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Vesiculo-Bullous Lesions - Coggle Diagram

- - - - Etilogy = caused by trauma and severance of an accessory salivary excretory duct
      - Method of Transmission = none
      - EO Characteristics = none
      - PO and IO Characteristics = blue hue with transparent appearance, slightly elevated, smooth dome-shaped, almost always asymptomatic
      - Distinguishing Characteristics = "superficial mucoceles" look like a vesicle
      - Dental Implications = tissue trauma to the buccal mucosa or the lip region
      - Treatment and Prognosis = may be chronic, removal of minor salivary glands around mucocele and mucocele
- - - - Secondary or Recurrent Herpes Simplex Infections
        
        Etiology = caused by reactivation of the latent virus of HSV-1, usually triggered by compromised immune system or by manipulation of tissues within the mouth
        
        Method of Transmission = none, but particles of HSV-1 can be transmitted
        
        EO Characteristics = at time of outbreak, vesicles may be seen
        
        PO and IO Characteristics = clusters of vesicles on the vermilion border, PO skin, or IO surfaces; vesicles quickly rupture and leave ulcers that crust and usually heal within 10-14 days
        
        Distinguishing Characteristics = burning, tingling, tissue warmth, itching, or pain before eruption
        
        Dental Implications = Treatment to be postponed until completely healed
        
        Treatment and Prognosis = over-the-counter ointments may reduce duration; Penciclovir applied early helps
      - Primary Herpetic Gingivostomatitis
        
        Etiology = commonly encountered and acquired during childhood, caused by HHV-1
        
        Method of Transmission = through close physical contact
        
        EO Characteristics = may be found in oral or genital areas
        
        PO and IO Characteristics = fiery red, marginal gingivitis that affects all areas of the dental arches; multiple small vesicular lesions appear on the gingiva, lips, tongue, oral mucosa, and occasionally on PO skin; vesicles rupture quickly and appear as ulcerations surrounded by erythema
        
        Distinguishing Characteristics = extreme pain, elevated temperature, and generalized malaise, cervical lymphadenopathy, sore throat commonly occur
        
        Treatment and Prognosis = Pallative treatment with a soft diet, liquids that are nonacidic, and noncarbonated beverages is optimal; cold foods; acyclovir suspension in first 3 days; usually resolve within 10 to 14 days
        
        Dental Implications = Treatment should be rescheduled until the lesions have healed
    - - Primary Varicella (Chckenpox)
        
        Etiology = HHV-3 is the causative agent
        
        Method of Transmission = Air droplets or direct contact with lesions
        
        EO Characteristics = malaise, sore throat, upper respiratory congestion; fever and slight lymphadenopathy precede or occur concurrently with a vesicular rash that appears on the trunk, head, and neck; vesicles form pustules and then ulcers with erythematous border
        
        PO and IO Characteristics = Vesicular lesions are usually found on the lips, hard palate, and the buccal mucosa
        
        Distinguishing Characteristics = subclinicial
        
        Dental Implications = Treatment should not proceed until completely healed
        
        Treatment and Prognosis = Pallative care with topical preparations to relieve pruritus; nonaspirin antipyretics recommended for discomfort; complete resolution from 2-3 weeks; vaccine available
      - Secondary Varicella-Zoster (Shingles or Herpes Zoster)
        
        Etiology = reactivation of the latent varicella zoster
        
        Method of Transmission = none other than the mode that causes the primary infection
        
        EO Characteristics = unilaterally over the sensory nerve affected in the head, neck, and trunk as a vesticular rash that is extremely painful; vesicles are single, 1 to 4 mm, and become shallow ulcerations; fever, pain, malaise, and lymphoadenopathy; pain described as stabbing, burning, tingling, and prickly
        
        PO and IO Characteristics = unilateral, small vesicular eruptions on any mucosal surface or on the palate
        
        Distinguishing Characteristics = Distant halt of lesions at midline
        
        Dental Implications = self-limiting, resolve in 2-3 weeks, can develop PHN lasting 90 days; spontaneous tooth exfoliation, pulpal necrosis, and osteonecrosis of the mandible; antiviral therapy in first 72 hours such as acyclovir, valacyclovir, and famciclovir
        
        Treatment and Prognosis = isolation, local management of the skin lesions, controlling pain, antiviral medications, and treatment of herpetic neuralgia; pallative with antiviral agents to prevent shedding; topical agents to reduce duration and decrease possibility of PHN; vaccine for varicella; shingles vaccine
  - - - Etiology = coxsackie A-16 virus and other coxsackie virus A and B strains
      - Method of Transmission = airborne and oral/fecal routes, fomites, and respiratory droplets; highly contagious; viral shedding occurs up to 2 weeks; usually most infectious during first week
      - EO Characteristics = maculopapular rash on the soles of the feet and palms of the hands; central vesicles; fever, sore throat, malaise, and lymphoadenopathy
      - PO and IO Characteristics = precede the cutaneous rash and may appear on any mucosal surfaces; lesions form vesicles that rupture, ulcerate, and become very painful; lesions found on tongue, palate, and buccal mucosa
      - Distinguishing Characteristics = vesicles and ulcers occur on the buccal mucosa, tongue, hard palate orally; external lesions on the soles of the feet, palms of the hands, and fingers and toes
      - Dental Implications = cause pain and difficulty with eating and swallowing
      - Treatment and Prognosis = symptomatic relief; antipyretic agents and topical agents for sore mouth; careful hand washing and watchful routes of exposure
    - - Etiology = caused by coxsackievirus, specifically A-16 coxsackievirus; prevalence in younger age groups; easily transmitted
      - Method of Transmission = easily transmitted via oral/fecal route; summer is optimal time for transmission
      - EO Characteristics = lesions found in posterior regions of eh mouth, soft palate, anterior and posterior pharyngeal pillars, and tonsils; diffuse reddening of the tissues, and the appearance of vesicles that rupture and ulcerate
      - PO and IO Characteristics = vesicular lesions ranging from 1 to 2 mm
      - Distinguishing Characteristics = small vesicles and ulcerations in the pharyngeal area
      - Dental Implications = Treatment needs to be postponed until completely healed
      - Treatment and Prognosis = palliative care; prognosis is excellent; complications rare
  - - - Etiology = originates from the Paramyxoviridae family
      - Method of Transmission = airborne and through respiratory droplets
      - EO Characteristics = dermal erythematous rash begins at face and moves toward to cover trunk and extremities
      - PO and IO Characteristics = Koplik spots on buccal and labial mucosa during initial stage; considered pathognomonic; appear bluish white spots on an erythematous background; pitting of the enamel in developing teeth may occur
      - Distinguishing Characteristics = Koptik spots with cutaneous rash
      - Dental Implications = treatment should be postponed until completely healed
      - Treatment and Prognosis = palliative care with nonaspirin antipyretics; complications may include pneumonia and encephalitis; death in immunocompromised individuals
  - - - Etiology =caused by togavirus
      - Method of Transmission = highly contagious spread through respiratory droplets; vaccine avaliable
      - EO Characteristics = malaise, fever, nausea, and poor appetite, and lymphoadenopathy with red/pink papules on the body
      - PO and IO Characteristics = small, discrete, dark-red papules on the soft and hard palate known as Forchheimer signs
      - Distinguishing Characteristics = Forchheimer signs visible in the soft palate, early sign of infection
      - Dental Implications = not applicable
      - Treatment and Prognosis = nonaspirin antipyretic medications for discomfort; vesicles present send to physician
- - - - Etiology = Antibodies usually target subepithelial components of the basement membrane zone; affecting gingiva is called desquamative gingivitis
      - Method of Transmission = idiopathic and classified as an autoimmune disease
      - EO Characteristics = over 80% of cases involve the oral mucosa; second site is conjunctiva; bullae are short-lived; break quickly and desquamate, leaving a raw erythematous or ulcerated surface
      - PO and IO Characteristics = oral cavity is most common involved site; shiny red gingival tissue; generalized desquamative gingivitis is present more than 90% of the time; gingiva is fairly friable
      - Distinguishing Characteristics = confined to gingiva in 50% of cases; positive Nikolsky sign is usually present; scarring or symblepharon may occur to the eyes
      - Dental Implications = not applicable
      - Treatment and Prognosis = topical corticosteroids and intralesional injections; not life threatening; possible dietary analysis; frequent maintenance visits due to lessened oral hygiene procedures from pain
    - - Etiology = autoimmune disease
      - Method of Transmission = autoimmune disease
      - EO Characteristics = none
      - PO and IO Characteristics = intraoral involvement is rare; when present it affects the gingiva; bullae develop slowly and may last weeks to months before breaking; oral lesions similar to MMP; follows a chronic course but remissions are common; usually affects skin first
      - Distinguishing Characteristics = none
      - Dental Implications = none
      - Treatment and Prognosis = systemic corticosteroids; daspsone, cyclosporine, sulfapyridine, and niacinamide; plaque control needed with frequent prophylaxis; remission is common after 2-3 years; rarely fatal