Oral diseases H. Jedličková Oral diseases – viral etiology nHerpes simplex HSV1 (2) (recidivans)-herpes labialis nGingivostomatitis herpetica – severe primary infection nErythema multiforme triggered by HS (late hypersensitivity) nHerpes varicella zoster II. , III. trigeminus branch - mucous membrane lesions nInfectious rashes nHerpangina, hand-foot-mouth disease (coxsackie A), morbilli (morbillivirus) Koplik´s spots n herpes-simplex-labialis 8-67 Common warts - human papilomavirus HPV 1-68 (2,4,40) 8-90 veruky-filiformni-oblicej Verruca vulgaris Verruca vulgaris filiformis Papillomatosis oris – condylomata plana type 13, 32 Verruca plana, (condyloma accuminatum is genital HPV infection) EBV hairy leucoplakia - HIV 6-133 n Oral diseases – bacterial Impetigo staphylogenes, streptogenes impetigo-brada impetigo-usta pyodermia-chancriformis-labii-inf Bullous impetigo (staph) Chancriform pyodermia) Oral diseases – bacterial - other n nScarlet fever – strept. pyogenes – strawberry tongue) nSyphilis – chancre, mucous patches, tonsilitis,makrocheilia, n guma, lymphadenopathy nGonococcal stomatitis –pharyngitis, erosions, lymphadenopathy nMycobacteria –tbc cutis colliquativa nStomatitis ulcerosa, necrotising gingivitis, noma (fusobacteria, streps, treponemas etc) – in malnutrition n syphilisll-mukosni-plaky Actinomycosis – cervicofacial form actinomyces israelii 8-51 Commensal oral flora – opportunistic patogens Formation of fistulas, discharge with white grains Tx –PNC, clindamycin – 3 weeks Oral diseases - fungal nCandidiasis – soor – thrush n(candida albicans, tropicalis, glabrata, crusei) nNewborns, ATB therapy, topical corticosteroids, immunosuppression, diabetes mellitus, oral diseases, HIV n n n soor3 Oral diseases – pigmentary changes nNormal pigmentation nLentigo, ephelis nBlue nevus / melanocytic nevus nMelanoma nPeutz Jeghers syndrome (intestinal polyps) nLaugier Hunziker syndrom n(no polyps) nAmalgam tattoo nDrug induced pigmentation nAddison disease 5-96 Oral diseases – blistering, autoimmune nPemphigus – p. vulgaris (desmogleins) nPemphigoid – cicatricial (anti BP, laminin 332 antibodies) nLinear IgA dermatosis nEpidermolysis bullosa acquisita EBA n nDesquamative gingivitis nErosions, scarring jizvici-pemfigoid-gingivitis Pemphigus vulgaris pemfigus-rty pemphigus-vulgaris-oblicej Pemphigus vulgaris 3-156 3-157 Oral connective tissue diseases nLupus erythematosus – SLE, CDE oral erosions, scarring nScleroderma – microstomia nSjögren syndrome - sicca syndrome 6-131 6-14 Scleroderma 6-27 sklerodermia-jazyk-tvar-dite Systemic scleroderma x localized scleroderma Lichen ruber planus 3-117 Non infectious inflammatory disorder – lichenoid reaction in dermoepidermal junctions delayed hypersensitivity reaction Etiology – viral – hepatitis C, respiratory vv. Drug eruptions – betablockers, antimalarials Contact stomatitis - gold Autoimmune diseases Chronic GVHD Lichen planus mucosae erosivus 6-130 6-129 6-128 6-127 112-1266_IMG 112-1264_IMG 112-1269_IMG lichen-ruber-buk-sliznice Oral allergic diseases nAngioneurotic/Quincke edema nIgE mediated, alternative complement activation pathway nhereditary abnormal C1-esterase INH nContact allergic stomatitis nOral food allergy syndrome nFixed drug eruption nErythema multiforme n 3-66-slor Contact allergic stomatitis 6-134 6-135 2-65 Mouthwashes, dental materials, gold etc.) Erythema exsudativum multiforme 3-109 nEM – minor form – delayed hypersensitivity after herpes simplex infections Stevens-Johnson syndrom, TEN (toxic epidermal necrolysis) major form of EM with inductions of massive apoptosis of keratinocytes - drug eruption (cotrimoxazol, antiepileptics) Lethality depends on body surface area affected erythema-mult-sj-rty erythema-mult-dorsum-ruky Tumors – benign 6-124 nevus-sebaceus-rty •Papilloma •Fibroma •Epulis (fibromatous, ossifying, acanthomatous) •Pyogenic granuloma •( vascular lesion,often in pregnancy) •Neuroma •Granular cell tumor •Pleomorphic adenoma (salivary glands) •Morsicatio buccarum (reactive hyperplasia) •White sponge nevus • Tumors malignant nLeucoplakia –precancerous nLeucokeratosis nicotina palati nSquamous cell carcinoma – most common nSmokers, hot food, HPV, toxic substances, lichen erosivus nMelanoma - rare nKaposi sarcoma (HHV 8) in HIV! nBasal cell carcinoma - lips n kaposi-sa-patro n Kaposi sarcoma Ca spinocellulare img0002 7-120 img0071 Oral diseases - hereditary nEpidermolysis bullosa hereditary nDarier disease nOsler disease nEhlers Danlos syndrome n n 114-1449_IMG 5-98 Ehlers Danlos syndrome Osler disease Cheilitis nAngular cheilitis – candida, streps, avitaminosis, anemia nCheilitis sicca – atopic nActinic cheilitis nCheilitis granulomatosa –Melkersson Rosenthal syndrom (cheilitis, paresis n.VII., lingua plicata) 6-132 3-26 Glossitis nLingua plicata nLingua geographica (psoriasis) nLingua villosa nigra nOral hairy leucoplakia (EBV infection in HIV) nMoeller Hunter glossitis – pernicious anemia nIron deficiency anemia Lingua villosa nigra Lingua geographica 6-125 6-126 n Gingivitis nGingivitis hyperplastic n - leukemia n - pregnancy - epulis n - drugs (fenytoin, cyclosporine) 3-27 Stomatitis a gingivitis nSjögren syndrome – sicca syndrome nGingivostomatitis herpetica nAphtous stomatitis – solitary – trauma, nRecurrent aphtous ulcers – allergy, gastritis, malabsorbtion, IBD, anemia, neutropenia, HIV n 6-137 6-138 Morbus Behcet - inflammatory disorder 6-67 6-65 Aphtous ulcers - mouth, genitals, iritis, uveitis, conjunctivitis, vasculitis, pathergy HLA B27, HLA B51