Cheilitis common in
AIDS
SE of PI
ACD of lip
Vermillion MC
f>M
Fragrance and nickel MC
Angular cheilitis
Elderly who wear dentures
Decreased vertical dimension of face
Plasma cell cheilitis
Sharply defined, dark red infiltrated plaque with a lacquer like glaze
Reactive
Plasmacanthoma
Verrucous tumor along the angles
Spectrum with plasma cell cheilitis
C albicans found
May involve perianal, periumbilical, inguinal, and toe webs
Drug induced ulcer of the lip
Painful, well defined ulceration of lower lip that heals with Med withdrawal
Phenylbutazone, chlorpromazine, phenobarbital, methyldopa, thiazides diuretics
Oral crohns
Metallic dysgeusia, gingival bleeding, diffuse oral swelling, focal mucosal hypertrophy and fissuring (cobblestoning), ulceration, polyploid lesions, indurated lower lip fissure, angular cheilitis, gran cheilitis, pyo veg
Oral involvement in 10-20% of crohns, esp males with early onset dz
Cutaneous findings in crohns
PG (more UC), EN, polyarteritis nodosa, pellagra, pernicious anemia, acrodrmatitis like rxn, urticaria, necrotizing vasculitis
Pyostomatitis vegetans
UC > crohns
Sclerosing cholangitis
Dense aggregates of neuts and eos
May see annular plaques of axilla, groin, scalp (pyodermatitis vegetans)
Melkerson rosenthal associations
Mega colon, otosclerosis, craniopharyngioma, odontogenic infection
Neuropathic origin?
Nicotine stomatitis
Hot beverages, heavy smokers, most severe with pipes
Fissured tongue (lingua plicata)
MRos, downs, PC, pemphigus vegetans, cowden
Geographic tongue
MC isolated
May be a manifestation of atopy or PSO, AIDS, lithium
Red patches with a white border, serpiginous
No sx, occasional glossodynia
No tx or retin a solution
Black hairy tongue
Benign hyperplasia of filliform papilla
Smoking, ab, psychotropic meds, candida
Hunter or moeller glossitis
Smooth tongue with b12 def
Eruptive lingual papillitis
Mean age 3, seasonal
Difficulty eating, fever, intense salivation
Hypertrophic of fungiform papillae
Involution in 2-15 days, avg week
Eosinophilic ulcer of the oral mucosa
Ulcer with indurated and elevated border with pseudomembrane Posterior tongue Post traumatic Self limited Cd30 cells in recurrent multifocal cases
Caviar tongue
Elastic degeneration
Phleboliths and thrombophlebitis may complicate
Epdermization of the lip
Smooth leukokeratosis of lower lip
Proliferative verrucous leukoplakia
F MC
70% become SCC (palate and gingiva especially)
Some associated with HPV 16, SCC RF not present
Acquired dyskeratotic leukoplakia
White plaques of gingiva, lips, palate
Unique finding of dyskeratotic cells of prickle layer
White sponge nevus
Acanthosis, vacuolated prickle cells, acidophilus condensations in cyto of keratinocytes (aggregated tonofilaments) Buccal mucosa MC, no extramucosal Progression stops at puberty Hpv16 found in some Tx = TCN
Ephelides
Lower lip
Darken with sun
Oral melanotic macules - young women, don’t darken with sun, acanthosis and basilar melanin on bx
Melanoacanthoma - proliferation of keratinocytes and melanocytes, young black pts on buccal mucosa, reactive, 40% spont resolve
Oral melanoma
Palate MC
Less than 5% survival at 5 yrs
Oral pigmentation
Amiodaquine, chloraquine, OCP, phenothiazines, quinacrine, quinidine, thallium, azt
Osseous choristoma of tongue
Nodule on dorsal tongue containing mature lamellar bone
Peripheral ameloblastoma
Gingiva of lower jaw in M in his 50s
Growing pink sessile mass
19% recurrence after excision
BCC simulated histologically
Trumpeters wart
Firm hyperkeratosis nodule on upper lip of trumpet player
Epulis
Benign lesion of gingiva, reactive
Giant cell epulis bluish red on gingiva, induced by dental implants, Cherubism, resemble GCT of the tendon sheath
Oral PG
MC gingiva
Granuloma fissuratum
Circumscribed, firm, whitish on the labioalveolar fold
Chronic irritation like poorly fitting dentures
Angina bullosa haemorrhagica
Sudden blood blisters on oral mucosa
No associated dz
May be recurrent
Multiple mucoceles
GVHD
Rupture of salivary glands with extravasated of sialomucin
Parotid duct cyst- musicians who play wind instruments, opposite the upper 2nd molar on buccal mucosa
Dermoid cyst - may occur on mouth floor
Trench mouth RF
Poor dental hygiene and nutrition, smoking, ectasy, immunosuppressive
Noma- fusospirillary gangrenous stomatitis in kids, triggered by measles
Acatalasemia (takaharas dz)
Catalase def in liver, m., BM, rbcs and skin
Progressive mouth gangrene
H202 added to blood turns blackish brown and doesn’t foam
Tx is extraction of diseased teeth and ab
PFAPA
Tonsillectomy cures
Oral hsv
Affects keratinzed mucosa of palate, gingiva, tongue that’s is attached to bone (herpangina and aphthous ulcers affect nonattached mucosa)
Aphthous stomatitis
White with a ring of hyperemia
Buccal or labial mucosa > edge of tongue> soft palate
Affect nonkeratinized mucosa not attached to bone
Rarely confluent (vs herpes)
MC lesion of oral mucosa
Maslow 5 min before meals held in mouth, kaolin can be added
Fluocinonide in orabase
Colchicine, dapsone
Major aphthous ulcer (Suttons dz)
HIV associated
Behcets
Dirty gray base with a bright red halo
Ocular lesions start with periorbital pain and photophobia, may see conjunctivitis and hypopyon, both eyes eventually involved
CNS resemble MS
Thrombophlebitis, thrombosis of the superior vena cava
Polyarthritis MC
LCV or neutrophilic vascular rxn on path
Sucralafate- colchicine- dapsone-thalidomide-mtx