Unit #2

Benign Hyperkatatosis (Focal Keratosis)
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)
Leukoplakia
White, opaque, leathery lesion that does not fit into any other category
Dysplastic Leukoplakia
Don’t know its dysplastic until its biopsied.
Usually elevated or flat, possibly fissured with some ulcerations
Solar Chelitis (ketosis or Keratosis)
Thin, white keratotic film over the lower lip usually
Pinpoint erosive areas
Predisposed to cancer of the lip
Firm when palpated
Actinic Keratosis
Ala targus line to the corner of the nose is usually where the sun damage occurs
A type of Solar Chelitis
White Sponge Nevus
Congenital, Bilateral, Not painful, Benign
It always involves the cheek
Spongy, white thickened area
Lichen Planus
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
Nicotine Stomatitis
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
Primary Herpes Simplex Infection
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
Recurrent Herpes Lesions
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
Herpes Zoster
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
Apththous Ulcer
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
Tuberculosis
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
Syphilis
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
Oral Candidiasis
Most common fungal infection in the oral cavity
Invades by: hypersensitivity or producing a potent toxin
Pseudomembraous Candidiasis
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
Erythematous
Red patches
Most common on palate and dorsal of tongue this causes depapilation
Angular Chelitis
Red fissures radiating from the corners of the mouth
Often covered by a pseudomembrane
Vitamin B deficiency causes this
HPV (Oral Verruca Vulgaris)
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
Fordyce Granules
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
Linea Alba
Raised, white irregular line on buccal mucosa
Thought to be hyperkeratosis
Cheek Biting (Morsicatio Buccarum)
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
Leukoedema
White-grey film on buccal mucosa which doesn’t rub off
Most often in dark pigmented people and older people
Has a glossy appearance
Chemical Damage
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
Burns and Trauma
Hot food or drink can cause erythema, pain, white patches, and ulceration
This includes: Anesthesia trauma, aspirin burn, pizza burn
Prominent Lingual Veins
More common in older people
Veins on ventral surface on tongue and floor of the mouth
Telangiectasia
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
Erythema Multiformae
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
Pemphigus
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
Hyperpigmentation of the Buccal Mucosa
Too much Melanin in basal layer
Often found in Addison’s disease (adrenal insufficiency)
Actinic Keratosis (Keratin Plaque)
Localized hyperothokeratosis
May develop into cancer
Pigmented Cellular Nevus
Pigment mole
Can convert into malignant melanoma
Basal Cell Carcinoma
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
Scleroderma
Most common in milddle aged women
Over production of collagen
Caused by an autoimmune disease
Lupus Erythematosus
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
Kaposi’s Sarcoma
Cancer that is 100% connected to AIDS
If you have HIV you don’t show this until you enter the AIDS stage
Papilloma
Benign Epithelial Neoplasm
Pedunculated
TX: Surgery
Fibroma
Benign Connective Tissue Tumor
Smooth surface, firm to the touch, sessile base
Most common along the linea alba
Slow growth
TX: surgery
Epulis Fissuratum
Connective Tissue Hyperplasia/Hypertrophy- reparative overgrowths
Cause is ill fitting dentures
Lipoma
Big glob of fat cells supported by connective tissue
Soft to palpation
On the floor of the mouth or buccal mucosa
Yellowish appearance
Benign
Schwannoma (Neurilemoma)
Overgrowth of Schwann cells
Slow growing
Benign
Neurofibroma
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
Hemangioma
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
Cavernous Hemangioma
Endothelial lined spaces filled with blood
Pulse sometimes felt through lesion
Soft to palate
It is contained
Squamous Cell Carcinoma
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
Carcinoma In Situ
Same as SCC but it doesn’t go into the basement membrane
Can look corrugated (from tobacco chew)
Normal Tongue
Filiform Papilla – keratinized
Fungiform Papilla- Have taste buds
Posterior- Circumvallate papilla, Von Ebners Salivary glands
Foliate Papilla- have taste buds
Median Rhomboid Glossitis
Midline atrophy of papilla of the tongue
May be a result of fungal infection
Can get it from kissing
TX: oral antifungal medication
Anklyglossia
Tongue tied
Broad/ short lingual frenum
TX: Lingual Frenectomy
Bifid Tongue
Congenital or on purpose
Fissured Tongue
Scrotal tongue
Deep grooves on the dorsal of the tongue
Hairy Tongue
Elongation of filiform papilla on dorsal of tongue
Stains- possibly from an antibiotic,
Type of Hyperkeratinization
Benign Migratory Glossitis
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
Varicose Veins
On lingual of tongue
Frequency is not associated with varicose veins anywhere else
Atrophic Glossitis
Absence or loss of filiform papilla
Caused by Vitamin B deficiency, Pernicious anemia, Iron Deficiency, Candidiasis, and Physiologic aging

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