PALM 302: CHAPTER 3 and 5

Term

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recurrent aphthous ulcer; "canker sores"

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Terms in this set (70)

recurrent aphthous ulcer; "canker sores"

-most common oral mucosal pathoses
-younger patients; 80% have before age 30
-no universal etiology; stress/hormones?
-occurs on movable mucosa
-use topical steroid for major cases

minor aphthous ulcer

most common 85%
-3-10mm (small)
-heals in 1-2weeks
-no scaring
-1-5 present

major aphthous ulcer

10%
-1-3cm (large)
-heals in 2-6 weeks w biopsy to rule out cancer
-1-10 present
-scars
-reoccurs

herpetiform

least common 5%
-1-3mm (small)
-heals 7-10days
-no scaring
-up to 100 present
-reoccurs

contact mucositis

-lesion that results from the direct contact of an allergen with the oral mucosa and skin
-an offending agent has contacted the mucosa
-erythematous and edematous
-burning/pruritus, smooth, shiny appearance that is firm to palpation
-small vesicles and ulcers may appear in the affected areas

contact stomatitis from cinnamon (lichenoid mucositis)

-concentrations of flavoring is 100x that in the natural spice
-signs/symptoms disappear within 1wk of discontinuation of cinnamon product
-reactions are most common in products associated w/ prolonged/frequent contact (candy, gum, toothpaste)
-toothpaste = diffuse
-candy/gum = localized

lichen planus

-immune mediated, benign, chronic disease affecting the skin and oral mucosa
-cause is unknown
-more common in females
-located on buccal mucosa, gingiva, tongue, lip
-white lace-like striation (Wickham striae)
-may have erythematous, bleeding
-purple, pruritic, polygonal papules (4p's)

reticular lichen planus

more common, asymptomatic, lace-like (Wickham striae)

erosive lichen planus

not as common, painful, erythematous, bleeding

lichen planus treatment

-chronic condition (waxes/wanes)
-no treatment, only palliative
-asymptomatic; follow up
-symptomatic: topical steroids

erythema multiforme-blistering ulcerative mucocutaneous condition of uncertain pathogenesis -hypersensitivity -due to herpes simplex virus (HSV), mycoplasma pneumonia's, medications -disease lasts 2-6wks; recurrent episodes are 20% -targetoid appearance (bullseye), crusting of eyes/lips*sjogern's syndrome "sicca syndrome"-autoimmune disease that affects the salivary and lacrimal glands, resulting in a decrease in saliva/tears -unknown cause -xerostomia, exophthalmia (dry eyes), keratonconjunctivitis -most common in females -bilateral swelling of parotid gland, dry eyes, dry mouth, burning tongue, caries, periodontal disease, candidates *40x increased risk of non-hodgkin B cell lymphoma* -treat with lots of water, sugar free gum, artificial saliva, change meds, anti fungal, pilocarpineprimary sjogren syndromeSalivary and lacrimal gland involvement without the presence of another autoimmune diseasesecondary sjogren syndromeanother autoimmune disease accompanies salivary and lacrimal gland involvement (50%)lupus erythematosus-an acute and chronic inflammatory autoimmune disease of unknown cause -most common collagen-vascular disease -common in females (31yrs: child bearing age) -3 types -kidney is one of the main complications that may lead to HBP, kidney failure, dealthsystemic lupus erythematosus (SLE)-weight loss, fever, arthritis, fatigue -located: skin, kidney, heart, lungs -intra-oral; may appear lichenoid or non-specific -50% have butterfly rash over molar area of nose -located in palata, buccal mucosa, gingva -lupus chelitis: involvement of the vermillion zonediscoid lupus erythematousanywhere on skinbehcet syndrome-chronic, recurrent autoimmune disease -adults -located oral ulcers, skin, genital, ocular -*oral ulcers recurrent 3x/year + 2 of the following: recurrent genital ulcers, eye lesions, skin lesions, positive pathergy test* -treatment depends on severity; medicationspemphigus vulgaris-a severe, progressive autoimmune disease that affects both the skin and mucous membranes -separation between epithelial cell "intraepithelial" -older adults -skin and mucosa (50% oral lesions begin first) -diagnose with biopsy and direct immunofluorescence (DIF): *intra-epithelial* -treat with high doses of steroidsacantholysisepithelial cell separation "intra-epithelial"nikolsky signgentle finger pressure with movement on clinically normal mucosa can produce a cleavage in the epithelium and result in the formation of a bullatzank cellsloss of attachment between the epithelial cells results in detached cells that appear rounded, present in the area of separationmucous membrane pemphigoid-cicatricial pemphigoid; benign mucous membrane pemphigoid -a chronic autoimmune disease that affects the oral mucosa, conjunctiva, genital mucosa, and skin -mucous membrane pemphigoid is not as severe a disease as pemphigus vulgaris -may heal with scarring (cicatricial pemphigoid) -located on the mouth, genital, eye, and gingiva (most common) -syrmblepharons (fibrous scars) along the eye -diagose with biopsy and direct immunofluorescence (DIF); *sub-epithelial separation* -treat with high doses of steroidsdifferential diagnosis for desquamative gingivitis1. lichen Plans 2. pemphigus vulgaris 3. mucous membrane pemphigoid (MMP) 4. lichenoid mucositis (allergy, hypersensitivity)developmental soft tissue abnormalities1. Ankyloglossia 2. Commissural lip pits 3. Lingual thyroidAnkyloglossia (tongue tie)tongue is attached to the floor of the mouth or gingiva -congenital, unknown cause -difficulty swallowing, talking -may cause recession -if severe, frenectomyCommissural Lip Pitsmall mucosal invaginations that occur at the corner of the mouth -cause unknown -uni/bi-lateral -no treatmentnon-odontogenic cysts (intra-osseous)*intra-osseous* 1. nasopalatine duct cyst 2. median palatal cyst 3. globulomaxillary cyst (not exist) 4. median mandibular cyst (not exist)nasopalatine duct cyst (Incisive Canal Cyst)most common non-odontogenic oral cyst -anterior hard palate midline -round, heart shaped radiolucency on x-raymedian palatal cystposterior to the incisive canal and palatine papilla -ovoid/circular on x-ray -not intimately associated with vital tooth -does not communicate with incisive canalglobulomaxillary cyst-not true developmental cyst -either laterally located "periapical" cyst or odontogenic keratocyst -always between mx cuspid and lateral incisor -well demarcated -upside down pear shapemedian mandibular cyst-located in the midline of the mandible -origin of the median md cyst is also unclear -surrounding teeth are vital -a well-defined RL is seen below the apices of the md incisors on x-raynon-odontogenic cysts (extra-osseous)*extra-osseous* 1. nasolabial cyst 2. brancial cleft cyst 3. thyroglossal duct cyst 4. epidermal cystnasolabial cystappears as a swelling of the upper lip, lateral to midline, resulting in elevation of ala of the nose -adult women -asymptomatic -requires surgical removal -rarebrachial cleft cyst*cervical lymph-epithelial cyst* occurs in upper lateral neck along anterior boarder of SCM as a soft, fluctuant mass -adults 20-40yrs -2/3 occur on L neck -requires surgical removalthyrogloassal duct cystdevelop from epithelial remnants of the thyroglossal tract -50% diagnosed before age 20 -presents as painless, fluctuant, movable swelling at/near midline, usually inferior to hyoid bone -fistulous tracts to the skin develop in 1/3 of cases -requires surgical removalpseudocysts "not a true cyst"1. stafne cyst 2. traumatic bone cyst 3. aneurysmal bone cyststafne bone cyst "stafne defect"*pseudocyst* -pressure on bone from submandibular gland -lingual concavity of the posterior mandible -well demarcated RL below inferior alveolar canal; sclerotic boarder -asymptomatic; no treatmenttraumatic bone cyst*pseudocyst* -caused by trauma-hemorrhage -benign, empty cavity within bone -well-defind RL sclerotic boarders -scallop between roots -teeth are vital -cone shaped outlineaneurysmal bone cyst*pseudocyst* -blood-filled spaces surrounded by connective tissues -young (20yrs) -most commonly located in jaw (posterior mandible) -most common clinical manifestation is a rapid enlarging swelling -pain is often reported -unilocular; can be multilocular -blow out or ballooning distentionalteration of teethsize shape structure number localized disturbance in eruptionshapegemination fusion concrescence dens in dente enamel pearl talon cusp taurodontism accessory roots dilacerationstructurehereditary -amelogensis imperfcta -dentinogenesis imperfecta -dentin dysplasia non-hereditary -regional odontodysplasia others -staining -hypoplasiasizemicrodonta macrodontanumberanodontia hypodontia hyperdontialocalized disturbance in eruptionimpaction ankylosishypodontia-lack of one or more teeth -permanent dentition most commonly -most often 3rd molars -hydrohidrotic ectodermal dysplasiaHyperdontia/Supernumerary teeth-increase in number of teeth -80% single tooth/most unilateral *mesiodens*: mx incisor (most common) *distomolar/distodens*: accessory 4th molarmicrodontiasmall size of teeth -peg lateralsmacrodontialarger than normal teeth -usually isolatedhypohidrotic ectodermal dysplasia-x-linked recessive (usually males) -group of syndromes all deriving from abnormalities of these ectodermal structures (hair, teeth, sweat glands, nails) -hypodontia -hypotrichosis (less than normal amount of hair) -hypohidrosis (abnormally diminished secretion of sweat) -feverGemination (twinning)defined as a single/enlarged/double/jointed tooth in which the tooth count is normal when the anomalous is counted as one (one tooth but tried to divide)Fusiondefined as a single enlarged/double/jointed tooth in which the tooth count reveals a missing tooth when the anomalous tooth is counted as one (two buds tried to join)concrescenceunion of two teeth by cementum aloneDens invaginatus (dens in dente)-deep surface invagination of the crown or root that is lined by enamel "tooth within tooth" -can be coronal (most frequent) or radicular *type I*: confined to the crown *type II*: extends below the CEJ *tyle III*: extends through the rootenamel pearl-enamel nodules at furcation of multicoated teeth (mx molars) -may have dentin or pulp -concern is pulp exposure and perio defecttaurodontism-enlargement of the body and pulp chamber -most common in md molars/premolars -no treatment -associated w/ Down syndrome, amelogenesis imperfecta, Klinefelter, ectodermal dysplasiadilaceration (curved)-from trauma or infection of the tooth bud, as root is forming -tooth remains viable -usually 3rd moalr -no issues unless endo -no treatmentsupernumerary root-most common: 3rd molars -no treatment needed; issues if endotalon cusp-accessory cusp of lingual incisor (mx lateral incisor) -pulp tissue inside -cusp of carabelli (ML cusp of mx molar)dens evaginates (occlusal pearl)-elongated cusp from occlusal surface -md molars/premolars -usually has pulp tissueimpaction-obstructed by a physical barrier = impacted -lack of eruption force = embedded -rarely occurs in deciduous teethankylosis-cenessation of eruption after emergence -fusion of cementum with bone -unknown pathogensis; typically attributed to traumaAmelogenesis Imperfecta (AI)*hereditary* -autosomal dominant; recessive; x-linked -both deciduous and permanent dentition are involved -affects enamel (thin), damage, decay -yellow-brown to white-pitted lesions -open bite -loss of contact -hypomaturation: snow caped -hypoplastic: pitted patterndentinogenesis imperfecta (DI)*hereditary* -autosomal dominant -steel gray, translucent/opalescent -both dentitions -brittle enamel -affects dentin -bulbous crowns -cervical constriction -early obliteration of pulp -shell teethdentin dysplasia type 1 (DDI) "rootless teeth"-autosomal dominant (AD): affects roots; short -affects both dentitions -chevron shaped pulp chamber -obliteration of pulp chamber -periapical RL -normal clinical crowndentin dysplasia type 2 (DDII)-autosomal dominant (AD) -bulbous crown -cervical constriction thin roots pulp stones thistle shaped pulp (flame shaped) -normal root lengthregional odontodyspluasia "ghost teeth"*nonhereditary developmental anomaly* (most believe it is due to an alteration in vascular supply) -children -both dentitions (permanent affected worse) -affects enamel, dentin, cementum, very large pulp with minimal dentin/enamel -located more in 1st quadrantturner's hypoplasia-periapical inflammatory disease of overlying deciduous tooth -enamel can be white, yellow, brown, and/or have different degrees of hypoplasia -most common in bicuspids because of their relationship with the deciduous molarstetracycline stain-using tetracycline during tooth development -minocycline affects teeth, bone, sclera, skin, nails -tx for acne, cystic fibrosis, and rheumatoid arthritis