P3 PRIMARY LESION ORAL DIAGNOSIS

Primary lesion

These lesions that arise de novo and are therefore the most characteristic of the disease process

Macules

THis primary lesion are flat well circumscribed colored area of tissue that varies in size color & shape

size of a pin head to several centimeter

In macules what is the size

1. Red

2.Brown

3.White

4.Black

4 colors of macules

Ephilis

What is the medical term of freckles

Erythematous

THis type of erythematous is simple erythema caused by localized congestion in hte vascularized bed

1. Chemical (caustic drug)

2 THermal (hot & cold beverages)

2 Causes of erthematous

color fades away when pressure is applied ( it wil blanch)

In macule, what happens if pressured is aplied

TRue

True or false: macule will blanch when pressure is applied

Aspirin burns

what is an example of alatal burn in erythematous

analgesic/topical applciation of hydrocortisone

Drug administered for macules

Petechia & ecchymosis

This type of macules are red-brown and results from hemorrhages into the tissue

Petechia & ecchymosis

This type of macule is considered as subcutaneous or submucosal hemorrhages

physical trauma or blunt traumatic insult to the tissue

Cause of petechia & ecchymosis

RBC is located within the tissue rather than in vessels/ it wont move because its areayd a clot

In petechia & ecchymosis, why dos it not blanch under pressure

1. Palate

2. Buccal mucosa

3. Floor of the mouth

3 common sites for petechia & ecchymosis

Avoid trauma

In petechia& ecchymosis, what is the management

1. Trauma from fellatio

2. Trauma from severe coughing & vomiting

3. Signs of infectious mononucleosis

4. Signs of hemostatic disease

In petechia & ecchymosis, what are the 4 other diagnosis for petechiae & ecchymosis

Pigmentary macules

This type of macule has a clinical feature brown to black extrinsic pigmentation

1. Ephelis (freckles)

2. Melanosis (melanoplakia), smokers melanosis

2 examples of physiologic pigmentary macules

1. Melanoplakia

2. Melanosis

3. Albinism

3 physiologic pigmentary macules

Melanoplakia ( black pigmentation)

This type of physiologic pigmentary macules is seen people have discernible degree of melanin pigmentation distributed throughout the epidermis of the skin/mucosa.

Melanosis

This type of physiologic pigmentary macules abnormal melanin pigmentation of oral mucosa ex,) cigarette smoking stimulates melanocytes

Albinism

This type of physiologic pigmentary macules is melanin formation is impaired by congenital decrease in tyrosinase.

Mccune Albright syndrome

In physiologic pigmentary macules, a disease that affects the bones, skin, endocrine system.

GNAS1 gene

In McCune Albright Syndrome, what gnee mutation causes it

Mosaicism

In McCune Albright Syndrome, The GNAS1 gene is assocaited with what?

Abnormal gnees is present in a fraction but not all of hte patient cells

What is the meaning of Mosaicism

TRue

True or false: McCune Albrigh Syndrome is not inherited

related to one, endocrine and skin

symptoms of McCUne ALbrihg syndrome

THyroid is all in neck (affects metabolism)

-presence of enlargement or masses (nodules/cyst)

In McCune Albright Syndrome, WHat happens to thyroid function

Too much pituitayr gowht hormone resulting to coarse facial features,larger hands & feet & arthritis.

In McCune Albright Syndrome, WHat happens to growth hormone?

Surgery & medication

Treatment for McCune Albright Syndrome

1. McCune Albright Syndrome

2. Von Recklinghausen syndrome

2 types of physiologic pigmentary macules

True

TRue or false: Von Recklinghausen Syndrome it is an inherited autosomal dominant trait

Neurofibromatosis Type 1 (NF1 )

What is the most common category of Von Recklinghausen syndrome

Multiple Neurofibromatosis

In Von recklinghausen syndrome, WHat is the most common sign on the skin?

Presence of Cafe-Au-Lait pigmentaiont

in Von REcklinghausen, What is another sign?

Lisch Nodules

In Von Recklinghause (pigmented hemartomas of the iris) translucent brown pigmentation spots in the iris.

1. Impacted, displaced or missingteeth in mandible

2. Overgowth of alveolar ridge

In VOn Recklinghausen syndrome, what are some oral manifestaiton (2)

Enlarged mandibular canal, Mandibular foramen

mental foramen

In Von Recklinghausen syndrome, what is the radiographic findings

Cheek

IN pathologic pigmentary macule, what is the most common site for pigmentation

Cheek

In pathologic pigmentary macules, this site has a highly reliable sign in primary adrenal insufficiency

Supplemental corticosteorids

in management of pathologic pigmentary macules, what drug/medication is always required prior to dental treatment to cope up with adrenal insufficnecy during stressful treatment

1.Addison's disease

2. Peutz Jegher Syndrome

2 examples of pathologic pigmentary macules e

Papules

THis is circumscribed superficial elevated areas varying in size

Size of a pin head to about 5 mm

What is the size of papules

flat, conical, circular, and pointed to umbilicate

What is the character is papules

Red-Yellow-WHite-Bluish Red

Colors of papules

1. Reticular

2.Papular

3.Erosive

4.Atrophic

5.Bullous

5 form papules

Reticular

which form of papule has lacework of intersecting white lines (striae of wickham)

erosive

Which form of papule has the presence of squamous cell

Atrophic

Which form of papule has presence of carcinoma

Bullous

Which form of apule is a malignant lesion

Nodules

This primary lesion is characterised by:

elevated circumscribed solid lesion

•enlarged papules deep seated which involves the submucosa or lower dermis of the skin

1. EPstein pearl

2. TOnsil nodules

2 exampes of nodules

-Traumatic origin

-Associated with theumatoid arthritis, leprosy, syphilis

IN nodules, it may be of what origin and or what is it assocaited with

EPstein pealrs

THis type of nodule is seen on palates of new born infants. (palatine cyst)

Arise from mucosa gland elements

What is the cause of epstein pelas

Tonsil nodules

THis type ofnodule is also seen on the lingual tonsils in lateral base of the tongue- foliate papilla.

TRue

TRue or false: vesciles are elevated

Vesciles

These are circumscribed single or group elevations of the epithelium of the skin or mucous membrane which consist of serum, plasma, blood

Pimary herpetic stomatitis, herpes simplex, herpes zoster and varicella

In vesciles, it is seen primarily in?

Pustules

What lesion is considered cutaneous lesion (skin) seen as superficial elevations which contains pus, serum fluid surrounded by area of erythema. Pustules are vesicles but differs from it's location, infrequent in oral mucosa.

1. Psoriasis

2.Impetigo

3.SUperficial bacterial disease

Example of psutules

Staphylococcu & streptococci

Causative factor of pustules

Antibiotics

Treatment of psutules

1. pets

2. dirty fingernails

3. beauty parlor

4. swimming pool

5. turkish bath

Source of infection of pustules (5)

Bullae or blebs

WHat lesion is larger than vesicles and deep seated and has a roof cavity more resistant to rupture, larger .

corticosteroid therapy

Management of bullar or blebs

Atutoimmune mucocutaneous disease ( characterized by intra-epihteila blister formation)

Cause of bullae or blebs

TUmescences

these lesion maybe reactive or neoplastic in character unless confirmed by biopsy

Tumor, Cyst, Epulis, Exostosis, Torus, Papilloma, Polyps.

exampels of tumescences (6)

Macule

Patch

2 types of nonpalpable primary lesions

Vitilago

Stage 1 pressure ulcer

examples of patch

Papule

Nodule

Wheal

Plaque

Tumor

five types of palpable primary lesions

Warts

Elevated Nevi

Seborrheic keratosis

Examples of papule (palpable)

Lipoma

Erythemanodosum

Cyst

Melanoma

Hemangioma

Examples of nodule (palpable)

Insect bites

Hives

Angiodema

Examples of wheal

Psorasis

Eczema

Pityriasisrosea

Examples of plaque (palpable)

Carcinoma (breast)

Example of tumor (palpable)

Vesicle

Pustule

Bullae

Cyst

types of fluid filled cavities within the skin