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Soutor 1e- Clinical Dermatology- Lecture 11- Diseases of the Oral Cavity
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Soutor 1e- Clinical Dermatology- Lecture 11- Diseases of the Oral Cavity
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Upload Date:
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Transcript:
Language: EN.
Segment:0 .
Segment:1 1. Diseases of the Oral Cavity.
DR. KOUTLAS: I'm Dr. Ioannis Koutlas Associate Professor in the Division of Oral and Maxillofacial Pathology at the University of Minnesota School of Dentistry. This presentation will cover the clinical findings of common disorders of the oral cavity.
Segment:2 2. Learning Objectives.
DR. KOUTLAS: Diseases of the oral cavity can be grouped into categories based on the type of lesions they present with. These include ulcers, vesicles and bullae, macules, papules or plaques, exophytic, papillary, nodular or polyploid, and pigmented lesions.
Segment:3 3. Oral Disorders that Present with Ulcers.
DR. KOUTLAS: Trauma and recurrent aphthous are common causes of mouth ulcers.
Segment:4 4. Traumatic Ulcers.
DR. KOUTLAS: Traumatic ulcers may be caused by accidental biting during eating, broken cusps of teeth, sharp food, thermal and chemical burns. They typically present as painful round, ovoid or irregular erythematous ulcers, usually covered by a pseudomembrane and surrounded by a white border as seen on the lower lip in this patient.
Segment:5 5. Recurrent Aphthous Stomatitis (RAS).
DR. KOUTLAS: Recurrent aphthous stomatitis minor, commonly called canker sores, affect up to 20% of people with a female and Caucasian predominance. They present with painful round or ovoid ulcers covered by pseudomembrane and surrounded by an erythematous halo as seen on the ventral surface of the tongue of the patient in Figure 2. Recurrent aphthous stomatitis major is less common and presents with larger ulcers as seen in Figure 3.
DR. KOUTLAS: The ulcers are deeper and last longer two to six weeks and are very painful.
Segment:6 6. Oral Disorders that Present with Vesicles and Bullae.
DR. KOUTLAS: Several oral diseases present with vesicles or bullae including primary and recurrent herpes simplex, herpes zoster, pemphigoid, pemphigus, erythema multiforme, and Stevens-Johnson syndrome toxic epidermal necrolysis.
Segment:7 7. Herpes Simplex/Herpes Zoster.
DR. KOUTLAS: Primary herpes simplex may present as acute gingivostomatitis in children and adolescents as seen on the lower gingiva and tongue in Figure 4.
DR. KOUTLAS: Recurrent herpes simplex usually presents with painful grouped vesicles on an erythematous base on lips and perioral skin as seen in the patient in Figure 5. Herpes zoster of the trigeminal nerve can present with painful small oral vesicles that rupture, leaving shallow painful ulcerations as seen on the palate of the patient in Figure 6.
Segment:8 8. Mucous Membrane Pemphigoid (MMP) and Pemphigus Vulgaris (PV).
DR. KOUTLAS: Mucous membrane pemphigoid and pemphigus vulgaris are chronic, progressive, uncommon immunobullous diseases with onset usually after age 60.
DR. KOUTLAS: Mucous membrane pemphigoid may present with intact blisters and/or erosions as seen in Figure 7. Pemphigus vulgaris presents with erosions and ulcers as blisters are flaccid, and break easily. Both may present as desquamative gingivitis as seen on the gingiva of the patient in Figure 8. Both may have scarring lesions in the eyes and other mucosal surfaces and both may have lesions on nonmucosal areas.
Segment:9 9. Erythema Multiforme Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis.
DR. KOUTLAS: Erythema multiforme typically occurs in young adults after a herpes virus infection. It presents with superficial erosions in the oral cavity as seen in Figure 9 and crusts on the lip with target lesions on the body. Stevens-Johnson syndrome/toxic epidermal necrolysis are usually caused by medications. They present with sudden onset of extensive painful erosions and ulcers with hemorrhage and/or necrosis in the oral mucosa as seen in the patient in Figure 10.
DR. KOUTLAS: The pharyngolaryngeal, esophageal, bronchial, ocular, or genital mucosa may also be affected. Patients may have widespread areas of denuded skin.
Segment:10 10. Oral Diseases that Present with Macules, Papules, or Plaques.
DR. KOUTLAS: There are several oral diseases that present with macules, papules or plaques including geographic tongue, candidiasis, lichen planus, leukoplakia, erythroplakia and squamous cell carcinoma.
Segment:11 11. Geographic Tongue.
DR. KOUTLAS: Geographic tongue is an inflammatory disorder of the tongue occurring in 1-3% of the general population.
DR. KOUTLAS: It presents with single or multiple, mostly asymptomatic lesions, sometimes surrounded by white or yellow line as seen on the dorsum of the tongue of this patient. The lesions change shape and size, sometimes within hours and usually occur on the dorsum of the tongue with loss of papillae.
Segment:12 12. Types of Oral Candidiasis.
DR. KOUTLAS: There are several presentations of oral candidiasis as listed below.
Segment:13 13. Pseudomembranous Candidiasis (Thrush) and Angular Cheilitis (Perlèche).
DR. KOUTLAS: Pseudomembranous candidiasis or thrush affects about 5% of infants and 10% of debilitated older adults. It may also affect patients who are treated with antibiotics and topical steroids. It presents with asymptomatic, white or yellow lesions on the palate buccal mucosa and tongue that can be wiped off easily as seen in figure 12. Angular cheilitis or perlèche is most common in older adults.
DR. KOUTLAS: It presents with fissures and cracks in lip commissures as seen in the patient in Figure 13.
Segment:14 14. Candidiasis: Atrophic, Hyperplastic, and Glossitis.
DR. KOUTLAS: Acute atrophic candidiasis is seen in patients on long-term antibiotic treatment with xerostomia, blood dyscrasias or immunosuppression. It presents with loss of filiform papillae. Median rhomboid glossitis presents as a depapillated smooth area on the dorsal tongue. Hyperplastic candidiasis presents as nonremovable white plaques on the buccal mucosa and tongue as seen in Figure 15.
Segment:15 15. Oral Lichen Planus.
DR. KOUTLAS: Oral lichen planus is a chronic disease with onset usually after age 60. It is more common in women, it presents with asymptomatic lacey, reticular patches, Wickham striae as seen in Figure 16, or with symptomatic atrophic patches or painful erosions as seen in the patient in Figure 17. Lichen planus typically occurs on the buccal mucosa bilaterally, dorsolateral tongue, gingiva, palate and lip vermilion.
Segment:16 16. Leukoplakia.
DR. KOUTLAS: Leukoplakia is a clinical term for a white plaque that cannot be characterized clinically or pathologically as any other disease. Figure 18 shows an area of leukoplakia on the ventrolateral tongue. Presentations of leukoplakia range from thin and homogeneous to thick irregular, leathery patches as seen in Figure 19. The lesions may have distinct borders or blend with the surrounding tissues.
DR. KOUTLAS: The causes include mainly tobacco and alcohol abuse. Leukoplakia has a premalignant potential. A biopsy is needed for diagnosis and to guide management.
Segment:17 17. Erythroplakia.
DR. KOUTLAS: Erythroplakia is a clinical term for a red plaque that cannot be clinically or pathologically diagnosed as any other condition until a biopsy is performed. It usually presents on floor of mouth, tongue and soft palate. It is most common in men.
DR. KOUTLAS: A biopsy shows severe dysplasia, carcinoma in situ or invasive squamous cell carcinoma.
Segment:18 18. Squamous Cell Carcinoma.
DR. KOUTLAS: Squamous cell carcinoma accounts for 95% of oral cancers. Squamous cell carcinoma accounts for 95% of oral cancers. It is most common in men over 60 years, but the incidence is increasing in younger patients. Risk factors include tobacco and alcohol. Lesions may be white, red or skin-colored and may be ulcerated as seen on the ventrolateral border of the tongue of this patient.
Segment:19 19. Oral Tumors that Present as Papillary, Exophytic, Nodular, or Polypoid Lesions.
DR. KOUTLAS: There are several oral tumors that present as papillary, exophytic, nodular or polyploid lesions. These include warts or human papillomavirus infections, neoplasias, fibromas, mucoceles, epulides and in some cases, squamous cell carcinoma.
Segment:20 20. Oral Human Papillomavirus (HPV) Infections.
DR. KOUTLAS: Oral human papillomavirus, HPV infections are more common in children and young adults. They typically present as solitary lesions with finger-like projections or a cauliflower-like pattern as seen in this case.
DR. KOUTLAS: The most common locations include the tongue, palate and lips. HPV types 16 and 18 may be associated with tonsillar oropharyngeal squamous cell carcinoma.
Segment:21 21. Neoplasias.
DR. KOUTLAS: Neoplasias may present as papillary, verrucoid, fungating lesions in addition to the plaque types covered in previous slides. Examples of tumors include solitary leukoplakias, proliferative verrucous leukoplakia, papillary squamous cell carcinoma and verrucous carcinoma as seen in this patient.
Segment:22 22. Fibromas and Mucoceles.
DR. KOUTLAS: Fibromas present as asymptomatic sessile or pedunculated, rubbery tumors covered by normal color mucosa as seen in Figure 24, or hyperkeratotic mucosa. Mucoceles present as a fluctuant nodular mass containing salivary mucus as seen in Figure 25.
Segment:23 23. Epulides.
DR. KOUTLAS: Epulides may be fibrous hyperplasia, fibroma, fibrovascular inflammatory hyperplasia, pyogenic granuloma, as seen in Figure 26.
DR. KOUTLAS: Peripheral ossifying fibroma as in Figure 27, or peripheral giant cell granuloma.
Segment:24 24. Oral Disorders that Present as Pigmented Lesions.
DR. KOUTLAS: There are several oral disorders that present with pigmented lesions as listed below.
Segment:25 25. Oral Melanotic Macules/Intraoral Nevi/Oral Melanoma.
DR. KOUTLAS: Oral melanotic macules are common and present as well-delineated light or dark brown lesions that are usually less than one centimeter in diameter. They typically occur in the oral cavity or on the lip as seen in Figure 28.
DR. KOUTLAS: Intraoral nevi are uncommon, they're usually acquired and present as brown or nonpigmented lesions less than one centimeter as seen on the upper lip of the patient in Figure 29. Oral melanomas are rare and present as black, brown or grey and rarely red or nonpigmented lesions as seen in the patient in Figure 30.
Segment:26 26. Smoker’s, Post-inflammatory, and Medication-Related Melanoses.
DR. KOUTLAS: Smoker's hyperpigmentation is seen only in heavy smokers. Postinflammatory melanosis may be seen in lichen planus, lichenoid mucositis and the immunobullous diseases.
DR. KOUTLAS: Medication-related melanin hyperpigmentation may be due to chloroquine and other quinine derivatives, phenolphthalein and estrogen.
Segment:27 27. Physiologic, Endogenous, and Exogenous Non-Melanin-Related Hyperpigmentation.
DR. KOUTLAS: Physiologic melanin hyperpigmentation is seen in darker-skinned individuals on the gingiva, buccal mucosa, lips and tongue. Exogenous hyperpigmentation is usually due to amalgam restorations as seen in the patient in the upper figure.
DR. KOUTLAS: Endogenous non-melanin-related hyperpigmentation is due to traumatic blood extravasation for example petechiae, ecchymoses, hematomas as seen in the patient in the lower figure. Products of hemoglobin degradation, i.e. bilirubin and biliverdin and medication metabolites.
Segment:28 28. Summary.
DR. KOUTLAS: In summary, many inflammatory, immunologic, infectious, and neoplastic diseases can also occur in the oral mucosa, with essentially similar clinicopathologic features.
DR. KOUTLAS: Occasionally the mouth is the sole manifestation of a dermatologic condition as in diseases such as lichen planus and pemphigoid.