated.
        Burkhart, Delong. pp 285
  - - - Intraoral/perioral: Most common site is the oral pharynx, with resultant gonococcal pharyngitis. Tonsillar region is often affected, with inflammation and pustular lesions. Other complaints include halitosis, stinging, and burning.
        Burkhart, Delong. pp 283
      - Distinguishing: Presenting features are not diagnostic and other factors must be considered such as lifestyle, and health history.
        Burkhart, Delong. pp 283
      - Extraoral: Person may appear in poor health and exhibit lymphadenopathy.
        Burkhart, Delong. pp 283
      - Significant Microscopic Feats: gram stains and serologic tests are used to make a definitive diagnosis. Left untreated, the inflammatory response becomes chronic, with macrophages and lymphocytes predominant.
        Burkhart, Delong. pp 283
  - - - Intraoral/perioral: Some of the specific infections produce an ulcerative lesion with indurated lesions. These fungal infections have some oral manifestations and warrant consideration in a differential diagnosis. Burkhart, Delong. pp 286
      - Distinguishing: Lesions may mimic other disease states, and they may be in combination with other health conditions. Some chronic infections may persist for long periods. Burkhart, Delong. pp 286
      - Extraoral: Lesions are usually ulcerative, sometimes necrotic depending on the stage. They are also pseudomembranous.
        Burkhart, Delong. pp 286
      - Significant Microscopic Feats: The organism involved is observed through special cultures and staining procedures. Further culture tests would be performed to confirm the diagnosis.
        Burkhart, Delong. pp 286
  - - - Intraoral/Perioral: Depends on the stage
        
        Secondary: Manifests with flu-like symptoms,fever, swollen lymph nodes that are nontender, skin lesions, and some mucocutaneous lesions several weeks after the primary stage. Condylomata lata may be noticed by the practitioner and there may be a rash on the infected person. The rash may be on the face, palms, feet, trunk, etc.
        Burkhart, Delong. pp 281
        
        Tertiary: Produces someserious complications that affects multiple organs. A gumma may appear initially as an indurated mass and, subsequently, an ulceration that promotes extensive tissue destruction in the localized area of the gumma. Most frequently, the tongue and the palate are involved. The palatal lesion may be extensive enough to penetrate to the nasal cavity. Gummatous Syphilis may affect skin, bones, and mucous membranes. During the late stages, Paralysis, insanity, blindness, knee joint damage, personality changes, impotency, aneurysm, and tumor on the skin or internal organs may occur Burkhart, Delong. pp 281
        
        Primary: A chancre is developed after direct contact. Appears within 1-3 weeks after exposure. Will heal within weeks with no other signs of the disease. most common oral site is the lip. They are painless and appear firm. They are highly infectious at this stage. Burkhart, Delong. pp 281
      - Distinguishing: Some clinical manifestations may go unnoticed or be mistaken for other conditions. With congenital exposure, teeth are affected, resulting in molar teeth exhibiting rounded, berry-shaped elevations on the occlusal surfaces known as mulberry molars. Incisor will have a notched appearance due to the spirochetes infecting the enamel during formation. The effects are part of the Hutchinson triad which also includes deafness as a result of loss of function in the 8th cranial nerve. and opacification of the cornea with loss of eyesight.
        Burkhart, Delong. pp 282
      - Extraoral: Features depend on stage of the disease. Skin lesions on extremities. Syphilis lesions appear on the genitals. Later stages can involve eyes causing blindness.
        Burkhart, Delong. pp 280
      - Significant Microscopic Feats: Specific stains in a dark-field exam of a smear are used to view the numerous "corkscrew-like" organisms that are diagnostically significant in extraoral syphilis. Burkhart, Delong. pp 282
- - - - Intraoral/perioral: Ulcers often have a crater-like appearance with some fibrinous exudate depending upon the degree of trauma and the stage of healing.
        Burkhart, Delong. pp 278
      - Distinguishing: Scar tissue appears with repeated trauma. Burkhart, Delong. pp 278
      - Extraoral: Vermillion border of the lip may be involved and can appear crusted and sometimes bleeding because of the trauma.
        Burkhart, Delong. pp 278
      - Significant Microscopic Features: Nonspecific and not diagnostic. Epithelium is lost in one area of the lesion and the ulcer is covered by an fibrinous exudate with underlying granulation. Burkhart, Delong. pp 278
  - - - Intraoral/perioral: The tissue may appear as an elevated mass that subsequently becomes ulcerative, painful and rapidly progressing. numbness is also reported.
        Burkhart, Delong. pp 279
      - Distinguishing: A deep, demarcated ulcer is characteristic of this. The deep lesion becomes coated with a thick yellow fibrinous covering.
        Burkhart, Delong. pp 279
      - Extraoral: N/A
        Burkhart, Delong. pp 279
      - Significant Microscopic Feats: Necrosis of the salivary gland is involved, and there is squamous metaplasia of the salivary duct epithelium.
        Burkhart, Delong. pp 279
- - - - Intraoral/perioral: Oral, genital, ocular lesions may be present. Burkhart, Delong. pp 293
      - Distiguishing:Cutaneous target lesions that are initially seen are the most characteristic.
        Burkhart, Delong. pp 294
      - Extraoral: Skin lesions present as erythematous papules that enlarge and form central vesicles.
        Burkhart, Delong. pp 293
      - Significant Microscopic Feats: Histologic findings include epithelial hyperplasia, spongiosis, vesicles vesicles, and lymphocytic infiltrate.
        Burkhart, Delong. pp 294
  - - - Intraoral/perioral: Vesicles, erythematous tissue, rash with varied sized macules, and ulcers may be seen depending on the reaction.
        Burkhart, Delong. pp 295
      - Distinguishing: Type IV hypersensitivity reactions often involve aphthous ulcers and erythema. Tongue and buccal mucosa are the prime areas.
        Burkhart, Delong. pp 295
      - Extraoral: Hives are common, cutaneous lesions, pruritus may accompany the lesion.
        Burkhart, Delong. pp 294
      - Significant Microscopic Feats: Nonspecific features are seen like spongiosis, apoptotic keratinocytes, lymphoid infiltrates, eosinophils, and ulcerations.
        Burkhart, Delong. pp 295
  - - - Intraoral/perioral: Half of the patients have oral ulcerations. Some of the lesions may appear aphthous like. may occur anywhere in the mouth.
        Burkhart, Delong. pp 292
      - Distinguishing: May appear similar to other disease states with common findings such as geographic tongue.
        Burkhart, Delong. pp 292
      - Extraoral: Small joints of the patient are affected., which usually involve the lower extremities. The genitals, anus, and rectum may be affected. Thickened, hyperkeratotic nodules that resemble pustular psoriasis are characteristic.
        Burkhart, Delong. pp 292
      - Significant Microscopic Feats: The lesions resemble psoriasis. Burkhart, Delong. pp 292
  - - - Intraoral/perioral: Oral lesions are present in all forms of the disease in 25-40% of patients. lesions are characterized by erythematous erosions or ulcerations surrounded by a white rim with radiating keratotic striae.
        Burkhart, Delong. pp 297
      - Distinguishing: NoneBurkhart, Delong. pp 298
      - Extraoral: Weight loss, arthritis, skin lesions, and a classic rash over the nose and malar region are common. The lips, vermillion border, and buccal mucosa are most commonly involved.
        Burkhart, Delong. pp 297
      - Specific Microscopic Feats: Lymphocytic infiltrate, thickened basement membrane zones, and connective tissue arechracteristic. The lymphocytic infiltrates are dispersed about appendages and vessels.
        Burkhart, Delong. pp 298
  - - - Intraoral/perioral: The ulcerative apperance is similar to the aphthous ulcers. The lesions, recurrent and painful, may range in size from several millimeters to several centimeters.
        Burkhart, Delong. pp 291
      - Distinguishing: The triad of minor ulcers, genital ulcers, and ocular lesions signals the possibility for a disease consideration. Burkhart, Delong. pp 291
      - Extraoral: Simultaneous cutaneous lesions may be present such as erythemia nodosum or acneform skin eruptions, arthritis, central nervous system lesions, and intestinal ulcerations. Burkhart, Delong. pp 291
      - Significant Microscopic Feats: Enhanced polymorphonuclear leukocyte chemotaxis and neutrophil/platelet hyperfunction. Vasculitis and perivascular infiltrate ultimately develop.
        ]Burkhart, Delong. pp 291
  - - - Intraoral/perioral: the lesionis are noncaseating epithelioid-type granulomas. Involved tissue may be fissured, and epitheliel hyperplasia is usually present. Intestinal signs and symptoms include abdominal discomfort, anorexia, weight loss, and fever
        Burkhart, Delong. pp 299
      - Distinguishing: None Burkhart, Delong. pp 299
      - Extraoral: May present with skin lesions. An association with pyoderma gangernosum and vegetans and Crohns disease has been recently described.
        Burkhart, Delong. pp 298-299
      - Significant Microscopic Features: Include nonspecific focal aggregations of lymphocytes and regular perivascular infiltrates of inflammatory cells. Noncaseating epithelioid granulomas may be found, and multinucleated foreign body giant cells may or may not be present.
        Burkhart, Delong. pp 299
  - - - Intraoral/perioral: Appearnce and location are important in clinical diagnosis. Ulcer appears as a shallow and somewhat crater-like lesion with a yellow-to-white pseudomembrane and an erthyematous border described as a halo appearance.
        Burkhart, Delong. pp 289
      - Distinguishing: RAUs are found on non keratinized tissue. They are not found on the dorsum of the tongue, the attached gingiva, and the hard palate mucosa because these areas are keratinized.
        Burkhart, Delong. pp 289
      - Extraoral: None related to RAUs unless the lesion is close to the lip and produces edema in that area.General health of the patient may appear below normal. Gastrointestinal-related problems are considerations. Burkhart, Delong. pp 289
      - Significant Microscopic Feats: There are nonspecific findings, and biopsies are usually not needed. Common findings are increased levels of lymphocytes, macrophages, and mast cells. Generally, the biopsy specimen reveals a nonspecific inflammatory process.
        Burkhart, Delong. pp 289
- - - - Intraoral/Perioral: May show a wide variety of clinical appearances. Many cases exhibit erythroplakia. Any lesion in the oral cavity has the potential to be malignant. The most frequent sites for oral cancer are found in what may be termed the "drainage" area. the dorsum of the tongue is low risk. Pay particular attention to the to the oral pharynx and tonsillar region.
        Burkhart, Delong. pp 301
      - Distinguishing: Early cancer can resemble many diseases or can appear benign.Unexplained lesions, continued enlargement, and a lesion that does not recede on its own should be evaluated by biopsy. Palpable nodes require follow-up. Burkhart, Delong. pp 302
      - Extraoral: Often develops in a preexisting actinic keratosis. Often presents as a painless, nonhealing, rough, erythematic, scaly papule that may cause pruritus or itching.Surrounding tissues are usually erythematic and inflamed.
        Burkhart, Delong. pp 100-101
      - Significant Microscopic Feats: Depending on the stage, cells may present with hyperchromatism, pleomorphism, increased nuclear cytoplasmic ratio, premature keratinization, and formation of spheroidal masses of keratin deep within the epithelium. Burkhart, Delong. pp 302