top 16-30 lesions

pathogenic fungi Candida albicans

candidasis

immune status of host
pt medication
oral mucosal enviro

pseudomembranous (thrush)

erythematous (acute atrophic)

denture stomatitis (chronic atrophic)

chronic hyperplastic

mucocutaneous

white plaque, rub offs, leaves red base

antibiotic therapy/immunosuppression

corticosteroid for asthma

erythematous

patchy red denuded areas

no white plaques

antibiotic therapy, post-radiation therapy, papillary response

erythematous mucosa under denture

acrylic allergy

white, epithelial thickening does NOT wipe off

chronic hyperplastic

corner of lips/mouth

oral/vaginal mucosa
nails
cutaneous

diffuse thick white plaques, dont wipe off

topicals (nystatin, clotrimazole)

systemic/oral (fluconazole, ketoconazole)

mouthrinse for denture stomatitis

excess heat, not chemical carcinogens

minor salivary gland duct orifices become obstructed/dilated

smoke cigars/pipes, not cigs

lesion reverses after month of discontinuing habit

biopsy areas not repairing

ectopic sebaceous glands

yellowish white papules

buccal mucosa and vermillion border of upper lip

no tx req'd

solitary/multiple recurring painful oral ulcers

unknown

canker sore

minor major herpetiform

mildly painful, annoying

few mm

heal in 7-10days

no scarring

recur 3-4 times/yr

more painful

more than 1cm

frequent recur

scarring

10-30days heal

tiny discrete ulcers coalesce into ulcerated patches (crops)

heal in 10 days

frequent recur

typically affect women

minor aphthous

movable mucosa, NEVER ON HARD PALATE OR ATT GINGIVA

soft palate and tonsillar folds

major aphthous

intra lesional steroid

tetracycline rinses

inflammatory fibrous hyperplasia

rolls of tissue assoc with denture flange

slow grow, firm/compressible

irritation from ill fitting denture

females more, middle aged/older adults

same as irritation fibroma: dense fibrous CT, vascular network, inconspicuous inflam

BUT will have fissue on top of that

excision, then remake or reline denture

tortuous vein on bottom of tongue

can be firm blue nodule if thrombosed

over age 60

sublingual/ventral surface of tongue

no tx unless thrombus cause pain

numerous grooves/fissures on dorsal tongue

mild burning/soreness

can have bacteria/candida in fissure

aging or genetic

geographic tongue

melkersson-rosenthal syndrome

facial paralysis
orofacial granulomatosis
fissured tongue

NSAIDs, corticosteroids, methotrexate

no tx req, brush tongue for odor remove

females
2x

multiple circumscribed red areas, surrounded by thin raised white border (serpiginous lines)

usually asympto, can be sensitive to spicy foods

can be seen alongside fissured tongue

anterior 2/3 of dorsal tongue

(only if symptomatic) secondary infection w candida may be possible, tx w antifungal or topical steroid

reactive proliferation related to: ill fitting denture, poor denture hygiene, prolonged denture wear

hard palate, sometimes edentulous alveolar ridge

epithelium fibrous and hyperplastic > papillary surface projections

chronic inflam infiltrate present in superficial connective tissue

removalelineemake denture

antifungal

excision if resistant

viral, spread thru saliva/active perioral lesions

pharynx, intraoral sites, lips, eyes and skin of upper trunk

primary: initial exposure

secondary: virus reactivation

UV radiation

remain latent in regional ganglia

acute herpetic gingivostomatitis

before age 5

malaise, fever, lymphadenopathy, gingival swelling and eythema

multiple vesicleslcers anywhere on both movable and att mucosa

clear initially, turn yellow

quick to rupture and leave painful shallow ulcers

pharyngotonsilitis

keratoconjunctivitis
pneumonitis
meningitis

site of primary inoculation or adj

vermillion border of lips

limited to bound keratinized mucosa

burning, twitching, itching in prodromal stage

topical and coating agents; benadryl w maalox, or docosanol

topical steroids permit spread of virus on mucous membranes

HSV1 with tingles in mouth, consistent recur

10-14 days

significant recur in immunocompromised hosts

may have scarring

inflammation of either or both corners of mouth

infection (candida/staph a)

irritants (poor fit denture, licking, drooling)

allergy (toothpaste, makeup, food)

infection and inflammation 1st, topical antifungal

anemia, nutrient def, HIV

white patch, located where tobacco held in mouth

usually disappear if tobacco habit stopped

assoc w slightly inc risk of developing oral cancer

thickened corrugated mucosa "elephant skin"

acanthosis and parakeratosis

spire or chevron formation--CHURCH SPIRING EFFECT

hyalinized band in lamina prop

local minor salivary glands fibrosis

gingiva, alv mucosa, buccal mucosa

if xray show radiopaque, no biopsy

if variation in color + irregular borders, biopsy to rule out melanoma

area of redness and loss of lingual papillae on central dorsum of tongue

"kissing lesion" sometimes

pt with inhaled steroids and smokers

folic acid def
diabetes

symmetric, well demarcated, erythematous, depapillated (smooth surface)

no tx req

topical or systemic antifungal can clear lesion

cystic transformation of epithelium within oral lymphoid tissue

well circumscribed, yellow white soft tissue papule

floor of mouth, ventral surface of tongue

strat sqm epith
lumen and epith surrounded by lymphoid tissue

enucleate