Oral Pathology: Transient Lingual Papillitis, Recurrent Ulcers, and Salivary Gland Disorders

EC: whats her fav color

green

EC: where did she go to college

UF

Three patterns of transient lingual papillitis

1. localized

2. generalized

3. generalized papulokeratotic variant

what does localized transient lingual papilitis effect

one to several fungiform papillae of tongue

where is localized transient lingual papilitis frequently in

anterior portion of dorsal surface

when does localized transient lingual papilitis resolve

has spontaneous resolution within hours to some days

where is general transient lingual papilitis localized in the mouth

tip and lateral portions of dorsal surface

when does general transient lingual papilitis resolve

resolution in 7 days with occasional recurrences

which transient lingual papilitis has asymptomatic papillae

generalized papulokeratotic variant

what is the treatment for generalized transient lingual papilitis

spontaneous resolution

how do aphthous ulcerations develop

from an immunologic reaction to an oral antigen

what is the most common recurrent aphthous stomatitis

minor aphthous ulcer (mikulicz aphthae)

what do some consider an additional form of recurrent ulcers

Behcet syndrome

what is a very complex multisystem disorder of recurrent ulcers

Behcet syndrome

what are the clinical manifestations of minor variation of recurrent ulcers

1. fewest recurrence

2. shortest duration

3. lesions almost only in nonkeratinized mucosa

4. ulcers measure 3-10 mm in diameter

5. typically 1-5 ulcers

what are the clinical manifestations of major variation of recurrent ulcers

1. longest duration per episode

2. scar formation

3. ulcers are deeper and measure 1-3 cm

4. affects any oral mucosa

5. scarring may become significant but restricted to mouth opening

what are the clinical manifestations of herpetiform variation of recurrent ulcers

1. greater number of ulcers(100 in asingle episode)

2. small lesions(1-3mm in diameter)

3. may affect any oral mucosa

treatment for herpetiform ulcers

topical corticosteroids: dexamethasone solution (0.5mg/5ml)

what is the triad to recognize Behcet syndrome

1. ocular inflammation

2. oral ulcers

3. genital ulcers

what is the cause of type A (augmented) adverse drug reaction

an exaggerated (otherwise expected) pharmacological action of drug

what is stomatitis medicamentosa

a reaction of the oral mucosa to the systemic administration of a medication

where do fixed drug eruptions recur

at the same site after administration of allergen

what is the diagnosis of stomatitis medicamentosa

1. detailed medical history

2. establish temporal relationship between medication and offense

what is the diagnosis in chronic drug reactions

observe the behavior of mucosal alteration

- does it resolve when drug is discontinued?

what is the treatment for stomatitis medicamentosa

discontinue the responsible medication if possible

T/F: frequency of true oral allergic reactions is rare

True

what are the clinical manifestations of allergic contact stomatitis when localized

removal of focal trauma

- e.g.., dental metals

diagnosis of acute allergic contact stomatitis

temporal relationship between agent and clinical manifestation

- do symptoms develop after exposure to allergen?

treatment for mild cases of allergic contact stomatitis

removal of suspected agent is sufficient

treatment for perioral dermatitis

no therapy in most cases

- discontinu the causative agent (cosemetics, creams, facial products, etc)

treatment for allergic reaction to cinnamon products

discontinuation of cinnamon products

what is a lichenoid contact reaction from dental restorative materials

an allergic response that appears as a lesion on the oral mucosa in direct contact with the dental material

diagnosis of lichenoid contact reactions

1. clinical characteristics of the lesion

2. lack of lesion migration

3. correlation to adjacent dental material

what is angioedema

swelling of soft tissue

causes of angioedema

dental trauma can precipitate angioedema in both hereditary and acquired forms

what is salivary gland aplasia

developmental anomaly

what are clinical manifestations of salivary gland aplasia on physical examination?

physical examination:

- face looks normal (site filled w/ connective or adipose tissue)

-absence of orifices of missing glands

- lacrimal glands or lacrimal puncta may be absent

what are the symptoms of salivary gland aplasia

- severe xerostomia

- leathery tongue

- frequent caries and erosion

what makes a mucocele not a true cyst

it lacks epithelial lining

what are the clinical manifestations of a mucocele (appearance)

dome-shaped mucosal swellings

what is the treatment for a mucocele

may rupture and heal spontaneously

what is a ranula

a mucocele that occurs in the floor of the mouth

- arise from the sublingual gland

what are the clinical manifestations of a ranula (physical examination)

- swollen lesion in the floor of the mouth

- blue (deeper lesions are normal color)

- dome-shaped

what is the treatment for a cervical (plunging) ranula

surgical removal of feeding gland

what is the difference between a mucocele and a salivary duct cyst

a salivary duct cyst is a true developmental cyst that is lined by epithelium that is separate from the adjacent normal salivary ducts

Clinical manifestation: what are the frequent locations of salivary duct cysts

- floor of mouth

- buccal mucosa

- lips

salivary duct cyst over the Wharton duct

histopathology of mucocele

no epithelial lining, mucin accumulation in cavity

histopathology of salivary duct cyst

cavity lined by epithelial tissue

clinical manifestation of sialoithiasis: frequency?

most common in the ductal system of submandibular gland

symptoms of sialolithiasis

- episodes of pain

- swelling of affected gland

- mealtimes: symptoms become more intense

what determines the severity of symptoms of sialolithiasis

1. degree of obstruction

2. amount of backpressure within the gland

Treatment for sialolithiasis (small)

conservative treatment aimed to facilitate passage of stone:

- gentle massage of the gland

- sialogogues

- moist heat

- increased fluid intake

Treatment for sialolithiasis (large)

surgical removal depending on glandular damage

what is sialadentis

inflammation of a salivary gland

what causes sialadenitis

viral infections:

- mumps (most frequent)

- HIV

- Flu

what are the non-infectious causes of Sialadenitis

- Sjogren syndrome

- Sarcoidosis

- Radiation therapy

- Various allergens

what glands are affected in acute bacterial sialidenitis

most common in parotid glands

clinical manifestations of chronic sialadenitis

periodic swelling and pain associated with mealtime (stimulation of salivary flow)

Clinical manifestations (sialadenitis): Juvenile recurrent parotitis

most common inflammatory condition in children in US

what is xerostomia

dry mouth: usually associated w/ hypofunction of salivary glands

What are the complications of xerostomia?

reduced salivary flow

leads to:

- oral candidiasis

- increased risk of dental decay, most cervical and root caries ( xerostomia-related caries)

What is Sjogren's syndrome?

chronic, systemic autoimmune disorder that principally involves the salivary and lacrimal glands

Sjogren's Syndrome causes (2 things)

Xerostomia (dry mouth)

Xeropthalmia (dry eye)

- keratoconjunctivitis sicca

what is it called when you have both xerostomia (dry mouth) and xerophthalmia (dry eye) in sjogren syndrome

sicca syndrome

what are the clinical forms of sjogren syndrome

1. primary sjogren syndrome

2. secondary sjogren syndrome

what is primary sjogren syndrome

sicca syndrome alone (no other autoimmune disorder present)

what is secondary sjogren syndrome

sicca syndrome with another autoimmune disease present

what is benign epithelial lesions associated with

human papillomavirus (HIV)

what are examples of HPV related lesions

- squamous papilloma

- verruca vulgaris

- condyloma acuminatum

- multifold epithelial hyperplasia

- fungiform papilloma

- inverted papilloma

How do you get HPV (modes of transmission)

- sexual and nonsexual person-to-person contact

- salivary transfer

- contaminated objects (fomites)

- autoinoculation

- breast feeding

- perinatal transmission

- possible prenatal transmission

which HPV types have a high risk of malignant transformation (2)

16 and 18

what is squamous papilloma

benign condition induced by HPV

what HPV type are commonly associated with squamous papilloma (2)

6 and 11

clinical manifestations: where do you find squamous papilloma

found anywhere in the oral mucosa

clinical manifestation: appearance on inspection of squamous papilloma?

exophytic nodule

treatment for squamous papilloma

conservative surgical incision, including base of lesion

what is verruca vulgaris

focal, benign, HPV-induced hyperplasia of stratified squamous epithelium

what is verruca vulgaris mostly caused by

HPV 2

where can you find verruca vulgaria

-common in the skin

-infrequent in oral mucosa

What is condyloma acuminatum?

venereal wart

- HPV-induced proliferation of stratified squamous epithelium of the anogenital region, mouth, and larynx

what common STD is an indicator of sexual abuse in children

condyloma acuminatum

what are the risk factors of multifocal epithelial hyperplasia

- lower socioeconomic status

- crowded living conditions

- poor hygiene

- malnutrition

- HIV infection

What types of HPV are common in fungiform papilloma (2)

6 and 11

clinical presentation of fungiform papilloma

- unilateral nasal obstruction

- epistaxis

treatment for fungiform papilloma

complete surgical excision

what is inverted papilloma

most common sinonasal papilloma variant

what papilloma variant have the greatest potential for local destruction and malignant transformation

inverted papilloma

what HPV types are most prevalent in inverted papilloma (4)

6, 11, 16, and 18

clinical manifestation: inverted papilloma peaks at what age

50s and 60s

clinical manifestation: signs and symptoms of inverted papilloma

- unilateral nasal obstruction

- epistaxis

- purulent discharge

- hyposmia

- headache

- local deformity

epithelial lesions NOT associated with HPV

- verruciform xanthoma

- oral melanotic macule

- leukoplakia

- erythroplakia

what is oral melanotic macule

flat, brown, mucosal discoloration produced by a focal increase in melanin deposition and, possibly, a concomitant increase in the number of melanocytes

treatment for oral melanotic macule

excisional biopsy is recommended to differentiate from malignant melanoma

what is leukoplakia

a white patch or plaque that cannont be characterized clinically or pathologically as any other disease

- precancerous lesion (white when wet)

what is the most common oral precancer

Leukoplakia

where are most leukoplakias located that show dysplasias or carcinomas

- tongue

- lip vermilion

- oral floor

clinical manifestation: proliferative verrucous leukoplakia (PVL)

- special high-risk form of leukoplakia

- multiple, slowly spreading, keratotic plaques w/ rough surface projections

clinical manifestation: erythroleukoplakia (speckled leukoplakia)

usually advanced dysplasia is shown in biopsies

clinical manifestation: mixed lesions (mixture of subtypes of leukoplakias)

biopsies should be taken from areas w/ higher risk of malignant or dysplastic changes