diagnostic considerations
- duration
- pt hx
- any systemic symptoms
- local factors at site
systemic symptoms
- fever
- weight loss
- night sweats
- malaise (Type B)
etiologic categories
- traumatic/reactive
- microbiologic
- immunologic
- neoplastic
traumatic/reactive etiology
- traumatic ulcer
- burns
- necrotizing sialometaplasia
T/F: traumatic/reactive lesions generally have an abrupt onset
true
local factors of traumatic ulcer?
- broken tooth
- old restoration
- contact irritants
cause of burns
- chemical
- iatrogenic
- thermal
- electrical
- radiation
necrotizing sialometaplasia lesions are reactive but mimics what?
malignancy
microbiologic etiology
- viral
- mycobacterial-deep fungal
- bacterial
viral lesions are mostly what?
- herpesviruses
- HHV-1
- HHV-3 (zoster)
mycobacterial-deep fungal lesions
- mycobacterium tuberculosis
- histoplasmosis
- cocidiodomycosis
- blastomycosis
bacterial lesions
- spirochetes
- fusiform bacilli
- cariogenic bacteria
immunologic etiology
- lichen planus
- lichenoid rxns
- pemphigus
- pemphigoid
- Crohn disease
- Wegener granulomatosis
T/F: lichen planus is unilateral
false, bilateral
what causes lichenoid rxns?
local agent
pemphigus lesion
- DIF
2. SKIN lesions
pemphigoid lesion
- DIF
2. OCULAR lesions
Crohn disease
GI symptoms
Wegener granulomatosis
- maxillary sinus
- gingiva
- palate
- lung
- kidney
…resembles strawberries
neoplastic etiology
- squamous cell carcinoma
- salivary gland tumors
- lymphoproliferative malignancies
squamous cell carcinoma may present as what?
as nonhealing ulcer
T/F: squamous cell carcinoma is an endophytic lesion
false, can be either endophytic OR exophytic lesion
salivary gland tumors
- adenoid cystic
2. PLGA-malignancies
lymphoproliferative malignancies
especially T-cell lymphoma with palatal ulcer
conclusions to dx’ing and tx’ing vesiculobullous-ulcerative lesions
- good clinical evaluation and judgement
- listen to patient hx
- don’t tx emperically
- biopsy often necessary, special considerations DIF
what can make cancers feel and appear better?
topical steroids