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Mucosal Lesions of The Oral Cavity
Mucosal Lesions of The Oral Cavity
Oral Cavity
Grand Rounds
3/2/2006
Outline
Case study
Mucosal lesions
Ulcerative lesions
Conclusions
Case Study
Acute
Chronic
Recurrent
Acute ulcerative
Bacterial
Acute necrotizing ulcerative gingivostomatitis
Poor oral hygiene, Punched-out ulcer at
interdental papillae, seen in young adults
with poor nutrition, heavy smoking
Streptococcal gingivostomatitis
B hemolytic strep, bright red gingivae
Oral tuberculosis
Gonococcal stomatitis
Syphilis
Acute ulcerative
Syphilis
Congenital syphilis- Hutchinson’s incisors, “moon’s molars”
Primary-painless, indurated, ulcerated, usually involving the lips,
tongue
Secondary- mucous patches, split papules
Tertiary- Gummas, can involve palate, tongue
Fungal
Oral Candidiasis
Histoplasmosis- disseminated form, oropharyngeal lesions may
present as ulcerative, nodular, or vegetative. Biopsy will provide the
diagnosis
Primary Herpetic Gingivostomatitis
Acute ulcerative
Viral Infections
Herpes simplex- 600,000 new cases annually,
prodrome followed by small vesicles that ulcerate,
primary infection involves the gingiva, and can
involve the entire oral cavity
Recurrent herpes simplex- prodrome present,
herpes labialis, limited to keratinized epithelium and
can involve the gingiva and hard palate
Varicella zoster virus- distribution of trigeminal nerve
Coxsackie- prodrome, vesicular, pharynx,tonsils, soft
palate
Recurrent herpes simplex
Erythema Multiforme
Acute ulcerative
Erythema multiforme
Mucocutaneous hypersensitivity reaction
Etiology- infectious (strong association with
HHV-1, viral, mycoplasma), drugs
(antiseizure medications, sulfonamides)
Clinically- target lesions develop over the
skin with erythematous periphery and central
area that can develop bullae, vesicles.
Erythema Multiforme
Drug reactions
Barbiturates, salicylates, phenolphthalein,
quinine, digitalis, griseofulvin, and dilantin
Chronic Ulcerative
Chronic ulcerative
Classification-
Minor <1.0cm, comprise 85% of all ulcers
usually anterior portion of oral cavity, ulcerative episode 7 to 10
days, no scarring
Major > 1.0 cm deeper, more painful, posterior aspect of oral
cavity, 6 weeks or longer in immunocompromised
Herpetiform- multiple pinhead-sized, pain greater than size of
lesion
Treatment- symptomatic, topical steroids, for larger lesions
intralesional steroids. Severe- short term systemic steroids.
Case Study
Prodrome
Rash present, major aphthous ulcers, genital
findings
No eye findings
No prior history
Conclusions