OP Chapter 3.2 Immunologic Oral Lesions

imunologic tolerance

the recognition and nonreponsivness of the immune system to one’s own cells or tissues.

autoimmune diseases

conditions where the recognition mechanism breaks down and certain body cells are no longer tolerated. The immune system now treats body cells as antigens, creating an immunopatholgic condition.

immunodeficiency

an immunopathologic conditions that involves compromised or entirely absent immune system involving WBC’s and their products in number, function, or interrelationships.

Recurrent Aphthous Ulcers

• aka canker sores or aphthous stomatitis

• a painful type of oral ulcers for which the etiology remains unclear

• can occur in association with certain systemic diseases, as well as with tobacco cessation and emotional stress

• three forms: minor, major, herpetiform

trauma

what is the most common precipitating factor in the development of aphthous ulcers?

Minor Aphthous Ulcers

• most commonly occurring type of aphthous ulcers and affect about 80% of patients with recurring ulcers. 

• discrete punched-out ulcers; up to 1cm in diameter; more common in anterior

Major Aphthous Ulcers

• aka Sutton disease and periadentitis mucosa nectrotia recurrens

• greater than 1 cm in diameter; deeper and last longer than minor ulcers; often occur in posterior but are overall less commonly occuring.

Herpetiform Aphthous Ulcers

• mistakenly resemble ulcers caused by herpes but they are NOT herpes; have been reported to occur in patients with HIV infection, Behcet syndrome, crohn disease, and reactive arthritis.

• the smallest type of ulcers; 1-2 mm in diameter and least common type; frequently encountered on lateral aspect of tongue

Aphthous ulcers appear on nonkeratinized oral mucosa that is nonattached.

what is the most important diagnosis for differentiating recurrent aphthous ulcers and recurrent intraoral ulceration caused by herpes simplex virus?

Nicotine Replacement Therapy

therapy for what past risky habit has been suggested to be helpful when aphthous ulcers occur in association with tobacco cessation?

Urticaria

• aka hives

• appears as multiple areas of well-demarcated edema ad erythema of the skin, usually accompanied by itching (pruritus).

Angioedema

• appears as diffuse edema of the tissue caused by permeability of deeper blood vessels

• usually NOT accompanied by itching

infection, trauma, stress, and systemic diseases

what are some of the most common causes reported with the onset of urticaria and/or angioedema?

Type I Hypersensitivity

urticaria and angioedema can occur as a result of the release of the biochemical mediator histamine from mast cells stimulated by IgE? This reaction is also knows…?

ACE inhibitors and ARB’s

What medications are the most common causes of angioedema encountered in the dental office?

Antihistamine drugs (Benadryl)

what is the standard treatment for urticaria and angioedema?

Allergic Contact Mucositis and Dermatitis

• lesions that result from the direct contact of an allerfen with the oral mucosa and skin

• conditions involves a T cell within a cell-mediated immune-response and is an example of type IV hypersensitivity.

preservatives in local anesthetics and components of medication

what are common causes of allergic contact mucositis and dermatitis reactions?

Fixed Drug Eruptions

• lesions that appear at the same site each time a drug is introduced, usually with greater intensity each time

• clinically may be single or multiple slightly raised, reddish patches or clusters of macules on the skin or rarely in the mucous membranes in the oral cavity

• pain and pruritus may occur

Type III Hypersensitivity

Fixed Drug Eruptions are an example of what kind of allergic reaction?