Oral Pathology: White & Red Lesions
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Questions and Answers

What pathology is observed in angular stomatitis and what does a Gram-stained smear typically show?

A Gram-stained smear shows large masses of tangled hyphae, detached epithelial cells, and leucocytes.

What are the suggested topical treatments for oral candidiasis?

Topical antifungals such as Nystatin or amphotericin lozenges are suggested for treatment.

What does a failure to respond to topical antifungals in a patient indicate?

It suggests an underlying immune deficiency.

What is acute antibiotic stomatitis and what can lead to its development?

<p>Acute antibiotic stomatitis is an inflammation of the oral mucosa due to the overuse of antibiotics, especially tetracycline.</p> Signup and view all the answers

What factors can lead to generalized candidal erythema in the oral cavity?

<p>Xerostomia and Sjogren's syndrome can lead to generalized candidal erythema.</p> Signup and view all the answers

In denture-induced stomatitis, what clinical features are typically observed?

<p>The mucosa shows asymptomatic erythema limited to the area occluded by a denture.</p> Signup and view all the answers

What histological features are typical in denture-induced stomatitis?

<p>Histologically, denture-induced stomatitis shows mild acanthosis, prominent blood vessels superficially, and a mild chronic inflammatory infiltrate.</p> Signup and view all the answers

What are the main categories of cleansers used for denture hygiene?

<p>Cleansers can be categorized into alkaline peroxides, hypochlorites, acids, disinfectants, and enzymes.</p> Signup and view all the answers

What characterizes candidiasis endocrinopathy syndrome (CES)?

<p>CES is characterized by chronic mucocutaneous candidiasis (CMC) during infancy or early childhood, coupled with endocrine anomalies like hypoparathyroidism and hypo-adrenocorticism.</p> Signup and view all the answers

Explain the difference between localized and diffuse CMC.

<p>Localized CMC involves chronic oral candidiasis and localized skin or nail lesions, whereas diffuse CMC is marked by widespread mucocutaneous infections and skin involvement.</p> Signup and view all the answers

What is the role of systemic antifungal drugs in managing CMC?

<p>Systemic antifungal drugs are used to control both oral and skin lesions of CMC, but lesions reappear quickly once treatment is stopped.</p> Signup and view all the answers

List two strategies to reduce the risk of oral candidiasis.

<p>Effective oral hygiene and the elimination of risk factors are key strategies to reduce the risk of oral candidiasis.</p> Signup and view all the answers

Why is maintenance of good oral and denture hygiene important?

<p>Good oral and denture hygiene is crucial to prevent the growth of Candida and avoid complications like stomatitis.</p> Signup and view all the answers

How does glucose intake affect oral candidiasis?

<p>High glucose consumption promotes Candida growth and enhances adherence to oral epithelial cells, increasing the risk of infection.</p> Signup and view all the answers

What is the effectiveness of nystatin tablets compared to oral suspension?

<p>Nystatin tablets are significantly more effective than nystatin oral suspension for treating oral candidosis.</p> Signup and view all the answers

How can heavy candidal plaques be effectively removed from oral lesions?

<p>Mechanical means can be employed to remove heavy candidal plaques, promoting antifungal action and accelerating healing.</p> Signup and view all the answers

What is the characteristic appearance of oral hairy leukoplakia and what is its primary association?

<p>Oral hairy leukoplakia presents as a corrugated white keratotic lesion, primarily associated with HIV infection.</p> Signup and view all the answers

Identify two important predisposing factors for oral candidosis.

<p>Immunodeficiency (such as diabetes mellitus or AIDS) and poor oral hygiene are important predisposing factors.</p> Signup and view all the answers

Describe the histopathological features associated with oral hairy leukoplakia.

<p>Histopathological features include hyperparakeratosis with irregular surfaces, acanthosis with superficial edema, and koilocytic cells in the spinous layer.</p> Signup and view all the answers

What is the most common form of oral candidosis and describe its clinical features?

<p>The most common form is acute pseudomembranous candidosis (thrush), characterized by painless, creamy plaques that can be wiped off to reveal an erythematous mucosa.</p> Signup and view all the answers

What treatment is typically effective for oral hairy leukoplakia in HIV patients?

<p>Antiviral medications, such as acyclovir, are effective in treating oral hairy leukoplakia in HIV patients.</p> Signup and view all the answers

Explain what is meant by the phrase 'disease of the diseased' in relation to oral candidosis.

<p>Oral candidosis is termed 'disease of the diseased' because it typically occurs in patients who are already afflicted with other debilitating conditions.</p> Signup and view all the answers

What are the common clinical manifestations of angular stomatitis in oral candidosis?

<p>Angular stomatitis manifests as inflammation and cracking at the corners of the mouth, commonly associated with all types of oral candidosis.</p> Signup and view all the answers

List two forms of oral candidiasis beyond thrush and describe their characteristics.

<p>Two other forms include angular stomatitis, which presents with cracks at the mouth corners, and chronic hyperplastic candidiasis, characterized by white patches that cannot be wiped off.</p> Signup and view all the answers

What are the two types of lytic enzymes mentioned that are effective against infections?

<p>Yeast lytic enzymes and proteolytic enzymes are effective against infections.</p> Signup and view all the answers

What solution is effective in completely eradicating C albicans from denture surfaces?

<p>A denture soak solution containing benzoic acid eradicates C albicans from denture surfaces.</p> Signup and view all the answers

How does a 0.12% chlorhexidine gluconate oral rinse impact C albicans on dentures?

<p>It results in complete elimination of C albicans from the acrylic resin surface of the denture.</p> Signup and view all the answers

What is the characteristic sign of angular stomatitis?

<p>Angular stomatitis is characterized by the leakage of Candida-infected saliva at the mouth's angles.</p> Signup and view all the answers

Which condition is defined by erythematous patches of atrophic papillae on the tongue?

<p>Median rhomboid glossitis is marked by erythematous patches of atrophic papillae.</p> Signup and view all the answers

What distinguishes candidal leukoplakia from other forms of leukoplakia?

<p>Candidal leukoplakia is distinguished by the presence of periodic acid-Schiff (PAS)-positive hyphae.</p> Signup and view all the answers

What are the prominent lesions of chronic mucocutaneous candidiasis (CMC)?

<p>The prominent lesions include hyperplastic mucocutaneous lesions, localized granulomas, and adherent white plaques.</p> Signup and view all the answers

Which diet is recommended to be avoided to prevent candidiasis infections?

<p>High-sucrose diets should be avoided to prevent candidiasis infections.</p> Signup and view all the answers

Study Notes

White & Red Lesions

  • Infectious oral white lesions are identified as a lecture topic.
  • Causes and different forms of oral candidiasis are part of the lecture objectives.
  • White lesions include hereditary, reactive/inflammatory, infectious, idiopathic leukoplakia, erythroplakia, lichen planus, lupus erythematosus, and miscellaneous types.

Oral Hairy Leukoplakia

  • Oral hairy leukoplakia is a corrugated white keratotic lesion.
  • Typically found on the lateral or ventral surfaces of the tongue.
  • Commonly linked to severe immunodeficiency, particularly HIV infection.
  • The Epstein-Barr virus (EBV) is the causative agent.

Histopathology of Oral Hairy Leukoplakia

  • Hyperparakeratosis with an irregular surface.
  • Acanthosis with superficial edema.
  • Koilocytic cells (virally affected cells) in the spinous layer.
  • Homogenous viral nuclear inclusions with a rim of normal chromatin are present.

Oral Candidiasis (Thrush)

  • Oral candidiasis is a common fungal infection in patients with other diseases or conditions.
  • It's not a spontaneous condition.
  • Candida are normal oral inhabitants; various predisposing factors, like immunodeficiency, poor oral hygiene, and pregnancy, lead to candidiasis.

Treatment & Prognosis of Oral Candidiasis

  • Antifungal medications (like acyclovir) help resolve the condition.
  • Treatment of HIV infection can alleviate oral candidiasis.

Types of Oral Candidiasis

  • Acute Pseudomembranous Candidiasis (Thrush): characterized by painless plaques on oral mucosa.
  • Erythematous Candidiasis: marked by red macules (spots) on the oral mucosa, commonly associated with HIV.
  • Candidal Leukoplakia (Hyperplastic Candidiasis):firm white leathery plaques on the oral mucosa, linked to deeper Candida invasion.

Additional types of oral candidosis (spectrums)

  • Acute/Chronic Candidiasis, Pseudomembranous candidosis, Erythematous candidosis, Candida-associated lesions.
  • Denture stomatitis (Localized simple inflammation, Diffuse erythematous type, Granular type (inflammatory papillary hyperplasia) *, Median rhomboid glossitis (MRG), Angular cheilitis)
  • Chronic mucocutaneous candidosis (CMC) (Congenital/Familial CMC, diffuse type, Acquired CMC, focal, or diffuse type, Endocrinopathy associated, Immunosuppression associated)
  • Candidiasis endocrinopathy syndrome (CES)
  • Chronic candidiasis associated with thymoma

Management of Oral Candidiasis

  • Treatment strategies include controlling any local causes, like topical antibiotics.
  • Antifungal medications, such as nystatin or amphotericin lozenges, are used to restore normal oral microflora.
  • For immunocompromised patients, systemic antifungals like fluconazole or itraconazole could be used.

Important predisposing factors for oral candidiasis

  • Immunodeficiency (diabetes mellitus, AIDS, immunosuppression)
  • Poor oral hygiene
  • Pregnancy
  • Anemia
  • Antibiotic use (suppressing normal oral flora)
  • Xerostomia (dry mouth)
  • Hematologic malignancies
  • Denture-related irritation or poorly fitting dentures.

Acute Antibiotic-Associated Stomatitis

  • Overuse or topical application of antibiotics (like tetracycline).
  • Results in suppression of normal oral competing oral flora.
  • Marked by generalized oral erythema and soreness.

Denture-Induced Stomatitis

  • Asymptomatic erythema confined to the occluded oral mucosa under a well-fitted denture.
  • Less irritation is seen under mobile dentures.
  • Angular stomatitis can accompany this condition.

Pathology (for different conditions)

  • Gram-stained smears may reveal fungal hyphae and yeast forms in oral candidosis.
  • Biopsy may show inflammatory infiltrate.
  • Periodic acid-Schiff (PAS) stain highlights fungal hyphae.
  • Inflammation could be a response to fungal enzymes, like phospholipases.

Denture Treatment

  • Denture hygiene is essential.
  • Cleansers based on alkaline peroxides, hypochlorites, acids, disinfectants, and enzymes can be used.
  • Denture soaks with benzoic acid can help eliminate Candida.
  • A protease-containing denture soak effectively removes plaque.
  • Chlorhexidine rinse can reduce inflammation.

General management strategies

  • Good oral hygiene.
  • Removal of heavy candidal plaques through mechanical means.
  • Elimination of risk factors is crucial.
  • Avoid high sucrose diets.
  • Correct ill-fitting dentures or other sources of irritation.

Antifungal Drugs

  • Medications including clotrimazole, miconazole, or nystatin, and amphotericin B, are prescribed for mild to moderate cases, typically for 7-14 days.
  • Imidazole derivatives (clotrimazole, miconazole) are used topically.
  • Systemic therapy (ketoconazole, itraconazole, fluconazole) is an option for severe cases or resistance to topical methods.

Other important points

  • Nystatin tablets are better than oral suspension for treating oral candidiasis.
  • Treatment duration should be sufficient (at least four weeks).
  • Underlying conditions need immediate attention.
  • Host defense systems help eradicate candidiasis.

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Description

This quiz covers the various infectious oral white lesions, including oral candidiasis and hairy leukoplakia. It highlights the causes, histopathological features, and associations with immune deficiency. Test your knowledge on these important topics in oral pathology.

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