Oral Diagnosis: Primary Lesions PDF

ORAL DIAGNOSIS: PRIMARY chemical burn (aspirin has acid in it and acid causes burning) LESIONS Clinical Features: There are 7 t...

ORAL DIAGNOSIS: PRIMARY chemical burn (aspirin has acid in it and acid causes burning) LESIONS Clinical Features: There are 7 types of primary lesion that may occur in the oral cavity and skin as - Red area is tender & painful a disease. They usually do not retain their - Blanches on pressures (turns white) initial appearance because they are altered - It’s size & shape depends on the by: caustic agent - Buccal & palatal mucosa are - trauma - mastication common sites - maceration - Aspirin burns are good examples for - movement of tissues palatal burns - and time Management: 1. Macules - Majority of these cases are mild & 2. Papules painless. If pain is present prescribe: 3. Nodules ✓ Analgesic/Topical application of 4. Vesicles hydrocortisone emollient base 5. Papules (Kenalog in Orabase) 6. Bullae or blebs 7. Tumescences 2. Petechiae and Ecchymosis - results from hemorrhages into the I. MACULES tissue (blood vessels rupture → - FLAT and well-circumscribed colored bleeding under the skin) area of tissue that varies in size color - considered as subcutaneous or & shape. submucosal hemorrhages. - Size = pin head to several - DOES NOT BLANCH centimeters - Color = Red - The red color does not - Color = Red-Brown-White- Black disappear on pressure Cause: THREE TYPES OF MACULES Physical trauma or blunt traumatic 1. Erythematous insult to the tissue. - simple erythema caused by localized - If examined, it is red in color but when congestion in the vascularized bed. sufficient time has lapsed, it will - BLANCHES - its color fades away permit the breakdown of the when pressure is applied. hemoglobin pigment, and turns bluish - 1st degree burn in color (bluish brown) Cause: Clinical Features: Thermal (hot & cold beverages) - Size varies according to the forces of - E.g. Extreme cold (frost bite) can the physical agents inflicting the cause vasoconstriction → low blood damage. supply → first degree (erythematous) - Borders are poorly demarcated. → black discoloration - Does not blanch under pressure Chemical (caustic drugs) because the RBC is located within - E.g. Aspirin the tissue rather than in the vessel. - do not place aspirin for too long in your mouth because it can cause Common sites:  - Palate - A positive test is 10 or more - Buccal mucosa petechiae per 1 square inch. - Floor of the mouth b. Idiopathic Thrombocytopenic Management: Purpura ✓ Self-limiting c. Trauma from fellatio ✓ Removal of the cause - seen mostly on the posterior palate ✓ Avoid trauma (usually persist 4 to 5 - the bruise will disappear in a few days days) after passing the various color blue- ✓ Palatal petechiae & ecchymosis green-yellow patches deserve special attention d. Trauma from severe coughing & when they occur as a solitary lesion vomiting at the junction of the hard & soft - appears a linear red or bluish bruise palate. at the junction of the hard & soft ✓ If continuous episodes, patient must palate. have a systemic problem and should e. Signs of infectious mononucleosis be examined for presence of - appears 6 to 20 petechiae in the soft hemostatic defects such as: palate before the patient becomes ill a. thrombocytopenia - this petechiae may also occur b. leukemia between the 5th & 12th day of illness. c. hemophilia - it goes along with malaise, enlarged - affects clotting factors nodes in the neck - Hemophilia A – factor VIII f. Hemostatic diseases - Hemophilia B – factor IX - Hemophilia C – factor XI d. SBE 3. Pigmentary Macules - Complete blood workout should be Clinical Features: done to be able to reach a diagnosis. - CBC - Brown to black (extrinsic - CT – BT pigmentation) - PT - PTT Other Diagnosis: A. PHYSIOLOGIC - genetic makeup; part of the person a. Dengue Fever already - petechiae - Tourniquet Test – used for diagnosis Etiology: of dengue fever - Unknown, but has been postulated How to do Tourniquet Test that macules maybe due to trauma or post inflammation 1. Take the patient's blood pressure and Clinical features: 2. record it, for example, 100/70. - Light Brown to Black 3. Inflate the cuff to a point midway - The deeper & heavier the deposit of between SBP and DBP, and melanin, the darker it appears maintain for 5 minutes, (100 + - Light tanned individuals have 70) ÷ 2 = 85 mm Hg normally even coloration, but dark 4. Reduce and wait 2 minutes. complexion frequently have macules 5. Count petechiae below of pigmentation antecubital fossa. Other diagnosis: - early puberty like menstrual bleeding before 2 years of a. Ephelis (Freckles) age b. Melanosis - boys shows less signs than - abnormal melanin pigmentation of girls oral mucosa - usually occurs on the gums Other effects on the endocrine system: - e.g. cigarette smoking – stimulates melanocytes Thyroid Function c. Melanoplakia (Black pigmentation) - thyroid gland is small in the neck that - people have discernible degree of affects the metabolism. melanin pigmentation distributed - majority have thyroid problem, like throughout the epidermis of the presence of enlargement or masses skin/mucosa (nodules/cyst). - sually occurs on the lips - Hyperthyroidism d. Albinism Growth Hormone - melanin formation is impaired by - too much pit. growth hormone. congenital decrease in tyrosinase resulting to coarse facial features like e. McCune-Albright syndrome larger hands & feet & arthritis. - not inherited, not contagious - Acromegaly - It results from a change (mutuation) - Abnormal bone growth in the skull in a gene that occurs by chance in the can lead to blindness or deafness womb; mutations in the GNAS1 gene due to pinched nerves. - It is associated with mosaicism, - Deformities may be seen in the meaning that the abnormal genes is frontal bone and can cause cosmetic present in a fraction, but not all, of the problems patient cells. - e.g. Cushing Syndrome - too much - a disease that affects the bones, skin, pituitary growth hormone resulting to endocrine system coarse facial features, larger hands & - renal (kidney) involvement may be feet & arthritis. seen in as many as half patients with - Tx: medication & surgery MAS. - classically defined by the clinical f. Von Recklinghausen's Disease triad: (Neurofibromatosis 1) fibrous dysplasia of bone (FD) - INHERITED autosomal dominant - larger bone condition (difference with McCune- - scar-like tissue Albright syndrome) - happens with weight bearing - It has eight category but most bones such as legs causing common is NF1. limping, deformity & fracture. - No prevalence for gender and race in - no treatment, but surgery NF1. may correct fractures and - Most common sign on the skin are deformities multiple fibromatosis that occurs in café-au-lait skin spots any part of the body - skin; patches of increased or - lisch nodules - pigmented darker skin coloring hemartomas of the iris; translucent and precocious puberty (PP) brown pigmentation spots in the iris - endocrine system; irregular - also manifest café-au-lait spots function of growth-regulating - crowe’s sign - inguinal and axillary glands that produce freckles is usually present hormones Manifestations:  - bone lesion - Nausea - cardiovascular and neurological - Vomitting abnormalities - Hypotension - mental deficiency - seizures - The cheek is the most common site - short statute for pigmentation. Highly reliable sign - scoliosis. in primary adrenal insufficiency. Oral Manifestations: Management: - tongue and buccal mucosa are - If suspected should not begin affected treatment, seek medical consultation - hemifacial disfigurement caused by first. plexiform neurofibroma of the - Supplemental corticosteroids trigeminal nerve medication is always required prior to - presence of impacted, displaced or dental treatment to cope up with missing teeth in the mandible and adrenal insufficiency during stressful overgrowth of the alveolar ridge treatment. - may have severe periodontitis & Other diagnosis: calcular deposits. a. Addisons disease Radiographic Findings: b. Peutz Jegher syndrome - enlarged mandibular canal, - Inherited autosomal dominant may mandibular foramen, mental foramen be a causative factor → displaced teeth - similar to ephelides but distribution - Neurofibroma can develop intra- seen around the lips (peri-oral osseously resulting to well distribution) demarcated unilocular & multilocular - seen around the lips, buccal mucosa, radiolucent lesion gingiva, hands, and feet. intestinal polyposis found in the jejenum is a manifestation of the peri- oral pigmentation subjective symptoms: abdominal B. PATHOLOGIC pain, rectal bleeding, and diarrhea c. Systemic Lupus Erythematosus Cause: - autoimmune disease in which the Bilateral Adrenocortical Destruction immune system attacks its own after TB tissues Idiopathic Atrophy - supplemental corticosteroid is Bilateral Tumor Metastasis given to suppress the immune Leukemic Infiltration system Amyloidosis of Adrenal Cortex - Butterfly Rash is a common sign of (adrenocortical insufficiency) SLE Addisons disease - give prophylactic antibiotic for 7 days Signs & Symptoms of Adrenocortical Insufficiency - Weakness - Weight loss  II. PAPULES - has clinical features of lichen planus. - ELEVATED - drugs like - usually associated with stress beta blockers, - Size = pinhead but measures greater metallic drugs (gold, salts, than 0.5cm arsenical, mercury, - Shape = flat, conical, circular, pointed anti-inflammatory (non-steroidal to umbilicated, has elevated and like indomethacin) raised bumped. and antibiotics (tetracycline and Examples: streptomycin) a. Pimples Management: removal of causative factor b. Lichen planus - white lesion, having an itching, o Differential Diagnosis burning sensation, pain, and macules – flat and have causative sometimes asymptomatic factors Causative Factor: papules – elevated and no causative factors Unknown, maybe due to psychological problem like deep III. NODULES emotional strain and remission after a - no pathological reactions. personal crisis personal crisis. - these are elevated circumscribed Other causative factors: solid lesion. - Diabetes Mellitus - It is enlarged papules deep seated - Mechanical Irritation which involves the submucosa or - Galvanic Currents – dissimilar metal lower dermis of the skin. components (e.g. amalgam + stainless steel resto) Examples: Clinical Features (five forms): a. Bohns Nodule - seen on buccal ridge; alveolar ridge 1) Reticular - lacework of intersecting of new born infants white lines (striae of Wickham – in - multiple white nodules and will be cheek biting) exfoliated by itself. 2) Papular – looks like pimples - cause: remnants of dental lamina 3) Erosive - presence of squamous cells b. Epstein pearls 4) Atrophic - presence of carcinoma - seen on palates of newborn infants. 5) Bullous – malignant in nature (palatine cyst) Sites seen: - cause: arises from the mucosa gland elements - Buccal Mucosa (85%) c. Tonsil nodules - Gingiva - seen on the lingual tonsils in lateral - Tongue base of the tongue-foliate papilla - Palate d. Rheumatoid nodules - Floor of the Mouth - common in rheumatoid arthritis and - Vermillon Border appear in approximately 25% of patients Management: ✓ topical application of cortisone (3x/day) Lichenoid Drug Reaction  IV. VESICLES denudation of the mucosa or - circumscribed single or group epidermis elevations of the epithelium of the - Nikolsky sign – positive to skin or mucous membrane which stippling of epithelium. consist of serum, plasma, and blood. - 2nd degree burns Cause: - e.g. Herpetic gingivostomatitis – from Autoimmune Mucocutaneous painful vesicles → ulcers Disease characterized by Intra- Cause: epithelial Blister Viral infection – chicken pox Examples: (varicella) Pemphigus Behcets Syndrome, Steven Johnson syndrome V. PUSTULES Ranula - have pus (usually caused by infection; bacteria) Management: - considered cutaneous lesion (skin) ✓ Corticosteroid Therapy - seen as superficial elevations which - immunosuppressive drug contains pus, serum, and fluid - will not recognize good and bad surrounded by area of erythema. bacteria - like vesicles, but differs in location and infrequent in oral mucosa. Examples: VII. TUMESCENCES - these lesion maybe reactive or Psoriasis neoplastic in character. Impetigo - non-neoplastic lesions, unless Superficial Bacterial Disease confirmed by biopsy. - All three are caused by staphylococci & streptococci Examples: - Usually occurs during summer or hot - Tumor - is not synonymous with months, humid weather and cancer, it simply refers to a a swelling commonly seen in children. (e.g. dental abscess) ✓ Tx: antibiotics - Cyst (e.g. eruption cyst) Sources of infection: - Epulis (e.g. epulis fissuratum – surgically remove the lesion and - Pets, remove denture) - Dirty Fingernails, - Exostosis, - Beauty Parlor, - Torus - Swimming Pool, - Papilloma - Turkish Bath - Polyps (e.g. pulp polyp) VI. BULLAE OR BLEBS - larger than vesicles and deep seated and has a roof cavity - more resistant to rupture - rubbing of non-vesiculated area may result in a formation to a vesicles or Additional: o BURNS - caused by both hot and cold (frost bite) - 1st degree – ERYTHEMATOUS MACULES - tender (painful on palpation), and painful even if not palpated - 2nd degree – VESICLES / BLEB TERMS & DEFINITIONS Tumor - means swelling Tumefaction - means edematous. Their base may either be sessile - attach to the base or pedunculated - pedicle/stem. Polypoid - smooth & pedunculated- epithelial tumor arising from the mucous surface. Papilloma - refers to a small nipple shaped epithelial tumor w/c cells are covered w/finger like process of stroma. Neoplastic lesion. Papillomatous - larger than papilloma Papillomatoid - refers to non- neoplastic lesion. Keratosis - abnormal thickening of the outer layer of the epith. Of the mucous membrane or the skin. Ex. Actinic keratosis (solar keratosis) Oral lesion - focal hyperkeratosis, nicotine stomatitis, lichen planus, leukoplakia, cheek biting