Questions and Answers
Acute necrotizing ulcerative gingivitis is associated with the ______ complex.
Fusospirochetal
Immunosuppression is common in patients with ______.
HIV
Symptoms include sensitivity to touch and severe ______ pain.
coronary
Diagnosis is based on clinical findings and ______.
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Punched out crater-like lesions are covered by a ______.
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Radiating pain may be aggravated by hot or ______ food.
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Which type of melanoma is most commonly found on the palms and soles?
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What characterizes Nodular Melanoma in clinical presentation?
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Which of the following genetic factors is linked to melanoma?
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Which feature is evaluated in the ABCDE rule for melanoma diagnosis?
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What histopathological feature is associated with the vertical-growth phase of melanoma?
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What is a characteristic presentation of Amelanotic Melanoma?
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Which type of melanoma is particularly common among individuals with fair skin?
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What diagnostic tools are primarily used for staging and assessing metastasis in melanoma?
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Study Notes
Acute Necrotizing Ulcerative Gingivitis (ANUG)
- Caused by the Fusospirochetal complex of bacteria.
- Immunosuppression is a significant host response factor, prevalent in HIV patients.
Local Predisposing Factors
- Pre-existing gingivitis increases the risk of ANUG.
- Any injury to the gingiva can trigger the condition.
- Poor dietary habits contribute to disease development.
- Malnutrition weakens the immune response.
- Diabetes and AIDS are notable risk factors.
- Presence of syphilis, cancer, and leukemia can predispose individuals.
- Elevated stress levels and harmful oral habits also play a role.
Acute Gingival Infections
- Psychological aspects such as stress and depression can affect oral health.
- Low polymorphonuclear (PMN) function is associated with increased infection risk.
Diagnosis
- Diagnosis is conducted through clinical examination.
- Biopsy can be used for more definitive diagnosis.
- Differential diagnoses include herpetic gingivostomatitis, agranulocytosis, desquamative gingivitis, and aphthous stomatitis.
Punched Out Crater-like Lesions
- Characteristic intraoral signs include punched-out crater-like depressions in the gums.
- Lesions appear covered by a pseudomembrane and show surrounding erythema.
- Presence of a yellowish line indicates severe periodontitis.
- Spontaneous gingival hemorrhage is common, with bleeding occurring upon soft stimulation.
Symptoms
- Patients experience sensitivity to touch and severe, radiating pain.
- Pain worsens with hot or spicy foods.
- Parotitis may occur alongside altered saliva production and a metallic taste.
Similar Conditions
- ANUG bears similarity to desquamative gingivitis.
- Nikolsky sign may be observed, indicating skin fragility in some cases.
Clinical Features
- Superficial Spreading Melanoma: Most prevalent melanoma type in Caucasians; appears as mixed-color lesions on sun-exposed skin.
- Nodular Melanoma: Characterized by well-defined nodules with varying pigmentation; commonly occurs on the back and head.
- Lentigo Maligna Melanoma: Typically macular; occurs on malar skin in older adults, with a prolonged radial-growth phase.
- Acral Lentiginous Melanoma: Forms on palms, soles, and under nails; more common in Black and Asian populations and exhibits pigmentation around nodules.
- Amelanotic Melanoma: Presents as pink or erythematous nodules; often misdiagnosed as other tumors due to lack of pigment.
Etiology
- Environmental Factors: High-risk elements include intermittent high-intensity sun exposure and artificial UV sources, such as tanning beds.
- Genetic Factors: Higher risk associated with familial melanoma history, conditions like xeroderma pigmentosum, and mutations in genes including CDKN2A, CDK4, RB1, PTEN/MMAC1, and ras.
Histopathological Features
- Radial-Growth Phase: Features atypical melanocytes in the basal epithelium, usually without host immune response.
- Vertical-Growth Phase: Malignant melanocyte proliferation occurs in the dermis, increasing potential for metastasis.
- Nodular Melanoma: Often shows large epithelioid melanocytes in connective tissue.
- Acral-Lentiginous Melanoma: Contains spindle-shaped cells in vertical-growth phase; noted for intense host-response and desmoplasia.
Radiological Features
- Radiological imaging is primarily for staging and metastasis assessment.
- Techniques like lymphoscintigraphy and technetium-labeled sulfur colloid are utilized.
ABCDE Rule for Diagnosis
- Asymmetry: Irregular halves of lesions.
- Border Irregularity: Edges appear blurring, notched, or ragged.
- Color Irregularity: Multiple colors present within the lesion.
- Diameter: Lesion diameter exceeds 6 mm.
- Elevation: Raised surfaces may indicate melanoma presence.
Treatment
- Surgical Excision: The primary treatment for cutaneous melanoma.
- Lymph Node Dissection: Recommended if lymph nodes are involved; elective dissection's efficacy is debated.
- Chemotherapy, Immunotherapy, Radiation: Considered for advanced melanoma; effectiveness varies based on individual cases.
- Oral Melanoma Treatment: Involves surgical excision, jaw resection, and lymph node dissection; alternative therapies like cryosurgery are minimally effective.
Prognosis
- Prognosis for cutaneous melanoma relies on histologic type, invasion depth, and tumor thickness (Breslow thickness).
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Description
Test your knowledge on Acute Necrotizing Ulcerative Gingivitis, its etiology, local predisposing factors, and psychosocial impacts. This quiz covers critical aspects including the role of bacteria and host responses, making it essential for dental and medical students. Explore the complexities of diagnosis and understand the implications of systemic conditions.
