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Benign Hyperkatatosis (Focal Keratosis)

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71% of all white lesions of the oral mucosa, Twice more common in men Site: Mandible, cheek, lip, tongue Appearance: cheek/tongue biting, linea alba, thermal burns, chemical burns Also be referred to as Morsicato Buccarum (chronic cheek biting)

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Leukoplakia

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White, opaque, leathery lesion that does not fit into any other category

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Dysplastic Leukoplakia

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Don't know its dysplastic until its biopsied. Usually elevated or flat, possibly fissured with some ulcerations

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Solar Chelitis (ketosis or Keratosis)

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Thin, white keratotic film over the lower lip usually Pinpoint erosive areas Predisposed to cancer of the lip Firm when palpated

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Actinic Keratosis

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Ala targus line to the corner of the nose is usually where the sun damage occurs A type of Solar Chelitis

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White Sponge Nevus

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Congenital, Bilateral, Not painful, Benign It always involves the cheek Spongy, white thickened area

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Lichen Planus

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Raised white lines and dots (wickams stria- burning mouth syndrome) Overcorrection from a hypersensitivity Skin lesion that can be on legs, arms, elbows, and oral Erosive form is painful- Rete pegs are sharp (up and down) Goes away on its own, but appearance doesn't go away

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Nicotine Stomatitis

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On the Palate- Red mucosa turning to white, Papules with central red dots corresponding to the inflamed mucous duct glands Caused by the heat and irritants from smoking Inflamed accessory salivary glands

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Primary Herpes Simplex Infection

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In children 1-3yrs, First outbreak is over entire mouth and it is painful Eyes, nose, mouth are very susceptible to Herpes 1 Manifests itself as gingivostomatitis Vesicles rupture and create painful ulcers Herpes Zoster- Shingles Cytomegaly Virus- Salivary gland disease, Kaposi's sarcoma Epstein-Bar Virus - Infectious Mononucleosis Hepatic Whitlow which is on the fingers travels up the trigeminal nerve and stays in ganglia

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Recurrent Herpes Lesions

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Reactivation from primary infection Reactivation agents include: Flu, Emotional upset, Tissue manipulation, Fever 10-14 days is complete healing Usually on the lip or palate

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Herpes Zoster

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Vesicle, Ulcer, Rash often preceded by pain for several days , most often limited to the Trigeminal nerve Affecting sensory neurons, may be reactivated form of chicken pox Effects 20% of Adults and has a burning/ itching sense Complications: bacterial super infection, Odontalgia, Alveolar bone necrosis Shingles are localized and affect the head/neck

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Apththous Ulcer

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On salivary gland bearing area, red nodule of plaque that ulcerates, increases in size 2 weeks for healing and can possibly leave a scar Caused by immunologic reaction probably to hemolytic strep Always occurs on the nonmasticatory tissue and on lip

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Tuberculosis

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Usually have an uncontrolled cough of sputum- which is contagious Caused by mycobacterium tuberculosis. Human type: most often found in developing countries. Bovine type: found in the past and in developing countries Lymph nodes can get very swollen Progression: usually from primary pulmonary lesion, respiratory tract, and ulcer of the mucous membrane

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Syphilis

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Sexually transmitted disease caused by the spirochete-treponema pallidum Primary lesion: chancre, oral lesion is a swelling which breaks down and forms an ulcer and regional lymphadentitis which resolves in 2-3 weeks Second lesion: weeks to months, flu- like symptoms Third lesion: 1-20 yrs, gumma(rubbery lesion often on the palate) Congential Syphilis: Placental passage- goes thru all the three stages with tooth malformation and saddle nose

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Oral Candidiasis

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Most common fungal infection in the oral cavity Invades by: hypersensitivity or producing a potent toxin

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Pseudomembraous Candidiasis

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Most common kind If it is on a baby it is called Thrush- TX= antifungal drops Can wipe this creamy white/yellow plaques and there will be read underlying mucosa

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Erythematous

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Red patches Most common on palate and dorsal of tongue this causes depapilation

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Angular Chelitis

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Red fissures radiating from the corners of the mouth Often covered by a pseudomembrane Vitamin B deficiency causes this

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HPV (Oral Verruca Vulgaris)

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Common Wart Caused by Human Papilloma Virus Sexually Transmitted Virus Every year 33,000 people have HPV related cancer. Out of that number 12,000 have cervical cancer. HPV 6 and 11 cause warts which you get from direct contact

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Fordyce Granules

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Ectopic sebaceous glands found in the lamina propria of the oral mucosa Appears as discrete yellow, creamy spots 1-2mm Found on buccal mucosa and occlusal plane, in men after puberty They are in about 82% of the population Benign

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Linea Alba

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Raised, white irregular line on buccal mucosa Thought to be hyperkeratosis

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Cheek Biting (Morsicatio Buccarum)

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Either unilateral or bilateral and on tongue May be chronic or isolated incident Can progress to erythematous papule to a hyperkeratotic reaction and to ulceration if it gets bad enough

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Leukoedema

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White-grey film on buccal mucosa which doesn't rub off Most often in dark pigmented people and older people Has a glossy appearance

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Chemical Damage

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May cause damage to oral mucosa either thru systemic reaction like allergic reaction, or local reaction like "aspirin burn" Can manifest itself as local or generalized edema, papular, itching, pain

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Burns and Trauma

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Hot food or drink can cause erythema, pain, white patches, and ulceration This includes: Anesthesia trauma, aspirin burn, pizza burn

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Prominent Lingual Veins

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More common in older people Veins on ventral surface on tongue and floor of the mouth

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Telangiectasia

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Hereditary disease resulting in clusters of capillary with enlarged ends Appear as flat, slightly raised erythematous patches Occur on the lips, gingiva, and buccal mucosa

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Erythema Multiformae

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Acute inflammatory response of the skin and mucous membrane 10-20 day duration Appearance: Target shaped lesions on lips, hands, feet Self limiting and is cause of hypersensivity Most common on lateral boarder of tongue, and lips

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Pemphigus

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Rare skin and mucous membrane disease in 8-10% and 5 yr. mortality Generalized sloughing Nikolsky test- rub skin and vesicles will appear It is every sensitive to the touch, it will become irritated if touched with cotton or gloves. Even air can set it off The large bullae can rupture and turn into an ulcer Cause: immune response

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Hyperpigmentation of the Buccal Mucosa

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Too much Melanin in basal layer Often found in Addison's disease (adrenal insufficiency)

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Actinic Keratosis (Keratin Plaque)

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Localized hyperothokeratosis May develop into cancer

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Pigmented Cellular Nevus

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Pigment mole Can convert into malignant melanoma

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Basal Cell Carcinoma

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Locally destructive Cause by the sun Appears as small papule with central ulceration which heals then breaks down Usually in the middle of the Face Ala-Tragus line but can be anywhere

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Scleroderma

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Most common in milddle aged women Over production of collagen Caused by an autoimmune disease

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Lupus Erythematosus

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Autoimmune disease causing damage to small vessel walls Skin rash with butterfly wing shaped over bridge of nose and zygoma Everything hardens and tissue gets stiff

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Kaposi's Sarcoma

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Cancer that is 100% connected to AIDS If you have HIV you don't show this until you enter the AIDS stage

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Papilloma

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Benign Epithelial Neoplasm Pedunculated TX: Surgery

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Fibroma

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Benign Connective Tissue Tumor Smooth surface, firm to the touch, sessile base Most common along the linea alba Slow growth TX: surgery

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Epulis Fissuratum

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Connective Tissue Hyperplasia/Hypertrophy- reparative overgrowths Cause is ill fitting dentures

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Lipoma

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Big glob of fat cells supported by connective tissue Soft to palpation On the floor of the mouth or buccal mucosa Yellowish appearance Benign

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Schwannoma (Neurilemoma)

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Overgrowth of Schwann cells Slow growing Benign

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Neurofibroma

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Overgrowth of all neuron elements- filled with neuron tissue Have to have a biopsy tell you that its this (either nerve sheath or schwan cells) Can be single or multiple Benign

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Hemangioma

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Vessels developed close to the surface instead of down below Types: Port wine stain- present at birth, flat and smooth, purple/red in color TX: lasered to break up the capillaries

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Cavernous Hemangioma

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Endothelial lined spaces filled with blood Pulse sometimes felt through lesion Soft to palate It is contained

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Squamous Cell Carcinoma

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Loss of cell cycle control- increase replication and reduced apoptosis (when cells are told to die) Increased tumor cell motility leading to metastasis Activation of oncogensis, Inactivation of tumor suppressor genes, Overexpression of angiogenic proteins (starts producing more blood vessels) Most common places to find SCC: Tongue- 25-40% on posterior lateral boarder, Floor of the mouth: 25-20%, Palate: 10-20%, Buccal mucosa and Gingiva: 10% Leading cause of deaths- 10th most in men and 14th most in females Facts: 35,000 are diagnosed with oral cancer and 7,500 will die from it, survival rate for oral cancers is only 53% Goes into the connective tissue CAUSES: HPV 16 and 18, Tobacco, Age Appears as: thick rolled boarder with ulceration in middle and feels indurated when palpated

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Carcinoma In Situ

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Same as SCC but it doesn't go into the basement membrane Can look corrugated (from tobacco chew)

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Normal Tongue

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Filiform Papilla - keratinized Fungiform Papilla- Have taste buds Posterior- Circumvallate papilla, Von Ebners Salivary glands Foliate Papilla- have taste buds

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Median Rhomboid Glossitis

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Midline atrophy of papilla of the tongue May be a result of fungal infection Can get it from kissing TX: oral antifungal medication

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Anklyglossia

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Tongue tied Broad/ short lingual frenum TX: Lingual Frenectomy

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Bifid Tongue

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Congenital or on purpose

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Fissured Tongue

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Scrotal tongue Deep grooves on the dorsal of the tongue

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Hairy Tongue

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Elongation of filiform papilla on dorsal of tongue Stains- possibly from an antibiotic, Type of Hyperkeratinization

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Benign Migratory Glossitis

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Geographic tongue Red lesions (usually papillary atrophy) surrounded with grey boarders Migrate from place to place on dorsal of tongue Can be unilateral or bilateral

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Varicose Veins

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On lingual of tongue Frequency is not associated with varicose veins anywhere else

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Atrophic Glossitis

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Absence or loss of filiform papilla Caused by Vitamin B deficiency, Pernicious anemia, Iron Deficiency, Candidiasis, and Physiologic aging

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