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Periodontics II

Mucocutaneous Disorders

Diverse group of diseases affect what? Skin and/or mucous membranes
In order to determine the correct treatment, there must first be a correct what? Diagnosis and understanding of the underlying etiology
Treatment typically focuses on what? Alleviating clinical signs and symptoms, and preventing the spread of disease.
Chronic desquamative gingivitis manifests in a variety of different oral mucous membrane diseases
What is Chronic desquamative gingivitis confused with? Lichen Planus, BMMR, Bullous Pemphigoid
What are Bullous Pemphigoids? large fluid filled blisters, which occur when the immune system attacks a thin later of tissue and the outer later of skin
Pemphigus blisters on mucus membranes
What is Chronic desquamative gingivitis characterized by? intense and desquamation (shedding) of the surface epithelium of the attached epithelium
Chronic desquamative gingivitis is felt to be what? nonspecific gingival manifestation of a variety of systemic disturbances
Mild clinical manifestations diffuse erythema throughout gingiva; usually painless frequent in females 17-23 yrs.
Moderate clinical manifestations patchy, red, and gray areas of marg. & attached gingiva; smooth, shiny, of soft consistency; epithelium readily sloughs off all mucosa smooth & shiny; 30-40 yrs.; key is burning sensation
Severe clinical manifestations denuded areas of gingiva & very red; “speckled” appearance due to gray gingiva surrounding these patches; epithelium readily peels off, may be surface bullae that rupture; ;
Severe clinical manifestations Nikolsky’s sign may be fissuring @ line of occlusion in buccal mucosa; extremely painful, dry, and has a burning sensation.
Painful, Sensitivity to hot and spicy foods Discomfort when brushing teeth
Separation of epithelium & CT; can resemble pemphigus (blisters) or Lichen Planus
Treatment Dilute hydrogen peroxide, soft tooth brush, topical corticosteroids a class of steroids—”prednisone”), systemic too, possible nutritional supplements
Lichen Planus Inflammatory disease of the skin & mucous membranes
Lichen Planus May be confined to skin or mucous membranes or involve both
skin condition of Lichen Planus is characterized by eruption of flat, taught, shiny, violet, papules on flexor surfaces (The parts of the skin that touch when a joint bends), male genitalia, and the mucosa of the oral cavity.
oral condition of Lichen Planus is characterized by variability, & diagnosis can be difficult. It is usually found on the buccal mucosa adjacent to occlusal plane. Involves friction as causative or exacerbating factors
Lesions Grayish, white, lacy striae (a slight or narrow furrow, ridge, stripe or streak, especially one of a number in parallel arrangement); May also be erosion and ulceration; may have vesicles and bulla (a large vesticle).
Skin lesions cause pruritus (itching); oral lesions may be sensitive in areas of erosion & ulceration. May be triggered by emotional stress
leukoplakia raised patches of hyperkeratosis
White sponge nevus (an anomaly)-- manifests in birth or childhood
Chronic Discoid Lupus Erythematous a photosensitive skin eruption which can be localized or widespread, manifest itself as red scaly patches which leave white scares which may itch or be painful, mainly affects areas exposed to sunlight.
Pemphigus acantholysis (separation of individual prickle cells from their neighbors as in keratosis); striations of Lichen Planus can differentiate
BMMP stands for what? Benign Mucous Membrane Phemphigoid
Treatment of lesions if erosive, bullous, or ulcerative hydrogen peroxide rinses, corticosteroids topically or systemic.
Bullous Pemphigoid large fluid filled blisters that are usually greater than 5 mm in diameter
Autoimmune subepithelial bullous disease o acantholysis (separation of individual prickle cells from their neighbors as in keratosis) Epithelium separates from CT
Bullous Pemphigoid Oral lesions present in only @ 10% of cases
Bullous Pemphigoid Treatment systemic corticosteroids
Cicatricial Pemphigoid (BMMP) Also known as “mucous membrane pemphigoid” (MMP) Or “Benign mucous membrane pemphigoid” (BMMP) Or “desquamative gingivitis” Or “Ocular pemphigus”
Chronic subepitheilial vesiculobullous disease Rare, autoimmune, blistering
Chronic subepitheilial vesiculobullous disease Mucosal tissues involved (characterized by erosive skin lesions usually not the skin) (The skin is involved in about 20% of the cases which results in scaring) Frequent eye lesions which can lead to blindness Females more than males; 40-70 years
Chronic subepitheilial vesiculobullous disease Treatment systemic corticosteroids; sometimes topical ; optimal OH
Pemphigus Vulgaris Autoimmune bullous (blister) disorder Oral mucosa erosions
Pemphigus Vulgaris These are at first localized but become generalized after a few months These break easily and are hard to heal Potentially lethal
Erythema Multiforme (Stevens-Johnson Syndrome) Acute, self-limiting diseases of skin and sometimes mucous membranes
Erythema Multiforme (Stevens-Johnson Syndrome) associated with allergies, seasonal changes, drug sensitivities or stress
Erythema Multiforme (Stevens-Johnson Syndrome) A severe inflammatory eruption usually occurring in children and young adults following a respiratory infection or as an allergic reaction to drugs or other substances
Erythema Multiforme (Stevens-Johnson Syndrome) Recurrent Preceded by chill then fever, & can last from 10 days to several weeks.
Erythema Multiforme (Stevens-Johnson Syndrome) Lesions: 80% of cases have oral lesions appear target like** macular eruptions with a dark red or purple and have macules or papules accompanied by bullous lesions Often involves the tongue and lips which can be very painful Surrounded by wheals (rings).
Erythema Multiforme (Stevens-Johnson Syndrome) Treatment systemic steroids for symptoms
Lupus Erythematosus Has periods of remission and exacerbation
Lupus Erythematosus Oral lesions are present in acute type; usually associated with skin lesions Only @ 10% of chronic pts have oral lesions, but about 75% of acute do 5x times more common in females than in males
Lupus Erythematosus Lesions Chronic-white lesions with red periphery localized, usually on buccal mucosa On tongue they have denuded (striped or bare) or leukoplakic patches Lips similar to oral lesions Acute: usually more with greater destructio
Lupus Erythematosus Treatment corticosteroids, antimalarial (treats malaria), bismuth (a brittle, grayish-white, red-tinged, metallic element used in the manufacture of fusible alloys and in medicine), gold, ACTH Avoid exposure to the sun
Stomatitis Medicamentosa Allergic inflammatory changes in the oral soft tissues associated with the use of drugs or medicaments, usually those taken systemically
Created by: daisenmurray