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Congenital Hemangiomas -present at birth -vascular proliferation -capillary and cavernous clinical features -middle aged and older population -also known as strawberry nevus "stork bit" -present at time of birth, but may not be apparent until early childhood -red toblue -blanch when compressed -No thrill ot bruit -lip, tongue, buccal mucosa -may undergo spontaneous involution -often circumscribed, rarely affects bone

Congenital Vascular Malformations

Persistant lesions that grow with individuals and do not involute
-mix of arteries, vein, and capillaries
-grows with patient
-Poorly circumscribed, may affect bone
-thrill and bruit
-does not involute
-difficult to resect
-recurrence common

Encephalotrigeminal Angiomatosis

Sturge-Weber Syndrome
> Port-wine stain, a facial lesion, involved skin innervated by one or more of trigeminal nerve
> Vascular maliformation
> Leptomeninges of cerebral cortex of face
> May involve buccal mucosa and gingiva
> Mental retardation, hemiparesis, seizure disorder

Hereditary Hemorrhagic Telangiectsia

-dilaceration of veins
- Rendu-Osler- Weber Syndrome
-autosomal dominant
-red macules= abnormal vascular dilationsof terminal vessels in skin, mucous membranes
-Epitaxis ( bleeding from ear), bleeding from oral lesions

Congenital Hemangiomas

> if central in bone ( maxilla or mandile) appear a radiolucent lesion with a honey comb pattern and distinct margin

> may involute spontaneously
> Surgery, arterial embolization, sclerosant therapy, laser

Venous Varix

Focal dilation of single vein
-commonly seen ventral surface tongue (underneath)
-lower lip of older patient
-varices are blue and blanch with compression
Treatment= None

Pyogenic Granuloma

Part of the Big Three
Exuberant connective tissue proliferation to a known stimulus or injury
- red color because hyperplastic granulation tissue (multiple capillaries)
"Pregnancy tumor"
-Clinical features
> attached gingiva usually
> caused by calculus or foreign material
> Hormonal changes

-also seen on lower lip, tongue, buccal mucosa
-ulcerated lesion may be covered with yellow, fibrinous membrane
Size= few mm to several cm
Any age
More common in females
Treatment =surgical excision biopsy

Peripheral Gait Cell Granuloma

Part of the Big Three
-Hyperplastic connective tissue response to injury to gingival tissue
-Reactive hyperplastic
-attached gingiva
-Has multinucleated gaint cells
Clinical features
>red to blue, broad based masses
> B/t permanent molars and incisors
-any age
-more common in females
-may cause underlying bone resorption
"Peripheral- cuff" radiolucency
-Histologically is identical to the central gaint cell granuloma and brown tumor of hyperoarathyriodism
> recurrence common b/c deep seated

Scarlet Fever

-Systemic bacterial infection
-Erythrogenic toxin causes capillary damage (group A streptococci)
-spread by droplet infection
-Chlidren (crowded conditions)
> Pharyngitis, tonsillitis, fever, lymphadenopathy, malaise, headache
> red rash on chest
> strawberry tongue
Treatment= penicillin (to help prevent complications of rheumatic fever and glomerulonephritis)-kidney problems


Red patch on oral mucous membrane
-Most are found to be severe dysplasia or carcinoma(91%) bad
-causes include tobacco, alcohol, nutritional defects, etc.
-seen much less commonly than leukoplakia(1:26)
1 red/ 26 white
-age 50-70

High risk sites=floor of the mouth, tongue, retromolar mucosa
DD: Kaposi's sarcoma, ecchymosis, contact allergic reaction, vascular maliformation, psoriasis

Treatment=surgical excisional biopsy
-It is generally accepted that severely dysplasticand in situ lesions eventually become invasive

Kaposi's Sarcoma

-Proliferation of endothelial cell origin
-Human herpes virus 8 (HHV8)
> multifocal reddish brown nodules primarily in the skinof lower extremities
Oral=palate, gingiva, tongue
> flat lesions to nodular exophytic lesions
> red and blue
-about 1/2 of AIDS affected patients with cutaneous Kaposi's sacroma develop oral lesions

DD: Hemangioma, erythroplakia, melanoma, pyogenic granuloma
Treatment= surgery, lower dose radiation, chemotherapy

Vitamin B Deficiencies

-See in poor socioeconomic conditions
-Also with GI disease, alcoholism, starvation, fab diets

Oral=cheilitis and glossitis
> Angular cheilitis
> Tongue reddened, with atrophy of papillea, and pain and burn
-Niacin=for D"S
> Dermatitis, diarrhea, dementia, death

Treatment =replacement therapy

Pernicious Anemia

Deficiency of vitamin B12
-mean ruinous, wicked, evil
-Result from inability to transport vitamin B12 across intestinal mucosa because off a relative lack of gastric sustance (intrinsic factor)
-Causes atrophic gastritis, achlorhydria, neurological changes, megaloblastic, macrocytic anemia

Clinical features:
Weakness, pallor, shortness of breath fatigue on exertion

Tongue: painful and burning, red due to atrophy of papillae
Hunter's or Moeller's glossitis

Treatment=parenteral B12

Iron Deficiency Anemia

-casue by iron deficiency
-Due to dietary intake, impaired absorption, chronic blood loss
-brittlenails and hair and koilonychia (spoon shaped nails)
Tongue: red, painful,smooth
Angular cheilitis
Decreased Hematocit
Treatment =dietary iron

Burning Mouth syndrome

Or burning tongue syndrome
-usually no clinically detectable lesions
>Fungi (candida albicans)= chronic atrophic candidiasis
> Bacteria (staph and strep)
-Xerostomia (Sjogren's syndrome, anxiety, drugs)
-Nutritional deficiences (B vitamin complex, iron, zinc)
-Anemias (iron and pernicious)
-Hormone imbalance (postmenopausal)

-Neuropsychiatric (depressio, anxiety, cancer, phobia, psychogenic)
-Diabetes mellitus
-Mechanical trauma
Clinical features:
Middle aged women
pain and burning
dysgeusia (altered taste)

Plasma Cell Gingivitis

Allergic or hypersensitivity reaction
-Due to mint or cinnamon flavored gum
clinic features:
> Burning mouth
> onset sudden
> attached gingvia is fiery red ( not ulcerated)
> tongue is atrophic and red
Treatment: stop using

Petechiae and Ecchymoses

Soft tissue hemorrhages
-Petechiae (pinpoint)
-Ecchymosis(bruise) greater than 1 cm
Red and Purple
Intraoral causes
>injury=cheek biting, coughing, fellatio, trauma from prosthetic, iatrogenic
-Blood dyscrasias= leukemia, mononucleosis, thrombocytopenic purpura, hemophilia, Von Willebrand's disease, polycythaemia vera, sickle cell anemia, porphyria

Purpuea (cont.) Pooling of Extravasated Blood in Soft Tissue

Clinical feature
> red to blue to purple
> gingival enlargement (leukemia)
Red Diagnosis
> the inability to otherwise explain appearance of any of these clinical signs should causes clinicians to suspect any of the blood dyscrasias
Gingival enlargment (leukemia)

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