Recurrent Aphthous Stomatitis:
aphtous ulcers in non keratinized tissue – herpes in keratinized tissue
aphthous stomatitis: recurrent discrete areas of ulceration that are almost always painful. Occurs
on freely movable mucosa that does not overlie bone,Aphthous can be differentiated since it
usually does not occur over bone, does not form vesicles and is not accompanied by fever or
QUESTION: Pt has occasional sores on mucolabial fold on mandibular arch that healed without
QUESTION: Ulcer that appears often on buccal vestibule that goes away without scarring after
a week or
so? Minor Apthous ulcer.QUESTION: Ulcer healing with scar tissue: major apthous ulcers AIDS
QUESTION: A chancre due to Syphilis mostly resembles: herpes ulcers
QUESTION: History of lesions that go away after 1 week – recurrent aphthous ulcers
QUESTION: What don’t u treat aphthous ulcers with – acyclovir
Benign Mucous Membrane Pemphigoid (cicatricial):
Pemphigoid = D = DEEPER (subepithelial separation) than pemphigus S = SURFACE
Know Pemphigoid–**autoimmune disorder where antibodies attack the fibrous attachment of
the skin and membrane epithelium. Blisters and vesicles
Histology: subepidermal ,no acantolysis
QUESTION: Pemphigoid – separation of basement membrane
QUESTION: Subepithelial separation on immunofluorescence indicates? benign mucous
membrane pemphigoid………….subepidermal / subepithelial -pemphigoid
Pemphigus vulgaris………..suprabasilar vesicle, acantholysis
QUESTION: Another name for chronic desquamative gingivitis? Cicatricial pemphigoid
QUESTION: The oral lesions of benign mucous membrane pemphigoid most
commonly present as desquamative gingivitis
Disease with Desquamative gingivitis: lichen planus, mucous membrane pemphigoid (95%) and
A band of red atrophic or eroded mucosa affecting the attached gingiva is known as dequamative
gingivitis. Unlike plaque-induced inflammation it is a dusky red colour and extends beyond the
marginal gingiva, often to the full width of the attached gingiva and sometimes onto the alveolar
QUESTION: Desquamative gingivitis is associated with which 2 conditions. Lichen planus and
Pemphigus vulgaris is MUCH LESS SEVERE and blistering of skin caused by binding of
antibodies to the surface of the cells of the outer skin
Clinical features: ulcerations & erosions covered by blood tinged exudates
QUESTION:Sloughing of gingiva epithelium in max and mand arches:
B) pemphigoidC) both
QUESTION: Child formed blisters with minor lip irritation? Epidermolysis bullosa
QUESTION: Which pemphigoid like lesion most often in infants?
EPIDERMOLYSIS BULLOSA : it is characterized by fluid filled blisters on the skin especially
on hands and feet due to friction.skin thickenening on the palms and soles of the feet.internal
QUESTION: Young child/infant exhibits ulcerations of mouth: epidermalysis bulosa
QUESTION: Condyloma accuminatum (genital wart) is caused by which virus? HPV 6 &11
QUESTION: Which of the following does not have cauliflower like , pebbly appearance?
carcinoma, fibroma , condyloma accuminata, papilloma.
Ans fibroma…..A FIBROMA IS A BENING NEOPLASM OF CONNECTIVE TISSUE
Candida forms – ulcer, Erythema, white hyperplastic, white/curd
QUESTION: Systemic antifungal in HIV patient?? Fluconazole
QUESTION: Hiv patient with oropharyngeal candidiasis, what would u prescribefluconzole ????
QUESTION: Patient with HIV has candidiasis- bec it is HIV related, increased CD 4… ( I wrote
QUESTION: which oral medication would you give to tx vaginal candidiasis? Nystatin,
monistat, Diflucan (fluconazole)
QUESTION: If pt undergoes radiotherapy for cancer, the most common oral infection that
drug tx in this stage is? 1. Candida albicans (answer)
QUESTION: Candidasis in cancer patients due to- chemotherapy, radionecrosis
QUESTION: Inhaled methacholine (steroid) produce oral candidiasis
QUESTION: Pt has multiple white patches that can be scraped off
QUESTION: Oral cytology smears are MOST appropriately used for the diagnosis of which
of the following? Pseudomembraneous candidiasis
QUESTION: What oral manifestation is seen in children with HIV? Candidiasis #1
QUESTION: Patient is 4yrs old on lots of AB what is most likely? Candidiasis
QUESTION: Candida- can wipe away: Nysatatin
QUESTION: systemic med for candida: amphotericin B
QUESTION: broad spectrum antibiotics :increase superinfection (infxn by candidiasis) and resistance.
QUESTION: Which is associated w/ burning mouth? Candida
QUESTION: Lesion in the middle of tongue also pt had it on palate before and pt is healthy?
Karposi, candidiasis, Syphilis
QUESTION: Rhomboid tongue thought to be- a type of candidiasis
QUESTION: Median rhomboid glossitis—***smooth red area of tongue that lacks the papillae
QUESTION: Healthy 36 year old, red patch on palate, redness in middle of tongue:
-median rhomboid glossitis
Gingivostomatitis Herpetica: initial presentation during the first (“primary”) herpes
simplex infection. of greater severity than herpes labialis (cold sores) which is often
the subsequent presentations. is the most common viral infection of the
mouth,affects both the free and attached mucosa. Tx Acyclovir, valacyclovir, Penciclovir
QUESTION: 85% of people have herpes
a. 65-90% worldwide; 80-85% Usa( I hav no idea)
QUESTION: Age of primary infection of herpes? 2 yo, 4 yo, 6 yo, 8 yo, 10 yo (added info below
From oral path book under viral infections; “acute herpetic gingivostomatitis arise between 6
months and 5 years, with peak prevalence btwn 2-3 years of age. Development before 6 months is
rare due to protection of maternal anti-HSV antibodies.
QUESTION: Young person w/ fever & vesicles: FEVER = PRIMARY herpes stomatitis
QUESTION: Primary herpatic gingivostomatitis- fever, ulcer in mouth. No symptoms
QUESTION: Primary herpatic gingivostomatitis- child 2 yrs , fever, not ant to eat
QUESTION: After orthodontic tx, pt with no other systemic disease develop high fever?
due to canker sores by newly placed brackets.
QUESTION: ways to treat kid w/ herpetic gingivostomatitis EXCEPT
b. give numbing anesthetic before eating
c. have pt rest and drink lots of water
Recurrent Herpes Simplex:
aphtous ulcers in non keratinized tissue – herpes in keratinized tissue
QUESTION: Herpes can be diagnosed by exfoliative cytology. A characteristic
multinucleated cell appears in the smear of herpes infections.
QUESTION: Recurrent intraoral herpes occurs almost exclusively on mucosa overlying bone.
The hard palate is the most common site, alveolar mucosa
QUESTION: 2ndary herpes ? lip, gingival, and palate pg 106, table 4-1
QUESTION: Herpes simplex is ASSOCIATED WITH Bell’s palsy& TRIGEMINAL
QUESTION: Herpetic withlow? Herpes on finger
DRUG OF CHOICE:
acyclovir: herpes I, II, VZV,EBV
ganciclovir (IV): CMV or (valancyclovir – oral)
Primary HSV: PALLATIVE
recurrent herpes medication: docosanol (abreva), acyclovir (zovirax)Know drugs that are used for Herpes: Acyclovir, valtrex (valacyclovir), docosanol (abreva),
QUESTION: Acyclovir given for herpetic lesions. Also, phosphorylated and activated in infected
QUESTION: herpes, zoster – Valacyclovir treats herpes labialis
QUESTION: Patient gets recurrent herpetic lesions very often with gingivostomatitis. What should be done?
QUESTION: Hiv pt with oral herpes, what would u prescribe- vir
QUESTION: Tx for herpatic gingivostomatitis?
• palliative tx**
• systemic antibiotic
QUESTION: best med for herpes, CMV…acyclovir
QUESTION: Valcyclovir (Valtrex): Tx for herpes simplex/herpes zoster
QUESTION: Tx for herpes simplex and herpes zoster : Valtrax
QUESTION: Which most closely mimics dental pain: herpes zoster
CORTICOSTEROIDS ARE CONTRAINDICATED IN PATIENTS WITH HERPES SIMPLEX
QUESTION: Patient comes with recurrent herpetic stomatitis on the lips and history shows no
of primary herpetic gingivostomatitis. Why? Most primary infections are subclinic
QUESTION: pt presents at 3 days with secondary herpes lesion? What the treatment of choice?
Acyclovir was an answer choice (but acyclovir works best before you get the lesion)QUESTION: Herpetic gingivostomatitis – within 3 days of onset: treat with Acyclovir 15mg/kg
per day for 7 days
All patients: palliative care: plaque removal, systemic NSAIDS, and topical anesthetics
Contagious when vesicles are present
QUESTION: Primary herpretic stomatitis? Reactivation of the primary can cause recurrent
QUESTION: Which dz is caused by the virus that causes acute herpetic gingivostomatitis?
A: herpes simplex 1
QUESTION: Herpes lesion intra orally how do u treat? Palliative, acyclovir?? *Tx is supportive
before eating, analgesics, maintain fluid/electrolyte balance, anti-viral agents. DO NOT GIVE
QUESTION: acyclovir inhibits mrna. How does it have selective toxicity MOA? Only
phosphorylated in infected cells and inhibits viral mRNA…does not work on dna
QUESTION: Acyclovir-inhib mRNA?-phosphorylated-. nucleoside analogues–can’t make RNA
The mechanisms of antiviral action of acyclovir are well known (Figure 40-9). The nucleoside
analogue is phosphorylated to form acyclovir monophosphate by herpesvirus-encoded
thymidine kinase and phosphorylated further by other enzymes to acyclovir diphosphate and
triphosphate. Acyclovir triphosphate acts to inhibit viral DNA polymerase and to terminate
elongation of the viral DNA chain as spurious nucleotide is incorporated into DNA. In the
noninfected host cell, phosphorylation of acyclovir occurs to a limited extent. Acyclovir
triphosphate inhibits HSV DNA polymerase 10 to 30 times more effectively than it does
mammalian cell DNA polymerase.
QUESTION: how is Acyclovir selective toxicity mechanism of action?
1. only phosphorylated in infected cells and inhibits viral mRNA
2. does NOT work on DNA
QUESTION: Post herpetic neuralgia cause by: (VZV)herpes zoster,
QUESTION: What does histoplasmosis oral lesion look like? NONHEALING ULCER
QUESTION: Same patient as #49, has upper denture, when he removes it, there is unilateral
lesion on the
palate. What could it be? – Herpes (other choices were more serious pathological lesions).
QUESTION: Pic with half the tongue (left side) that looks like herpes lesion and other nothing
on it- Iwrote zoster