Term
| local causes of ulcerative diseases |
|
Definition
1) burns
2) trauma
3) aphthous stomatitis
4) malignant neoplasms
5) drugs
6) infectious diseases: syphilis, TB, viral stomatitis, dep fungal infections, ANUG, HIV |
|
|
Term
| systemic causes of oral ulcerative disease |
|
Definition
1) mucocutaneous disease
2) blood disorders
3) GI disease
4) rheumatic disease
5) vasculitides
6) endocrine disorders
7) drug reactions |
|
|
Term
| you should ____ biopsy an ulcer that has been present for more than ____ days |
|
Definition
| always biopsy an ulcer that has been present for more than 14 days |
|
|
Term
| extraoral findings suggesting systemic etiology of ulcers |
|
Definition
1) skin lesions
2) ocular lesions
3) anogenital lesions
4) purpura
5) fever
6) lymphadenopathy
7) splenomegaly
8) chronic cough
9) weight loss
10) fatigue/weakness
11) GI complaints |
|
|
Term
| most common ulcers are due to _____ or _____ |
|
Definition
| trauma or aphthous stomatitis |
|
|
Term
| aphthous stomatitis is a... (laymen terms) |
|
Definition
|
|
Term
| is aphthous stomatitis common or rare? |
|
Definition
|
|
Term
| aphthous stomatitis usually occurs during... |
|
Definition
|
|
Term
| aphthous stomatitis is more/less common in wealthy? |
|
Definition
| more common in the wealthy |
|
|
Term
| aphthous stomatitis is more common in M/F? |
|
Definition
|
|
Term
| is aphthous stomatitis recurrent? |
|
Definition
|
|
Term
| aphthous stomatitis presents with ____ (#), _____ ulcers |
|
Definition
| one or more painful ulcers |
|
|
Term
| how long do aphthous stomatitis ulcers last? |
|
Definition
|
|
Term
| where are aphthous stomatitis ulcers most common found? |
|
Definition
movable mucosa (lip, buccal mucosa, soft palate)
-not hard palate, dorsal tongue or gingiva) |
|
|
Term
| 3 types of aphthous stomatitis |
|
Definition
1) minor
2) major
3) herpetiform |
|
|
Term
| which type of aphthous stomatitis is most common? |
|
Definition
|
|
Term
| minor aphthous stomatitis ulcers are less than ___ cm |
|
Definition
|
|
Term
| minor aphthous stomatitis ulcers are ____ (duration) |
|
Definition
|
|
Term
| minor aphthous stomatitis ulcers are found more in the ____ part of the mouth |
|
Definition
|
|
Term
| major aphthous stomatitis ulcers are more ____ than minor ulcers |
|
Definition
|
|
Term
| major aphthous stomatitis ulcers are found more in the ____ part of the mouth |
|
Definition
|
|
Term
| minor aphthous stomatitis ulcers recur about every ____ months |
|
Definition
|
|
Term
| how do minor aphthous stomatitis ulcers look clinically? |
|
Definition
| oval, grayish-yellow necrotic center with erythematous periphery |
|
|
Term
| are minor aphthous stomatitis ulcers painful? |
|
Definition
|
|
Term
| how long does it take for minor aphthous stomatitis ulcers to heal? |
|
Definition
|
|
Term
| major aphthous stomatitis ulcers usually affect what part of the mouth? |
|
Definition
|
|
Term
| are major aphthous stomatitis ulcers painful? |
|
Definition
|
|
Term
| major aphthous stomatitis ulcers may cause.... |
|
Definition
|
|
Term
| major aphthous stomatitis ulcers may heal with ____ formation |
|
Definition
|
|
Term
| what are the pathology findings of aphthous stomatitis ulcers? |
|
Definition
-non-specific ulceration
-inflammatory infiltrate
-can see bacterial colonization on surface |
|
|
Term
| systemic conditions that are associated with recurrent aphthous stomatitis |
|
Definition
1) vitamin deficiencies: B12 and folic acid
2) Bechet's syndrome
3) Crohn's disease, IBD
4) HIV
5) mTOR inhibitor use (rapamycin) |
|
|
Term
| if systemic etiology is suspected for apthous stomatitis ulcers, the patient needs a work up for... |
|
Definition
|
|
Term
| treatment for recurrent aphthous stomatitis includes... |
|
Definition
1) palliation
2) reduce inflammation
3) reduce TNF |
|
|
Term
| tx for minor aphthous stomatitis ulcers |
|
Definition
1) topical palliation:
-benzocaine gel
-topical lidocaine
-benadryl suspension
2) leukotriene antagonist
-amlexanox gel
3) topical steroids
-triamcinalone
-fluocinonide
4) pain management
-NSAIDS
-acetaminophen |
|
|
Term
| tx for major aphthous stomatitis ulcers |
|
Definition
1) pain management
-NSAIDS
-acetaminophen
-narcotics
-lidocaine
-benadryl
2) steroids
-decadron suspension
-prednisone
3) anti-TNF
-pentoxifylline
-thalidomide |
|
|
Term
| non-recurrent ulcers can be caused by... |
|
Definition
1) trauma
2) cancer
3) infections: fungal, viral, HIV, bacterial |
|
|
Term
| causes of aphthous stomatitis ulcers? |
|
Definition
1) increased peripheral blood CD8+ and reduced CD4+ cells
2) ulcerative phase --> increased mucosal levels of cytotoix T-cells
3) increased levels of adhesion molecules in submucosa precedes clinical manifestations
4) increased TNF alpha levels in serum and saliva |
|
|
Term
| what cytokine is used for monitoring of apththous stomatitis ulcers? |
|
Definition
|
|
Term
| ORAL MANIFESTATIONS OF DERMATOLOGIC DISEASES |
|
Definition
|
|
Term
| types of dermatologic diseases that have oral findings |
|
Definition
1) lichenoid diseases
2) autoimmune diseases
3) other
-erythema multiforme |
|
|
Term
| types of lichenoid diseases |
|
Definition
-lichen planus
-Lupus
-GVHD
-Hep C |
|
|
Term
| types of autoimmune diseases |
|
Definition
-pemphigus vulgaris
-paraneoplastic pemphigus
-mucous membrane pemphigous |
|
|
Term
| what is desquamative gingivitis? |
|
Definition
| when the gingiva peels away |
|
|
Term
| is desquamative gingivitis a diagnosis? |
|
Definition
|
|
Term
| desquamative gingivitis is a ____ term used to describe a manifestation usually of _____ or _____ |
|
Definition
| a clinical term used to describe a manifestation usually of lichen planus or mucous membrane pemphigoid |
|
|
Term
| desquamative gingivitis is found more in M/F? |
|
Definition
|
|
Term
| desquamative gingivitis usually involves what part of the mouth? |
|
Definition
|
|
Term
| gingiva that has desquamative gingivitis looks... |
|
Definition
|
|
Term
| desquamative gingivitis may have a sensitivity to... |
|
Definition
|
|
Term
| skin lesions of lichen planus clinically look like... |
|
Definition
| purple, polygonal papules |
|
|
Term
| are lichen planus lesions itchy? |
|
Definition
|
|
Term
| where are lichen planus skin lesions found? |
|
Definition
| flexor surfaces of extremities |
|
|
Term
|
Definition
1) reticular form
2) erythematous form |
|
|
Term
| is the reticular form symptomatic or asymptomatic? |
|
Definition
|
|
Term
| where is the reticular form found in the mouth? |
|
Definition
|
|
Term
| which type of lichen planus is more common? |
|
Definition
|
|
Term
| what are the lacy white striations in oral lichen planus called? |
|
Definition
|
|
Term
| on the dorsal tongue, lichen planus can look like... |
|
Definition
|
|
Term
| is the erythematous form of lichen planus symptomatic or asymptomatic? |
|
Definition
|
|
Term
| erythematous form of lichen planus clinically looks... |
|
Definition
| red areas with or without ulcerations |
|
|
Term
| ____ are at the periphery of erythematous lesions in lichen planus |
|
Definition
|
|
Term
| which form of lichen planus causes desquamative gingivitis? |
|
Definition
|
|
Term
| erythematous form of lichen planus must be distinguished from ___ and ____ |
|
Definition
| mucous membrane pemphigous and pemphigus vulgaris |
|
|
Term
| lichenoid mucositis is associated with... |
|
Definition
1) NSAIDS
2) anti-hypertensive drugs
3) anti-hyperglycemic drugs
4) cholesterol lowering drugs
5) anti-gout meds
6) amalgam restorations
7) cinnamon flavoring
8) herbal remedies |
|
|
Term
| on histo, lichen planus shows... |
|
Definition
| orthokeratosis or parakeratosis |
|
|
Term
| on histo, the rete ridges of lichen planus look |
|
Definition
| saw tooth rete pegs (sharp and pointy instead of rounded) |
|
|
Term
| on histo in lichen planus, the basal cell layer looks... |
|
Definition
| degenerated...more squamous and pink |
|
|
Term
| on histo in lichen planus there is a band-like infiltrate of... |
|
Definition
|
|
Term
| 2 basic options for tx of lichen planus |
|
Definition
1) observation if patient isn't bothered
2) topical corticosteroids |
|
|
Term
| what corticosteroids are used to treat localized lesions of lichen planus? diffuse lesions? |
|
Definition
-localized lesion: fluocinonide or clobetasol
-diffuse lesion: dexamethasone elixir |
|
|
Term
| when treating lichen planus, prophylactic ____ should be used in patients who are predisposed to ____ |
|
Definition
| prophylactic anti-fungals in patients predisposed to candidiasis |
|
|
Term
| patients with lichen planus have a ___% increased risk of developing SCCa |
|
Definition
|
|
Term
| _____ is recommended in treatment for lichen planus |
|
Definition
|
|
Term
| what is lichenoid mucositis? |
|
Definition
| drug-related lichen planus (as opposed to idiopathic) |
|
|
Term
| ____ can be seen on histo in lichen planus that represents degenerating keratinocytes in the epithelium and connective tissue interface |
|
Definition
|
|
Term
| ____ is the most common connective tissue disease in the US |
|
Definition
|
|
Term
| 3 subtypes of lupus erythematosus |
|
Definition
1) systemic lupus erythematosus
2) chronic cutaneous lupus erythematosus
3) subacute cutaneous lupus erythematosus |
|
|
Term
| the early stages of SLE are... |
|
Definition
| non-specific (fever, weight loss, arthritis, fatigue) |
|
|
Term
| _____ is involved in 40-50% of ppl w/ SLE |
|
Definition
|
|
Term
| there are oral lesions in ____% of ppl w/ SLE |
|
Definition
|
|
Term
| oral lesions in SLE can look like _____ lesions on the ____, ____ or ____ |
|
Definition
| lichenoid lesions on the palate, buccal mucosa or gingiva |
|
|
Term
| is chronic cutaneous lupus erythematosus a systemic disease? |
|
Definition
|
|
Term
| CCLE lesions are exacerbated by ____ |
|
Definition
|
|
Term
| healing of CCLE lesions results in ___ with ____ |
|
Definition
|
|
Term
| clinically, CCLE skin lesions look like...___ patches on ____ |
|
Definition
| scaly red patches on sun-exposed skin |
|
|
Term
| oral lesions of CCLE look exactly like ____ lesions |
|
Definition
lichen planus lesions
-erythematous zone
-fine white striae
-may be sensitive to acidic or salty foods |
|
|
Term
| subacute cutaneous lupus erythematosus features are between... |
|
Definition
|
|
Term
| ____ lesions are the most prominent feature of SCLE |
|
Definition
|
|
Term
| skin lesions of SCLE are sensitive to ___ |
|
Definition
|
|
Term
| do skin lesions of SCLE heal like CCLE? |
|
Definition
| no, there is no atrophy or scarring |
|
|
Term
| similar to SLE, there is involvement of ____ and ____ in SCLE? |
|
Definition
| joints and musculoskeletal |
|
|
Term
| unlike SLE, there isn't involvement of ____ in SCLE |
|
Definition
|
|
Term
| oral lesions of lupus erythematosus resemble... |
|
Definition
|
|
Term
| in oral lesions of lupus erythematosus, there are patchy deposits of ____ material in the basement membrane |
|
Definition
|
|
Term
| _____ on histo in lupus erythematosus distinguishes it from lichen planus |
|
Definition
|
|
Term
| immunofluorescence test in lupus erythematosus shows ______ deposition in a ____ band at the _____ |
|
Definition
| IgM, IgG and C3 in a granular band at the basement membrane |
|
|
Term
| anti-nuclear antibodies are found in what % of lupus erythematosus? |
|
Definition
|
|
Term
| antibodies against double stranded DNA are found in what % of lupus erythematosus? |
|
Definition
|
|
Term
| antibodies against small nuclear RNA are found in what % of lupus erythematosus |
|
Definition
|
|
Term
| antibodies against ___ is the most specific for lupus? |
|
Definition
|
|
Term
|
Definition
-avoid sun exposure
-mild disease managed w/ NSAIDS and anti-malarials |
|
|
Term
| ____ is the #1 cause of death in patients with SLE |
|
Definition
|
|
Term
treatment for chronic cutaneous lupus erythematosus
- avoid ____
-med ____
-____ or ____ for resistant cases |
|
Definition
-avoid sun exposure
-topical corticosteroids
-thalidomide or anti-malarials for resistant cases |
|
|
Term
| 5% of CCLE cases transform into ____ |
|
Definition
|
|
Term
| graft versus host disease is seen in what patient population? |
|
Definition
| allogeneic stem cell transplant recipients |
|
|
Term
| milder graft v host diseases is seen in what patients? |
|
Definition
1) better histocompatibility match
2) younger
3) cord blood received
4) female |
|
|
Term
| acute graft v host disease is seen within how many days of transplant? |
|
Definition
|
|
Term
| ___% of patients are affected with acute GVHD |
|
Definition
|
|
Term
|
Definition
diarrhea
nausea
vomiting
liver dysfunction
abdominal pain |
|
|
Term
| chronic graft v host disease is seen within how many days of transplant? |
|
Definition
| continuation of acute form or new development >100 days |
|
|
Term
| ___ may be the only sign of GVHD |
|
Definition
|
|
Term
|
Definition
1) Wickham striae
2) diffuse white papules on tongue, labial mucosa, buccal mucosa
3) burning mucosa
4) xerostomia
5) palatal mucoceles
6) ulcers that last >2 weeks |
|
|
Term
| histo of GVHD looks like... |
|
Definition
|
|
Term
| on histo, advanced cases of GVHD have ____ deposition |
|
Definition
|
|
Term
| on histo of GVHD, ____ show inflammation then ____ and ____ |
|
Definition
| *minor salivary glands show periductal inflammation then *acinar destruction and *fibrosis |
|
|
Term
| tx for oral ulcers in GVHD |
|
Definition
| topical or intra-lesional steroids |
|
|
Term
| ____ is used to identify auto-antibodies bound to patient's tissue |
|
Definition
| direct immunofluorescence |
|
|
Term
| ____ identifies auto-antibodies circulating in the patient's blood |
|
Definition
| indirect immunofluorescence |
|
|
Term
| different types of pemphigus diseases |
|
Definition
-pemphigus vulgaris *most common
-pemphigus vegetans
-pemphigus erythematosus
-pemphigus foliaceus |
|
|
Term
| pemphigus vulgaris is caused by.... |
|
Definition
|
|
Term
| does pemphigus vulgaris affect M/F more? |
|
Definition
| neither (unlike many autoimmune diseases which are more F) |
|
|
Term
| population affected more by pemphigus vulgaris? |
|
Definition
|
|
Term
| clinical features of pemphigus vulgaris |
|
Definition
painful oral sores
dyphagia
weight loss |
|
|
Term
| do oral lesions or skin lesions show first in pemphigus vulgaris? |
|
Definition
|
|
Term
| do oral lesions or skin lesions resolve first in pemphigus vulgaris? |
|
Definition
skin lesions resolve first
oral lesions are first to show and last to go! |
|
|
Term
| pemphigus vulgaris has a positive ___ sign |
|
Definition
| Nikolsky: you can induce formation of a new lesion (bullae, vessicle, blister) with pressure |
|
|
Term
| on histo, pemphigus vulgaris shows ____ separation where? |
|
Definition
| intraepithelial separation above the basal layer (suprabasilar cleavage) |
|
|
Term
| histo of pemphigus vulgaris shows ____ of the spinous layer |
|
Definition
| acantholysis: splitting apart of epithelial cells |
|
|
Term
| histo of pemphigus vulgaris shows rounded ____ |
|
Definition
| Tzanck cells: cells that split apart become more rounded |
|
|
Term
| pemphigus vulgaris is usually positive with... |
|
Definition
| direct or indirect immunofluorescence |
|
|
Term
| treatment for pemphigus vulgaris |
|
Definition
-corticosteroids
-azathioprine
-immunoglobulin therapy |
|
|
Term
| if pemphigus vulgaris is untreated, mortality is ___% |
|
Definition
|
|
Term
| paraneoplastic pemphigus affects what type of patients? |
|
Definition
patients with an underlying neoplasm
-CLL
-lymphoma
-thymoma |
|
|
Term
| what causes paraneoplastic pemphigus |
|
Definition
| cross-reactivity between antigens to tumor and antigens in epithelium |
|
|
Term
| clinically, paraneoplastic pemphigus presents with ____ on ____ |
|
Definition
| vesiculobullous lesions on skin and oral mucosa |
|
|
Term
| ____ distinguishes paraneoplastic pemphigus from pemphigus vulgaris |
|
Definition
| palmar and plantar bullae |
|
|
Term
| 70% of patients with paraneoplastic pemphigus have... |
|
Definition
|
|
Term
| on histo, paraneoplastic pemphigus shows _____ or _____ clefting |
|
Definition
| sub-epithelial or intra-epithelial (supra or sub-basilar) |
|
|
Term
| direct immunofluorescence of paraneoplastic pemphigus shows.... |
|
Definition
|
|
Term
tx for paraneoplastic pemphigus
-benign lesions...
-malignant lesions... |
|
Definition
-benign lesions: excision of benign tumor
-malignant lesions: systemic immunosuppressive therapy (but then may cause reactivation of malignancy) |
|
|
Term
| mucous membrane pemphigoid is caused by.... |
|
Definition
| antibodies to hemidesmosomes |
|
|
Term
| mucous membrane pemphigoid is present more in M/F? |
|
Definition
|
|
Term
| is mucous membrane pemphigoid more or less common than pemphigus vulgaris? |
|
Definition
| mucous membrane pemphigoid is twice as common |
|
|
Term
| subtypes of mucous membrane pemphigoid... |
|
Definition
-only ocular involvement
-only oral cavity involvement
-mucosal and cutaneous lesions
-multiple mucosal surfaces but not skin involvement |
|
|
Term
| 25% of patients with mucous membrane pemphigoid develop... |
|
Definition
|
|
Term
| mucous membrane pemphigoid can cause ____, ___ or ____ in the eyes |
|
Definition
symblepherons = adhesions
entropions = inward turning eyelids
trichiasis = irritation second to eyelid rubbing against eye |
|
|
Term
| there is a positive ___ sign in mucous membrane pemphigoid |
|
Definition
|
|
Term
| on histo in mucous membrane pemphigoid, there is ____ separation |
|
Definition
| sub-epithelial (sub-basilar) |
|
|
Term
| deposition of ___ and ___ suggests more severe disease in mucous membrane pemphigoid |
|
Definition
|
|
Term
| tx for mucous membrane pemphigoid |
|
Definition
topical steroids for oral lesions
*refer to ophthalmologist for eye lesions |
|
|
Term
| ____ is the most common autoimmune blistering disease |
|
Definition
|
|
Term
| bullous pemphigoid is similar to mucous membrane pemphigoid but with.... |
|
Definition
|
|
Term
| ____ are seen within subepithelial bullae in bullous pemphigoid |
|
Definition
|
|
Term
| epidermolysis bullosa acquisita is an autoimmune condition with antibodies against.... |
|
Definition
|
|
Term
| ___% of patients with epidermolysis bullosa acquisita have oral lesions |
|
Definition
|
|
Term
| histo of epidermolysis bullosa acquisita shows epithelial cleavage where? |
|
Definition
|
|
Term
| antibodies are where in epidermolysis bullosa acquisita? in pemphigoid vulgaris? |
|
Definition
| on the floor of the cleft in epidermolysis bullosa acquisita and on the roof of the cleft in pemphigoid vulgaris |
|
|
Term
| linear IgA disease is similar to... |
|
Definition
| mucous membrane pemphigoid |
|
|
Term
| ___ is needed to differentiate between linear IgA disease and mucous membrane pemphigoid |
|
Definition
direct immunofluorescence
--> shows linear deposit of IgA at basement membrane |
|
|
Term
| angina bullosa hemorrahgica present with... |
|
Definition
| painful, blood-filled blisters |
|
|
Term
| angina bullosa hemorrhagica usually involves what part of the mouth? |
|
Definition
|
|
Term
| angina bullosa hemorrhagica is associated with a history of... |
|
Definition
| trauma or corticosteroid inhalers |
|
|
Term
| erythema multiforme is usually caused ___ to ____ |
|
Definition
secondary to HSV or mycoplasma pneumoniae
(cross reactivity to bacteria and patient's tissues) |
|
|
Term
| is erythema multiforme most common in M/F? |
|
Definition
|
|
Term
| clinically, erythema multiforme lesions have what type of lesions? |
|
Definition
| ulcerations, targetoid cutaneous lesions |
|
|
Term
| in erythema multiforme, ___ and ___ are usually spared |
|
Definition
|
|
Term
| on histo, erythema multiforme shows... |
|
Definition
**non-specific histology
-sub-epithelial or intra-epithelial vesiculation
-mixed infiltrate of inflammatory cells
-perivasculities |
|
|
Term
| erythema multiforme is a diagnosis of... |
|
Definition
|
|
Term
| tx for erythema multiforme |
|
Definition
steroids
anti-viral meds for frequently recurring cases |
|
|
Term
| does erythema multiforme recur? |
|
Definition
|
|
Term
| Stevens-Johnsons syndroms is triggered by... |
|
Definition
|
|
Term
| Stevens-Johnson syndrome can involve what parts of the body? |
|
Definition
| ocular, genital mucosa, oral, skin |
|
|
Term
| toxid epidermal necrosis/Lyell disease is caused by... |
|
Definition
| severe form of Stevens-Johnson syndrome |
|
|
Term
| more than ___% of the total body area is involved in toxic epidermal necrosis/Lyell disease |
|
Definition
|
|
Term
| toxic epidermal necrosis causes... |
|
Definition
| diffuse sloughing of skin and mucosa |
|
|
Term
| mortality rate or toxic epidermal necrosis? |
|
Definition
|
|
Term
| ORAL COMPLICATIONS OF CANCER THERAPY AND THE MANAGEMENT OF CANCER PATIENTS |
|
Definition
|
|
Term
| what % of patients treated for non-head and neck cancer will develop oral complications? |
|
Definition
|
|
Term
| are oral complications acute or later? |
|
Definition
| both; acute --> mucositis; late --> xerostomia |
|
|
Term
| are oral complications of radiation therapy acute or chronic? |
|
Definition
|
|
Term
| are oral complications of cancer therapy direct or indirect injury? |
|
Definition
both
direct injury --> xerostoma
indirect injury --> caries |
|
|
Term
| what are the 2 types of risk factors for oral complications of cancer therapy? |
|
Definition
1) treatment related risk factors
2) patient related risk factors |
|
|
Term
| what are the treatment related risk factors for cancer therapy? |
|
Definition
1) type of treatment
2) drug selection
3) dose & schedule
4) route of administration |
|
|
Term
| what are the patient related risk factors for cancer therapy? |
|
Definition
1) tumor diagnosis
2) preexisting oral infection: can increase proinflammatory cytokines (ex. addison's), shorten cell cycle (ex. psoriasis)
3) gender: women are at higher risk
4) age: younger kids are at higher risk because they have more rapidly dividing cells
5) body mass
6) genetics: affect biological pathways that drive toxicity |
|
|
Term
| ____ is the worst complications of ablative chemotherapy |
|
Definition
|
|
Term
| ____ is the most identificable source of bacteremia/sepsisi among granulocytopenic cancer patients |
|
Definition
|
|
Term
| does the cycles of chemotherapy affect the severity of mucositis? |
|
Definition
| yes, with each chemo cycle the mucositis gets worse |
|
|
Term
| does the level of radiation affect the severity of mucositis? |
|
Definition
| yes, as the cumulative radiation increases, the ulcers get worse |
|
|
Term
| where is mucositis found in the mouth? |
|
Definition
| only on movable mucosa, not attached gingiva |
|
|
Term
| what layers of the mucosa does mucositis affect? |
|
Definition
|
|
Term
| mechanism of damage by radiation (5 steps) |
|
Definition
1) initiation: radiation generates ROS --> damage to cells and tissues
2) upregulation and message generation
3) signaling and amplification: alteration of mucosal environment
4) ulceration: cytokine amplification, inflammation, pain, ris of bacteremia/sepsis
5) healing |
|
|
Term
| approved drug for mucositis found in cancer patients with hematologic malignancies |
|
Definition
|
|
Term
|
Definition
1) prevention of DNA strand breaks
2) downregulation of pro-inflammatory cytokines
3) activation of antiapoptotic factors (bcl-2)
4) enhanced epithelial regeneration |
|
|
Term
| what is one of the most consistent and bothersome side effects of head and neck radiation therapy? |
|
Definition
|
|
Term
|
Definition
| effect of radiation therapy on acinar cells of parotid gland |
|
|
Term
| what does early onset xerostomia usually start? |
|
Definition
| 1 week after the start of radiation therapy |
|
|
Term
| patient with cumulative radiation doses greater than 60 Gy develop what? |
|
Definition
| irreversible xerostomia w/ 80% loss of salivary gland function |
|
|
Term
| spontaneous recovery from radiation induced xerostomia is unlikely if the xerostomia lasts how long? |
|
Definition
|
|
Term
| what does xerostomia cause? (symptoms) |
|
Definition
1) dysphagia
2) loss of taste |
|
|
Term
| ways to prevent xerostomia |
|
Definition
1) tissue sparing radiation therapy techniques
2) parotid sparing radiation therapy using 3D treatment
3) cytoprotective therapy |
|
|
Term
|
Definition
1) stimulate salivary gland function
2) replace secretions |
|
|
Term
| radiation induced caries are common in patients with... |
|
Definition
|
|
Term
| mechanisms of radiation induced caries in patients with xerostomia? |
|
Definition
1) changes in salivary composition
2) decreased buffering capacity
3) loss of cleaning action
4) tooth decalcification |
|
|
Term
| how do radiation induced caries appear clinically? |
|
Definition
| lesions at cervical margins with decalcification of incisal edges |
|
|
Term
| what is osteoradionecrosis? |
|
Definition
| denudation of soft tissue and necrosis of bone caused by radiation |
|
|
Term
| what is the probably cause of osteoradionecrosis? |
|
Definition
| decreased vascularization |
|
|
Term
| risk factors for osteoradionecrosis |
|
Definition
1) gender: men 3x more likely than women
2) edentulism
3) active dental disease
4) tooth extraction
5) radiation doses greater than 65 Gy
6) poor nutrition and immune status |
|
|
Term
| treatment for osteoradionecrosis |
|
Definition
1) most cases heal in 6 months w/ conservative therapy (debridement, saline irrigation, antibiotics)
2) penicillin or tetracycline |
|
|
Term
| treatment for progressive osteoradionecrosis lesions? |
|
Definition
1) surgical debridgement
2) hyperbaric oxygen |
|
|
Term
| the mouth is a common site of _____ in allogeneic stem cell transplant recipients |
|
Definition
|
|
Term
| how does GVHD present clinically? similar to what other lesion? |
|
Definition
| vesiculobullous lesions similar to lichen planus |
|
|
Term
| _____ can be involved in GVHD resulting in_____ |
|
Definition
| salivary glands can also be involved in GVHD resulting in xerostomia |
|
|
Term
| patients with GVHD are at increased risk of delevoping... |
|
Definition
|
|
Term
| med used to reduce toxic effects of radiation therapy |
|
Definition
|
|
Term
| med to increase saliva in the mouth |
|
Definition
| salagen (pilocarpene): cholinergic agonist |
|
|
Term
| med to help with dry mouth symptoms |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what do serous/mucinous acini secrete? |
|
Definition
1) salivary fluid
2) salivary proteins |
|
|
Term
| what do ductal cells secrete? |
|
Definition
1) mostly they modify the composition of salivary fluid
2) some protein secretion |
|
|
Term
| sympathetic autonomic innervation of salivary glands controls what? |
|
Definition
|
|
Term
| parasympathetic autonomic innervation of salivary glands controls what? |
|
Definition
|
|
Term
| is a mucocele common or uncommon? |
|
Definition
|
|
Term
| what type of salivary gland causes a mucocele? |
|
Definition
|
|
Term
| what is the pathophysiologic cause of a mucocele? |
|
Definition
1) rupture of salivary duct
2) spillage of mucin |
|
|
Term
| why do mucoceles develop? |
|
Definition
|
|
Term
| how does a mucocele appear clinically? |
|
Definition
-dome shaped
-translucent erythematous
-can be clear or bluish depending on how deep it is |
|
|
Term
| multiple mucoceles on the soft palate can be caused by what? |
|
Definition
|
|
Term
| superficial mucoceles are associated with what other disease? |
|
Definition
|
|
Term
| where is the most common location for a mucocele? |
|
Definition
|
|
Term
| how is a mucocele usually treated? |
|
Definition
|
|
Term
how does a mucocele look on histo?
1) spilled ___ surrounded by ____
2) type of cell
3) maybe this...
4) ____ of adjacent ____ |
|
Definition
1) spilled mucin surrounded by granulation tissue
2) foamy histiocytes
3) maybe ruptured duct
4) inflammation/dilation of adjacent glands/ducts |
|
|
Term
|
Definition
| sublingual gland mucocele |
|
|
Term
| what is a plunging ranula? |
|
Definition
a ranula that is so deep that it bissects the mylohyoid muscle
--> causes neck swelling |
|
|
Term
|
Definition
|
|
Term
| a ranula can ____ the floor of the mouth and ____ the tongue |
|
Definition
| fill the floor of the mouth and elevate the tongue |
|
|
Term
| a salivary duct cyst is otherwise known as a... |
|
Definition
|
|
Term
| is a mucous retention cyst a true cyst? |
|
Definition
| yes, it's an epithelium lined cavity |
|
|
Term
| what is the cause of a mucous retention cyst? |
|
Definition
| unclear -- developmental, obstruction, trauma |
|
|
Term
| who usually gets mucous retention cysts? |
|
Definition
|
|
Term
| what salivary gland usually causes mucous retention cysts? |
|
Definition
|
|
Term
| a mucous retention cyst is clinically identical to what other lesion? |
|
Definition
|
|
Term
| tx for a mucous retention cyst? |
|
Definition
|
|
Term
on histo in mucous retention cyst you see...
1) lining is...
2) ___ in the lumen is common |
|
Definition
1) lining is variable: cuboidal, columnar, atrophic squamous epithelium
2) mucous secretions in the lumen |
|
|
Term
|
Definition
| calcifications within salivary ducts |
|
|
Term
|
Definition
| calcifications within salivary ducts (*not glands) |
|
|
Term
| sialoliths usually have a lot of.... |
|
Definition
|
|
Term
| are sialolithis related to a disorder? |
|
Definition
|
|
Term
| what salivary gland is involved w/ sialoliths? |
|
Definition
|
|
Term
clinically a sialolith looks like...
are they palpable? |
|
Definition
round hard mass
may be visible/palpable |
|
|
Term
| how do sialoliths present? |
|
Definition
| episodic pain with or without swelling |
|
|
Term
how do sialoliths look on histo?
1) _____ laminations
2) ____ inflammation
3) |
|
Definition
1) concentric laminations
2) periductal inflammation
3) sialadenitis |
|
|
Term
| what type of imaging can you use to diagnose sialoliths? |
|
Definition
1) occlusal plain films
2) sialography
3) ultrasonography
4) CT |
|
|
Term
| are all stones visible on imaging? |
|
Definition
|
|
Term
|
Definition
| inflammation of the salivary glands |
|
|
Term
| infectious causes of sialadenitis |
|
Definition
1) viral
2) bacterial due to low salivary flow +/- ductal obstruction |
|
|
Term
| what is the most common bacteria that causes sialadenitis? |
|
Definition
|
|
Term
| what are non-infectious causes of sialadenitis? |
|
Definition
1) Sjogren syndrome
2) sialolithiasis: inflammation secondary to a stone |
|
|
Term
| _____ is a common symptom with sialadenitis |
|
Definition
| periodic swelling or pain |
|
|
Term
|
Definition
| tx is based on the underlying etiology |
|
|
Term
| what is salivary gland hypofunction? |
|
Definition
| objective decrease in salivary flow that may or may not be associated with symptoms |
|
|
Term
|
Definition
| subjective oral dryness that may or may not be associated with hypofunction |
|
|
Term
| what is the most common cause of salivary gland hypofunction? |
|
Definition
|
|
Term
| what are clinical features of salivary gland hypofunction? |
|
Definition
1) difficulty eating/speaking/swallowing
2) taste changes
3) oral burning
4) candidiasis
5) cervial/interproximal decay |
|
|
Term
| common causes of salivary gland hypofunction |
|
Definition
1) medications
2) head and neck radiation
3) sjogren syndrome
4) diabetes mellitus
5) chronic GVHD
6) smoking
7) mouth breathing
8) dehydration |
|
|
Term
| what is the mechanism of sialogogue therapy? |
|
Definition
cholinergic agonists w/ M1/M3 affinity (selectively expressed in salivary glands)
*treating symptoms, not underlying disease |
|
|
Term
| 2 med examples of sialogogues |
|
Definition
1) pilocarpine
2) cevimeline |
|
|
Term
| what type of material is used to fill cervical caries? |
|
Definition
|
|
Term
| what type of filling is used for interproximal caries? |
|
Definition
|
|
Term
| what is sjogren syndrome? |
|
Definition
a systemic autoimmune disease that presents as sicca syndrome
--> xerophthalmia (dry eyes bc lacrimal gland doesn't work)
--> xerostomia (dry mouth bc salivary glands don't work |
|
|
Term
| is sjogren syndrome a primary or secondary disease? |
|
Definition
| can be either (not associated w/ another autoimmune disease or associated w/ another one) |
|
|
Term
| do M/F most commonly get sjogren syndrome? |
|
Definition
|
|
Term
| what is the most common secondary disease associated w/ sjogren's? |
|
Definition
|
|
Term
| what other conditions present like Sjogren? |
|
Definition
1) chronic GVHD
2) HIV
3) HCV
4) fibromyalgia |
|
|
Term
| what is the clinical presentation of sjogren? |
|
Definition
1) salivary gland hypofunction/xerostomia
-mucosal dryness
-dental caries
-candidiasis
-sensitivity
2) salivary gland enlargement |
|
|
Term
| are other mucous secreting tissue affected in sjogren? |
|
Definition
| yes -- Ex. vaginal mucosa dryness can be presenting symptom |
|
|
Term
| what are systemic manifestations of sjogren? |
|
Definition
1) fatigue
2) lymphadenopathy
3) interstitial nephritis
4) interstitial lung fibrosis
5) vasculitis
6) peripheral neuropathies |
|
|
Term
| what other disease are people w/ Sjogren's at increased risk for? |
|
Definition
lymphoma (40x)
-because of underlying autoimmunity |
|
|
Term
| what lab studies are used to diagnose sjogren's? |
|
Definition
1) increased ESR
2) increased serum IgG
3) autoantibodies |
|
|
Term
| what do you see on histo in Sjogren? |
|
Definition
1) chronic inflammatory aggregates of lymphocytes
2) focal aggregates w/ normal acini between |
|
|
Term
| what do you usually biopsy for suspected Sjogren? |
|
Definition
|
|
Term
| what are treatments for Sjogrens? |
|
Definition
-mostly supportive
1) artifical tears for eyes
2) xerostomia management
3) immunosuppressive/antirheumatic agents |
|
|
Term
| what is necrotizing sialometaplasia? |
|
Definition
| locally destructive inflammatory condition of salivary glands caused by ischemia/infarction of salivary tissues |
|
|
Term
| what other disease does necrotizing sialometaplasia mimic? |
|
Definition
| squamous cell carcinoma...but necrotizing sialometaplasia develops very quickly |
|
|
Term
| what are predisposing factors for necrotizing sialometaplasia |
|
Definition
1) trauma
2) dental injections
3) previous surgery
4) bulimia |
|
|
Term
| what glands are most commonly affected by necrotizing sialometaplasia? |
|
Definition
|
|
Term
| are M/F more commonly affected by necrotizing sialometaplasia? |
|
Definition
|
|
Term
| how does necrotizing sialometaplasia present clinically? |
|
Definition
1) non-ulcerated swelling w/ pain and/or parasthesia
2) after 2-3 weeks the necrotic tissue sloughs leaving an ulcer
3) heals within 6 weeks |
|
|
Term
| what is seen on histo in necrotizing sialometaplasia? |
|
Definition
-acinar necrosis
-squamous metaplasia of salivary ducts
-spillage of mucin
-inflammatory response
-architecture of involved salivary glands is preserved |
|
|
Term
|
Definition
1) papillon-lefevre syndrome
2) plummer-vinson syndrome
3) burning mouth syndrome |
|
|
Term
| name systemic granulomatous diseases |
|
Definition
1) orofacial granulomatosis
2) sarcoidosis
3) ANCA associated granulomatous vasculitis
4) Crohn's disease |
|
|
Term
| name systemic autoimmune diseases |
|
Definition
|
|
Term
| inheritance pattern of papillon-lefevre syndrome |
|
Definition
|
|
Term
| 2 characteristics of papillon-lefevre syndrome |
|
Definition
1) periodontitis at a very young age
2) palmoplantar keratoses |
|
|
Term
| 2 syndromes that are similar to papillon-lefevre syndrome |
|
Definition
1) haim-munk syndrome:
-palmoplanta keratosis, progressive periodontal disease, skin infections, skeletal manifestations
-mutation in cathepsin C gene
2) keratoderma palmoplantar of unna-thost/meleda disease: similar cutaneous manifestatons without periodontitis |
|
|
Term
| skin findings manifest by what age in papillon-lefevre syndrome |
|
Definition
|
|
Term
| what bacteria is associated with periodontal destruction in papillon-lefevre syndrome |
|
Definition
|
|
Term
| when does periodontitis develop in papillon-lefevre syndrome |
|
Definition
| soon after eruption of teeth |
|
|
Term
| what gene has defect in papillon-lefevre syndrome |
|
Definition
cathepsin C gene
--> affects neutrophil function |
|
|
Term
| progression of papillon-lefevre syndrome |
|
Definition
| premature loss of primary teeth --> gingiva resumes normal appearance --> eruption of adult teeth --> loss of most of adult teeth --> endutlism by teens |
|
|
Term
| does the gingiva ever look normal in papillon-lefevre syndrome? |
|
Definition
| yes, when there aren't any teeth |
|
|
Term
| what does histo of papillon-lefevre syndrome look like? |
|
Definition
nonspecific findings similar to periodontitis
-vascular connective tissue w/ mixed inflammatory cell infiltrate |
|
|
Term
| tx for papillon-lefevre syndrome |
|
Definition
1) skin lesions: retinoids
2) periodontal disease:
-tetracycline to prevent redevelopment of disease after loss of primary dentition
-antimicrobial clearance: amoxicillin, clavulanate potassium
-hygiene, chlorhexidine rinses, prophylaxis |
|
|
Term
| what population does plummer-vinson syndrome affect most often? |
|
Definition
|
|
Term
| what are the clinical features of plummer-vinson syndrome? |
|
Definition
1) burning sensation of mucosa
2) glossitis
3) iron deficiency anemia
4) koilonychia: nail changes
5) dysphagia
6) squamous cell carcinoma of mouth and esophagus |
|
|
Term
| tx for plummer-vinson syndrome |
|
Definition
-correct anemia
-monitor for SCCa |
|
|
Term
| burning mouth syndrome is a ____ syndrome characterized by: |
|
Definition
neuropathic pain syndrome characterized by:
1) perception of swelling
2) altered taste |
|
|
Term
| are there really mucosal alterations in burning mouth syndrome? |
|
Definition
|
|
Term
| burning mouth syndrome is strongly associated with... |
|
Definition
|
|
Term
| specific population that burning mouth syndrome affects frequently |
|
Definition
|
|
Term
| does burning mouth syndrome affect M/F more? |
|
Definition
|
|
Term
| burning mouth syndrome usually occurs ____ years after ____ |
|
Definition
|
|
Term
| does burning mouth syndrome happen gradually or abruptly? |
|
Definition
|
|
Term
| where are the most common places to feel burning in burning mouth syndrome? |
|
Definition
| anterior dorsal tongue and palate |
|
|
Term
| when are the symptoms of burning mouth syndrome mildest? |
|
Definition
|
|
Term
| things to rule out w/ burning mouth syndrome |
|
Definition
-candidiasis
-vitamin deficiency
-diabetes |
|
|
Term
| tx for burning mouth syndrome |
|
Definition
1) viscous lidocaine
2) alpha-lipoic acid
3) clonazepam
4) amitriptyline
5) counseing |
|
|
Term
| syndrome associated with 100s of basal cell carinomas and KOT |
|
Definition
|
|
Term
| syndrome associated with osteomas, supernumerary teeth and colon cancer |
|
Definition
|
|
Term
| syndrome associated w/ mucosal neuromas and medullary carcinoma of the thyroid |
|
Definition
|
|
Term
| syndrome associated with fibrous dysplasia |
|
Definition
|
|
Term
| syndrome associated w/ multiple neurofibromas |
|
Definition
| von Recklinghausen disease |
|
|
Term
| granulomatous disease are characterized by the presence of ____ including _____ |
|
Definition
| inflammation including epithelioid histiocytes |
|
|
Term
| disease that have "granuloma" in the name but are NOT granulomatous diseases |
|
Definition
pyogenic granuloma
giant cell granulomas
traumatic ulcerative granuloma
periapical granuloma
eosinophilic granuloma (type of Langerhan cell histiocytosis) |
|
|
Term
| examples of granulomatous diseases |
|
Definition
sarcoid
TB
tertiary syphillis (gumma)
leprosy
foreign body *most common
orofacial granulomatosis
ANCA associated vasculitis
Crohn's disease
fungal infections |
|
|
Term
| what is the most common site of swelling in orofacial granulomatosis? |
|
Definition
|
|
Term
| ____ of the buccal mucosa is common in orofacial granulomatosis |
|
Definition
|
|
Term
| histo features of orofacial granulomatosis |
|
Definition
-granulomatous inflammation:
epitheliod histiocytes
multinucleated giant cells
lymphocytes |
|
|
Term
| what is NOT seen in orofacial granulomatosis that is seen in other granulomatous disease? |
|
Definition
-caseating necrosis
-foreign material
-infectious organisms |
|
|
Term
| tx for orofacial granulomatosis |
|
Definition
-rule out other sources of granulomatous inflammation
-topical or intralesional steroids |
|
|
Term
| population that sarcoidosis affects most |
|
Definition
|
|
Term
|
Definition
| nonspecific: cough, chest pain, fever) |
|
|
Term
| do symptoms appear quickly or slowly in sarcoidosis |
|
Definition
|
|
Term
| sign of sarcoidosis on radiograph of lung |
|
Definition
| bilateral hilar lymphadenopathy |
|
|
Term
| what is lupus pernio? what disease is it seen in? |
|
Definition
violaceous lesions of lips, ears, nose and face
-seen in sarcoidosis |
|
|
Term
| what do oral sarcoid lesions look like? |
|
Definition
-firm
-dark red or brown
-maculo-papular |
|
|
Term
| where are sarcoidosis lesions most commonly found in the mouth? |
|
Definition
|
|
Term
| there can be positive biopsies of ____ even in thea bsence of any oral lesions in sarcoidosis |
|
Definition
|
|
Term
| syndromes associated w/ sarcoidosis |
|
Definition
1) Lofgren syndrome:
-erythema nodosum
-bilateral hilar lymphadenopathy
-athralgia
2) Heerfordt sydrome:
-parotid enlargement
-anterior uveitis
-facial paralysis
-fever |
|
|
Term
|
Definition
| -observation followed by corticosteroids (for ppl who need) |
|
|
Term
| ANCA associated granulomatous vasculitis is characterized by... |
|
Definition
1) necrotizing granulomas of the respiratory tract
2) glomerulonephritis
3) vasculitis |
|
|
Term
| oral lesions of ANCA-associated granulomatous vasculitis are called... |
|
Definition
strawberry gingivitis
-bright red, hemorrhagic, stippled surface
-gingiva is hyperplastic and overgrows |
|
|
Term
| 3 forms of ANCA-associated granulomatous vasculitis |
|
Definition
1) classic: respiratory tract, renal lesions
2) limited form: respiratory tract without renal lesions
3) superficial form: skin and mucous only |
|
|
Term
| histo features of ANCA-associated granulomatous vasculitis |
|
Definition
1) perivasculitis
2) PEH
3) eosinophils |
|
|
Term
| what is used for diagnosis of ANCA-associated granulomatous vasculitis? |
|
Definition
| perinuclear or cytoplasmic antineutrophil cytoplasm antibodies |
|
|
Term
| tx for ANCA-associated granulomatous vasculitis |
|
Definition
| -prednisone and cyclophosphamide |
|
|
Term
|
Definition
1) granulomatous disease
2) IgE mediated hypersensitivity
3) ACE inhibitors
4) activation of complement pathway |
|
|
Term
oral lesions of Crohn disease present with...
1) inflammatory hyperplasia with ____
2) _____ lesions on vestibular and retromolar mucosa
3) ____ with _____ margins |
|
Definition
1) inflammatory hyperplasia w/ fissuring (cobblestone effect)
2) polypoid tag-like lesions on vestibular and retromolar mucosa
3) linear ulcers with hyperplastic margins |
|
|
Term
|
Definition
1) corticosteroids
2) immunosuppressive agents
3) surgical management for fibrotic strictures, fistulas and bowel obstruction |
|
|
Term
| oral manifestations of diabetes |
|
Definition
1) periodontal disease
2) delayed healing
3) diabetic sialadenosis (bilateral swelling of parotids)
4) enlargement and erythema of gingiva
5) infection: candida, deep fungal infections |
|
|
Term
| what is drug-related gingival hyperplasia? |
|
Definition
| abnormal growth of gingival tissues secondary to systemic medication |
|
|
Term
| what is the degree of growth related to in drug-related gingival hyperplasia? |
|
Definition
|
|
Term
| 3 meds commonly associated w/ gingival hyperplasia |
|
Definition
phenytoin
cyclosporine
nifedipine |
|
|
Term
| where does drug-related gingival hyperplasia begin? and then... |
|
Definition
| interdental papillae and then spreads across facial and lingual surfaces |
|
|
Term
| ____ areas are usually spared in drug-related gingival hyperplasia |
|
Definition
|
|
Term
| histo of drug-related gingival hyperplasia |
|
Definition
-redundant tissue of normal composition
-surface epithelium has elongated rete ridges extending into connective tissue
-increased vascularity and inflammatory cels can be secondary to inflammation |
|
|
Term
| in drug-related gingival hyperplasia, ____ is proliferating causing hyperplasia |
|
Definition
| collagen (epithelium isn't really the problem) |
|
|
Term
| tx for drug-related gingival hyperplasia |
|
Definition
1) discontinue med
2) hygiene, prophylaxis
3) antibiotics
4) gingivectomy |
|
|
Term
| in drug-related gingival hyperplasia, what antibiotics can be used for cyclosporine-related cases? |
|
Definition
| metronidazole or azithromycin |
|
|
Term
| in drug-related gingival hyperplasia, what antibiotics can be used for phenytoin or nifedipine-related cases? |
|
Definition
|
|
Term
| substances associated w allergic contact mucositis |
|
Definition
1) lipsticks, toothpaste, candy, chewing gum
2) mouthwashes
3) denture adhesives
4) volatile oils
5) impression material
6) ceramic/metal alloys |
|
|
Term
| lichen planus can be secondary to what medications? |
|
Definition
hypertensives
statins
NSAIDS
antibiotics
antigout
amalgam
cinnamon flavoring agents
herbal remedies |
|
|
