Red-Blue Lesions
Pyogemic Granuloma
Etiology: Trauma or local irritation. Often appear in pregnancy because of increased hormones
Method of Transmission: Neither contagious nor an infectious lesion
Characteristics: Lesion may appear bright red, pedunculated (stem-like), or more sessile (flat-based). Only occur on soft tissue. Inflammatory tissue will become ulcerated and be replaced with a fibrinous tissue,making it appear yellow. Lobular, smooth, and papillary. Generally occur on the maxillary anterior gingiva, lower lip, tongue, and buccal mucosa.
Dental Implications: Follow up appts for patients even after pregnancy. Trauma may led to a mucocele that matures, isftraumatized again it will lead to a developed granulation tissue.
Treatment & Prognosis: Once hormones are at a consistent and reduced level the growth will reduce. Surgery such as lasers and cryotherapy. Chemical aids such as chlorhexidine gluconate mouth rinses are recommend, thorough scaling procedures and excellent home care to reduce plaque.
Peripheral Giant Cell Granuloma
Etiology: Reactive hyperplastic responses to tissue injury, producing an exuberance of the tissue.
Method of Transmission: NOT contagious
Characteristics: Found on the gingiva or edentulous ridge and usually found forward of the molar region. Lesions can range 1-2cm, deep red or bluish purple, can be soft to somewhat firm, and smooth in texture.
Dental Implications: Can cause bone resorption
Treatment & Prognosis: Periosteum and periodontal ligament must be removed with lesion to avoid recurrence. local irritation must also be identified and removed. When the entire lesion has been removed the prognosis.
Petechiae, Ecchymoses, and Purpura
Etiology: Hemorrhages in soft tissue due to trauma or blood dyscrasias.
Method of Transmission: NOT contagious
Characteristics:
Petechiae- tiny, perfectly round, purplish-red spots that appear on skin or submucosal hemorrhage. Size range from 1-2mm.
Purpura- focal, circumscribed hemorrhagic lesions in mucous membrane that are larger but less than 1cm.
. Ecchymoses- hemorrhagic spots in the skin or mucous membrane caused by extravasation of blood into subcutaneous tissue. Measure over 1cm
Dental Implications; Identification of blood disease and dyscrasias is important in seeking medical treatment & those under care should take special precautions when dental treatment is necessary
Treatment & Prognosis: Removing sources of the trauma and the prognosis depends upon the cause of the lesion
Lichen Planus
Etiology: Anxiety and stress are contributing factors. Unknown etiology. Lichen planus behaves like a cell-medicated immune response.
Method of Transmission: NOT contagious
Characteristics: keratotic, violaceous, puritic plaque occurring most frequently on the flexor surface in 30% to 50%. Red patches with white wickham striae, bullous form ranges from a few mm to cm. Erosive forms may be raw,red, and ulcerative with pseudomemranous coverings
Dental Implications: Professional scaling and a prophy are essential in limiting the lesions. Home care products that cause minimal abrasion and low amounts of flavoring agents, also soft bristle brush. Air polishers are not recommended, scaling with hand instruments are necessary for those with highly erosive lesions, and high settings on ultrasonic may cause tissue trauma
Treatment & Prognosis: Medications prescribed include flucinonide, betamethasone and clobetasol propionate.
Hypersensitivity Reactions
Etiology: Delayed cell-mediated immune responses. Contact allergies and sensitivity to food products, flavoring agents, dental hygiene products, and even dental restorations
Method of Transmission: NOT contagious
Characteristics: Fiery red and somewhat bulbous
Dental Implications: Determining the source and discontinuing contact with offending products
Candidosis
Etiology: caused by Candida albicans
Method of Transmission: NOT contagious, unless person is susceptible
Characteristics: White (cottage cheese) or bright red, raw, and ulcerative appearance depending upon the location and predisposing factors. Angular cheiltis- lesions found on commissures and appear red, dry, and rough. Median rhomboid glossitis- defect of the tongue, papillary atrophy of the filiform papillae characterized in a rhombus-shape, well demarcated and have a red appearance.
Dental Implications: Xerostomia and poor oral hygiene. Emphasis home care and procedures focused on treating candida so patient does not get reinfected.
Treatment and Prognosis: nystain oral suspension, statin oral powder, clotrimazole oral troches, nystatin ointment, miconazole cream, and disinfect applicances. Prognosis depends on the health state of the patient.
Kaposi Sarcoma
Human herpes 8 is associated with this lesions. Malignant neoplasm occurring in the skin, oral tissues, and lymph nodes. More common in in patients with AIDS and elderly. They have a blue to purple appearance and purple to red macules that may be focal or diffuse and easily overlooked. Hard palate and gingiva are most often affected.
Erythroplakia
Etiology: Tobacco, alcohol use, dietary deficiencies,and lifestyle factos
Method of Transmission: NOT contagious
Characteristics: Red or red and white patches, deep, velvety red color or dark pink. Surfaces are sorruglated/pebble and some instances smooth. Lesions may be broad and coalescing or circumscribed and localized.
Dental Implications: Any lesions should be guarded, watched carefully, or biopsied. Clinician may want to use one of the abnormal cell detection devices.
Treatment and Prognosis: Depends on histologic diagnosis. Radiation and chemotherapy are used. Follow-ups should be performed at 12 month intervals
Varicosity:
Etiology: Abnormally dilated and tortuous vein found under the tongue. NOT associated with any systemic disease status
Method of Transmission: NO transmission factor
Characteristics: dark blue or purple found on the lingual surface of the tongue, lips, or buccal mucosa. A thrombus may be present in some cases and will seem firm when palpated.
Dental Implications: N/A
Treatment and Prognosis: NO treatment. Surgical removal or lasers for thrombus lesions and the prognosis is excellent.
Congenital Hemamgioma
Etiology: Bengin proliferation of blood vessels, found in infancy or childhood. Composed of capillaries and venules.
Method of Transmission: NOT contagious
Characteristics: Dark pink to dark purple and lesions may be single or multiple with a raised appearance. Will blanch with pressure.
Dental Implications: Evaluated, clinically diagnosed, and watched carefully.
Treatment and Prognosis; Some will be evaluated, surgically removed with laser treatment and sclersoing solution. Prognosis is excellent. Monitoring teh area is needed, since hemamgiomas may enlarage and develop thrombosis.
Lymphangioma
Occur during embroyogenesis and present at birth. Lesions consist of lymphatic vessels and vary in size and location. Found on the tongue (most common site), buccal mucosa, and floor of the mouth. Present as multiocular lesions with some transparency. They are surgically removed and recurrence is common.
Hereditary Hemorrhagic Telangiectasia
Etiology: Autosomal dominant condition. The blood vessels are small collections of dilated capillaries.
Method of Transmission: NOT contagious
Characteristics: Bright red and occurring on the lips and anterior tongue, can rupture, hemorrhage, and appear as an ulcer when traumatized. "Spider veins".
Dental Implications: Lesions tend to bleed a lot when traumatized, causing a problem with dental treatment. Patient may be premeditated for certain dental treatments depending on the severity and extent of procedure,
Treatment and Prognosis: Preventing hemorrhage is the key factor. Patient must be monitored throughout their life. Anemia may result from blood loss, there may be complications of the liver and spleen. The extend of the bleeding depends upon the severity of the disease. Prognosis is guarded, depending upon the severity.
Resources: General & Oral Pathology for the Dental Hygienist (pg. 309-327)