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Conditions of the Mouth, FSUSMLEDermatology, Robbins PathOral Cavity -…

- - - - Chronic inflammatory condition unknown cause
    - - ZN stain
      - Grocott /PAS
      - Polarise for foreing material
    - - Exclude other causes of granulomas (TB, sarcoid, Crohn's)
      - Blood tests
        
        Folic acid
        
        Iron
        
        Vit B12
      - CXR
      - Endoscopy
      - Tuberculin skin test of QuantiFERON gold bloot test for TB
      - Patch tests
        
        Dietary allergen related
        
        Cinnamaldehyde
        
        Benzoates
- - - - Viruses
      - Herpes simplex virus
        
        Hepetic Gingivostomatitis
        
        Young children
        
        6mnth - 8 yrs old
        
        Herpes labialis
        
        Primary infx in childhood
        
        Virus remains latent in trigeminal ganglion
        
        Recurrence precipitated by bright sunlight / fatigue / stress
      - Coxsakie
        
        Hand foot mouth
        
        Presentation:
        Oral ulcers
        Vesicular rash on extremities
        
        Highly contagious
        
        Herpangina
        
        Presentation:
        
        Oral ulcers
        
        No rash
      - Varicella zoster
      - Herpes Zoster Virus - Human Herpesvirus Type3
        
        Chicken Pox
        
        Shingles
        
        Presentation:
        
        Elderly
        
        Pain precedes rash
        
        Along nerve disrtibution
        
        Ramsay Hunt
        
        Symptoms:
        
        Rash
        
        Pain
        
        Palsy
        
        Loss of taste
      - Epstein Barr virus
        
        Infectious mononucleosis (glandular fever
        
        Presentation:
        
        Fever
        
        Severe sore throat
        
        Lymphadenopathy
        
        EBV mucocutaneous ulcers
        
        Oral hairy leukoplakia
        
        Nasopharyngeal carcinoma
        
        Lymphoma (EBV associated lymphoproliferative)
    - - Pemphigus
        
        Presentation
        
        Females
        
        40-60yrs
        
        Ekina nd mouth extensive ulceration
        
        Mouth erosions
        
        Mouthbullae
        
        Histology
        
        Intraepithelial split
        
        Acantholysis
        Loss of adherence of suprabasal prickle cells
        
        Tzank cels
      - Pemphigoid
      - Erythema multiforme
      - Vesiculobullous (immunobullous)
      - Dermatitis herpetiformis
      - Linear IgA
  - - - Bacteria
      - Syphilis
        
        Micro
        
        Sexually transmitted disease
        
        Treponema pallidum
        
        Presentation
        
        Primary chancre 1-2 weeks after exposure
        
        Single painless indurated ulcer
        
        Heals spontaneously within 2 months
        
        May have regional lymphadenopathy
        
        No bone involvement
        
        Secondary
        
        4-8 weeks after chancre
        
        Multiple painful shallow ulcers / erosions with grey speudomembrane surroudning erythema
        
        Snail track ulcers and mucous patches
        
        Mucous patches
        
        Symmetrical generalised skin rash
        
        Usually soft aplate, tonsillar pillars, tongue
        
        Bone involvement very rare
        
        Snail track ulcers
        
        Tertiary
        
        1yr after evolution
        
        Non infectious
        
        Hard palate granulomatous lesion
        
        Atrophic fissured lobulated tongue
        and Dorsal leukoplakia
        
        Spirochaetes not seen
      - TB
    - - Recurrent aphtous
        
        Location
        
        Non keritinised oral mucosa
        
        Duration
        
        days - weeks
        
        Pattern of recurrence
        
        Irregular
        
        Histopathological exam
        
        Non specific inflammation
        
        Mainly plasma cells with plump endothelial cells
        
        Possible spirochaetes (spiral bacteria)
        
        Precipitating factor
        
        Hormonal changes
        
        Certain foods and drugs
        
        Intercurrent infx
        
        Stress
        
        Local trauma
        
        Hematinic deficiencies
        
        Ferritin
        
        Folate
        
        Iron
        
        Vit B
        
        Zinc
        
        THE persistent single ulcer
      - Lichen planus
      - Allergic
- - - - Histology
        
        Amalgam pigment is in deep connective tissue - not epithelium
        
        Clumbs
        
        Fine granules
        
        Staining collagen fibres
        
        Clumps
  - - - Oral melanotic macule
      - Naevus
      - Melanoma
    - - Phyciologic
      - Smokers melanosis
      - Post inflammatory
      - Addisons
      - Peutz-JeghersZ
      - Pregnancy
      - Medication
- - - - Keratinised
      - Non-keratinised
    - - Reticulated epithelium
    - - Enamel
      - Dentine
      - Pulp
      - pERIODONTAL LIGAMENT
- - - - Can be rubbed off
    - - Frictional keratosis (cheek biting)
      - Lichen planus
      - Leukoplakia
        Premalignant white patch
    - - Chemical burn
      - Oral hairy leukoplakia
        
        Presentation
        
        Asymptomatic white patch
        
        On lateral borders of tongue, buccal mucos, floor of mouth, retromolar, soft palate
        
        Vertical striations, corrugated
        
        HIV +
        
        Can occur in HIV - immunocommpromised and immunocompetent
  - - - Reticular white striae~
      - Desquamative
      - Erosive
      - Dorsumtongue plaque
      - Disease of skin and mucous membranes
      - Presentation
        
        Middle aged females
      - Histology
        
        Compact band of lymphocytes hugging the basal layer
        
        Degeneration of basal layer
        Apoptotic basal cells
        
        Lymphocyte exocytosis
      - Purple papular rashes elswhere
- - - - Intraepithelial split
      - Degenerated epithelial nuclie
      - Multinucleated keratinocytes
      - Nuclear moulding, nuclear margination
    - - Primary herpetic gingivostomatitis
      - Herpes labialis
  - - - Chiken pox
      - Shingles
        
        Elderly
        
        Pain recedes rash
        
        Along nerve distribution
      - Ramsay Hunt (reactivation in CNVII)
        
        Rash
        
        Pain
        
        Palsay
        
        Loss of taste
- - - - Autoimmune disease
      - Oral signs
        
        Ulceration :balloon:
        
        Oral lesions of lichen planus :white_large_square:
        
        Petechiae :white_flower:
        
        Damage of salivary galnds - xerostomia :sweat_drops:
    - - Autoimmune disease
      - M<F
      - Main signs
        
        Sicca syndrome
        
        Keratoconjucntivitis sicca
        
        Xerostomia
      - Oral Signs
        
        Disease in salvia
        
        Xerostomia
        
        Dry red wrinkled mucosa
        
        Difficulty swallowing and eating
        
        Disturbance in taste and speech
        
        Increased denal caries
        
        Infections
        
        Atrophy of papillae
        
        Candidiasis
  - - - Diffuse labial, gingival or mucosal swelling
      - Cobblestoning of buccal mucosa and gingiva
      - Aphatous ulcers
      - Mucosal tags
      - Angular cheilitis
      - Oral granulomas
    - - Oral signs present in periods of exacerbation of disease
      - Aphatous ulceration or superficial haemorrhagic ulcers
      - Angular stomatitis
      - Pyostomatitis vegetans
      - Poyostoatitis grangrenosum
- - - - HIV+
      - Immunocompromised
      - Organ transplant
    - - Thrush - scrapable
      - Leukoplakia - precancerous
- - - - Macules
      - Papules
      - Target lesions
- - - - Pruritic
      - Purple
      - Polygonal , Planar, Papules
      - Plaques
    - - Wickham striae - reticular white lines
      - Hypergranulosis
- - - - Coelaic disease
      - Inflammatory bowel diseases
        
        Crohn's
      - Behcet disease
  - - - Candida Albicans
    - - Immunocompromised
      - Diabeteic
      - Inhaled corticosteroids
      - AIDS
      - Post antibiotic use
    - - Pseudomembranous
      - Erythematous
      - Hyperplastic
- - - - Sjorgren syndrome
  - - - Bacterial
      - Viral
      - Trauma
      - Autoimmune
  - - - Benign tumours consiting of micture of ductal (epithelial ) and myoepithelial cells
      - Rounded well demarcated masses
    - - Composed of viarble mixtures of swuamous cells, mucus0secreting cells and intermediate cells