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110 Cards in this Set

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If you see a traumatic ulcer, what should you ask the Pt?
If they recently injured themselves or if they've had this condition before.
**if there is an obvious irritant, remove it.**
What is the apperance of a traumatic ulcer?
Can be "craterlike" or "ditched out". 
Exudate or bleeding may be present
Can be "craterlike" or "ditched out".
Exudate or bleeding may be present
What are some DD's of traumatic ulcers?
syphilis, gonorrhea, apthous ulcer.
How could someone Tx an traumatic ulcer?
Saline rinse, oragel.  
It will usually resolve in 7-14 days…if not, then need to re-evaluate.
Saline rinse, oragel.
It will usually resolve in 7-14 days…if not, then need to re-evaluate.
What is necrotizing sialometaplasia?
minor salivary gland necrosis related to (R/T) trauma
minor salivary gland necrosis related to (R/T) trauma
Where in the mouth is necrotizing sialometaplasia usually found?
Around tooth 2 & 14  (the 2nd Mx molars)
Around tooth 2 & 14 (the 2nd Mx molars)
What are some DD's of necrotizing sialometaplasia?
syphilitic gummas,
deep fungal infection,
squamous cell carcinoma
What are the 3 stages of syphilis?
Primary-Chancre  
Secondary-Mucous patches  
Third-gumma-->can show up 10-20 years later.
Primary-Chancre
Secondary-Mucous patches
Third-gumma-->can show up 10-20 years later.
During what stages is syphilis most contageous?
Primary-Chancre &  
Secondary-Mucous patches
Primary-Chancre &
Secondary-Mucous patches
Recognize image
Primary Chancre
Primary Chancre
Recognize image
Secondary -mucous patches
Secondary -mucous patches
Recognize image
Gumma
Gumma
Which populations is syphilis more promenent?
African-American Men & AIDS Pt's
How is syphilis transmitted?
Usually via sexual contact.
Can be passed mother to child or in blood transfusions
If a Pt presents with stage 1 or 2 syphilis, how should I Tx them?
They are highly infectious-->Don't Tx Pt.
How long does the Primary-chancre stage last?
How long does the Primary-chancre stage last?
Usually 1-3 months and then resolves
How long does the Secondary-mucous patch stage last?
How long does the Secondary-mucous patch stage last?
Typically 4-12 weeks but can go latent for many years.
In congential syphilis what makes up the Hutchinson's Triad?
1) Inflammation of cornea
2) Deafness
3) dental abnormalities (notched incisors/mulberry molars)
What age group is gonorrha usually found in?
15-29 year olds.
What symptoms of gonorrhea are usually found in men?
Men don't usually show symptoms
How is gonorrhea usually transmitted?
Sexually transmitted of via Mother to fetus

*Babies who don't get Tx can die from this.*
What type of lesions will someone with gonorrhea usually present with and where?
Pustular lesions on the tonsils & oropharynx
Pustular lesions on the tonsils & oropharynx
What does the affected area look like?
Red an inflamed?
What are some DD's Gonorrhea?
Aphthous ulcers, cancer of the tonsil, Pemphigus
What type of infection is actinomycosis?
Bacterial
Since a fistula is the primary characteristic of actinomycosis, what often accompanies the presence of a fistula?
Smelly Stink!
The sulfur granules stink!
How is actinomycosis treated?
Antibiotics
What is another name for aphthous ulcers?
Cancer sore
Cancer sore
What casuses apthous ulcers?
Stress, food trauma
Hos long do apthous ulcers usually take to heal?
They are self limiting and usually heal with in 7-10+ days (14 days)
Where in the mouth are apthous ulcers usually found?
Nonkeratinized mucosa
Nonkeratinized mucosa
What is the most common ulcer seen in the oral cavity?
Apthous Ulcers
How would you treat cancer sores?
With a saline rinse
The apthous ulcers that appear on keratinized tissue are cause by _______ ________.
primary herpes
What is a herpetiform?
A type of apthous ulcer.
What is the size of a herpetiform?
small would be 1-3mm but they can coalese into clusters of 10-100 ulcerations   
(They are smaller and more numerous than minor Apthous Ulcers AU's)
small would be 1-3mm but they can coalese into clusters of 10-100 ulcerations
(They are smaller and more numerous than minor Apthous Ulcers AU's)
What is the size of a large AU?
1-3 cm (30mm)
What is erythema multiforme?
An acute inflammatory disease of the skin and mucous membranes/
Target lesions on the skin are…..
erythema multiforme….these lesions go" hand in hand" with this condition.  
**Really know that target lesions are Erythema multiforme.  Know these go together!**
erythema multiforme….these lesions go" hand in hand" with this condition.
**Really know that target lesions are Erythema multiforme. Know these go together!**
Where are the target lesions found?
Where are the target lesions found?
On the hands, body and oral tissue may be involved.
What does erythema multiforme look like?
Blister, surrounded by red inflammed tissue with a lighter ring of edema surrounding it. (Give it a target look)
Blister, surrounded by red inflammed tissue with a lighter ring of edema surrounding it. (Give it a target look)
Are you going to have dental Tx in a Pt presenting with this condition?
No!
What is the more sever form of erythema multiforme called?
Stevens-Johnson syndrome
Its self limiting but can be fatal.
What causes oral lesions associated with hypersensitivity?
A product or medication that gives a tissue response.

**Talk with your Pt to see what "new" things have been added to their oral cavity lately. Toothpaste, mouthwash, gum.**
What type of disease is Lupus erythematosus?
Autoimmune (The body attacks itself)
Who is more likely to experience lupus erythematosus?
Who is more likely to experience lupus erythematosus?
Women in the 30 year old range.
What is the classic distribution of lupus erythematosus?
Butterfly distribution  

**Know this term is synomous with Lupus Erythematosus**
Butterfly distribution

**Know this term is synomous with Lupus Erythematosus**
Skin involvement of Lupus Erythematosus is most common in areas with _____ ________.
Sun Exposure.
Sun Exposure.
How do oral lesions appear with Lupus Erythematosus?
Eroded lesions, gingiva may be sluffing and erosive.  Erythematous (red)
Eroded lesions, gingiva may be sluffing and erosive. Erythematous (red)
What type of disease is Crohn's disease?
GI disease
What do the oral lesions of Crohn's disease look like?
Ulcer looking, have the "cobble stone effect"  
They are Extremely painful and slow to heal!
Ulcer looking, have the "cobble stone effect"
They are Extremely painful and slow to heal!
Keratin Pearls is synomous with what condition?
Squamous cell carcinoma--Cancer of the stratified squamous epithelium
Squamous cell carcinoma--Cancer of the stratified squamous epithelium
Which population is squamous cell carcinoma most common?
Males 45+
Which cancer accounts for 90% of all oral cancers?
Squamous cell carcinoma
What are risk factors in squamous cell carcinoma?
Tobacco, betel nut, alcohol and sunlight
(diet and stress also contribute)
What are the primary areas for developing oral cancer?
Later border of Tongue, Floor of mouth, gingiva. (salivary glands and areas of drainage are frequent sites)
Outside of the oral cavity where is a popular site for squamous cell carcinoma?
The LIPS!
The LIPS!
What is another name for Oral squamous papilloma?
Oral WART!   

Its very common
Oral WART!

Its very common
What virus causes oral squamous papilloma?
HPV…which means its sexually transmitted.
Be aware when discussing with juvenilles under 18
What is the look of oral squamous papilloma?
Cauliflower look and texture…usually white to pink in color.
Cauliflower look and texture…usually white to pink in color.
What is the TX for oral warts?
Excise them
Verruca Vulgaris is a common ______ _______.
skin wart.  

Caused by HPV
skin wart.

Caused by HPV
What is the Tx for verruca vulgaris?
Excise the wart.
Condyloma Acuminatum is a ________ wart cause the the ________ virus.
venereal wart
HPV
What does Codondyloma acuminatum look like?
Cauliflower-like growth similar to papilloma.
It is white-pink in color
Where is condyloma acuminatum usually found?
Lips, tongue, palate, labial & lingual frenum
There can be multiple and coalesce.
What is the Tx for Condyloma Acuminatum?
Excise the wart.
Which conditions are related to HPV?
Oral Squamous Papilloma,
Verruca Vulgaris,
Condyloma Acuminatum
What are some possible DD's for "wart lesions"?
Oral Squamous Papilloma,
Verruca Vulgaris,
Condyloma Acuminatum
Focal epithelial hyperplasia is more common in which population?
Native Americans  (first noted in Navajo Indians)
Native Americans (first noted in Navajo Indians)
What is another hame for focal epithelial hyperplasia?
Hecks Disease
What does Focal Epithelial Hyperplasia look like?
Multiple nodules on lower lip, buccal mucosa and tongue, cauliflower like and pink-white.
Multiple nodules on lower lip, buccal mucosa and tongue, cauliflower like and pink-white.
What is the DD for Focal Epithelial Hyperplasia?
Crohn's disease?
How is Focal Epithelial Hyperplasia transmitted?
Genetics and HPV
What is papillary hyperplasia associated with?
Wearing dentures 24 hours a day or ill fitting dentures
Wearing dentures 24 hours a day or ill fitting dentures
What should you advise the Pt to do if presenting with papillary hyperplasia?
What should you advise the Pt to do if presenting with papillary hyperplasia?
Remove the dentures and let the tissue rest.
Dentures may need to be "re-lined"
Verrucous Carcinoma is related to what habit?
Chewing tobaco (comes from the carcinogens)
Chewing tobaco (comes from the carcinogens)
Who is more likely to encounter verrucous carcinoma?
Men 55+
How does Verrucous Carcinoma present?
White patches early and then cauliflower like larger areas as the cancer grows.  Ulcerations may be present.
White patches early and then cauliflower like larger areas as the cancer grows. Ulcerations may be present.
What are the 3 major forms of skin cancer?
Basal Cell Carcinoma
Squamous Sell Carcinoma &
Melanoma
Who might be the first to detect skin cancer lesions?
Dental Hygienists!
Dental Hygienists!
What is the most common cancer among women ages 20-29?
Melanoma!

Its also the #1 cancer in men over 50!
What is the most common form of skin cancer?
Basal Cell Carcinoma
Basal Cell Carcinoma
What are risks for Basal Cell Carcinoma?
Ultaviolet light, genetics & arsenic ingestion
What is it about basal cell carcinoma that makes it look different from other skin cancers?
The Pearly Border!   
**Don't forget basal cell carcinoma is very slow growing.**
The Pearly Border!
**Don't forget basal cell carcinoma is very slow growing.**
What is the TX for basal cell carcinoma?
Excise the lesion.
*If you catch the lesion before it metastasizes there is a 99% 5 yr survival rate. If the lesion has matastasized there is only a 10% survival rate.*
What are some risks for Squamous cell carcinoma?
Sun exposure, tobacco use, burned skin & genetics
What is a key factor for squamous cell carcinoma?
What is a key factor for squamous cell carcinoma?
It develops in pre-existing actinic keratosis.  

**Any lesion that is non-healing NEEDS to be evaluated.**
It develops in pre-existing actinic keratosis.

**Any lesion that is non-healing NEEDS to be evaluated.**
Melanoma makes up ____% of skin cancers?
4%
Looks like a nevi
**But if it metastasizes…it can be deadly!**
What is the Tx for Melanoma?
Excise the lesion Possibly chemo or radiation.  

**5 Year survival rate is 90-97%**
Excise the lesion Possibly chemo or radiation.

**5 Year survival rate is 90-97%**
What are the ABCD's of skin cancer?
A-->Asymmetry  is there a lack of uniformity to the lesion?  
B--> Border Irregularity  are the edges of thelesion blurred, notched or ragged  
C-->Color  Variation Does the lesion vary in shades of tan, brown, black w/red white or blue pigments  
D-->
A-->Asymmetry is there a lack of uniformity to the lesion?
B--> Border Irregularity are the edges of thelesion blurred, notched or ragged
C-->Color Variation Does the lesion vary in shades of tan, brown, black w/red white or blue pigments
D--> Diameter Noted when lesions ismore than 6mm or larger (size of pencil eraser)
What is the most common type of precancerous lesion? (Know This!)
Actinic Keratosis!  

(Often seen in the lips where someone is chronically burning them.)
Actinic Keratosis!

(Often seen in the lips where someone is chronically burning them.)
Actin Keratosis is an early marker for ________ _________ ___________.
Actin Keratosis is an early marker for ________ _________ ___________.
Squamous Cell Carcinoma.

(Check the back of hands, ears, forehead and lower lip!)
What does actin Keratosis look like?
Scaly or crusty patches
Scaly or crusty patches
_________ _________ is a form of actinic keratosis. (Apparently we will see this all the time in practice)
Actinic Cheilitis
Where is Actinic Cheilitis usually found?
Lip mucosa (exposed to sunlight)  

**Has a blothcy apperance and smokers are more at risk!**
Lip mucosa (exposed to sunlight)

**Has a blothcy apperance and smokers are more at risk!**
Neoplasms can be either __________ or ____________.
Benign or Malignant
Describe the traits of a benign neoplasm.
Encapsulated
Grow Slowly
Don't Spread
Can be Fatal (A benign tumor in the brain for example)
Describe traits of a Malignant neoplasm
Not Encapsulated,
Grow Quickly
Spreads Metastasizes to other sites
Can't tell where normal tissue starts and malignant tissue ends,
Fatal if undetected. (Terms used Carcinoma & Sarcoma)
Dysplasia
Creation of abnormal cells from normal cells
Carcinoma in Situ
Early stage of cancer/carcinoma…when dysplastic cells are separated from the surrounding tissues by the basement membrane.
Invasive carcinoma
A malignant neoplasm composed of epithelial cells that infiltrate & destroy surrounding tissues and may metastasize!
Metastasis
The spread of cancer to distant parts of the body from where it orginated.
What is cancer staging? (In general)
In general, it describes the extent or severity of an individuals cancer based on:
Location of primary tumor
Size & number
Lymph node involvement
Cancer type & grade (how closely the cancer cells resemble normal tissue)
Presence or absence of metastases
What does TNM refer to?
T= based on extent of Tumor
N=extent of spread to lymph Nodes
M= presence of Metastasis
**A number is added to each letter to indicate the size or extent of tumor and extend to the spread of the disease.**
Localized
limited to the area it begain w/o spreading
Regional
spread beyond orginal primary site to nearby lymph tissues/nodes
Distant
Cancer has pread from primary site
What are the biggest causes of cancer?
Tobacco 30% & Diet/Obesity 30%
Tobacco 30% & Diet/Obesity 30%
What are 3 BIG oral side effects of cancer Tx? (KNOW THIS!)
1) Xerostomia--loss of function of salivary glands  
2) Mucositis--painful oral ulcers on any mucocal tissues  3) Radiation caries--happens VERY FAST  Seen at cervial 1/3, destruction of salivary glands and inadequate OHI  
**4) Candidiasis may be prese
1) Xerostomia--loss of function of salivary glands
2) Mucositis--painful oral ulcers on any mucocal tissues 3) Radiation caries--happens VERY FAST Seen at cervial 1/3, destruction of salivary glands and inadequate OHI
**4) Candidiasis may be present due to compromised immune system.**