TEST BANK - Oral Pathology for the Dental Hygienist,
8th Edition by Ibsen and Peters
Macule - ANSWER: = circumscribed area of any size characterized by flatness and
usually distinguished from surrounding skin by coloration
- FLAT, discolored, NOT RAISED
- most are not bad
- if in mouth, is *Oral Melanotic Macule*
What disease is characterized by Cafe Au Let Macules? - ANSWER: =
NEUROFIBROMATOSIS
Papule - ANSWER: = circumscribed solid elevation of skin with NO visible fluid
- from pinhead to 1 cm
- has elevation, NO FLUID
Vesicle - ANSWER: = fluid-filled raised area 5 mm or less across
- if it's BIGGER THAN 5mm, it's a BULLA
Bulla - ANSWER: = large vesicle MORE THAN 5MM IN DIAMETER
- Could have Bullous Pemphigoid or Pemphigus
Pustule - ANSWER: = a small blister or pimple on skin containing pus
- is a papule with pus
- fits ACNE DEFINITION
- *30% of people in US have a skin problem*
Ectodermal Dysplasia - ANSWER: = inherited defects of ectodermally-derived
anatomic structures
- Affects: Skin, Hair, Teeth, Nails, Sweat Glands
- HEAT INTOLERANCE
Sx: sparse hair (HYPERTRICHOSIS), don't sweat (hyperhidrosis), *HYPODONTIA*
- TEETH ARE CONICAL SHAPED, deficient maxilla, xerostomia
- PERIOCULAR HYPERPIGMENTATION
,- Dystrophic brittle nails, reduced eyebrows/eyelashes
Neurofibromatosis - ANSWER: = multiple neurofibromas can occur anywhere
- small papules, large nodules, pedunculated masses
- *CROW'S SIGN* (Axillary Freckling)
- Lische nodules, brown pigmented spots on iris
- Cafe Au Lait Pigmentation
- *ORAL LESIONS 72-92% OF CASES*
Peutz-Jeghers Sydrome - ANSWER: = autosomal dominant, freckle-like lesions in and
around oral cavity
- intestinal polyposis with predisposition to change into ADENOCARCINOMA
- intestinal polyps in JEJUNUM and ILEUM of SMALL INTESTINE, with 2-3%
malignancy transformation, can cause blockage
Ehlers-Danlos Syndrome - ANSWER: = multiple variations of abnormal collagen
production due to genetic abnormalities
- hypermobility of joints and elasticity of the skin
- don't heal well, can have huge scars
- 50% can tough their nose with their tongue
- *Subluxation of the TMJ*, *Bruising and Bleeding of the Oral Tissues*
Lichen Planus - ANSWER: = *MOST COMMON DISEASE SEEN IN ORAL MEDICINE*
- chronic inflammatory disease that causes white triations, papules, or plaques on
the buccal mucosa, tongue, and gingiva
- 45-60, Women 2x men, rare in children
- skin lesions common; IS AN ORAL DISEASE THAT MAY HAVE SKIN LESIONS, also nails
and conjunctiva
- T-cell mediated autoimmune disease in which CD8 cells trigger apoptosis of oral
epithelial cells
- alcohol and tobacco greatly increase risk
- people with persistent mouth sores are at increased risk to get SCC
Tx: don't treat if not painful; want to keep it from breaking down
- *Steroids* for oral lesions, lidocaine for pain, *Magic Mouthwash*
- Goal is to keep it RETICULAR, do not want it to break down
Where are the most common locations for Lichen Planus? - ANSWER: Buccal >
Tongue > Gingiva > Lips
Lichen Planus - Histology - ANSWER: - Basal cell layer looks like it's not there, forms a
little *pink band*
- Under pink band is a band of lymphocytes
,- SAW-TOOTHED RETE RIDGES
- Bottom left picture is ERROSIVE LICHEN PLANUS
What is a common cause of Lichen Planus? - ANSWER: = Lichenoid Drug Reactions
- He usually blames HYPERTENSIVES and DIURETICS
- *20% are medication-induced*, others are allergic or immunologic
- also CHRONIC HEPATITIS C
- psycogenic (stress and anxiety)
- dental materials
Poor Man's Magic Mouthwash - ANSWER: 1. Diphenydramine 12.5 mg/5mL
2. Maalox
- 1 pint; rinse with 1-2 tsp, REFRIGERATE
Magic Mouthwash - ANSWER: 1. Viscous Lidocaine 2%
2. Maalox
3. Diphenhydramine 12.5 mg/5 mL
- 240 mL bottle, up to 4 times/day
Ulcerative Disease Therapy - ANSWER: Topical:
- *Clobetasol Proprionate Gel* (use for month and see)
- Dexamethasone (less potent, children, used when under control)
- Flucinonide
Lichen Planus Therapy - ANSWER: 1. Tracrolimus (Protopic) Ointment 0.1%
- is NON-STEROIDAL, use if Clobetasol is not effective enough
BLACK BOX: might cause cancer
How many cases of Lichen Planus are medication-induced? - ANSWER: = 20% (1/5)
- HYPERTENSIVE, GOUT medications
- *ATENOLOL*********, is a HTN medication/beta-blocker
Lichen Planus Skin Lesions - ANSWER: = the 4 P's
1. Purple
2. Polygonal
3. Papular
4. Pruiritic
Chronic Ulcerative Stomatitis (CUS) - ANSWER: = painful, exacerbating and remitting
oral erosions, and ulcerations
, - possibly a severe variant of Lichen Planus
Tx: usually resistant to steroids
- *Hydroxychloroquine (Plaquenil)* is often used (Systemic Steroid)
- 200 mg Plaquenil 2x/day
What does a patient require if they are on Plaquenil? - ANSWER: = 1x per year eye
exams (can get eye lesions)
- Liver enzyme panel 2x per year, screening for AST/ALT ratio
Nikolsky Sign - ANSWER: = first used in 1895 to DIAGNOSE PEMPHIGUS
- *Dislodgement of skin by lateral pressure*
- indicates multiple diseases
- RUB OR BLOW AIR ON TISSUE and it separates
Benign Mucous Membrane Pemphigoid - ANSWER: - aka Scarring Pemphigoid,
Cicatricial Pemphigoid
- Women 2:1, age 60
- ORAL LESIONS (conjunctival, nasal, esophageal, laryngeal, vaginal)
Sx:
- *clinical vesicles, bullae, ulcers in oral cavity*
- *ARE BLOOD-FILLED******
- oral bleeding, sore gums, difficulty swallowing
Tx: *Doxycycline* (helps with eye lesions) 50-200 mg/day
- Mincycline, Tetracycline, Dapsone, Nicotinomide
BMMP - Eye Lesions - ANSWER: = ocular invovlement MOST SIGNIFICANT with
Pemphigoid
- may lead to blindness
- 25% in one eye before the other
- LOSES TEARS, keratin becomes opaque and blincness ensues
1. Symblepharons (Adhesions)
2. Entropian (scarring/eyelids turn inward)
3. Trichiasis (eyelashes rub cornea and globe and scarring closes openings of lacrimal
glands)
Pemphigoid vs. Pemphigus - ANSWER: Pemphigoid = D = DEEPER (subepithelial
separation) than pemphigus S = SURFACE (intraepithelial separation)
- Pemphigus is more ragged, thinner
What are the three eye lesion symptoms of BMMP? - ANSWER: 1. Symblepharons
8th Edition by Ibsen and Peters
Macule - ANSWER: = circumscribed area of any size characterized by flatness and
usually distinguished from surrounding skin by coloration
- FLAT, discolored, NOT RAISED
- most are not bad
- if in mouth, is *Oral Melanotic Macule*
What disease is characterized by Cafe Au Let Macules? - ANSWER: =
NEUROFIBROMATOSIS
Papule - ANSWER: = circumscribed solid elevation of skin with NO visible fluid
- from pinhead to 1 cm
- has elevation, NO FLUID
Vesicle - ANSWER: = fluid-filled raised area 5 mm or less across
- if it's BIGGER THAN 5mm, it's a BULLA
Bulla - ANSWER: = large vesicle MORE THAN 5MM IN DIAMETER
- Could have Bullous Pemphigoid or Pemphigus
Pustule - ANSWER: = a small blister or pimple on skin containing pus
- is a papule with pus
- fits ACNE DEFINITION
- *30% of people in US have a skin problem*
Ectodermal Dysplasia - ANSWER: = inherited defects of ectodermally-derived
anatomic structures
- Affects: Skin, Hair, Teeth, Nails, Sweat Glands
- HEAT INTOLERANCE
Sx: sparse hair (HYPERTRICHOSIS), don't sweat (hyperhidrosis), *HYPODONTIA*
- TEETH ARE CONICAL SHAPED, deficient maxilla, xerostomia
- PERIOCULAR HYPERPIGMENTATION
,- Dystrophic brittle nails, reduced eyebrows/eyelashes
Neurofibromatosis - ANSWER: = multiple neurofibromas can occur anywhere
- small papules, large nodules, pedunculated masses
- *CROW'S SIGN* (Axillary Freckling)
- Lische nodules, brown pigmented spots on iris
- Cafe Au Lait Pigmentation
- *ORAL LESIONS 72-92% OF CASES*
Peutz-Jeghers Sydrome - ANSWER: = autosomal dominant, freckle-like lesions in and
around oral cavity
- intestinal polyposis with predisposition to change into ADENOCARCINOMA
- intestinal polyps in JEJUNUM and ILEUM of SMALL INTESTINE, with 2-3%
malignancy transformation, can cause blockage
Ehlers-Danlos Syndrome - ANSWER: = multiple variations of abnormal collagen
production due to genetic abnormalities
- hypermobility of joints and elasticity of the skin
- don't heal well, can have huge scars
- 50% can tough their nose with their tongue
- *Subluxation of the TMJ*, *Bruising and Bleeding of the Oral Tissues*
Lichen Planus - ANSWER: = *MOST COMMON DISEASE SEEN IN ORAL MEDICINE*
- chronic inflammatory disease that causes white triations, papules, or plaques on
the buccal mucosa, tongue, and gingiva
- 45-60, Women 2x men, rare in children
- skin lesions common; IS AN ORAL DISEASE THAT MAY HAVE SKIN LESIONS, also nails
and conjunctiva
- T-cell mediated autoimmune disease in which CD8 cells trigger apoptosis of oral
epithelial cells
- alcohol and tobacco greatly increase risk
- people with persistent mouth sores are at increased risk to get SCC
Tx: don't treat if not painful; want to keep it from breaking down
- *Steroids* for oral lesions, lidocaine for pain, *Magic Mouthwash*
- Goal is to keep it RETICULAR, do not want it to break down
Where are the most common locations for Lichen Planus? - ANSWER: Buccal >
Tongue > Gingiva > Lips
Lichen Planus - Histology - ANSWER: - Basal cell layer looks like it's not there, forms a
little *pink band*
- Under pink band is a band of lymphocytes
,- SAW-TOOTHED RETE RIDGES
- Bottom left picture is ERROSIVE LICHEN PLANUS
What is a common cause of Lichen Planus? - ANSWER: = Lichenoid Drug Reactions
- He usually blames HYPERTENSIVES and DIURETICS
- *20% are medication-induced*, others are allergic or immunologic
- also CHRONIC HEPATITIS C
- psycogenic (stress and anxiety)
- dental materials
Poor Man's Magic Mouthwash - ANSWER: 1. Diphenydramine 12.5 mg/5mL
2. Maalox
- 1 pint; rinse with 1-2 tsp, REFRIGERATE
Magic Mouthwash - ANSWER: 1. Viscous Lidocaine 2%
2. Maalox
3. Diphenhydramine 12.5 mg/5 mL
- 240 mL bottle, up to 4 times/day
Ulcerative Disease Therapy - ANSWER: Topical:
- *Clobetasol Proprionate Gel* (use for month and see)
- Dexamethasone (less potent, children, used when under control)
- Flucinonide
Lichen Planus Therapy - ANSWER: 1. Tracrolimus (Protopic) Ointment 0.1%
- is NON-STEROIDAL, use if Clobetasol is not effective enough
BLACK BOX: might cause cancer
How many cases of Lichen Planus are medication-induced? - ANSWER: = 20% (1/5)
- HYPERTENSIVE, GOUT medications
- *ATENOLOL*********, is a HTN medication/beta-blocker
Lichen Planus Skin Lesions - ANSWER: = the 4 P's
1. Purple
2. Polygonal
3. Papular
4. Pruiritic
Chronic Ulcerative Stomatitis (CUS) - ANSWER: = painful, exacerbating and remitting
oral erosions, and ulcerations
, - possibly a severe variant of Lichen Planus
Tx: usually resistant to steroids
- *Hydroxychloroquine (Plaquenil)* is often used (Systemic Steroid)
- 200 mg Plaquenil 2x/day
What does a patient require if they are on Plaquenil? - ANSWER: = 1x per year eye
exams (can get eye lesions)
- Liver enzyme panel 2x per year, screening for AST/ALT ratio
Nikolsky Sign - ANSWER: = first used in 1895 to DIAGNOSE PEMPHIGUS
- *Dislodgement of skin by lateral pressure*
- indicates multiple diseases
- RUB OR BLOW AIR ON TISSUE and it separates
Benign Mucous Membrane Pemphigoid - ANSWER: - aka Scarring Pemphigoid,
Cicatricial Pemphigoid
- Women 2:1, age 60
- ORAL LESIONS (conjunctival, nasal, esophageal, laryngeal, vaginal)
Sx:
- *clinical vesicles, bullae, ulcers in oral cavity*
- *ARE BLOOD-FILLED******
- oral bleeding, sore gums, difficulty swallowing
Tx: *Doxycycline* (helps with eye lesions) 50-200 mg/day
- Mincycline, Tetracycline, Dapsone, Nicotinomide
BMMP - Eye Lesions - ANSWER: = ocular invovlement MOST SIGNIFICANT with
Pemphigoid
- may lead to blindness
- 25% in one eye before the other
- LOSES TEARS, keratin becomes opaque and blincness ensues
1. Symblepharons (Adhesions)
2. Entropian (scarring/eyelids turn inward)
3. Trichiasis (eyelashes rub cornea and globe and scarring closes openings of lacrimal
glands)
Pemphigoid vs. Pemphigus - ANSWER: Pemphigoid = D = DEEPER (subepithelial
separation) than pemphigus S = SURFACE (intraepithelial separation)
- Pemphigus is more ragged, thinner
What are the three eye lesion symptoms of BMMP? - ANSWER: 1. Symblepharons
