Other Red and White Lesions

White/yellow “serpentine” irregular raised lesions, red depressed centers, bilateral tongue, can change shape frequently.

Erythema Migrans

Where is Erythema Migrans common found?

On tongue (rarely effects soft palate, buccal mucosa and Floor of mouth)

What type of food can cause issues with Erythema migrans?

Spicy foods

Large scale, white patch (flat) surface change due to coagulation necrosis of epithelium

Chemical injury

What commonly causes chemical injury?

• Aspirin

• Hydrogen peroxide

• Phenol

Clinically signs:

• Petechiae

• Purpura

• Ecchymosis (bruise)

• Hematoma

Oral Mucosa Hemorrhage

Etiology:

• Blunt trauma, increased blood pressure (valsalva coughing)

Oral Mucosa hemorrage

White/yellow linear interconnecting lesions on the tonsils

Tonsillitis and Pharyngitis

What is the most often cause of Tonsillitis and Pharyngitis

MOST often Viral (adenovirus, enterovirus, flu, parainfluenza, EBV)

What bacteria cause Tonsillitis and Pharyngitis

• Group A Strep.

• B-hemolytic Strep.

Symptoms:

• sudden onset sore throat

• Fever

• Dysphagia

• tonsillar hyperplasia

• Redness

• Yellowish tonsillar exudate

Tonsillitis and Pharyngitis

Do these signs signal Bacterial or viral tonsillitis?

• Conjunctivitis

• Rhinorrhea

• cough

• hoarseness

• diarrhea

• No fever

Viral

If you suspect bacterial Tonsillitis what test should you do?

Rapid antigen detection (good sensitivity and specificity)

If the rapid antigen test is negative for strep what should you do?

Throat culture

Why are antibiotics ony prescribed for confirmed Bacterial infection strep?

Avoid complications of glomerulonephritis, rheumatic fever or tonsillar abscess.

Oral Candidiasis is due to a chronic infection of what?

Candida Albicans

What forms does candida albicans take?

Dimorphic, both yeast and hyphal forms

Who is at the greatest risk for candidiasis

• Young/elderly

• immunosuppressed

• broad spectrum antibiotics

• steroids

• cigarette

• dentures

• xerostomics

Removable white plaque

Pseudomembranous Candidiasis

Red, occasional white component

Erythematous Candidiasis

Factors that can give rise to erythematous candidiasis

• Acute atrophic (antibiotic sore mouth)

• angular cheilitis

• Central papillary atrophy ± palatal erythema (kissing lesion)

• combo of these make it multifactorial candidiasis

If candidiasis is non removable what is it called?

Chronic hyperplastic candidiasis

If you scrape away candidiasis and there is no bleeding what does this mean?

It is on the surface and does not break epithelial layer (pseudomembranous)

Cheesy white plaques that are removable on buccal mucosa, palate and tongue

Pseudomembranous Candidiasis

• Diffuse loss of filliform papillae

• scalded sensation to tongue

• Comes after antibiotic use

• Patchy redness

Acute Atrophic Candidiasis

How to tell Acute atrophic candidiasis from Coated tongue

Patchy redness present signals candidiasis

Central paillary atrophy also known as what?

Median Rhomboid glossitis

• Well demarcated red zone

• posterior dorsal tongue

• midline

• flat and smooth

• Often symmetric

Central Papillary atrophy

Central papillary atrophy + an additional site (kissing lesion on palate and or angular cheilitis)

Chronic Multifactorial Candidiasis

Erythema, fissuring, and scaling of the angles of the mouth. Will come and go

Angular Cheilitis

T/F a reduced VDO in denture patients will increase the risk of Angular cheilitis

True, corners of mouth will turn down and pool saliva

If candidiasis spreads to the entirety of the lips, not just corners what is it called?

Cheilocandidiasis

Erythema of palate in a pt that has a denture and possibly wears them at night

Denture stomatitis

T/f A steroid inhaler can predispose to erythematous or pseudomembranous candidiasis of hard/soft palate

True

Chronic Hyperplastic candidiasis will mimic what?

Mimics Leukoplakia

Non-removable white plaques, on buccal mucosa and tongue.

Chronic Hyperplastic Candidiasis

If Chronic Hyperplastic Candidiasis does not clear with antifungals what is the next step?

Biopsy

What candidiasis tx method is easiest for pt compliance?

Fluconazole, one pill once a day

What candidiasis method is the most senstive?

Culture, but takes a few days to grow

Candiasis dx method that is quick and inexpensive, involves KOH prep.

Cytology

Periodic acid-schiff stained slide takes how long to give results?

Next day

Angular cheilitis ± patchy or diffuse red patches and atrophy or ulceration of the tongue that does not respond to antifungal therapy could be due to what?

Nutritional deficiency (Iron, Vit B2,3,6,12)

Many white round perimeter lesions surrounded by red tissue. Will see STRIATIONS

Oral Lichen Planus

The come and go of Oral Lichen planus signals that it is what disease category?

Immune mediated

Inflammation and ulcers are another sign OLP is what disease category?

Immune mediated

Most common type of OLP, non-painful, interlacing striations (wickhams), dorsal tongue involvement showing patchy keratosis

Reticular OLP

Painful OLP, shallow ulcers with peripheral edema and RADIATING white lines (striated border). When gingiva is involved, will show bright red eroded appearance = “Desquamative gingivitis”

Erosive / Ulcerative OLP

Does Erosive or reticular OLP require treatment?

Erosive, should be treated with strong topical corticosteroids