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Vesiculo-Bullous Lesions - Coggle Diagram
Vesiculo-Bullous Lesions
Traumatic or Inflammatory Lesions
Mucocele
Etiology
:
Trauma
Severance of an accessory salivary excretory duct
Results in fluid retention in surrounding tissues
Repeated trauma may occur because of biting on the raised lesion
Characteristics:
dome-shaped
painless
benign
soft, fluctuant
may have a blue hue
often found on inside of lower lip
single or multiple lesions
AKA mucus extravasation phenomenon
Method of Transmission
No method because the lesion is caused by trauma
Dental Implications
Tissue trauma to the buccal mucosa or the lip region due to elevated tissue and tendency for the patient to traumatize the area while eating or chewing.
Treatment and Prognosis
May need to be removed, the minor salivary glands that are adjacent and feeding into the mucocele are also removed.
When it is classified as a mucous retention cyst of blockage of the duct has occurred, surgical approaches are warranted (marsupialization and laser ablation)
Ranula
Characteristics:
occurring on floor of mouth
sublingual/submandibular gland involvement
Infectious Viral Diseases (Herpes Simplex Virus)
Primary Herpetic Ginginvostomatitis
Etiology
Commonly encountered and acquired during childhood.
Caused by HHV-1 (initial exposure to the virus)
Characteristics
Vesicles found on the lip, tongue, gingiva, and buccal mucosa
May involve perioral tissues
Mild to severe
Symptoms may include pain, elevated temp., generalized malaise
Method of Transmission
Close physical contact (kissing, shared utensils, aerosols (sneezing or coughing), crowded living conditions.
Spread through saliva.
Can be transmitted with no symptoms or lesions.
Mucosa and intact skin are susceptible
Dental Implications:
High risk of spreading the virus during dental treatment.
Treatment should be rescheduled until lesions have healed.
Eating is the most significant problem - Encourage patient to stay hydrated.
Treatment and Prognosis
Palliative - soft diet, cold foods
Acyclovir suspension during first 3 days.
Usually resolve in 10-14 days
Secondary/Recurrent Herpes Simplex Infections
Characteristics
Most commonly found on vermillion border
Generally localized
Prodromal symptoms prior to vesicle appearance may include: burning, pain, tingling, itching
Etiology
Reactivation of the latent virus
Results from a triggering event - cold/fever, compromised autoimmune system, sunburn, emotional stress
Method of Transmission
When the virus become reactivated, it produces a recurrent infection.
Dental Implications
When lesions are present, postpone care to prevent discomfort and spread. The lesion should be completely healed with no exudate apparent.
Treatment and Prognosis
Herpes labials antiviral topical, OTC ointments or creams may reduce duration and may stop some lesions from developing.
Use sunscreen to protect the tissue.
Herpetic Whitlow
Characteristics
Occurs on the end of the finger
Begins as primary infection
Can reoccur
Health care providers, especially oral health care providers are susceptible
Etiology
HSV
Method of Transmission
Close physical contact
Dental Implications
None because it is not associated with the mouth.
Treatment and Prognosis
Usually resolves on its own.
Antiviral medication
Ocular Herpes
Etiology
Usually caused by autoinoculation
Characteristics
Can result in blindness
Method of Transmission
Aerosols/debris
Dental Implications
Dental healthcare providers must be careful regarding splatter to the eye.
Treatment and Prognosis
Usually resolves on its own.
Antiviral medications
Primary Varicella (chickenpox)
Characteristics
Original infection (HHV-3)
Virus remains dormant in the body following initial infection.
Etiology
HHV-3 infection
Method of Transmission
Air droplets or direct contact
Dental Implications
Treatment should be cancelled until the person is completely healed with no visible exudates in any of the lesions, both orally and extraorally.
Treatment and Prognosis
Palliative care
Avoid aspirin products due to Reyes syndrome
Secondary Varicella-Zoster (Shingles)
Characteristics
Symptoms include pain, malaise, neuralgia
Lesions are unilateral
May have trigeminal nerve involvement
Treatment and Prognosis
Anti-viral medication
Pain control
Should resolve in 2-3 weeks
Etiology
Reactivation of the latent varicella virus
Method of Transmission
None
Dental Implications
None
Congenital or Genetic Diseases
Epidermolysis Bullosa
Characteristics
All lesions can occur as the result of some trauma and can heal with some scarring. Fingernails are often obliterated because of scarring over time.
Fragile skin and mucosa
oral lesions - erosion to scarring of tissue
Etiology
Inherited
Method of Transmission
Rare group of conditions with both autosomal dominant recessive and X-linked modes of inheritance with over 20 different forms identified.
Epidermolysis acquisita - autoimmune form
Dental Implications
Enamel hypoplasia can occur in developing teeth
high caries rate
ability to tolerate procedure depends on severity
Modify oral hygiene procedures to accommodate various types with limited tissue disruption.
Alcohol-free rinse
Systemic use of fluoride
Topical fluorides, daily sodium fluoride mouth rinses, fluoride varnishes to help caries.
Treatment and Prognosis
Depends on severity
Wound care for mild cases
Antibiotics to prevent secondary infection
Plastic surgery to correct deformities caused by scarring
Noncariogenic soft diet
1% neutral sodium fluoride applied daily to prevent caries
Gentle home care techniques
Prognosis depends on the type of genetic defect and can range from good to fatal.
Epidermolysis Bullosa Acquista
Characteristics
Chronic blistering disease
Similar appearance to mucous membrane pemphigoid
Two types - inflammatory and noninflammatory
Lesions heal with milia and scarring
Rare
No sex or race predilection
Skin is fragile with blisters producting vesicles and bullae
Etiology
Autoimmune disease
Caused by circulating autoantibodies to the dermal-epidermal junctio
Method of Transmission
Autoimmune disorder
Genetic
Dental Implications
Use caution in scaling procedures since these patients suffer when ultrasonic devices are used at high power. Harsh or abrasive products cause problems as well and air polishers will be highly destructive.
Treatment and Prognosis
Inflammatory form responds well to corticosteroids
Severe widespread EBA may require more extensive measures such as immunosuppressive medications, intravenous immunoglobulin, rituximab
Non-infectious Vesiculobullous Diseases Autoimmune Diseases
Pemphigus Vulgaris
Characteristics
rare
can be life threatening
Nikolsky sign
bulla/blister formation
Treatment and Prognosis
High dose steroid therapy
60-80% mortality rate if left untreated
Etiology
It is an autoimmune disease of skin and mucous membranes characterized by development of antibodies to desmoglein involved in the maintenance of adhesion between the epithelial cells of the skin and mucous membranes.
Method of Transmission
None
Dental Implications
Effective oral hygiene is crucial.
The patient may not be able to brush thoroughly and plaque will cause increased inflammation of the gingiva.
Alcohol-containg products and abrasive dental products may be harmful. The use of non-alcohol-containing mouth rinses such as chlorhexidine mixed in water may be beneficial. Do not use tooth-whitening agents. Gentle debridement with minimal tissue manipulation. May include multiple appointments. Take clinical photographs did DC flavoring agents. Products with hydrogen peroxide may be irritating. Eliminate spicy foods.
Mucous Membrane Pemphigoid
Dental Implications
Avoid oral care products with sodium laurel sulfate and alcohol
Avoid spicy foods and strong flavoring agents
Etiology
Antibodies, usually IgG, sometimes IgA target subepithelial components of the basement membrane zone.Scarring and fibrosis result from the basal destruction and separation.
Characteristics
bulla formation in subepithelial area between connective tissue and basement membrane.
Gingiva becomes highly friable and sloughing occurs, leaving painful, erythematous/ulcerated surface
Method of Transmission
Autoimmune disease
Treatment and Prognosis
Topical corticosteroids
Intralesional injections
Not life threatening
Bullous Pemphigoid
Characteristics
Affects skin first, then oral lesions
Intraoral involvement is relatively rare (10-40%)
Etiology
Autoimmune disease
Method of Transmission
None
Dental Implications
Good biofilm control is desired
Avoid alcohol-based oral products
Treatment and Prognosis
Systemic corticosteroids and possibly other immunosuppressive agents
Infectious Viral Diseases (Coxsackievirus infections)
Hand-foot-and-mouth disease
Etiology
Coxsackie A-16 virus
other coxsackievirus
Method of Transmission
Airborne
oral/fecal routes
fomites
respiratory droplets
Characteristics
highly contagious
children under 5 are especially susceptible
lesions on soles of feet, palms of hands, tongue, palate, buccal mucosa
fever, sore throat, malaise, lymphadenopathy
Dental Implications
Oral lesions cause pain and difficulty with eating and swallowing
Treatment and Prognosis
Symptomatic relief
Antipyretic agents and topical medications for sore mouth
Excellent prognosis
Herpangina
Characteristics
Young children most susceptible
oral lesions found in posterior portion of the mouth, as well as throat/tonsils
Etiology
A-16 coxsackievirus
Method of Transmission
Oral/fecal route
Dental Implications
Postpone treatment until all vesicles and ulcerations are healed
Treatment and Prognosis
Palliative treatment
Excellent prognosis
Acute Lymphonodular Pharyngitis
Characteristics
Rare condition
Involves throat and tonsil area
Etiology
Coxsackievirus
CVA10
Infectious Viral Diseases (Paramyxoviridae Virus Infections)
Rubeola (measles)
Characteristics
Kopek spots - oral manifestation
Rash, fever, malaise, conjunctivitis, upper respiratory congestion, cough
Etiology
Paramyxoviridae family
Method of Transmission
Airborne/respiratory droplets
Dental Implications
Postpone until virus has been eliminated
Treatment and Prognosis
Non-aspirin products
Infectious Viral Diseases (Togavirus Infections)
Rubella (German Measles)
Characteristics
Red/pink papules on the body
Forchheimer signs: small dark-red papules on soft and hard palate
Fever, malaise, nausea, poor appetite
Etiology
Togavirus replicates in the oropharynx and regional lymph nodes and spreads through the bloodstream to the skin and distal organs
It can cross the placental barrier
Method of Transmission
Respiratory droplets
Dental Implications
None
Treatment and Prognosis
Non-aspirin medications
Citations used include:
"Lesions that have a Vesicular Appearance" PPT
General and Oral Pathology for the Dental Hygienist
Chapter 10 pages 246-270